One hundred and sixty-two women were evaluated for psychiatric morbidity in the second trimester of pregnancy and also six to eight weeks postnatally. A sizeable proportion of the women also had a second prenatal assessment in their third trimester and in the lying-in ward shortly after giving birth. Assessments were conducted with the 28-item GHQ. This was initially validated using a subsample of 106 women, taken from the original group, who were interviewed with the PAS. Thirty per cent of the women were ‘cases' at the first prenatal assessment, while only 14% were ‘cases' six to eight weeks postnatally. Thus, even though there was an overlap between prenatal and postnatal morbidity, there was also substantial difference between the groups that were symptomatic at both periods. This observation was reinforced by the low correlation between the mean GHQ scores at both periods. Both prenatal and postnatal morbidities were associated with recent adverse life events, with the latter more likely to be associated with marital and family events. This observation is in support of the view that neurotic problems, prenatally or postnatally, are caused mainly by psychosocial factors.

Associations between delusions and abnormal behaviour were retrospectively assessed in a sample of 83 consecutively admitted deluded subjects. All were interviewed about events in the previous month using a new measure of delusional phenomenology and action. For 59 subjects this information was supplemented by informant interviews. Clinical consensus was reached concerning the probability that actions reported by informants were linked to delusions. Half of the sample reported that they had acted at least once in accordance with their delusions. Violent behaviour in response to delusions was uncommon. Information provided by informants suggested that some aspect of the actions of half of the sample was either probably or definitely congruent with the content of their delusions. However, there was no link between self-reports and informants' reports of such action. A latent class analysis of self-reported delusional action suggested three classes of action, namely aggressive to self or other, defensive action, and either none or single action. Self-reported action was associated with delusions of catastrophe. Informant data suggested that persecutory delusions were the most likely to be acted upon, but in contrast delusions of guilt or catastrophe appeared to decrease the chance of delusional behaviour. Actions associated with abnormal beliefs are more common than has been suggested.

Psychiatric morbidity among 74 non-affected first-degree relatives and 93 non-affected second-degree relatives of patients with Huntington's disease (HD) was compared with that of 37 patients with HD and with matched control groups. Due to specific age criteria, the first-degree relatives were at decreased risk and the second-degree relatives at negligible risk of being carriers of the gene for HD. Information on admissions to departments of psychiatry and diagnoses at discharge were obtained for all subjects from a nationwide central register. Psychiatric morbidity was no greater among relatives than among controls, whereas HD patients had significantly more admissions and psychiatric diagnoses than relatives. Growing up with a risk of developing HD does not itself increase the risk of developing psychiatric illness resulting in hospital admission. Severe psychiatric disorders in HD patients were thus most likely to be aetiologically related to the disease process, possibly through a genetic mechanism.

Neuropsychological and psychiatric evaluations were made of 39 subjects with possible Alzheimer's disease and a history of excessive alcohol consumption (AD + ETOH), who had been abstinent or had drunk minimally for at least three months before evaluation, and 225 patients with probable Alzheimer's disease (PAD) of comparable age, years of education, and baseline global impairment. At baseline, there were no significant differences between the groups in terms of age of onset of dementia, neuropsychological test scores, or current behavioural or psychiatric symptoms. One year later, no differences in rates of decline between 20 abstinent AD + ETOH patients and 88 PAD subjects could be shown. Thus, past heavy alcohol consumption does not appear to modify the presentation of dementia of the Alzheimer's type, nor does it modify progression over a one-year interval.

Sixty-nine mentally ill patients in treatment in an intensive community support system in Boulder, Colorado, were evaluated using the same measures of quality of life and psychopathology as were used in assessing mentally ill patients in hospital and community facilities in Manchester. Psychopathology was greater in the Boulder samples, but quality-of-life scores were no worse for the American patients. The relationship of these findings to systems of care and availability of psychiatric hospital beds is discussed.

