Most family studies of psychiatric disorders examine one syndrome at a time, and identify probands in clinical rather than epidemiological settings.

In the National Comorbidity Survey, 5877 respondents were asked about the history of five psychiatric disorders in their parents: major depression (MD), generalised anxiety disorder (GAD), antisocial personality disorder (ASP), alcohol abuse/dependence (AAD) and drug abuse/dependence (DAD).

Significant familial aggregation was seen for all disorders. Controlling for other disorders produced only modest reductions in the odds ratios for MD. GAD and AAD and larger reductions for ASP and DAD. The familial transmission of these disorders can be explained by underlying vulnerabilities to internalising and to externalising disorders transmitted across generations with moderate fidelity.

Familial aggregation of common psychiatric and substance use disorders is substantial in epidemiologic samples. The examined environmental adversities account for little of the observed parent-offspring transmission of these conditions.

The aim of this part of the Northern Ireland Suicide Study was to investigate the prevalence of DSM - III - R axis I (clinical syndrome) and axis II (personality) disorders among suicides (14 years and older) in Northern Ireland during a one-year period.

A psychological autopsy study based on a variety of documentary sources and interviews with bereaved informants and health care professionals.

Ninety per cent of suicides (106/118) had a current axis I and/or an axis II mental disorder. At least one current axis I disorder was diagnosed in 86% of suicides (102/118), and at least one axis II disorder was diagnosed in 44% (52/118). Suicides under 30 years (92% male) were less likely to have a current axis I disorder (68%; 26/38) than those 30 years and older (95%; 76/80). Psychiatric comorbidity was present in 55% of suicides (65/118). The time between the last contact with a health care professional and death was greater among suicides under 30 years and male suicides.

Notwithstanding the aetiological complexity of suicide, the prevention, recognition and treatment of mental disorder will continue to play key roles in suicide prevention.

The management of disturbed behaviour in facilities for those with learning disabilities involves a spectrum of approaches including the prescription of emergency medication, restraint and seclusion. The use of these techniques has recently come under close scrutiny.

All incidents requiring emergency medication or seclusion that occurred in a large hospital for those with learning disabilities were studied over a six-months period. The precipitating factors, course and outcome of those who had received emergency medication or seclusion were then examined.

In all, 286 incidents involving 72 individuals occurred during the study period. The episodes requiring seclusion comprised 19% of all incidents. Two-thirds of the patients involved were male but six female patients accounted for 36% of all incidents. During the second part of the study, when the staff knew that the treatments used were being monitored, there was a significant reduction in use of restraint and emergency drugs given intramuscularly. Patients receiving seclusion were judged to have a better outcome one hour after the onset of the incident compared with those who received medication.

Despite concerns about the use of seclusion, the results of this survey suggest that procedures that remove the patient from the environment contributing to the disturbance may have certain advantages in this population.

Lewy body dementia (LBD) is emerging as a common cause of degenerative dementia. However, LBD cannot yet be diagnosed with certainty in life. There is some preliminary evidence that the pattern of cognitive impairment in LBD is different from that in Alzheimer's disease (AD). We set out to compare the performance on different subtests of the Cambridge Cognitive Examination (CAMCOG) of LBD patients and AD patients who were similar in overall degree of cognitive impairment.

All patients were recruited from a memory clinic LBD (n = 17) was diagnosed according to the McKeith clinical criteria. AD (n = 17) was diagnosed according to NINCDS-ADRDA criteria. The performances of LBD and AD patients on the neuropsychological subscales of the CAMCOG were compared by applying Hotelling's multivariate test of significance and subsequent univariate F tests.

There were no statistically significant differences between the two groups on Mini-Mental State Examination and global CAMCOG rating. Hotelling's test with LBD and AD as the between-group factor and the neuropsychological subtests from CAMCOG as dependent variables revealed a statistically significant group effect (P < 0.05). Univariate F tests showed that recall (P < 0.02) and praxis (P < 0.003) significantly contributed to this effect.

These results suggest that there may be different neuropsychological profiles in the two conditions, with LBD subjects being better on recall but worse on praxis than those with AD.

