Diagnostic communication between doctors and patients is thought to differ radically between Japan and Western countries. To understand diagnostic disclosure to psychiatric patients, a questionnaire with six case vignettes was sent to practising psychiatrists in Japan (N = 166) and North America (N = 112). While over 90% of both groups would inform patients with affective and anxiety disorders of their diagnoses, only 70% of North Americans and less than 30% of Japanese would similarly inform patients with schizophrenia or schizophreniform disorders. The Japanese preferred alternative was to give a vague alternative diagnosis such as neurasthenia. North Americans would discuss differential diagnoses with the patient instead. Nearly all in both groups would inform the family, but North Americans would do so only with patient consent. For disorders for which there are effective treatments, diagnostic disclosure is common to both cultures; when prognosis is uncertain or the diagnosis is feared, as in schizophrenia, culturally constructed views of patienthood govern disclosure practice.

Data from a case-control study of Alzheimer's disease (AD) were analysed in relation to age of onset and familial/sporadic status. The analyses were restricted to environmental exposures which might injure the brain. Later-onset AD was found to be positively associated with starvation/malnutrition and with nose-picking and negatively with analgesics, while earlier-onset was associated with physical underactivity and nervous breakdown more than 10 years before. Sporadic AD was associated with starvation/malnutrition and with head injury. These analyses merit replication in other large case-control studies of AD.

The effect of conduct disorder on adult social functioning in the areas of work, sexual/love relationships, social relationships and criminality was studied in a sample of young adults who spent much of their childhoods in group-cottage children's homes and an inner-city comparison group. Most subjects with conduct disorder had pervasive (but not necessarily severe) social difficulties compared to peers without conduct disorder. Less than half of this group met DSM-III adult criteria for antisocial personality disorder and just over half were given a diagnosis of personality disorder on interviewer clinical ratings. A latent class model that used both the retrospective and contemporaneous indicators of conduct disorder confirmed the very high continuity with adult social difficulties. Current diagnoses did not adequately describe this group and conduct disorder appeared to be an almost necessary condition for multiple social disability in adults in these samples.

Patterns of psychiatric diagnoses given during adolescence to a group of individuals continuously registered with a single general practitioner in South London over 20 years were analysed first during ‘early adolescence’ and secondly during ‘early adulthood’. Psychiatric diagnoses were found to be relatively common. Of the young adolescents who received a psychiatric diagnosis (almost one in ten of the group), 38% received a psychiatric diagnosis as young adults compared with only 16% of the remainder. Comorbidity was found to be very common – over 50% of young adults with a diagnosis of depression also had a diagnosis of anxiety and phobic neuroses.Young people with problems of a psychological nature therefore deserve more attention, particularly from the primary care team.

The memory deficit in Alzheimer's disease (AD) has been characterized as consisting of multiple components. The purpose of this study was to confirm the utility of a two-process model, and to examine changes in the nature and extent of the neuropsychological deficits after a one-year interval. The results replicate the initial observation that the memory loss in AD can be described as consisting of a focal amnesic syndrome and a dysexecutive syndrome characterized by failure of rapid information processing and search of both episodic and semantic memory. One year after the initial observation, all dysexecutive patients and the majority of the amnesic patients had become non-focal. No patient developed a dysexecutive syndrome, but 18 patients developed amnesic syndromes. These results suggest that, like other aspects of the cognitive deficits of AD, the memory loss is multifactorial. These results have implications for understanding the pathophysiology of AD, and for designing pharmacotherapeutic intervention.

As part of a 5-year, prospective, epidemiological survey of normal and pathological ageing, this cross-sectional analysis examines the relationship between depressive symptomatology (CES-D) and cognitive functioning (MMS) in a community sample of 2792 non-institutionalized persons (age ≥ 65) living in Southwest France. Of the sample, 13·4%, report depressive symptoms above the cut-off. A significant association was found between CES-D and MMS scores, but after adjusting for age, living arrangements, and especially functional limitations, the relationship remained strong only for women.

GPs and psychiatrists from South Wales were asked to make decisions based on the information included in each of 16 vignettes describing depressed and anxious subjects. This information contained randomly assigned sex, psychiatric label, good and bad psychosocial context and age as well as eight different severity ratings of depression and anxiety symptoms. Our results showed that both GPs and psychiatrists were influenced in their decision making by the severity of the illness, but that GPs alone were also strongly influenced by the presence of male sex and by the presence of a psychiatric label. Good or bad psychosocial context had no influence on the GPs' referral decision, and previous experience in psychiatry or other vocational training had no detectable effect, but this may be because of the sample size.

