Instruments designed to assess psychiatric disorders in people with learning difficulties (mental handicap) were critically reviewed from a psychometric perspective. Major trends were found in the assessment of psychopathology related to DSM-III and depressive disorders although research in other areas was patchy. Although some psychometrically sophisticated measures were identified the area was characterized by an absence of important psychometric data for many measures. Future research should attend to developing assessments of schizophrenia, psycho-sexual disorders, adjustment disorders and the validation of screening procedures and instrument formats. Future studies should include more people with severe and profound learning difficulties.

In a case-control study, two potential interpersonal risk factors of non-endogenous depression, namely a patient's perception of their current intimate partner as dysfunctional and a patient's recall of exposure to previous deprivational parenting, were quantified. The interpersonal characteristics of the partner were assessed principally by a brief self-report questionnaire, the Intimate Bond Measure (IBM). By cross-sectional and longitudinal comparison of this instrument with other interview-derived and self-report measures, the convergent, discriminant and predictive validity of the IBM in depressed patients was established. Further, little evidence of any distorting effect of depressed mood or neuroticism was detected. The perception of the current intimate partner as dysfunctional imparted a risk to non-endogenous depression of at least five times, while reported exposure to parental ‘affectionless control’ was quantified as a four times' risk. Importantly, IBM care scores predicted the course of the depressive disorder over a six-month period.

The hypothesis that recurrent or chronic depressive illness produces a long-term change in neuroticism was examined in a sample (N = 34) from a consecutive series of 89 depressed patients admitted to the Maudsley Hospital in 1965/6. The Eysenck Personality Inventory (EPI) was administered at the time of the index illness both when the patients were depressed and on recovery, and then again at follow-up 18 years later. The change in the neuroticism (N) score over the 18-year-period was compared in good and poor outcome groups defined variously by a global rating of outcome, frequency of episodes, extent of subsequent hospitalization and the presence or absence of subsequent chronicity. The mean N score for the sample as a whole did not change significantly over the 18 years, and no differential change in the N score was observed between any of the good and poor outcome groups. Thus, the hypothesis was not supported.

Uptake of 99mTc-Exametazime, a marker of relative regional cerebral blood flow has been determined with Single Photon Emission Tomography (SPET or SPECT) in 20 healthy, elderly female subjects during neuropsychological challenge. Each subject was studied under basal conditions after injection of 125 MBq 99mTc-Exametazime. Without moving the head of the subject, they were scanned again after injection of 375 MBq 99mTc-Exametazime. The second injection was made in 10 subjects during a test of verbal fluency, usually regarded as a test of the integrity of function of the left frontal cortex. In the other 10 subjects the second injection was made during simple verbalization (counting). This method of splitting the normal full dose of 99mTc-Exametazime allows a novel comparison between basal and active conditions for different brain regions. Verbal fluency was associated with reduced uptake bilaterally in the region of the basal ganglia and in left temporal (peri-sylvian) cortex when compared with calcarine cortex, an unstimulated reference sensory area. By contrast, counting produced relative activation, greatest in frontal and parietal areas. Thus, a clinically relevant neuropsychological test can be characterized metabolically by a pattern of regional brain activity, whose localization cannot readily be predicted from classical studies of brain lesions. Reduction of regional uptake may suggest an important role for de-activation or inhibition of function in human cognition. The involvement of basal ganglia and temporal areas is of particular interest in relation to the investigation of functional psychiatric illness.

A cross-sectional survey of minor psychiatric disorder is reported in a representative community sample of 2204 men between the ages of 45 years and 64 years living in Caerphilly, South Wales. Minor psychiatric disorder was measured by the 30-item General Health Questionnaire and validated by the Clinical Interview Schedule in a consecutive sample of 97 men, weighted to provide one-third cases, two-thirds non-cases. A case threshold of 4/5 on the General Health Questionnaire was chosen on the basis of ‘ROC’ analysis. An overall estimated ‘true’ prevalence rate for minor psychiatric disorder of 22·0% was found, with 22·3% of men scoring 5 or more on the General Health Questionnaire. Rates of minor psychiatric disorder were higher in widowed and divorced men than in married men but were also, unexpectedly, lower in single as opposed to married men. There was no social-class gradient in minor psychiatric morbidity but a lower rate in Social Class III NM may be largely explained by lower unemployment rates. There were markedly higher rates of minor psychiatric morbidity in unemployed men and those who retired ill. Men with no available social contacts had higher rates of morbidity than men with some or high social contacts.