Previous research has generally found that variations in relatives' affective attitudes (expressed emotion; EE) towards a schizophrenic family member could not be accounted for by differences in the severity or form of the patient's symptomatology. These findings have been based on clinicians' ratings of psychopathology in patients.

To approach the question from a different perspective, videotaped interactions between a patient and family members, obtained four to five weeks after hospital discharge, were coded for subclinical signs of psychopathology expressed by the patient. The Behavioral Subclinical Rating Scale (BSRS) was developed to compare subclinical levels of non-verbal and paralinguistic symptoms expressed by patients from both high- and low-EE families.

Highly significant differences were found in the BSRS data. Patients from high-EE families showed more hostile and unusual behaviour with relatives than those from low-EE homes, who, in contrast, showed more anxious behaviour.

These data suggest that a complex transactional model is necessary to understand how family attitudes evolve during the course of a relatives' schizophrenic disorder.

Suicide rates among young men are rising. Further information about their contacts with services and possible associated stressful life events is necessary.

The sample consisted of all cases where the coroner in the County of Avon had given an inquest verdict of suicide over a 20-month period, together with those who were categorised as suicide by a panel of psychiatrists even though they had received open or accidental inquest verdicts. The coroners dossiers and hospital notes were examined and the relevant general practitioners interviewed.

Interpersonal stress in the last 72 hours was much higher in younger suicides. Young male suicides were also much less likely than others to seek help. Levels of alcohol misuse were no higher in younger than older suicides.

Various subgroups of suicide behave differently in the way they seek and utilise help. The implications of these findings for suicide prevention and service strategy are discussed.

Panic disorder is associated with neuroendocrinological abnormalities, some of which overlap with those seen in major depression. To date, there has been little assessment of the role of cholinergic mechanisms in this disorder.

Sixteen patients with DSM–III–R panic disorder and an age and gender-matched comparison group were administered 120 mg of the acetylcholinesterase inhibitor pyridostigmine. Growth hormone (GH) responses over a three-hour period were monitored.

Mean ΔGH, the difference between basal and the maximum pyridostigmine levels, was significantly greater in patients with panic disorder than in the comparison group.

This may reflect increased cholinergic responsivity in panic disorder.

A few recent linkage studies have shown a possible locus for bipolar disorder on chromosome 18. Cytogenetic studies may assist in the further localisation of susceptibility loci on this chromosome.

A search was made for abnormalities of chromosome 18 in two separate large cytogenetic databases. In Denmark detection of mental illness in subjects with chromosome abnormalities was done by cross-linking the two separate register of psychiatric and chromosome disorders. In Scotland the Cytogenetic Registry of the MRC Human Genetics Unit undertakes long-term clinical follow-up of all cases with chromosome abnormalities.

Cross-linking the two Danish register's revealed a family with the rare karyotype abnormality inv(18) (p11.3;q21.1) with one inversion carrier who also suffered from bipolar disorder. In this family there were two other cases of bipolar disorder, but the karyotype of these cases could not be established. One family in Scotland showed a case of schizophrenia in a carrier of inv(18) with the same breakpoints as the Danish family.

We suggest further studies of the 18p11.3 and 18q21.1 regions in order to identify genes involved in bipolar affective disorder and schizophrenia.

Although road traffic accidents are a major cause of injury and death in children and adolescents, research into their psychological consequences consists mainly of case reports.

A prospective study was made of young road traffic accident victims; 57 subjects, aged 5–18 years, who had been injured in road traffic accidents, and their parents, were interviewed 2–16 days post-accident and re-examined after 12–15 weeks.

Post-accident stress symptoms occurred at both times. There was a decrease of symptom severity between the two interviews, but at the later time, 14% still suffered from moderate or severe post-traumatic stress disorder, 17% from serious traffic-related fears, and parents reported increased mood disturbance in their children compared with the pre-accident period. High levels of distress during and immediately after the accident were associated with severe post-traumatic stress symptoms.

There is an urgent need for healthcare staff working with children and adolescents involved in road traffic accidents to be aware of the potential psychological consequences and the importance of the immediate accident experience on subsequent coping.

