Background. Long-term studies of severe depression have described high rates of non-recovery, recurrence, chronic incapacity and mortality. A more recent cohort was followed-up to ascertain whether the course had improved given developments in pharmacological and psychological treatments in the last 15 years.

Method. Subjects from a cohort of 70 mainly severe recurrent depressives originally recruited to a shorter follow-up study from 1990–1992 were followed-up after 8–11 years. Data included longitudinal information on course of depression and other psychiatric disorders, pharmacological and psychological treatment and social functioning during follow-up.

Results. Sixty-nine (99%) subjects were successfully followed-up, with 61 of 66 living subjects interviewed and detailed follow-up data obtained in total on 65. Sixty (92%) of 65 subjects recovered during follow-up, with two-thirds subsequently suffering a recurrence. Eleven (17%) suffered from an episode of chronic depression of at least 2 years duration during follow-up. Social function at follow-up was good and there were high levels of pharmacological and psychological treatment. Greater severity of illness was the most consistent predictor of poor outcome. Times to recovery and recurrence and recovery and recurrence rates were very similar to older studies.

Conclusions. The long-term outcome of depression still shows high recurrence rates and does not appear to have changed in the last 20 years.

Objective. This study sought to examine the factors associated with spatial working memory and the use of strategies to impairments in spatial working memory in children with attention deficit hyperactivity disorder (ADHD). The developmental trajectories for spatial working memory in medicated and medication naïve children with ADHD were investigated. In addition, the effect of psychostimulant medication on deficits in spatial working memory was examined.

Method. A cross-sectional study compared performance between 21 psychostimulant medicated children with ADHD, 27 medication naïve children with ADHD and 26 matched control subjects on computerized tests of spatial memory and spatial working memory.

Results. Compared with the controls, performance in medication naïve children with ADHD was significantly worse on the spatial working memory task. There was no difference in performance between the medicated children with ADHD and the control subjects on this same task, despite the ongoing symptoms of ADHD in the former group. The pattern of normal and abnormal performance in the ADHD groups was age-independent.

Conclusions. Deficits in executive functions related to spatial working memory do occur in children with ADHD, although the magnitude of these deficits is not related to the child's age or the level of ADHD symptoms. These deficits were not present in the current sample of children who were receiving psychostimulant medication.

To ascertain the frequency and distribution of new cases of dementing illness in the elderly population of Mannheim (population 308000), a survey sample of community residents of > 65 years of age was re-examined after an interval of 7–8 years, and a sample of elderly persons in long-stay care after 5–6 years. The estimated annual incidence rate for all forms of dementia, after correction for ageing of the samples, was 15·4 per 1000 persons aged > 65, made up of dementia of Alzheimer type (8·9 per 1000), vascular dementia (4·4 per 1000) and other forms (2·1 per 1000). Apart from the expected association with age > 65 years, the most powerful predictors of onset of a dementing illness were residence in long-stay care and the presence of minor cognitive deficits at the initial examination, each of which was associated with a highly significant increase in risk. In addition, a number of socio-demographic characteristics (marital status, occupational history and quality of present living accommodation) was found to be predictive, though analysis of larger samples or pooled research data would be necessary to establish their importance in this respect. The findings suggest that identification of mild cognitive impairment on screening could prove helpful in assessing risk for dementia from two to three years before the condition becomes clinically apparent.

Background. Self-report instruments assessing the DSM personality disorders are characterized by overdiagnosis due to their emphasis on the measurement of personality traits rather than the impairment and distress associated with the criteria.

Methods. The ADP-IV, a Dutch questionnaire, introduces an alternative assessment method: each test item assesses ‘Trait’ as well as ‘Distress/impairment’ characteristics of a DSM-IV criterion. This item format allows dimensional as well as categorical diagnostic evaluations. The present study explores the validity of the ADP-IV in a sample of 659 subjects of the Flemish population.

Results. The dimensional personality disorder subscales, measuring Trait characteristics, are internally consistent and display a good concurrent validity with the Wisconsin Personality Disorders Inventory. Factor analysis at the item-level resulted in 11 orthogonal factors, describing personality dimensions such as psychopathy, social anxiety and avoidance, negative affect and self-image. Factor analysis at the subscale-level identified two basic dimensions, reflecting hostile (DSM-IV Cluster B) and anxious (DSM-IV Cluster C) interpersonal attitudes. Categorical ADP-IV diagnoses are obtained using scoring algorithms, which emphasize the Trait or the Distress concepts in the diagnostic evaluation. Prevalences of ADP-IV diagnoses of any personality disorder according to these algorithms vary between 2·28 and 20·64%.

Conclusions. Although further research in clinical samples is required, the present results support the validity of the ADP-IV and the potential of the measurement of trait and distress characteristics as a method for assessing personality pathology.

