We evaluated the dexamethasone suppression test (DST) as a predictor of response to drugs and placebo in 105 patients, in a large double-blind placebo-controlled out-patient trial to determine the efficacy of paroxetine HCI, a selective serotonin reuptake inhibitor, compared with that of imipramine HCI and placebo. The presence of a positive or negative DST did not predict response to either paroxetine or imipramine. However, a positive DST predicted a poorer response to placebo: only 3 out of 18 patients who showed DST non-suppression responded to placebo, as opposed to 11 out of 21 who exhibited DST suppression (P<0.05). A positive DST was associated with a 61% response to drugs and a 16% response to placebo. This finding suggests that the presence of a positive DST implies the need for active somatic treatment.

The Scale for the Assessment of Negative Symptoms (SANS) was developed in order to facilitate evaluation of five important symptoms frequently observed in ‘core schizophrenia’ (process schizophrenia, the schizophrenic defect state, negative schizophrenia). These symptoms include affective flattening, alogia (poverty of speech and thought), avolition, anhedonia, and attentional impairment.

Sexual anxiety was examined in 98 patients presenting with sexual dysfunction and 68 of their partners at a psychosexual clinic using the SOMA questionnaire. All patients had raised values for heterosexual anxiety. Female partners had raised values while male partners did not. This provides further evidence for the role of heterosexual anxiety in the aetiology and treatment of sexual dysfunction.

A retrospective study of 92 patients admitted with mania, aged over 65 years of age, found that 26% had no prior history of affective illness; 30% had previously only experienced depression, and half of these had at least three episodes of depression before the first manic illness. Patients with a family history of affective disorders had a significantly earlier age of onset of illness. There was evidence of cerebral organic impairment in 24% of the patients, and this group had a significantly later age of onset of illness. Prognosis was good, with only 8% still in hospital at six months. Half of the patients were started on lithium prophylaxis, but this did not significantly alter the number of readmissions. A quarter of those started on lithium developed evidence of lithium toxicity.

Twenty patients with panic attacks and ten controls were given a standardised interview about thoughts occurring during times of anxiety or panic attacks. The interviewer was blind to the subject's diagnosis. The 20 panic patients underwent a psychophysiological test battery which included a cold pressor test, mental arithmetic task, and 5.5% CO2 inhalation. More patients than controls reported thoughts centred on fears of losing control and shame when anxious. Panic patients rated their thoughts as stronger and clearer than did controls and they had more difficulty excluding them from their minds. A feeling of anxiety preceded anxious thoughts in patients. This suggests that ‘faulty cognitions' are not the initial event in a panic attack, although anxious thoughts may exacerbate or maintain them. Significant correlations were found between the intensity of anxiety-related thoughts in anticipation of mental arithmetic and changes in diastolic blood pressure and heart rate during mental arithmetic.

Patients (n = 490) suffering from a major depressive episode according to DSM-III criteria were randomly allocated to groups receiving either moclobemide, imipramine, or placebo treatment. Subjects were treated as out-patients for 6 weeks. On overall assessment of efficacy and on results of the Hamilton Rating Scale for Depression, both moclobemide and imipramine were superior to placebo, but the differences between moclobemide and imipramine were not significant. Premature termination due to insufficient efficacy was more frequent with placebo than with moclobemide or with imipramine, these differences being significant. The overall assessment of tolerance clearly favoured placebo and moclobemide over imipramine. This was also reflected in the frequency of premature terminations due to poor tolerance, as well as in the frequency of adverse events, which were highest in the imipramine group. The only cardiovascular finding was an increase of the mean heart rate with imipramine, maximum at the end of week 1, while placebo and moclobemide displayed no relevant changes. There were no other important drug-related changes.