Citalopram is a serotonin reuptake inhibitor which has been demonstrated to be highly selective and with a superior tolerability profile to the classical tricyclic antidepressants. This study was designed to test whether there was any difference in eff icacy in the management of panic disorder (PD) between Citalopram and placebo.

This was a double-blind, placebo and clomipramine controlled, parallel group eight-week study. A total of 475 patients with PD, with or without agoraphobia, were randomised to treatment with either placebo, clomipramine 60 or 90 mg/day, or Citalopram 10 or 15 mg/day, 20 or 30 mg/day, or 40 or 60 mg/day. Doses were increased over the first three weeks, stabilised during the fourth week and fixed between weeks five and eight.

Treatment with Citalopram at 20 or 30 mg, 40 or 60 mg and clomipramine were significantly superior to placebo, judged by the number of patients free of panic attacks in the week prior to the final assessment. All rating scales examined suggested that Citalopram 20 or 30 mg was more effective than Citalopram 40 or 60 mg.

The most advantageous benefit/risk ratio for the treatment of PD was associated with citalopram 20 or 30 mg/day.

Successive DSM versions struggle with the heterogeneity of the eating disorders. Criteria were mainly based on clinical impressions and on descriptive and inferential studies.

In a study of 55 eating-disordered adolescents, we investigated whether patients could be grouped on an empirical basis, using principal components analysis (PCA) with optimal scoring (scaling), i.e. PCA with no a priori assumptions. Clustering was based on Morgan-Russell subscales, each measured four times over the course of illness.

Contrary to DSM – IV criteria, patients did not cluster primarily on the basis of anorectic symptoms; the occurrence of bulimic symptoms was more dominant. Core symptomatology (preoccupation with food, disturbed body perception and inadequate sexual behaviour) did not differ between patients, either at referral or over time.

These results support the spectrum hypothesis of the eating disorders, which considers them as one syndrome with different manifestations.

This study investigates patterns of qat use among 207 Somalis living in London.

Subjects were recruited using privileged access interviewing. Somalian interviewers were recruited who shared the same culture as the subjects. Data were collected by means of a structured interview.

One hundred and sixty-two subjects (78%) had used qat. The majority (76%) used more qat than in Somalia. Some users reported moderate dependence; a minority reported severe problems. Adverse psychological effects included sleep problems, anxiety and depression. Medical problems associated with qat use were rare.

Qat users who continue to use this drug when it is transplanted from a traditional context may experience difficulties. Qat use can also be seen as playing a positive role in supporting the cultural identity of the Somalian community. Severe problems were rarely reported. Qat consumption should be considered when addressing health-related topics with patients from those communities in which qat use is common.

The symptoms of dementia are the most obvious stressors to which caregivers are exposed and many studies have investigated the association of such symptoms with the adverse consequences of caring. The present paper represents the only dedicated review of this literature.

Manual and computer (MEDLINE) literature searches were performed.

Seventeen empirical studies were found.

Variability in conceptual and methodological approaches and inconsistencies in the reported findings have prevented firm conclusions from being drawn. However, the literature provided support for a relationship between non-cognitive features in dementia and psychological problems in caregivers, and suggested possible associations between cognitive deficits and some negative care-giver outcomes. New methodological and conceptual approaches are required if decisive evidence is to be forthcoming. This information is a prerequisite for investigations into the causal mechanisms that sustain these relationships, and for rationally designed interventions.

Although several studies have directly explored serotonin (5-HT) transmission in patients with obsessive compulsive disorder (OCD), their results have been inconsistent and their clinical relevance is doubtful

According to a double-blind placebo-controlled design, plasma prolactin (PRL) response to a specific serotonergic probe, d-fenfluramine, was measured in 20 drug-free obsessive compulsive patients and in 20 matched healthy controls. After the neuroendocrine test, 5 patients completed a lO-week treatment with fluvoxamine. Psychopathological assessment was performed before and after therapy.

PRL response in OCD patients was blunted under the drug-free condition; correlated inversely with pretreatment ratings of obsessive-compulsive and depressive symptomatology; and correlated inversely with the improvement in obsessive-compulsivescore observed after fluvoxamine treatment.