The 30-item General Health Questionnaire (GHQ), the 24-item Self-Reporting Questionnaire (SRQ), and a Chinese version of the Minnesota Multiphasic Personality Inventory (MMPI) were administered to 225 English-speaking Chinese. The GHQ was found to have high internal consistency as a scale and to assess 5 dimensions of psychopathology: anxiety, inadequate coping, depression, insomnia, and social dysfunctioning. As a brief screening instrument, it correlated 0·49 with the SRQ. In the ‘case–non-case’ classification, it yielded a concordance rate of above 75% with the SRQ. Using the MMPI modal profiles derived from classification research as criterion measures, sensitivity, specificity and correct classification rates were above 70%. Implications for future research with the GHQ are discussed.

Background. Reports of an increased incidence of schizophrenia in Afro-Caribbean immigrants to the UK are a matter of much debate. It is of interest, therefore, that in the 1970s and 1980s many immigrants from Surinam and The Netherlands Antilles have settled in The Netherlands. The purpose of our study was to compare the risk of a first admission for schizophrenia for Surinamese- and Antillean-born persons aged 15–39 years to that for their Dutch-born peers in the period 1983–1992.

Methods. We used data from the Dutch psychiatric registry. Age-adjusted relative risks were calculated using Poisson regression analysis.

Results. The risk for the immigrants was found to be three to four times higher than that for the Dutch-born. Age-adjusted relative risks were significantly higher for male than for female immigrants.

Conclusions. The results provide evidence of an increased incidence in these immigrant groups and support similar findings on Afro-Caribbeans in the UK. Migration from Surinam was on such a large scale that selective migration of persons at risk for the disorder is unlikely to account entirely for these findings.

Background. It has been suggested that patients with unipolar depression show abnormal responses to negative feedback in the performance of cognitive tasks. Positron emission tomography (PET) has previously identified blood flow abnormalities in depressed patients during cognitive performance. We have also used PET to identify regions where there is differential neural response to performance feedback in normal volunteers. In this study we aimed to test the hypothesis that blood flow in these regions, the medial caudate and ventromedial prefrontal cortex, would be abnormal in depressed patients.

Methods. Six patients with unipolar depression and six matched controls were scanned using PET while performing cognitive tasks in the presence and absence of feedback.

Results. Compared with controls, depressed patients failed to show significant activation in the medial caudate and ventromedial orbitofrontal cortex. Blood flow was lower and a differential response, observed in normals, under different task and feedback conditions was not seen in the patients.

Discussion. The findings suggest that the behavioural response to feedback in depressed patients is associated with an abnormal neural response within the medial caudate and ventromedial orbitofrontal cortex, regions implicated in reward mechanisms. We argue that the observed abnormalities may depend on a combination of psychological factors, with both cognitive and emotive components.

The notion that psychotic symptoms lie on a continuum with normality has become an accepted dogma. It is supported by several lines of empirical evidence, fits in with the orientation of modern services and has a ‘moral’ appeal. However, there is confusion as to the nature of the continuum or continua under discussion. According to the author, commentators on this topic do not often distinguish between the variability and severity of the phenomena themselves, within or between individuals, versus the distribution of symptoms or risk factors in a population. The implications of these two types of continua differ. Furthermore, the evidence for continua of delusional beliefs and hallucinations can be challenged on a number of grounds, both methodological and conceptual. To some extent, whether phenomena are viewed as continua or categories depends on the intentions of the observer. Finding the distinctive characteristics of psychotic phenomena in people with clinical disorders, in addition to their origins in ‘normal’ cognitive processes, is a worthwhile goal.

Taxometric procedures have been used extensively to investigate whether individual differences in personality and psychopathology are latently dimensional or categorical (‘taxonic’). We report the first meta-analysis of taxometric research, examining 317 findings drawn from 183 articles that employed an index of the comparative fit of observed data to dimensional and taxonic data simulations. Findings supporting dimensional models outnumbered those supporting taxonic models five to one. There were systematic differences among 17 construct domains in support for the two models, but psychopathology was no more likely to generate taxonic findings than normal variation (i.e. individual differences in personality, response styles, gender, and sexuality). No content domain showed aggregate support for the taxonic model. Six variables – alcohol use disorder, intermittent explosive disorder, problem gambling, autism, suicide risk, and pedophilia – emerged as the most plausible taxon candidates based on a preponderance of independently replicated findings. We also compared the 317 meta-analyzed findings to 185 additional taxometric findings from 96 articles that did not employ the comparative fit index. Studies that used the index were 4.88 times more likely to generate dimensional findings than those that did not after controlling for construct domain, implying that many taxonic findings obtained before the popularization of simulation-based techniques are spurious. The meta-analytic findings support the conclusion that the great majority of psychological differences between people are latently continuous, and that psychopathology is no exception.

