Two hundred and ten psychiatric patients with one of three DSM-III diagnoses, generalized anxiety disorder (N = 71), panic disorder (N = 74) or dysthymic disorder (N = 65), were included in a clinical trial in which diazepam, dothiepin or placebo tablets, cognitive and behaviour therapy, or a self-help package were given over ten weeks. Personality status was assessed independently using a structured interview, the Personality Assessment Schedule. One hundred and ninety-eight patients had personality assessments, 89% with a close informant. Thirty-six per cent had a personality disorder and these patients had more severe psychopathology than those with no personality disorder. Personality disorder was more common in patients with dysthymic disorder and this group responded less well to treatment. The category of personality disorder had no apparent influence on symptoms.

Although clinical findings suggest that in the aftermath of depression a process of ‘scarring’ may ensue, research examining the issue of ‘scars’ (including biological, psychological and cognitive changes) has remained largely inconclusive. This paper proposes a new approach to the concept of ‘scars’ that is (i) based on a dimensional view of depression, (ii) uses methods that take into account the dynamic interplay between the person and his context, (iii) differentiates between scars following depression and scars following the factor that actually caused the depression such as stress and (iv) introduces a dynamic view of the concept of ‘scars’ in that it hypothesizes that scars can wax and wane. This approach may stimulate the discovery of new entries in the puzzle underlying the ontogenesis of vulnerability and resilience. Furthermore, it may provide insights that help to develop new therapies for depression.

Background. This paper examines the association between exposure to the Chornobyl nuclear power plant explosion and the psychological and physical well-being of mothers with young children. The study also examines whether exposure to Chornobyl increased the vulnerability of mothers to subsequent economic and social stress, and thus represents a unique test of the stress–vulnerability model in a non-Western setting.

Method. The sample consisted of mothers evacuated from the contamination zone surrounding the plant (evacuees) and mothers who had never lived in a radiation-contaminated area (controls). In addition to exposure status, the interview obtained data on perceived economic stress, social stress and stress moderators. The dependent variables were measured by the SCL-90 global severity index (GSI), perceived physical health and number of days unable to work due to illness.

Results. Overall, evacuees reported fewer stressors and greater personal and social resources than control mothers. Nevertheless, evacuees scored higher on the GSI, reported lower perceived physical health and took more sick days relative to control mothers, even after controlling for demographic factors, stressors and stress moderators. Tests of interaction effects were not statistically significant.

Conclusions. The findings confirmed that married women with young children evacuated to Kyiv following the Chornobyl nuclear power plant explosion reported significantly poorer psychological and perceived physical health than controls 11 years later. Although perceived social and economic adversities also affected these outcomes, there was no evidence that exposure to the Chornobyl accident increased the vulnerability of mothers to these stressors, giving support to the additive burden model of stress.

Recent data from a 2-year follow-up of functional non-affective psychosis, and particularly schizophrenia, favoured social selection rather than social causation theory. Data concerning the cohort were compared with inter- and intra-generational mobility in a random Dutch sample. The results indicate that the educational and occupational mobility of patients, relative to their fathers, was greater than expected. Although patients were better educated than the random sample, they fared less well occupationally. An analysis of patterns of occupational mobility before and after the onset of psychosis also showed that social selection played a major role in achieving social status. The outcome of patients' occupational career at follow-up was poor, and only a minority succeeded in obtaining or keeping a regular job.

Background. Although genes are known to influence the aetiology of ADHD, the impact of exposure to parental ADHD has received limited scientific scrutiny. This study investigated the impact of exposure to parental ADHD on clinical features and dysfunction in offspring.

Methods. We studied 1099 offspring (53% male, mean age 12·4 years) of non-ADHD, remitted ADHD, and persistent ADHD parents, using structured diagnostic interviews and a battery of cognitive and psychosocial measures. Offspring across these three groups were compared on clinical, cognitive and psychosocial outcomes, adjusting for exposure to other parental psychopathology, offspring ADHD status and social class.

