Background. Memory deficits are commonly experienced by patients with schizophrenia, often persist even after effective psychotropic treatment of psychotic symptoms and have been demonstrated to interfere with many aspects of successful psychiatric rehabilitation. Because of significant impact on functional outcome, effective remediation of cognitive deficits has been increasingly cited as an essential component of comprehensive treatment. Efforts to remediate memory deficits have met with circumscribed success, leaving uncertain whether schizophrenia patients can be taught, without experimental induction, independently to employ semantic encoding or a range of other mnemonic techniques.

Method. We examined the feasibility of using memory and problem solving teaching techniques developed within educational psychology – techniques which promote intrinsic motivation and task engagement through contextualization and personalization of learning activities – to remediate memory deficits in a group of in-patients with chronic schizophrenia spectrum disorders.

Results. Although our memory remediation group significantly improved on the memory remediation task, they did not make greater gains on measures of immediate paragraph recall or list learning than the control groups.

Conclusions. Targeted remediation of memory appears to yield task specific improvement but the gains do not generalize to other memory tasks. Subjects receiving memory remediation failed to independently activate mnemonic encoding strategies learned and used successfully within training tasks to other general measures of verbal learning and memory.

It has been proposed that schizophrenia is a prostaglandin-deficiency disease and also that it is a disease of prostaglandin excess. New evidence is reviewed which suggests that ‘classic’ schizophrenia is due to a specific deficiency of prostaglandin E1 while certain toxic and vitamindeficiency psychoses may be due to a broader spectrum of prostaglandin deficiency. There is also good evidence that a particular schizophrenic subgroup, which includes catatonic schizophrenia but may not be confined to it, is associated with an excess of prostaglandins. Part of the explanation may be that prostaglandin E1 has a ‘bell-shaped’ dose-response curve with high concentrations having effects similar to those of prostaglandin deficiency.

Background. Although urban place of birth has been identified as a risk factor for schizophrenia, the extent to which this association is mediated by socially patterned risk factors such as obstetric complications and childhood socio-economic position is unclear. The diagnostic specificity of the association within the clinical psychotic syndromes is also unclear.

Method. A population cohort of 696025 males and females, born in Sweden between 1973 and 1980 and with linked birth and socio-economic data was followed up from age 16 for up to 9·8 years. Hospitalized cases of schizophrenia and other non-affective psychosis were identified from the Swedish Inpatient Discharge Register. We examined associations of these disorders with a three-level measure of urbanicity of birthplace before and after controlling for measures of foetal nutrition, obstetric complications and level of maternal education.

Results. Urban compared to rural birthplace was associated both with increased risk of adult onset schizophrenia (hazard ratio 1·34, CI 0·91–1·96) and other non-affective psychoses (hazard ratio 1·63, CI 1·18–2·26). None of these associations was greatly affected by adjustment for obstetric complications or maternal educational level. In the group of other non-affective psychoses urban–rural differences in disease risk were strongest among those born in the winter months.

Conclusion. Urbanization of birthplace is associated with increased risk of non-affective psychosis but this is not confined to narrowly defined cases. The magnitude of the association in Sweden is lower than that reported in other studies. Causal factors underlying this association appear to operate independently of risks associated with obstetric complications and parental educational status.

Regional cerebral blood flow, oxygen consumption and glucose consumption were measured by positron emission tomography in six young autistic men. No significant differences were found between patients and normal controls for any of the physiological variables. The results do not substantiate the previous finding of glucose hypermetabolism in autism; the likely reasons for the variance in findings are discussed.

Background. Previous research has reported co-morbidity between attention deficit hyperactivity disorder (ADHD) and anxiety disorders. Interpretation of these findings is complicated by symptom overlap in the clinical presentation of the disorders. We estimate the prevalence of ADHD in both the current and childhood histories of adults with anxiety disorders, while taking symptom overlap into account. We also evaluate the utility of the Wender Utah Rating Scale (WURS) for retrospective reporting of ADHD.

Methods. Consecutive admissions (N=149) to an anxiety disorders clinic were given a diagnostic and psychometric assessment. The WURS was administered to obtain a retrospective diagnosis of childhood ADHD. Twenty-nine of the 35 people surpassing the cut-off score on the WURS were given a structured interview of adult ADHD symptoms.

Results. The WURS contains many ‘internalizing’ items that may inflate retrospective accounts of ADHD. After taking this into account, there is still a significantly higher prevalence of ADHD in the retrospective reports of adults with anxiety disorders (15%) than would be expected by chance (4%). Furthermore, of those who meet retrospective criteria for ADHD, 45% (13 of 29) continue to meet diagnostic criteria for ADHD as adults.

Conclusions. The WURS may require considerable revision for use with clinical populations. In spite of these difficulties with retrospective assessment, available evidence indicates that ADHD is more prevalent in the histories of anxiety disordered patients than would be expected from base rates.

In close agreement with Essen-Möller, a classification of mental disorders is described. The two basic principles are the application of four independent classifying bases—namely, symptomatology, severity, aetiology, and course, and the breakdown of doubtful disease entities and syndromes to elementary cardinal symptoms and of comprehensive personality terms to simple traits.