A comparative study of diabetics with autonomic neuropathy (N = 13) as against non-neuropathic diabetics (N = 16) and healthy control persons (N = 20) was carried out with respect to heart rate both at rest and under stress, frequency of cardiac arrhythmias in a 24-h ECG and accuracy of heartbeat and arrhythmia perception. In the subjects with diabetic autonomic neuropathy, the spontaneous variability and stress-induced reactivity of the heart rate as well as the number of tachycardic episodes were reduced, whereas the frequency of ventricular extrasystoles was somewhat increased. Impaired heartbeat perception and a complete loss of perception of arrhythmias as a consequence of neuropathic deafferentation could be demonstrated. Cardiac perception disorders also play a vital role in other clinical problems, e.g. silent myocardial infarction and lack of awareness of hypoglycaemia in diabetes mellitus.

Meta-analysis of 19 double-blind placebo-controlled trials of antidepressants (N = 13) and benzodiazepines (N = 6) for patients with panic disorders showed that active treatment had 25% greater success rate than placebo over a mean duration of 14 weeks. There were no statistically significant differences observed between treatment sub-groups (antidepressants – mean duration 16 weeks; and benzodiazepines – mean duration 7 weeks). On this basis antidepressants and benzodiazepines prescribed in clinical settings are likely to be equally effective in the short-term treatment of people with panic disorders.

Three hundred and forty-three eating disorder patients (50% anorexia nervosa, 37% bulimia and 13 % atypical eating disorder) were seen by the eating disorder service in the Wellington (New Zealand) region between 1977 and 1986. Ninety-six per cent were female. Annual rate of referral for anorexia nervosa remained stable at 5 per 100000 population (34 per 100000 females aged 15–29 years). Annual referral rate for bulimia increased from 6 to 44 per 100000 females aged 15–29 years.

This paper reviews the recent empirical studies on psychosocial family intervention in schizophrenia. Six family educational intervention studies and five more intensive family work studies with 2-year follow-up have been included. A series of questions is asked relating to the effects of such interventions, the efficacy of the different educational models, the active ingredients of these multi-component treatment packages, and the contribution of this new generation of studies to our understanding of the mechanisms through which these interventions work. Suggestions for further research are made. Finally, from the published manuals, the common components of these diverse, multi-component treatment packages of different family-intervention studies are identified.

Sixty-four in-patient cases of deliberate non-fatal self-poisoning were compared for psychosocial problems in a case-control study with a similar number of individually matched community controls. A strongly significant association was found between unemployment and self-poisoning. Further analysis revealed no firm evidence to support the hypotheses that unemployment was causally related to self-poisoning in an indirect manner or that it increased the vulnerability of individuals who self-poison to other stressful life events and difficulties. It is concluded that a possible explanation is that some third factor independently increases the risk of both unemployment and self-poisoning, giving rise to a non-causal relationship between these last two variables.

Detailed interviews were conducted with 1523 married professional and managerial employees of a major US corporation to test associations of acute and chronic occupational and domestic stress with DSM-III-R major depression and current depressive symptoms. After controlling for demographic and clinical risk factors, both sources of stress were significantly associated with the two measures of depression. On the other hand, neither the demographic and clinical risk factors, nor several psychosocial characteristics (social support, sense of mastery and organizational commitment) moderated the relationship between stress and depression.

A prospective study of sixteen Chinese anorexic patients in Hong Kong indicates that they were single young females who came from lower social class, exhibited severe self-induced weight loss, rigid maintenance of low body weight and amenorrhea. Weight reduction was primarily by dietary restriction. The typical bulimic syndrome and major depression were uncommon. There were multiple aetiological factors, but no pre-morbid obesity and little pressure to pursue slimness for beauty. Instead of displaying an intense fear of obesity and a distorted body image, patients more commonly attributed poor food intake to abdominal bloating. As such, they only partially fulfilled current criteria for diagnosis. It is argued that such clinical patterns arise logically from their sociocultural backgrounds, but may gradually change with Westernization.

The phenomenon of object chaining was investigated to determine its relationship to thought disorder in schizophrenia. Samples from thought-disordered schizophrenics (N = 12) and controls (10 non-thought-disordered schizophrenics and 10 normals) were analysed. Using the object subject ratio (OSR) to measure object chaining, we found higher OSRs in the speech of thought-disordered subjects than in that of subjects free of thought disorder. Object chaining correlated with low predictability of speech. We conclude that object chaining is associated with reduced speech comprehensibility and probably contributes to the judgement that thought disorder is present.