These results support the idea of a dysfunction of 5-HT transmission in OCD, and suggest that the greater this impairment, the better the response to drugs which selectively block the reuptake of 5-HT.

The study focused on: (1) the existence of genetic anticipation in a randomly selected sample of bipolar I patients using broad and narrow definitions of the affection status in the parental generation; (2) the relationship between anticipation and the age at investigation in probands and in their relatives; (3) the relationship between anticipation and imprinting.

One hundred and fifteen bipolar I patients and their first- to third-degree relatives were diagnosed according to DSM–III–R criteria using the Diagnostic Interview for Genetic Studies and the Family Interview for Genetic Studies.

Age at onset was found to be 6–10 years younger in probands with affected parents or uncles/aunts. Two-thirds of these families showed positive anticipation under both the broad and the narrow definitions of affection status in the parents' generation. The age at investigation was younger in probands showing positive anticipation. Anticipation was found only in probands inheriting the disorder from the paternal side.

In spite of the inevitable association between young current age and young age at onset, which could result in spurious anticipation effects, our findings suggest that this phenomenon is not the sole cause of observed anticipation.

Because of continuing concern regarding the inadequacy of existing NHS provision for mentally disordered remand prisoners, the Bentham Unit was commissioned as a pilot project to provide rapid assessment and, where appropriate, hospital admission for such prisoners from the former North West Thames catchment area.

Information is presented on the 150 referrals and 62 admissions in the first year of the service's operation.

The service met the Reed Report targets for assessment time. Most of those referred were previously known to psychiatric services. The alleged offences were more serious than anticipated. Those admitted were transferred to appropriate services of the conclusion of their court cases, and remained in contact with services three months later. Waiting for the conclusion of court proceedings significantly prolonged the length of stay. Substantial cost transfers from the criminal justice system to the health system were evident.

Adequate services for mentally disordered remand prisoners are entirely achievable; provision of such services is a resource issue, not a clinical problem.

Affective disorders typically have a better outcome than schizophrenia, although recent evidence suggests that some patients with affective disorder have a relatively poor outcome, with cognitive impairments and persistent symptomatology.

Fifty chronically hospitalised geriatric patients with mood disorders (major depression or bipolar disorder) were compared on the clinical symptoms and aspects of cognitive impairment with 308 geriatric schizophrenic patients who were hospitalised at the same institution. The two samples did not differ in current age or in premorbid education level, but the affective patients had a later age of onset and more females in the sample.

There were no overall differences in cognitive functioning between the groups, although the clinical symptom profiles resembled those seen in better outcome patients.

Cognitive impairment is present in poor-outcome patients with affective disorders as well as schizophrenia, suggesting that cognitive impairments predict poor outcome across psychiatric disorders and not just in schizophrenia.

Although subjective ratings of health have been shown to be accurate predictors of physical health outcomes, there is little research on the association between subjective emotional health (SEH) and psychiatric outcomes.

This paper utilises data from the Epidemiologic Catchment Area study to explore the relationship between baseline SEH and the risk for major depression in the next year. Both recurrent and incident episodes of depression are outcomes of interest.

The age- and gender-adjusted relationship between SEH and depression is quite significant, and remains so after adjusting for other factors associated with major depression. The more positive the SEH rating, the lower the risk of an episode of depression in the next year.

Some possible explanations for this association are explored, including possible confounders that were not accounted for and the possibility that SEH ratings pose an independent risk for major depression.

Findings are presented from an evaluation of a pilot remand and assessment service - the Bentham Unit, The aims of the Bentham Unit are to provide rapid assessment, identify mentally disordered remand prisoners, and speed their transfer from prison to NHS care, where a need is indicated.

The number, rate and speed of referral, assessment and transfer to NHS care of offenders remanded to Wormwood Scrubs prison during periods before and after the Bentham Unit opened were compared.

The service attracted a large volume of referrals. Between the two periods, significant increases in the numbers of referrals and hospital disposals, and major reductions in the interval between reception on remand into the prison, NHS assessment and transfer to NHS care, were observed.

The aims of the unit were met. Implications for service configurations are discussed.