Background. Apathy is a frequent neurobehavioural sequel in patients with acquired brain damage and it may seriously affect outcome of rehabilitation.

Methods. Patients with traumatic brain injury, cerebrovascular insults and hypoxic brain injury, categorized into four lesion localization groups: left hemisphere damage (LHD); right hemisphere damage (RHD); bilateral hemispheric damage (BHD); and subcortical damage (SCD) were assessed with the Apathy Evaluation Scale (AES) and Montgomery and Åsberg Depression Rating Scale (MADRS). Heart rate and electrodermal activity were recorded in an experimental situation that exposed the patients to mental stressors in order to measure psychophysiological reactivity.

Results. Significant differences in level of apathy were found between diagnostic groups as well as between localization subgroups. SCD and RHD patients displayed most apathy. Factor analysis of MADRS revealed a three-factor solution; depressed mood, somatic symptoms and negative symptoms. Apathy was significantly correlated with negative symptoms in all localization subgroups, except among the BHD patients. Apathy was not correlated with depressed mood or somatic symptoms. Moreover, apathy was significantly correlated with heart rate reactivity, but not with electrodermal reactivity.

Conclusion. Apathy is common, its severity depending on diagnosis and localization of lesion. Apathy and depression in brain damaged patients share common features, but may be differentiated. The significant relationship between apathy and heart rate may provide a psychophysiological correlation of the disengagement, lack of interest and absence of emotional responsivity typically seen in apathy. The results have implications for the theoretical understanding of apathy and related negative symptoms, and for rehabilitation practice.

Background. This article provides evidence about the relationship between psychiatric disorders, physical disorders and hospital use in the general medical sector using a broadly based survey of the US population.

Methods. The data are from the 1989 National Health Interview Survey. This survey contains medical and mental health evaluations for the entire sample. In a multivariate framework, the author estimates the effect of mental illness on the probability of being admitted to a general hospital, the number of admissions and the length of stay.

Results. Hospital use in the general medical sector is significantly higher for persons with coexisting physical and psychiatric conditions than for those with no psychiatric disorders. For a wide range of medical conditions, the predicted number of hospital admissions and the length of a hospital stay increase substantially when the physical illness is accompanied by a psychiatric condition.

Conclusions. One implication of this finding is that economic evaluations of alternative psychiatric treatments should consider any differences in hospital costs related to the treatment of coexisting medical conditions. Another implication pertains to health care systems where insurers have some discretion over which individuals to insure. In the absence of adequate adjustments in insurance payments for high-risk potential enrollees, psychiatrically disabled persons may have more limited access to health insurance.

The task of improving the ability of clinicians to predict which of their patients will be violent has come to be seen as one of establishing the relative merits of actuarial and clinical prediction. The meaning of these terms is unclear. ‘Clinical’ is usually defined by exclusion, that is, as something other than actuarial. The term ‘actuarial’ is often used to refer to the techniques of risk prediction in financial services. In the psychiatric and psychological literature relating to the assessment of dangerousness, three further meanings have emerged. That whereby actuarial refers to any mathematical means of combining information is the most widely accepted. Whichever definition is employed, the conclusion of most reviews has been that the future is actuarial. It is argued here that, while mathematical approaches have been successful in showing that risk factors for violence in the general population apply also to the mentally disordered, important questions remain unanswered. Mathematical methods address only one form of probability, that which arises from chance. A development of another form of probability, that which arises from causes, offers the prospect of improved risk assessment in psychiatry. It also offers a definition of clinical prediction that is not based on exclusion.

Background. African-Caribbean patients have less desirable routes of entry into the psychiatric services than other ethnic groups in Britain but this may not apply to the first contact with services.

Methods. Patients' pathways to care, type of admission or referral and sectioning details were recorded for all first contact patients presenting to south London psychiatric services over a 2-year period. We also conducted a retrospective analysis of data from the Camberwell Register, comparing rates of compulsory admission between ‘Whites’ and ‘African-Caribbeans’ for first and readmissions, over a 20-year period.

Results. Our first contact sample comprised 38 White, 38 African-Caribbean and 24 Asian patients with CATEGO defined broad schizophrenia. GP referral was found to be the most common mode of contact and there were no significant differences between the ethnic groups with regard to compulsory admission. Similarly, data from the Camberwell Register showed no significant difference in rates of compulsory admission between first admission White and African-Caribbean patients. However, when all readmissions were examined, African-Caribbeans were more likely to be admitted involuntarily.

Conclusions. Our findings suggest that reports of less desirable routes of entry for African-Caribbean patients into the psychiatric service do not apply to their first admission but are likely to develop over time and repeated contact with the services.

Background. We studied whether heterogeneous profiles of cognitive function are relevant to survival in patients with early Alzheimer's disease.

Methods. CAMCOG subscales of cognitive function were used as predictors of survival, together with gender in 157 consecutively referred patients with early Alzheimer's disease. Statistical analysis was performed with Cox proportional hazards analysis and Kaplan–Meier survival curves. Survival rates were compared with those in the general population.

Results. Eighty patients (51%) died during the follow-up that extended to 5·7 years, with a median survival of 4·4 years after entry. Only the praxis subscore was statistically significant related to survival (P<0·0001). Its predictive power was based on only two items, including copying ability for a spiral and a three-dimensional house, independent of age, sex, education, overall CAMCOG score, dementia severity and symptom duration. Kaplan–Meier curves for the combined score of these items (0, 1, or 2) showed three groups with significantly different survival rates for both men and women. Comparison of gender specific survival rates with data from the general population showed that excess mortality was statistically significant (P<0·01) higher in men (51%) than in women (21%) after follow-up extending to 5 years.

Conclusions. A simple test of copying ability defines subgroups of AD patients with large differences in survival rates. This suggests that parietal lobe impairment is an important predictor of mortality in AD. Also, the course of AD may be more benign in women than in men.

Background. Systematic reviews should identify all relevant trials in order to minimize the potential for bias and the play of chance in their results. Other specialities have shown that conference proceedings are a rich source of trials, but many of these trials are never fully published.

Methods. All clinical trials presented at a single conference (Vth World Congress of Psychiatry, Mexico, 1971) were identified by hand searching. Full publications of these abstracts were then sought on five databases by searching for the authors or relevant key words.

Results. Full publications were found for 46% of the abstracts. The odds of publication decreased for abstracts that were from a non-Anglophone country or that failed to mention randomization.

Conclusions. Anyone wishing to undertake a systematic review of a mental-health care topic should search relevant conference proceedings for trials.

The European Epilepsy Academy announces a teaching course on Temporal Lobe Epilepsy in Children, to take place on Wednesday 14 April 1999 at the 10th Bethel-Cleveland Clinic Epilepsy Symposium and also an educational course/seminar on Comprehensive Care/Integral Epileptology in Childhood at the Epilepsy Centre Bethel in Bielefeld, Germany, 5–10 October, 1999. Information on both can be obtained from Mrs Verena Hézser-v. Wehrs, EUREPA Secretariat, Maraweg 21, D-33617 Bielefeld, fax +49 521 144 4311, eurepa@owl-online.de