This study examined 49 in-patients with obsessive-compulsive disorder who were treated over three years. The patients had failed to respond to previous treatment. Treatment consisted of in-patient exposure, occasionally combined with other interventions individually tailored to the patient's specific difficulties. This resulted in significant clinical improvements and an average 40% reduction in rituals in 31 (63.3%) of these chronic patients. These gains were maintained at an average 19-month follow-up. Checking rituals were more likely to be associated with good outcome. Women had a later onset of the disorder and a slight tendency to better prognosis. No other predictors of outcome were found.

The aim of the study was to identify the phenomenological characteristics of those delusions which are associated with action. The sample consisted of 79 patients admitted to a general psychiatric ward, each of whom described at least one delusional belief. The variables studied included the phenomenology of the delusions, and behaviour. Two behavioural ratings were used, one derived from the subjects' own description of their behaviour and the other from information provided by informants. There was no association between delusional phenomenology and acting on a delusion when the subjects' behaviour was described by informants. When action was described by the subjects themselves, acting was associated with: being aware of evidence which supported the belief and with having actively sought out such evidence; a tendency to reduce the conviction with which a belief was held when that belief was challenged; and with feeling sad, frightened or anxious as a consequence of the delusion.

Clinico-pathological correlations were examined in 54 patients with neuropathologically verified Alzheimer's disease (AD) who were part of a prospective study. Behavioural disturbance was documented using an expanded version of the Stockton Geriatric Rating Scale (SGRS). The subscores for physical disability (P), apathy (A) and communication failure (C) (summation score PAC) were closely correlated and were high in most patients during the late stages of illness. High PAC scores correlated with an earlier onset and longer duration of illness, lower brain weight, more severe tangle pathology in the parahippocampal gyrus and the frontal and parietal neocortex, and lower neuron counts in the hippocampus and basal nucleus of Meynert. Features of the Klüver-Bucy syndrome (range behaviour and hypermetamorphosis) were significantly associated with lower counts of large neurons in the parahippocampal gyrus and parietal neocortex, but not with more severe plaque or tangle formation or with neuronal loss in the subcortical nuclei. No correction was made for multiple comparisons. These findings may signify decreased cortical inhibition in patients with relatively well preserved subcortical structures who show features suggestive of the Klüver-Bucy syndrome. High PAC scores on the SGRS could reflect more advanced and widespread cerebral pathology in the end stages of AD.

Cannabis abuse is a major public health problem in The Gambia and other parts of West Africa, and the rise in the incidence of psychotic illness reflects the increased background use of cannabis by the local population. A case-control study was performed to determine the association between psychosis and cannabis abuse in The Gambia and the importance of other risk factors. Out of 234 patients admitted to Campama Psychiatric Unit over 12 months, 210 (90%) were enrolled in a case-control study. Urine was tested for cannabinoid substances and 38% were positive compared with 12% of matched non-psychotic control subjects. Analysis of the matched pairs showed that a positive urinary cannabinoid test, cigarette smoking, alcohol consumption, travel to Europe and family history of mental illness were all significant risk factors for psychotic illness; Koranic education reduced the risk. There was a positive correlation among the psychotic patients between a positive urinary cannabinoid test and the use of alcohol, ataya tea and cigarette smoking; a family history of mental illness showed a negative correlation.

Somatising patients present with a variety of psychosocial dysfunctions. Using the Dysfunctional Analysis Questionnaire and the Global Assessment of Functioning scale, we studied the nature and severity of psychosocial dysfunction in a group of somatising patients. Dysfunction was less marked in the cognitive area than in social, vocational, personal and familial areas. Patients with depressive disorders showed more dysfunction than those with somatoform disorders in all psychosocial areas except cognitive.

