In three collaborating institutions 105 hospitalized female anorexia nervosa patients were assessed for depressive symptomatology periodically during treatment. As a whole, patients were mildly to moderately depressed, being as depressed as anxious neurotics and less depressed than depressed neurotics. The more depressed patients showed a variety of characteristics, many of which have previously been shown to be indicators of poor prognosis. Over the course of treatment patients became less depressed. Weight gain was correlated with a decrease in depression.

Background. The relationship between cognitive function and symptomatology in bipolar disorder is unclear. This study assessed executive function during the manic, depressed and remitted stages of bipolar I disorder.

Method. Tasks assessing phonological and semantic verbal fluency, the Hayling Sentence Completion Test, the Stroop Neuropsychological Screening Test and the Cognitive Estimates Test were administered to manic (n=15), depressed (n=15), and remitted (n=15) bipolar I patients, and to healthy controls (n=30). Multiple regression analyses and analyses of covariance were used to identify potential determinants of executive dysfunction in the three bipolar groups.

Results. Executive function deficits were particularly associated with the manic state. In general, manic patients performed less accurately than the remitted and depressed groups, and their performance deficit was related to the severity of positive thought disorder. The depressed and remitted bipolar groups showed a less widespread pattern of impairment. Deficits in response initiation, strategic thinking and inhibitory control were evident in all the bipolar groups.

Conclusions. Executive function deficits in bipolar I disorder are most evident during mania, and are particularly associated with formal thought disorder. However, deficits in response initiation, strategic thinking and inhibitory control may be more related to the underlying disorder than a particular symptom profile.

Background. An obstacle to the successful classification of attention deficit hyperactivity disorder (ADHD) is the frequently reported co-morbidity between ADHD and conduct disorder (CD). Prior work suggested that from a familial perspective, ADHD children with CD may be aetiologically distinct from those without CD.

Methods. Using family study methodology and three longitudinal assessments over 4 years, we tested hypotheses about patterns of familial association between ADHD, CD, oppositional defiant disorder (ODD) and adult antisocial personality disorder (ASPD).

Results. At the 4-year follow-up, there were 34 childrenwith lifetime diagnoses of ADHD + CD, 59 with ADHD + ODD and 33 withADHD only. These were compared with 92 non-ADHD, non-CD, non-ODDcontrol probands. Familial risk analysis revealed the following: (1)relatives of each ADHD proband subgroup were at significantly greaterrisk for ADHD and ODD than relatives of normal controls; (2) ratesof CD and ASPD were elevated among relatives of ADHD + CD probandsonly; (3) the co-aggregation of ADHD and the antisocial disorders couldnot be accounted for by marriages between ADHD and antisocial spouses;and (4) both ADHD and antisocial disorders occurred in the samerelatives more often than expected by chance alone.

Conclusions. These findings suggest that ADHD with and without antisocial disorders may be aetiologically distinct disorders and provide evidence for the nosologic validity of ICD-10 hyperkinetic conduct disorder.

Background. Recent epidemiological data suggest a decline in bulimia nervosa (BN) incidence in primary care. We sought to examine BN point prevalence from 1982 to 2002 in a college population.

Method. In 1982, 1992, and 2002, 800 women and 400 men were randomly sampled from a university for a study of health and eating patterns. Participation rates were 72% in women and 63% in men, resulting in n=2491 participants.

Results. BN point prevalence decreased significantly in women over the period of observation. Eating Disorder Inventory Bulimia scores decreased across cohorts, and these decreases remained significant when male and female and Caucasian and non-Caucasian students were analyzed separately.

Conclusion. These data support a decline in BN rates that cannot be attributed to changes in service utilization. Changing socio-cultural factors may explain a true decrease in BN incidence and prevalence.

Background. Recent research has focused upon the subdiagnostic level in an effort to derive more valid domains of psychotic disorder. This has led to the influential positive–negative dichotomy in schizophrenia being superseded by a three-syndrome model. The strategy of looking for syndromes within poorly validated diagnostic categories, such as schizophrenia, has limitations, particularly since it originated in, and has been largely restricted to, the more chronic subsamples.

Method. A representative sample of first episode psychosis (N=509), which includes the full spectrum of functional psychosis, was utilized to re-examine the dimensional structure of functional psychosis from first principles. Patients were assessed with the Royal Park Multidiagnostic Instrument for Psychosis (MIP), a comprehensive procedure that documents the psychopathology of the first episode in a clinically valid manner.

Results. Principal axis factor analysis was carried out on the tetrachoric correlation matrix of 92 core psychopathological items. A robust and clinically valid four-factor solution was obtained, comprising depression, mania and only two other factors. The first was a Bleulerian blend of negative symptoms, catatonic/motor symptoms and disorganization. The second was a combination of Schneiderian first rank symptoms, and other hallucinations and delusions. The data thus failed to support the three-syndrome model for non-affective symptoms in this population. A six-factor solution, although partially consistent with other studies, represented a more complex and confusing elaboration of the more clinically valid four-factor solution.

Conclusions. The findings have implications for the conceptualization of early psychosis, which need to be explored further in validation studies.

Background. The hippocampus, amygdala and related functional circuits have been implicated in the regulation of emotional expression and memory processes, which are affected in major depression. Several recent investigations have reported abnormalities in these structures in adult and elderly depressives.