Environmental as well as individual socio-demographic and illness characteristics are related to the risk of admission. This paper addresses the problem of the interrelationships of these factors to admission rates. Using the Groningen Psychiatric Case Register, admission rates (during 1986 and 1987) from 34 administrative areas were calculated. Logit models were fitted in order to test the relationship between the relative risk of being admitted and sex, age, marital status, diagnosis, urbanization and distance from facilities. The effect of urbanization remains under the control of the other independent variables. The concept of ‘need for care’, related to ‘true’ and ‘treated’ incidence, is discussed.

A randomized trial in general practice compared: (i) a brief psychological treatment (problem-solving) given by a psychiatrist; (ii) any treatment of the GP's choice, whether psychological or pharmacological. The patients had recent onset emotional disorders of poor prognosis. Patients in the problem-solving group showed significantly greater reductions in symptoms. Problem-solving as given by a psychiatrist was feasible in primary care and acceptable to patients. Problem-solving is now being evaluated as given by general practitioners trained in the method.

Post-traumatic stress disorder (PTSD) was studied in the Piedmont region of North Carolina. Among 2985 subjects, the lifetime and six month prevalence figures for PTSD were 1·30 and 0·44 % respectively. In comparison to non-PTSD subjects, those with PTSD had significantly greater job instability, family history of psychiatric illness, parental poverty, child abuse, and separation or divorce of parents prior to age 10. PTSD was associated with greater psychiatric co-morbidity and attempted suicide, increased frequency of bronchial asthma, hypertension, peptic ulcer and with impaired social support. Differences were noted between chronic and acute PTSD on a number of measures, with chronic PTSD being accompanied by more frequent social phobia, reduced social support and greater avoidance symptoms.

Gender differences in demoralization (depressive symptoms) were examined in a firstever true prevalence study conducted in a kibbutz. The unusual organizational arrangements of this commune, where women have achieved higher levels of equality than in most other societies, offered a laboratory-like opportunity to test the psychosocial factors imputed as a partial explanation for the higher rates of demoralization in women.

Demoralization was studied using the 27-item scale of the Psychiatric Epidemiology Research Interview (PERI) in all of the adult population of a single kibbutz. The response rate was close to 95%. Univariate and multivariate analyses were conducted to assess the effects of key sociodemographic and kibbutz-related variables on gender differences. The results showed that women had higher mean scores and rates even after these variables were controlled. The female: male demoralization ratio was well within the range of results obtained in non-socialist Israeli urban settings. The paper concludes with a discussion on the tentative relevance of the study results for the interpretation of the 2:1 female–male ratio of depression found in the epidemiological literature.

There is considerable evidence from inter-respondent and test–retest studies that the data obtained in structured life event inventories are not very reliable. Inter-respondent reliability estimates are presented in this paper for the life event reports obtained in a community survey that was designed to facilitate recall of life events. It is documented that respondents were able to recall many sorts of severe negative events with adequate reliability over a twelve-month recall period. Data are also presented to show that respondents could date event occurrence with good consistency. Sensitive events, such as involvement in criminal activities and difficulties in marriage, were not reliably reported. These results suggest that the problems of faulty memory and conceptual confusion about serious events can be overcome with careful question wording and administration procedures, but that the problem of respondent reticence about reporting sensitive events remains unresolved.

In 1983 we presented a systematic analysis of the available literature on the course of anorexia nervosa (Steinhausen & Glanville, 1983 a). The survey was based on 45 English and German language studies published between 1953 and 1981. During the past decade there has been a striking increase of publications related to eating disorders in general. This pertains as well to follow-up studies on anorexia nervosa. In addition to studies compiled in our previous report, we were able to locate another 22 follow-up studies published in major English and German language journals between 1981 and 1989.

Socio-demographic and clinical aspects of compulsory and informal admissions to general adult psychiatry wards over a two-year period are compared. In addition, Afro-Caribbean patients are compared with white UK-born patients. Relative rates of admission are examined. The study confirms other reports of greater than expected compulsory admissions of Afro-Caribbean patients and pays particular attention to the circumstances preceding compulsory entry to hospital and the persons and agencies involved in that process.