The aim of this study was to establish the prevalence of current and past psychiatric morbidity in HIV seropositive asymptomatic subjects belonging to three transmission categories (gay men, intravenous drug users, and heterosexuals) compared with that found in HIV seronegative controls from the same groups. A cross-sectional, controlled study including 279 seropositive subjects belonging to groups II and III defined by the Center for Disease Control (94 gay men, 157 intravenous drug users, and 28 heterosexuals) and 159 seronegative subjects (38 gay men, 91 intravenous drug users, and 30 heterosexuals) is reported. Outcome measures included standardised, self-report questionnaires and a semistructured interview to assess current psychopathological status and past psychiatric history. In addition, a psychiatric diagnosis according to DSM-III-R criteria Axis I and II was made in the seropositive subjects. Results showed that these subjects differed very little from the controls and that overall levels of psychiatric disturbances in both groups were low and similar to those found in other life-threatening illnesses. Furthermore, intravenous drug users, regardless of HIV serological status, had the highest levels of psychological morbidity. Psychosocial distress was associated with previous and current lifestyle, independently of HIV status.

An international mental health relief programme for children and adults was implemented in Soviet Armenia after the 7 December 1988 Spitak earthquake. This paper presents: (a) the steps considered essential in the selection, preparation and support of mental health workers for the relief work; (b) a method which facilitated the screening and treating of large numbers of students in their classrooms; (c) the rate of post-traumatic stress disorder (74%) and major depressive disorder (22%) of 582 victims clinically evaluated before entering treatment three to six months after the earthquake; (d) clinical observations of significant psychological problems that may be overlooked in brief crisis-orientated psychotherapy; (e) multiple severe post-earthquake adversities (such as the collapse of the social network, the recurrence of after-shocks, the delay of reconstruction and the ongoing political turmoil) which contributed to the psychological problems of the victims and delayed their recovery; (f) the extension of the outreach programme beyond its traditional therapeutic role to an advisory one to other relief organisations.

In this comparative study with a control group of prisoners, psychiatric morbidity was measured in two groups of sentenced prisoners, each group completing the GHQ-30 and 21-item Beck Depression Inventory (BDI). Group 1 consisted of 40 segregated HIV-positive prisoners and group 2 a matched control group in the main prison who had no history of HIV seropositivity. All members of group 1 had a history of intravenous drug abuse. The mean GHQ-30 and BDI scores were significantly higher in group 1, and 90% of group 1 were psychiatric ‘cases’ compared with just over 42% of group 2. Levels of psychiatric morbidity present in a third group, consisting of HIV-positive prisoners who had not been segregated (prison authorities were unaware of their seropositivity) are an interesting pointer for further research.

In a prospective study, 32 patients with depressed mood and cerebral pathology were compared over one year with 66 depressed patients who were cerebrally intact. The hypothesis that the former would have a poorer outcome for depression was not confirmed, although the group with cerebral pathology had a significantly higher than expected death rate. Prognostic factors were identified only for the cerebrally intact group. Those who had major depression were more likely than those with minor depression to be given physical treatments, irrespective of which group they belonged to.

There is a perceived need for schools and casualty departments to receive appropriate information and guidelines in order to minimise the effect of PTSD. A recommended screening battery for PTSD was administered at the start of a two-session debriefing group and again three months later to a group of seven young survivors of a minibus accident. No studies using this screen other than those of shipping disasters have been reported to date. Screen scores were compared with those of survivors of the cruise ship Jupiter. No significant differences were found between minibus survivors when assessed at six months (before intervention), and Jupiter survivors, who when assessed at five months had already undergone debriefing. Post-debriefing assessment of minibus survivors demonstrated significant reductions on all measures.

A community study was conducted to determine the prevalence of depressive symptoms and syndromes in 11–16-year-old girls. Girls from three secondary schools (1072 girls in total) were administered questionnaires and 375 were selected for direct interview. The estimated prevalence for current major depressive disorder (within the past month) for the population was 3.6%, and for the past year was 6.0%. Scores on the self-report questionnaire of mood disturbance increased with age, as did the prevalence of depressive disorder. A large proportion of interviewed girls reported depressive symptoms which did not meet the DSM-III-R criteria for major depressive disorder. The estimated prevalence of this ‘partial syndrome’ group was 8.9% for a current episode and 20.7% for the past year.