Despite neuroleptic medication, many schizophrenic patients continue to experience residual positive psychotic symptoms. These residual symptoms cause distress and disability. We report a controlled trial of two cognitive-behavioural treatments to alleviate residual hallucinations and delusions. Forty-nine patients were recruited into the trial, of whom 27 entered the trial and completed post-treatment assessment, and 23 were reassessed at six-month follow-up. Patients were randomly allocated to either coping strategy enhancement (CSE) or problem solving (PS). Half the patients were allocated to a high-expectancy positive demand condition and half to a counterdemand condition to evaluate expectation of improvement. Patients receiving either cognitive-behavioural treatment showed significant reductions in pyschotic symptoms compared with those in the waiting period, who showed no improvement. There was some evidence, although equivocal, that patients receiving CSE improved more than those receiving PS. There was no evidence that improvements generalised to negative symptoms or social functioning, nor was there evidence that expectancy of treatment benefit contributed to the treatment effect.

Using a structured instrument, 325 elderly patients admitted to a general hospital for an acute medical problem were evaluated daily in order to detect symptoms of delirium. Patients were scored for ‘hyperactive’ or ‘hypoactive’ symptoms, and then the 125 patients with DSM–III delirium were rated as ‘hyperactive type’ (15%), ‘hypoactive type’ (19%), ‘mixed type’ (52%), or ‘neither’ (14%). There were no statistically significant differences between the groups with respect to age, sex, place of residence, or presence of dementia. These definitions of subtypes should be studied further.

Although many studies have shown an increased mortality in schizophrenic patients, the literature provides little information about mortality from specific causes in relation to age, gender, and duration of illness. This study examined mortality and causes of death in a total national sample of 9156 first admitted schizophrenic patients. Suicide accounted for 50% of deaths in men and 35% of deaths in women. Suicide risk was particularly increased during the first year of follow-up. Death from natural causes, with the exception of cancer and cerebrovascular diseases, was increased. Suicide risk during the first year of follow-up increased by 56%, with a 50% reduction on psychiatric in-patient facilities. The study confirms that mortality in schizophrenia is still markedly elevated, and the finding of an increasing suicide risk may be an indicator of some adverse effects of deinstitutionalisation.

One hundred and forty-seven mothers were screened for major depression at six to eight weeks postpartum. Using predetermined cut-off points, the Edinburgh Postnatal Depression Scale and the Beck scale were compared in their abilities to identify the 15% of subjects who had major depression according to DSM-III criteria. The sensitivity of Edinburgh scale was 95% and its specificity 93%. The performance of the Beck scale was markedly inferior, with a sensitivity of 68% and specificity of 88%.

The Carroll rating scale (CRS) was developed as a self rating instrument for depression, closely matching the information content and specific items of the Hamilton rating scale (HRS). The CRS was found to have acceptable face validity and reliability. The concurrent validity of the CRS was acceptable, based on comparisons with the HRS and the Beck Depression Inventory (BDI). The internal consistency of the CRS was very similar to that of the HRS. The CRS contained information about HRS scores beyond what could be predicted from BDI scores, but the BDI did not predict HRS scores beyond what could be predicted from CRS scores. The CRS and BDI scores were strongly correlated and both had access to a subjective dimension of depression that could not be predicted from HRS scores. The complementary uses of self ratings and observer ratings are evident from these results. The CRS may be a useful alternative to the BDI as a self rating scale, with the additional advantage of closer correspondence to the HRS.

The reliability and validity of the Chinese version of the 17-item Hamilton Depression Rating Scale (CHDS) was assessed. Interrater reliability was excellent, the item total-score correlations were good, and the internal reliability was satisfactory. The concurrent validity was tested by correlating the CHDS score with the Global Assessment Scale score; the strong negative correlation found indicated that the CHDS reflects the overall level of disability. Five distinct factors were generated by principle-component analysis; these factors account for 52.4% of the total variance. Rigorous evaluation of the numerous translated scales being used in clinical and research settings of non-Western countries is important.