Burnout signifies the chronic depletion of coping resources following prolonged exposure to emotionally charged demands. It is manifested by symptoms of emotional, physical and cognitive exhaustion, and is usually studied in relation to occupational stressors. We hypothesized that the major life crisis engendered by missile attacks would give rise to burnout or exacerbate preexisting burnout symptoms. We also hypothesized that individuals suffering from prewar burnout would appraise the war as being more threatening and would be more vulnerable to upper respiratory infections (URI). Wartime and pre-war (baseline) levels of burnout and related symptomatology (cognitive weariness, listlessness, tension and somatic complaints) were compared among 162 Israeli civilians who carried on with their employment duties throughout the Gulf War. We found that the war impacted primarily on younger individuals (age < 45). All the pre-war levels of the above measures increased significantly (except for a marginal increase in tension). The impact of the war was mediated by threat appraisal, as indicated by worry and apprehension. Worry was positively associated with pre-war burnout, and negatively with age and education. Pre-war burnout was associated positively with wartime URIs. It was concluded that the war accelerated the depletion of coping resources and that burnout may be affected by factors other than occupational stress.

Medical records were selected from the Danish National Patient Register in order to study individuals between the ages of 17 and 49 years in the general population who, during an 8-year period, were admitted at least 10 times to a general hospital (N = 282). Fifty-six subjects (19%) were found to be persistent somatizers, i.e. they were admitted repeatedly to general hospitals for physical symptoms without an organic basis. This corresponded to a frequency of persistent somatization in the population 0·6 per 1000 men and 3·2 per 1000 women.

This prospective study of 2163 women attending a breast-screening clinic, or for a routine medical check-up, indicates that there is a statistically small but potentially important clinical link between the methods used to cope with stressful situations and breast disease.

Few empirical studies have examined the mental health of workers on North Sea oil and gas installations, and it is unclear from the available literature whether offshore employees show impaired mental health relative to their onshore counterparts. The present study was intended to clarify this issue by direct comparison of the General Health Questionnaire (GHQ) scores of onshore and offshore personnel engaged in similar work. As compared with published data, only the onshore group showed low GHQ-12 scores, although both groups were low in neuroticism. Analysis of GHQ subscale scores demonstrated that anxiety was significantly higher among offshore workers than among those working onshore, but there were no significant differences in somatic symptoms or social dysfunction. Regression analyses showed that this result was not affected by control for age, job level, and neuroticism, although there was a significant interaction between job level and neuroticism in predicting anxiety. The nature of the offshore environment, and the factors which may play a causal role in elevated anxiety among offshore workers, are discussed.

The applicability of the Charing Cross health indicator (CH-X) to the field of mental health was investigated in a community setting using descriptive statistics and principal components analysis. The CH-X is based on assessments of (i) distress and (ii) disability. Our results suggest that with respect to quality of life in mental health settings measurements of distress may be of greater importance than disability. In addition, the CH-X may be insensitive to variations in the severity of mental disorder and may primarily reflect physical disability as opposed to social disability. QALYs methodology may require the adoption of a multidimensional measure of health in order to fulfil its proposed role in comparing medical and mental health programmes.

The prevalence of psychiatric disorders was investigated in all inhabitants over 85 years of age (N = 1259), residing in Leiden, The Netherlands. The study design consisted of two phases. In the first phase the Mini-Mental State Examination (MMSE) and the 12-item version of the General Health Questionnaire (GHQ-12) were used to screen for potential cases; in the second phase all potential cases and a sample of the non-cases were interviewed with the Geriatric Mental State Schedule (GMS). DSM-III diagnoses were made based on the GMS and on information obtained from caregivers. There was a high prevalence of organic disorders of 31% (95% CI: 27–35%). The estimated overall prevalence rate for functional disorders was 8% (95% CI: 4–12%). This is an underestimate because organic and functional disorders are mutually exclusive in DSM-III. The prevalence rate estimated for the population at risk for functional disorders (i.e. the total population minus the organic cases) was 12% (95% CI: 6–18%). This is very similar to prevalence rates for functional disorders found in population based surveys in younger age groups. Therefore, in contrast with the dementias, there appears to be no increase with age for the functional disorders.

Drug use was examined in a French general population adult sample from a household survey conducted in 1987–8 in a newly built town near Paris. Psychotropic drug use was measured by the percentage of subjects reporting their use during the past week. It was prominently represented by benzodiazepines (90% of psychotropic users), differed strongly between genders (4·6% in men, 10·2% in women) and age groups (higher after 40 years). A lifetime history of major depressive episode (MDE) or of anxiety disorders was associated with a higher proportion of psychotropic drug use. Psychotropic drug use also went with a current well-being questionnaire score. Using a logistic analysis, the following set of variables held for women: well-being score, history of both MDE and anxiety disorder, age, and marital status. Making allowance for the cross-sectional nature of this retrospective survey, these finding confirmed the relatively high level of benzodiazepine drug use in an urban French community sample and emphasized its association with mental health status.

