Using a wide range of rare, early printed sources, including literary material, some of the first English language dictionaries, medical lexicons and medical texts, the historical origins, development and application of five terms relating to eating abnormalities are investigated. It is demonstrated that four of these, which are in current psychiatric usage, exhibited notable consistency of meaning and application over many centuries.

In a case control study which formed one arm of a large, population-based investigation of colorectal cancer incidence, aetiology and survival, ‘The Melbourne Colorectal Cancer Study’, among others, 22 psychosocially orientated questions were asked by personal interview of 637 histologically confirmed new cases of colorectal cancer and 714 age/sex frequency matched community controls, from Melbourne (population 2·81 million). Self-reported childhood or adult life ‘unhappiness’ was statistically significantly more common among the cancer cases, while ‘unhappiness with retirement’ was similarly distributed among cases and controls. Questions which were formulated to test a particular personality profile as a cancer risk, and which included the elements of denial and repression of anger and of other negative emotions, a commitment to prevailing social norms resulting in the external appearance of a ‘nice’ or ‘good’ person, a suppression of reactions which may offend others and the avoidance of conflict, showed a statistically significant discrimination between cases and controls. The risk of colorectal cancer with respect to this model was independent of the previously found risk factors of diet, beer intake, and family history of colorectal cancer, and was also independent of other potential confounding factors of socioeconomic level, marital status, religion and country of birth. Although the results must be interpreted with caution, the data are consistent with the hypothesis that this personality type may play a role in the clinical expression of colorectal cancer and was also independent of other potential confounding factors of socioeconomic level, marital status, religion and country of birth. Although the results must be interpreted with caution, the data are consistent with the hypothesis that this personality type may play a role in the clinical expression of colorectal cancer and merits further study.

The hypothesis is advanced that the psychological stance which patients adopt in response to cancer can, in some cases, influence the course of their disease. This hypothesis is examined in the light of the author's 15-year follow-up study of women with early breast cancer and of other pertinent studies. The available evidence supports the hypothesis in respect of certain earlystage non-metastatic cancers.

The possible relationship between psychological responses among breast cancer patients and discase outcome continues to be an area of controversy and debate. Two parallel findings are reported separately in the literature: first, that emotional control is more common among women with breast cancer than in women with benign breast disease or in healthy controls and second, that a helpless attitude towards the disease is related to a poor prognosis.

These previously unrelated psychological responses are examined here in a group of women (N = 359) with early stage breast cancer, who were seen one to three months after diagnosis. The relationships between emotional control, adjustment to cancer and psychological morbidity were examined. Prevalence levels of 16 and 6% were observed for anxiety and depression respectively, which are lower than reported more generally in the literature. The results indicated a highly significant association between scores for the tendency to control emotional reactions and a fatalistic attitude toward cancer. A significant association was observed between anger control and a helpless attitude. Psychological morbidity was also linked to type of adjustment to cancer. The data are interpreted in terms of a process model of psychological responses which suggests that emotional control (an important component of the Type C behaviour pattern) fatalism, helplessness and psychological morbidity are linked.

This study reports the cognitive abnormalities of a group of 58 patients with definite multiple sclerosis (MS). The psychometric functions measured were: ‘IQ deficit’, verbal and visual memory, abstracting ability, visual and auditory attention and naming ability. The presence of brain pathology was investigated using magnetic resonance imaging (MRI). A group of 46 physically disabled controls without significant brain disease was used for comparison. Normative MRI data were obtained from a groulp of 40 normal volunteers. The psychometric performance of the MS group was compared to the previously reported findings in patients with clinically isolated syndromes.

MS patients had widespread cognitive deficits sparing naming ability and affecting verbal memory less severely than other intellectual functions. The overall performance on psychometric tests was related to the severity of the MRI abnormalities and to the duration of the illness, but was not significantly influenced by the presence of psychiatric morbidity or the degree of physical disability. Patients with clinically isolated syndromes occupied an intermediate position between MS patients and disabled controls in terms cognitive and MRI abnormalities.

A whole population cohort of 157 patients with idiopathic Parkinsonism, most of whom had previously been clinically examined by Mutch (1986 a), were assessed to determine prevalence figures for dementia and examine the relationship between dementia, cognitive impairment and Parkinsonian signs. Dementia according to DSM-III-R criteria was diagnosed in 23·3% of all patients (95% confidence interval: 17·1 to 32·4%). Dementia and cognitive impairment were associated with overall measures of Parkinsonian impairment and rigidity, but not tremor, even after controlling for age, sex and education.