Background. The literature on executive function in antisocial populations is unclear due to variation in diagnostic criteria and variation in the inclusion of healthy control comparison groups. Some studies suggest prototypical psychopathy is associated with specific deficits in ventromedial prefrontal (VMPFC) function rather than dorsolateral prefrontal (DLPFC). Meta-analytical studies, however, suggest that antisocial personality disorder may be associated with a broader range of executive deficits. This study assessed DLPFC and VMPFC function in antisocial personality disorder subjects and controls using the Cambridge Neuropsychological Test Automated Battery (CANTAB) and a Go/NoGo task respectively.

Methods. All subjects were screened for Axis I pathology, substance misuse and prescribed medication. The performance of 29 subjects with antisocial personality disorder DSM-IV and 20 male right-handed controls (matched for age and IQ) on the neuropsychological test battery was compared.

Results. Subjects with antisocial personality disorder displayed impairments on DLPFC executive function tasks of planning ability and set shifting. Impairments were also seen in VMPFC Go/NoGo tasks and in visual memory tasks.

Conclusions. Antisocial personality disorder is associated with a broad range of deficits in DLPFC and VMPFC function. Future studies need to examine relationships between the interpersonal and behavioural components of antisocial personality disorder and neuropsychological function.

Background. Research is needed to evaluate the efficacy of prevention and treatment for post-partum depression.

Method. Subjects were screened with the Edinburgh Post-natal Depression Scale (EPDS) at the obstetric clinic. Mothers at risk (N = 258) (EPDS scores [ges ]9) were randomly assigned to a prevention/treatment group or a control group. The prevention group received one cognitive-behavioural prevention session during hospitalization. At 4 to 6 weeks post-partum, subjects were screened again with the EPDS, after drop-out rates (refusals plus no return of the second EPDS) of 25.4% (33/130) in the intervention group and 10.9% (14/128) in the control group. Mothers with probable depression (EPDS scores [ges ]11) were assessed using the Hamilton Depression Rating Scale (HDRS) and the Beck Depression Inventory (BDI). Mothers with major depression continued in the treatment group (N = 18) or in the control group (N = 30). Treated subjects received a cognitive-behavioural programme of between five and eight weekly home-visits.

Results. Compared with the control group, women in the prevention group had significant reductions in the frequency of probable depression (30.2% v. 48.2%). Recovery rates based on HDRS scores of <7 and BDI scores of <4 were also significantly greater in the treated group than in the control group.

Conclusions. The study suggests that this programme for prevention and treatment of post-partum depression is reasonably well-accepted and efficacious.

Background. Staff and severely mentally ill patients differ in their assessments of need. This study compares staff and patient assessments of need for people suffering from psychotic disorders.

Method. The needs of an epidemiologically representative sample of 137 patients from a catchment area psychiatric service in South London who had an ICD-10 diagnosis of a functional psychotic disorder were assessed cross-sectionally by patients and staff, using the Camberwell Assessment of Need.

Results. Staff rated patients to have on average 6·1 needs, and patients rated 6·7 needs (t=2·58, df=136, P=0·011). This difference was accounted for by the staff rating of 1·2 unmet needs and the patient rating of 1·8 unmet needs (t=3·58, df=136, P<0·001). There was no difference in rating of total number of met needs. There was no difference in ratings in relation to any patient sociodemographic characteristics. There was moderate or better agreement on the presence of a need for 13 of the 22 domains in the Camberwell Assessment of Need.

Conclusions. Staff and patients moderately agree about met needs, but agree less often on unmet needs.

Background. To understand the relationship between parenting and psychopathology in offspring, it is critical to clarify the determinants of parenting behaviour itself.

Methods. A 16-item version of the Parental Bonding Instrument (PBI) was administered to parents of epidemiologically sampled adult female–female twin pairs, who reported on the parenting they provided to their twins, and to the twins themselves who reported on the parenting they and their co-twin had received (N=828 twin families). Using a mixed-model regression, we examined the impact on parenting, as retrospectively reported by parents and twins, of six variable domains: demographic factors, family characteristics, parental symptoms and personality, parental psychopathology, child vulnerability and childhood temperament.

Results. The PBI yielded three factors: warmth (W), protectiveness (P) and authoritarianism (A). W was most strongly predicted by parental personality and psychopathology, parental marital quality, and child temperament. P and A were both most strongly predicted by parental educational level and religious fundamentalism. In addition, P was predicted by neurotic/anxious traits in both parent and child. For a number of variables that predicted W, the strength of the association was stronger when twins were reporting than when parents were reporting.

Conclusions. Parenting is a complex, multi-determined set of behaviours that is influenced by parental personality, psychopathology, values and marital quality and by a range of child characteristics. W appears to be strongly influenced by parental and childhood temperament and vulnerability to psychiatric illness while P and A are more strongly influenced by ‘sociological’ factors such as religious affiliation and educational status.