Cognitive deficits in schizophrenia can be differentiated into state-linked accompaniments of psychotic episodes and trait-linked signs of a more enduring vulnerability to schizophrenia (Zubin & Spring, 1977; Cromwell & Spaulding, 1978). Elsewhere (Spring & Zubin, 1978) we suggested that a marker of psychotic episodes is one that deviates in highly symptomatic schizophrenic patients and normalises as their florid psychotic symptoms remit. A stable vulnerability marker, in contrast, continues to deviate in remitted patients, their biological relatives, and others who are vulnerable to schizophrenia but not floridly psychotic. In addition, Nuechterlein & Dawson (1984) proposed a mediating vulnerability marker which demonstrates characteristics of both vulnerability and episode markers. On such a marker, asymptomatic vulnerable individuals differ from normal; the advent of psychosis magnifies the deviation.

An analysis of the temporal distribution of 115 in-patient suicides that occurred in two Swiss psychiatric hospitals in the years 1977–86 failed to reveal any statistically significant clustering of suicides. Thus, the modelling effect does not generally play a decisive role in psychiatric in-patient suicide.

The hypothesis that the gene for schizophrenia is located in the pseudoautosomal region of the sex chromosomes predicts that same-sex concordance will occur in paternally rather than maternally derived pairs. In 120 families that included at least one sibling pair with schizophrenia, affected members were significantly more likely to be of the same sex when there was a history of illness on the paternal than on the maternal side, the difference remaining significant when parent of origin was assessed by three different methods. The finding is as predicted by the pseudoautosomal hypothesis: therefore a search for the gene should be focused on this small (three megabase) region of the genome. The ratio of same to mixed sex pairs in paternally-derived cases (approximately 3:1) suggests the gene is located in the centromeric one-third of the pseudoautosomal region.

The antidepressant efficacy, tolerability, and safety of moclobemide, a reversible, monoamine oxidase-A inhibitor, were compared with those of imipramine in parallel groups of patients with a major depressive episode, in a 4-week, multicentre (17 centres), randomised study. A total of 381 patients were randomly allocated to either treatment; they were not required to avoid tyramine-rich foods. Drop-out rates were comparable in both groups at about 17%. Judged primarily on the HRSD, no significant differences in efficacy were observed between the groups, but the number of patients presenting with adverse events, as well as the total number of adverse events, was greater with imipramine. Cardiovascular tolerability was satisfactory and physical examination, body weight, and laboratory values were essentially unaffected in both groups.

All insulin-dependent diabetics between the ages of 16 and 25 years attending the diabetic clinic at the Royal Infirmary, Edinburgh, (152 women and 139 men) were asked to complete the EAT, the EDI, and the GHQ, and to provide a control subject (sibling or close friend) of similar age who would do likewise. Marked differences were found between diabetic women (but not men) and their controls in eating attitudes, in many of the psychological characteristics associated with eating disorders, and in GHQ scores. Although some of the women had classic anorexia nervosa or bulimia, others with abnormal eating attitudes did not fulfil the formal criteria. Overall, diabetics were significantly heavier than controls but the differences in eating attitudes were not eliminated by correcting for overweight. Abnormal scores were associated with high HbA, levels and independently with retinopathy. The weight gain and psychological effects of diabetes are identified as probably of aetiological importance in the abnormal eating attitudes of young diabetic women.

This discussion follows from a key premise that there is potential clinical value in identifying and directly treating the cognitive abnormalities which for over a century have been seen as the hallmarks of schizophrenia. This is both an old and a relatively new idea. It is old, in that the psychodynamic approaches to psychotherapy, especially ego psychology, have long sought to modify cognition in schizophrenia, if unsystematically and indirectly. It is new, in that only in the last decade have both the contemporary technologies of the information processing laboratory and of cognitive-behaviour modification been applied to the problem of treatment. The failures of psychodynamic treatment approaches with schizophrenic patients have perhaps discouraged widespread experimentation with cognitive models in clinical assessment and treatment. This is unfortunate, as contemporary clinical procedures and laboratory technologies are hardly comparable to psychodynamic methods. In the past decade findings have accumulated, in the form of case reports, single-subject experiments and treatment trials, which support the potential usefulness of assessing and directly treating schizophrenic patients' cognitive abnormalities (reviewed by Spaulding et al, 1986).