Data from the 1981 East Baltimore Mental Health Survey were used to examine the relationship between cognitive impairment and psychiatric diagnosis in an adult population. The Mini-Mental State Examination was administered to 3841 household respondents and a subset of 810 received psychiatric evaluations. Of the 810, 23% were found to be cognitively impaired. Over one-third of those with cognitive impairment, however, did not meet DSM-III criteria for a psychiatric diagnosis. Education, geographical background, race and neurological status were predictive of cognitive performance. There was no linear effect of age on cognitive performance with disease status and education controlled. In addition to their cognitive impairment these individuals, who ranged in age from 19 to 89, were found to have significant functional disabilities. Cognitive performance itself, along with physical and emptional health, predicted total functional disability.

A prospective study documenting psychopathology was undertaken in 48 subjects exposed to a range of physical trauma, but whose injuries were of similar severity. No support was found for the DSM-III-R view correlating the severity of the stressor with the development of post-traumatic stress disorder (PTSD). Distress post injury (high scores on the impact of event scale), indicative of difficulty with cognitive assimilation of the traumatic event, was found to be highly predictive of psychiatric morbidity and PTSD at 6 months.

A review of research on Kleptomania – the syndrome of compulsive stealing – suggests that kleptomania may be a common disorder, especially among women, and that it may frequently be associated with other forms of psychopathology, such as mood, anxiety, and eating disorders. There appears to be a range of abnormal or non-antisocial stealing behaviours, all with impulsive and/or compulsive features. Kleptomania, as defined by modern criteria, may represent the most compulsive variant. Kleptomania may be related to mood disorder, and might be a form of ‘affective spectrum disorder’.

Using family study methodology and assessments by blind raters, this study tested hypotheses about patterns of familial association between DSM-III attention deficit disorder (ADD) and antisocial disorders (childhood conduct (CD) and oppositional disorder (OPD) and adult antisocial personality disorder) among 457 first-degree relatives of clinically referred children and adolescents with ADD (73 probands, 264 relatives), psychiatric (26 probands, 101 relatives) and normal controls (26 probands, 92 relatives). Among the 73 ADD probands, 33 (45 %) met criteria for OPD, 24 (33 %) met criteria for CD, and 16 (22 %) had no antisocial diagnosis. After stratifying the ADD sample into those with CD (ADD + CD), those with OPD (ADD + OPD) and those with neither (ADD) familial risk analysis revealed the following: (1) relatives of each ADD probands subgroup were at significantly greater risk for ADD than relatives of both psychiatric and normal controls; (2) the morbidity risk for ADD was highest among relatives of ADD + CD probands (38%), moderate among relatives of ADD + OPD (17%) and ADD probands (24%) and lowest among relatives of psychiatric and normal controls (5% for both); (3) the risk for any antisocial disorder was highest among relatives of ADD + CD (34%) and ADD + OPD (24%) which were significantly greater than the risk to relatives of ADD probands (11 %), psychiatric (7%) and normal controls (4%); and (4) both ADD and antisocial disorders occurred in the same relatives more often than expected by chance alone. Although these findings suggest that ADD with and without antisocial disorders may be aetiologically distinct disorders, they are also consistent with a multifactorial hypothesis in which ADD, ADD + OPD and ADD + CD fall along a continuum of increasing levels of familial aetiological factors and, correspondingly, severity of illness.

The responses of thirteen patients with bulimia nervosa and sixteen controls matched for age and weight are described following the ingestion of a carbohydrate and a calorie-free placebo mixture in simulated binges. Psychological, hormonal and biochemical parameters were measured before and at 15 minute intervals for two hours after the simulated binge.

At baseline, the bulimics were clearly more symptomatic than the controls. The control population showed a specific satiating effect of carbohydrate upon hunger ratings. Bulimic patients responed differently showing a blunting of the normal sensation of hunger and an enhanced rating for nausea.

Prolactin, growth hormone (GH) and cortisol failed to show a carbohydrate-mediated stimulation in either population. The bulimic patients showed a different pattern of GH release, but this was independent of the challenge condition. Large neutral amino acid (LNAA) levels fell following carbohydrate ingestion, but produced an increase of up to 20% in the trytophan: LNAA ratio in both bulimic patients and the control group. Thus, while this increase in tryptophan availability failed to provoke hormone release, the time course of the carbohydrated specific effect on the sensations of hunger and nausea is compatible with a mechanism based on increased tryptophan availability. The confusion of satiety with nauseas may provide a useful focus for the future treatment of patients with bulimia nervosa.

Three monozygotic twin pairs are described who are concordant for DSM-III-R obsessive-compulsive disorder while being discordant for schizophrenia or schizoaffiective disorder. Follow-up interview showed the non-psychotic co-twins to have schizotypal personality disorder. It is concluded that obsessive-compulsive and schizophrenia-spectrum disorders can truly co-exits, thus supporting diagnostic changes introduced into DSM-III-R, and may in some cases be inherited together.

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.

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.

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.

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.

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.