This paper describes quantitative and qualitative aspects of social support in a sample of 40 long-term schizophrenic day patients attending a rehabilitation unit. The influence of symptomatology and experience of life stressors on network and support characteristics was also investigated. The primary networks of these patients were found to be small, comprising on average 7 members, of whom only 3 were seen regularly. Despite this, subjects rated their perceived support as adequate. The secondary networks were of the order of 32. It emerged that greater prevalence of negative symptoms was significantly associated with lower ideal levels of support and this group of patients was significantly less likely to seek support in the event of a life stressor. This may be a protective mechanism to insulate the person from the effects of stressful relationships but at the same time means that they are isolated from potential supports. The clinical implications are discussed in terms of offering optimum support for this marginalized group.

Seventy-three patients with the features of ‘cycloid psychosis’, adopted from Perris and Leonhard, were identified from case records. Information concerning background, presenting illness and follow-up was compared with that from the case-records of patients with schizophrenic, affective and schizoaffective psychoses. The characteristic features of ‘cycloid psychosis’ were a female predominance and a remittent course. The ‘cycloid’ group resembled the conventional groups in some respects, but differences from schizophrenic, affective and, to a lesser extent, schizoaffective groups were also striking. The factors which might account for the apparent independence of the ‘cycloid’ group from other diagnostic categories are discussed.

Fifty patients attending a neurological outpatient clinic for Parkinson's disease were assessed by standardized methods for both physical and psychiatric symptoms. The patients then received treatment with L-dopa, L-dopa with carbidopa or anticholinergic drugs and/or amantadine. During the following six-month period the subjects were assessed at intervals, both physically and psychiatrically. Forty patients were followed up for the full six-month period. The severity of physical signs and affective symptoms was shown to be significantly related at several stages of the investigation. Initially, the patients showed a high psychiatric morbidity. During treatment, 22 patients developed a depressive disorder, 12 of which had a history of previous depressive episodes. By contrast, of the 11 patients who showed very few affective symptoms during follow-up, none had a history of depression. Of the 22 patients with a depressive disorder, only two were in the anticholinergic/amantadine group, compared with nine and 11 in the other groups. L-dopa was not an effective antidepressant agent. The probable relevance of the findings of the study to the management of patients with Parkinson's disease is outlined.

Background. One of the many controversies surrounding chronic fatigue syndrome (CFS) is the possible impact of the diagnostic label: is it disabling or enabling? In this paper, we discuss the pros and cons of labelling CFS.

Method. A narrative synthesis of the literature.

Results. Diagnosed CFS patients have a worse prognosis than fatigue syndrome patients without such a label. The ways in which CFS patients perceive themselves, label their symptoms and appraise stressors may perpetuate or exacerbate their symptoms, a process that involves psychological, psychosocial and cultural factors. Labels can also lead to conflicts with doctors who fear diagnosis might lead to worse outcomes. However, on the other hand, finding a label that fits one's condition can provide meaning, emotional relief and recognition, whilst the denial of the diagnosis of CFS in those who have already reached their own conclusion can be very counter productive. The act of diagnosis therefore seems to be a trade-off between empowerment, illness validation and group support, contrasted with the risk of diagnosis as self-fulfilling prophecy of non-recovery.

Conclusions. The answer to the question of ‘to label or not to label’ may turn out to depend not on the label, but on what that label implies. It is acceptable and often beneficial to make diagnoses such as CFS, provided that this is the beginning, and not the end, of the therapeutic encounter.

Background. Depression in women is associated with social deprivation and violence. We describe the prevalence and risk factors for depression during pregnancy, in particular the association with poverty and violence, in a Brazilian setting.

Method. A cross-sectional survey of women in the third trimester of pregnancy attending a public hospital maternity clinic from August 2003 to July 2004 in Rio de Janeiro. Participants were interviewed about their sociodemographic status, obstetric and medical conditions, substance use, stressful life events, and social support. Depression was diagnosed through the Composite International Diagnostic Interview (CIDI).

Results. A total of 230 of 240 eligible women consented to participate. The 12-month prevalence of depression was 19·1% (95% CI 14·4–24·9). On multivariate analyses, having been educated beyond primary school was protective (OR 0·5, 95% CI 0·2–0·9). Risk factors were: being divorced or widowed (OR 4·9, 95% CI 1·3–18·3); a history of depression before pregnancy (OR 7·9, 95% CI 3·1–20·5); loss of an intimate relationship (OR 8·4, 95% CI 3·3–21·4), experienced financial difficulties (OR 6·6, 95% CI 2·5–17·2) and having been exposed to violence in the previous year (OR 4·2, 95% CI 1·5–11·8).

Conclusions. Depression is common during pregnancy and is associated with indicators of socio-economic deprivation, violence and the loss of an intimate relationship, and with a previous history of depression. Psychosocial interventions and appropriate social policies need to be implemented in this population to reduce the burden of maternal depression.

New cases of neurotic illness identified during one month by each in turn of eight general practitioners in a London borough were investigated by means of standardized clinical and social interviews. When compared with a matched control group of consulting patients, the index group was found to have experienced significantly more life events during the three months before the onset of illness. Events particularly associated with neurotic illness were unexpected crises and failure to achieve various life goals. The distribution of events suggested that serious, threatening events have an important aetiological role; minor events appear to play a small contributory part which may become critical when the morbid risk is already high. The problems of method involved in this type of investigation are discussed.