Methods. Elderly DSM-III-R unipolar depressives (N=40) and normal controls (N=46) participated in a magnetic resonance imaging study (1.0T). Brain images were obtained in the coronal plane. Using established anatomical guidelines for structure delineation, volumetric measurements of left and right hippocampus and anterior hippocampus/amygdala complex were completed under blinded conditions using a semi-automated computer mensuration system, with patients and controls in random order.

Results. Medial temporal volumes did not significantly distinguish either elderly depressed and age-similar normal control subjects, or late onset and early onset depressed patients (ANCOVA). Major overlap of measured volumes existed between patient and control groups. In depressives, hippocampal volumes significantly correlated with age, and cognitive and depression ratings, but not with number of prior depressive episodes or age-at-onset of first depression.

Conclusions. Hippocampal volumes do not discriminate a typical clinical population of elderly depressed patients from age-similar normal control subjects. If hippocampal dysfunction contributes to a diagnosis of syndromal depression in the elderly, such dysfunction does not appear to be regularly reflected in structural abnormalities captured by volumetric measurement as conducted. On the other hand, relationships between hippocampal volumes and clinical phenomena in depressives, but not controls, suggest potentially meaningful interactions between hippocampal structure and the expression of major depression in the elderly.

Background. There is a large literature indicating that the offspring of mothers with Major Depressive Disorder (MDD) are at increased risk for depression. However, much less is known about the effects of paternal MDD on offspring psychopathology.

Method. We addressed this issue using a large community sample of parents and their adolescent and young adult offspring (n=775). Parents and offspring were independently assessed with semi-structured diagnostic interviews. Offspring were interviewed three times from mid-adolescence to age 24 years.

Results. Maternal MDD was significantly associated with offspring MDD. Paternal MDD was also significantly associated with MDD in offspring, but only among offspring with depressive episodes of moderate or greater severity. These effects persisted after controlling for socio-economic status, family intactness, and non-mood disorders in both parents. Rates of MDD were particularly elevated in offspring of mothers and fathers with early-onset MDD, and offspring of fathers with recurrent MDD. The magnitude of the associations between MDD in parents and offspring was generally in the small-to-medium range.

Conclusions. These results confirm previous findings of elevated risk of MDD in the offspring of depressed mothers. In addition, the results suggest that MDD in fathers is associated with increased risk of depression in offspring, but that it is limited to MDD episodes in offspring of moderate or greater severity.

Background. Gender and cross-cultural differences in the association between somatic symptoms and emotional distress were investigated, using data from the World Health Organization Collaborative Project on Psychological Problems in General Health Care.

Methods. Data were collected at 15 centres in 14 countries around the world. At each centre, a stratified random sample of primary care attenders aged 15–65 years was assessed using, among other instruments, the 28-item General Health Questionnaire and the Composite International Diagnostic Interview-Primary Health Care Version.

Results. Females reported higher levels of somatic symptoms and emotional distress than males. A strong correlation between somatic symptoms and emotional distress was found in both sexes, with females reporting more somatic symptoms at each level of emotional distress. However, linear regression analysis showed that gender had no significant effect on level of somatic symptoms, when the effects of centre and emotional distress were controlled for. In both sexes, no specific pattern of association emerged between somatic symptom clusters and either anxiety or depression. Primary care attenders from less developed centres reported more somatic symptoms and showed greater gender differences than individuals from more developed centres, but inter-centre differences were small. Finally, gender was not a significant predictor of reason for consultation (somatic versus mental/behavioural symptoms), after controlling for levels of somatic symptoms and emotional distress as well as for centre effect.

Conclusions. These data do not support the common belief that females somatize more than males or the traditional view that somatization is a basic orientation prevailing in developing countries. Instead, somatic symptoms and emotional distress are strongly associated in primary care attenders, with few differences between the two sexes and across cultures.

Background. Hypofrontality has been demonstrated in mood disorders by functional brain imaging methods such as positron emission tomography. However, the neurobiological basis of hypofrontality has not been well clarified. Near-infrared spectroscopy (NIRS) is a non-invasive technique for continuous monitoring of alterations in oxygenated (oxyHb) and deoxygenated (deoxyHb) haemoglobin using near-infrared light, which penetrates biological tissues.

Methods. We used NIRS during cognitive and physiological tasks to investigate alterations of haemoglobin oxygenation in the frontal region of euthymic patients with mood disorders (major depressive disorder (MD) and bipolar disorder (BP)) and in controls.

Results. The increase of oxyHb during a verbal fluency task was significantly less in the MD and the BP groups than in the controls. The MD group showed a significantly smaller decrease of oxyHb during hyperventilation than the controls. The BP group also showed a similar trend.

Conclusions. These findings suggest that the hypofrontality in mood disorders may be associated with a poor response in the cerebral blood vessels to neuronal and chemical stimuli.

Psychopathy is a developmental disorder marked by emotional hypo-responsiveness and an increased risk for antisocial behavior. Influential attention-based accounts of psychopathy have long been made; however, these accounts have made relatively little reference to general models of attention in healthy individuals. This review has three aims: (1) to summarize current cognitive neuroscience data on differing attentional systems; (2) to examine the functional integrity of these attentional systems in individuals with psychopathy; and (3) to consider the implications of these data for attention and emotion dysfunction accounts of psychopathy.