Factor analyses of the General Health Questionnaire have attempted to interpret the factors as measuring anxiety, depression and social functioning. Data from two large community surveys were used to conduct an unrotated principal components analysis of the 30-item General Health Questionnaire. A general factor, indicating overall severity of psychiatric disorder, accounted for around 30% of the variance. The next most important factor, accounting for about 8% of the variance, was bipolar with the positive (‘less than usual’) items of the General Health Questionnaire having positive coefficients and the negative (‘more than usual’) items having negative coefficients. It is suggested that the concepts of positive and negative mental health derive empirical support from the results and may prove to be a useful classification of dimensions of mental health in the community.

Ninety-four patients were asked about the presence of psychiatric symptoms on admission to hospital using the revised Psychiatric Assessment Schedule. Three months later they were asked to recall their symptoms at admission using the same instrument retrospectively. The results of the initial and retrospective interviews showed good rates of agreement in terms of PAS score, ID level, psychiatric ‘caseness’ and both CATEGO and DSM-III-R diagnoses. The study demonstrates that it is possible to make reliable measurements of the mental status of three months previously, simultaneously with assessments of current mental status. The uses of such a measuring instrument are discussed.

Men convicted of sex offences (N = 102) were interviewed in two prisons. Cluster analysis was used to generate three groups according to pattern of denial; a fourth group was composed of men who denied their offence altogether. The groups differed in their ethnic make-up, offence type and past history of sexual offending.

Many of the standardized interviews currently used in psychiatry require the interviewer to use expert psychiatric judgements in deciding upon the presence or absence of psychopathology. However, when case definitions are standardized it is customary for clinical judgements to be replaced with rules. The Clinical Interview Schedule was therefore revised, in order to increase standardization, and to make it suitable for use by ‘lay’ interviewers in assessing minor psychiatric disorder in community, general hospital, occupational and primary care research.

Two reliability studies of the revised Clinical Interview Schedule (CIS-R) were conducted in primary health care clinics in London and Santiago, Chile. Both studies compared psychiatrically trained interviewer(s) with lay interviewer(s). Estimates of the reliability of the CIS-R compared favourably with the results of studies of other standardized interviews. In addition, the lay interviewers were as reliable as the psychiatrists and did not show any bias in their use of the CIS-R. Confirmatory factor analysis models were also used to estimate the reliabilities of the CIS-R and self-administered questionnaires and indicated that traditional measures of reliability are probably overestimates.

Major psychiatric disorder is more common in people of lower rather than higher socioeconomic status. This is less clear for the commoner, so-called minor psychiatric disorders, but these are more affected by tendency to report symptoms. To examine this the distribution of minor psychiatric disorder by employment grade measured by the 30-item General Health Questionnaire is reported from the first cross-sectional phase of the Whitehall II Study of 10314 London-based civil servants, men and women between 35 and 55 years. Validation of the GHQ in a random subsample stratified by grade and sex (N = 201) suggested that people in lower employment grades tend to under-report minor psychiatric disorder on the GHQ relative to those in higher employment grades. The prevalence of minor psychiatric disorder corrected by the coefficients from the validity study was greater in the lower employment grades than the higher employment grades particularly for men. This was echoed in grade differences in well-being measured by the Affect Balance Scale, and in symptoms and recurrent health problems. Overall, for women there were few clear-cut differences in minor psychiatric disorder by employment grade. The lack of social class gradient in women suggests that further exploration should examine women's role at work and their personal lives for the aetiology of minor psychiatric disorder.

This paper describes quantitative and qualitative aspects of social support in a sample of 40 long-term schizophrenic day patients attending a rehabilitation unit. The influence of symptomatology and experience of life stressors on network and support characteristics was also investigated. The primary networks of these patients were found to be small, comprising on average 7 members, of whom only 3 were seen regularly. Despite this, subjects rated their perceived support as adequate. The secondary networks were of the order of 32. It emerged that greater prevalence of negative symptoms was significantly associated with lower ideal levels of support and this group of patients was significantly less likely to seek support in the event of a life stressor. This may be a protective mechanism to insulate the person from the effects of stressful relationships but at the same time means that they are isolated from potential supports. The clinical implications are discussed in terms of offering optimum support for this marginalized group.