The 25-item Hopkins Symptom Checklist (HSCL–25) was used on two occasions four weeks apart to identify self-reported symptoms of anxiety and depression in patients attending a family planning service. Only 28 per cent of patients classified as anxious to start with remained so four weeks later, but 62 per cent of those with high depression scores and 74 per cent of those with high depression and high anxiety scores maintained significant levels of depression. The implications of these findings for routine screening are discussed.

Two cognitive measures were used to assess 22 patients who met DSM–III–R criteria for major depressive disorder: the Autobiographical Memory (AM) test and the Dysfunctional Attitude Scale. They were followed up over seven months. Measurement of dysfunctional attitudes did not predict outcome at seven months. Overgeneral recall on the AM test at initial assessment, especially for emotionally positive memories, was highly correlated with failure to recover from depression and accounted for 33% of the variance in HRSD score at follow-up. Overgeneral recall of emotional memories did not change during follow-up. It is suggested that overgenerality is a trait marker indicating vulnerability to persistent depression.

Twenty-one schizophrenics with prominent negative symptoms were compared with 37 schizophrenics without them, 33 patients with major affective disorder and 20 non-patient controls on a battery of measures including a role-play test of social skills, the Social Adjustment Scale, and the Quality of Life Scale. The negative schizophrenics were most impaired on every subscale of each measure, followed in order by the non-negative schizophrenics, affective disorder patients, and non-patient controls. The social skill measures were not correlated with positive symptom levels, but were highly correlated with measures of community functioning. The results are consistent with the hypothesis that social dysfunction results from focal deficits in social skills.

In recent years there has been a considerable interest in the classification of depressed patients, and in the use of multivariate statistical techniques as tools for classifying, with the hope of either validating traditional classifications or suggesting useful new ones. One technique employed for this purpose has been factor analysis. A number of studies have used this method to explore the overlapping endogenous-reactive or psychotic-neurotic dichotomies. Most have demonstrated a factor or factors reflecting such a dimension which appears to form a consistent, systematic source of variance in ratings of depressed patients (1, 5, 11, 15, 16, 18, 26, 31, 33).

During the last fifty years, and particularly the last twenty, innumerable different classifications of depressive illness have been proposed, and several disputes are smouldering away between the protagonists of rival schools. Much of this is too well known to need, or bear, repetition. But the conflicting claims and proposals are now so numerous, and methodological problems loom so large, that those who are not intimately involved have increasing difficulty in understanding what is going on; while those who are involved are mostly too intent on developing and promoting their own particular schema to review the overall situation in any broader context. This article is an attempt to describe the main elements in a confusing situation, to outline the important problems, and to indicate the areas of agreement that are beginning to emerge, without advocating any particular solution.

Schizophrenia research embodies a microcosm of the vexing problems that confront the behavioural sciences, but particularly those disciplines concerned with psychopathology. We are ignorant of the means to prevent schizophrenia because we continue to be ignorant about its aetiology. Despite recognizable descriptions of the syndrome in ancient Hindu treatises (c. 1400 b.c.) and 76 years after its designation as dementia praecox by Kraepelin (1896), we are still grappling with such basic issues as when and how to diagnose Eugen Bleuler's (1911) ‘group of schizophrenias' (cf. Katz, Cole, and Barton, 1968). Despite brilliant advances in molecular biology, neurochemistry, and brain-behaviour phenomena generally, we cannot pinpoint any necessary biological defect in all or most schizophrenics. Despite selfless expenditures of time and energy by gifted psychotherapists and sophisticated social science efforts, we cannot specify any necessary life experience, either at the level of the family or of a culture, common to all or most schizophrenics. While there is obvious merit in casting the problem in an interactionist framework, aetiology still defies an easy solution because we must then isolate what element(s) in the genotype interact with what element(s) in the internal and/or external environment (as well as when and how) to produce the phenotype we recognize as a schizophrenic one.

Eight patients suffering from a major unipolar depression and having failed to respond to treatment for three weeks or more with tricyclic antidepressants were given lithium. All eight patients experienced a remarkable relief of their depression within 48 hours. This rapid antidepressant effect of lithium in ‘treatment-resistant’ patients might be due to the enhancement of the efficacy of the central serotoninergic system, unveiling the tricyclic antidepressant-induced sensitization of the serotoninergic postsynaptic receptors.