Elderly patients with early-onset and late-onset depressive illness presenting to psychiatrists for treatment were compared for social, demographic, and clinical measures. For most factors measured no statistically significant differences were found. In the early-onset cases, patients were significantly more severely depressed. There was some evidence for the hypotheses that family history is less important and biological factors more important in late-onset depression. It is suggested that the latter hypothesis should be tested by a range of the newer neuroanatomical and neurophysiological laboratory investigations. The findings indicate that neuroticism is an important underlying factor in both early-onset and late-onset depression in the elderly.

By use of latent-trait item analysis (the Rasch model), the internal validity of the behaviour section of the MRC-HBS schedule was analysed. The set of behavioural symptoms in this rating scale was found to measure a one-dimensional structure. Thus addition of item scores provides a meaningful index. Such a numerical measure for the degree of behaviour disorder facilitates comparison between different patients or groups, and furthermore, forms the basis for quantitative description of the outcome of therapeutic intervention. A diagnosis of behaviour disorder was established in 17.2% of 302 mentally-handicapped adults. However, some kind of deviant behaviour was found in 41%, and was correlated with origin and degree of retardation, epilepsy, and place of living. The distribution of the symptoms strongly indicates that organic brain damage is a major aetiological cause.

Audiovisual tapes of emotional situations were shown to 34 schizophrenics and 15 controls who were asked to rate the emotional content of the scenes using an adjective check-list. The schizophrenic patients failed to detect the dominant character of the scenes, and perceived the opposite emotions to those perceived by the controls. Such deviant responses were not related to paranoid symptoms, flattened affect, formal thought disorder, general level of morbidity, or duration of in-patient stay.

Recent clinical studies have identified significant olfactory deficits in several neuropsychiatric disorders, notably Alzheimer's disease and Parkinson's disease. These have correlated with neurochemical and neuropathological studies of the olfactory system. The presence of a specific sensory deficit may be related to the localisation of pathology within the brain. There is a need for incorporation of olfactory testing into routine clinical examination.

Over 75 years ago, Bleuler (1911) confronted psychiatry with the question of ‘schizophrenia’ or ‘schizophrenias'. Today we recognise the heterogeneity of the condition, but we are still groping at efforts to clarify the different subtypes or subprocesses. Over the decades there have been various attempts to subclassify schizophrenia and tease apart the syndromes, none of which has been entirely successful. More recently, as a result of the work by Crow (1980) in England and Strauss et al (1974) in the USA, it has been proposed that two distinct syndromes can be discerned from the phenomenological profiles. The positive syndrome consists of productive features superadded to the mental status, such as delusions, hallucinations, and disorganised thinking. The negative syndrome represents absence of normal functions, such as deficits in the cognitive, affective, and social realms.

A register of violent incidents showed a progressive increase in in-patient violence from 1976 to 1984, followed by a slight decline to 1987. The case notes of all 137 in-patients committing assaults during 1982 were analysed and compared with those of matched controls. Violence was often repetitive. The most common victims were nurses and then patients. The violent patients were more likely to be schizophrenic, deluded and hallucinated, and to have been repeatedly admitted. The violent and control groups had similar backgrounds, and both showed high levels of social isolation and unemployment. Violence tended to be repetitive, and the violent patients were usually identifiable from previous aggressive and disturbed behaviour. There was a high proportion of Afro-Caribbean patients who tended to be younger, more psychotic, and more seriously violent. Afro-Caribbeans were particularly likely to be detained compulsorily and treated in a locked ward.

Diminished emotional responsiveness as characterised by a reduction in facial expression, modulation of feelings, and communicative gestures. Basis for rating: observation of physical manifestations of affective tone and emotional responsiveness during the course of interview.

Schizophrenia research is affected by the current change of scientific paradigms of thinking and investigation. The 1960s and 1970s were mainly characterised by a theoretical shift from a unifactorial towards a multifactorial view of the aetiology of schizophrenia, while in the 1980s, traditional linear models of pathogenesis have been more and more given up in favour of systems models.