Results. Parental ADHD was associated with an increased risk for ADHD in offspring relative to no parental ADHD, but no significant differences were found between children of remitted versus persistent ADHD parents. Exposure to parental ADHD predicted higher levels of family conflict and lesser levels of family cohesion relative to families without parental ADHD, independent of other psychopathological conditions in parents or ADHD status. Significant interactions were detected in which parental ADHD had a deleterious impact on measures of school performance in offspring without ADHD but not in those with the disorder.

Conclusions. These results find no support for the hypothesis that exposure to parental ADHD increases the risk for ADHD in children beyond that conveyed by the liability associated with the diagnosis in the parent. However, since exposure to parental ADHD was associated with a disruptive family environment, the identification and treatment of adults with ADHD may be an important component of the treatment plan of youth with ADHD.

Background. In schizophrenia research, ‘high risk’ traditionally referred to studies of the offspring of schizophrenic parents at genetically enhanced risk of illness development. Sixteen major high-risk studies have been undertaken although only six followed through to formal illness so data on prediction remain weak. Recently, ‘high risk’ has widened to encompass individuals considered ‘at risk’ by having ‘high risk mental states’, regardless of family history, in whom initiation of early treatment is postulated to improve outcome.

Method. The major familial high-risk studies are reviewed from the perspective of the Edinburgh High Risk Study of Schizophrenia (EHRS), with emphasis on prediction.

Results. Familial high-risk studies have established multiple biological markers, the most reproducible of which relate to neuromotor development and cognition, especially aspects of memory/learning. Although most are probably not specific, they support a neurodevelopmental hypothesis. Family and environmental variables point largely to secondary or indirect associations. Pre-illness, non-specific affective symptomatology may be of greater predictive power than most psychotic phenomena.

Conclusions. Traditional high-risk designs embody many problems but are able to distinguish non-specific markers from illness predictors, and are ideally suited to exploring the evolution of schizophrenia both clinically and biologically (especially with imaging techniques). The EHRS supports the view that greater specificity may accrue to cognitive domains as precursors of predictive utility.

The 30-item General Health Questionnaire (GHQ) and the Clinical Interview Schedule (CIS) were administered to 120 consecutive attendere at a general practice in Northern Italy run by a doctor who had a formal psychiatric training. The Italian versions of both the GHQ and the CIS were found to be feasible instruments for general practice studies in Italy. GHQ misclassification rates, sensitivity and specificity values are presented for different cut-off scores, a total score of 5 or more being the best discriminator between ‘cases’ and ‘non-cases’. The prevalence of confirmed cases in this sample was 47·5%, a rate higher than those reported so far in developed and developing countries.

Background. A number of studies have suggested that indirect semantic priming is enhanced in thought-disordered schizophrenics. However, research on direct semantic priming has produced conflicting results. The aim of the present study was to resolve some of the ambiguities of previous findings.

Methods. For the present study, 44 schizophrenic patients were split according to the presence of associative loosening into a positive thought-disordered (TD) and non-positive thought-disordered (NTD) group. Thirty healthy subjects and 36 psychiatric patients served as controls.

Results. Schizophrenics displayed increased indirect semantic priming compared with psychiatric controls. When subtyping the sample, TD-patients exhibited significantly enhanced indirect semantic priming compared with healthy and psychiatric controls as well as NTD-patients. Overall slowing was found to be independent of priming effects. Medication, age and chronicity of the schizophrenic illness did not modulate priming.

Conclusions. In line with Spitzer and Maher it is inferred that disinhibited semantic networks underlie formal thought disorder in schizophrenia. For future research, it would be appropriate to: employ indirect semantic priming rather than direct semantic priming conditions; and, pay more attention to potential moderators of the priming effect, most importantly, the prime display duration and the length of the stimulus onset asynchrony.

Forty patients on chronic haemodialysis were studied in order to gather information about the relationship of locus of control and adjustment. Negative correlations of high statistical significance were found between locus of control and compliance with the diet, and locus of control and vocational rehabilitation, as well as between locus of control and acceptance of disability. All the findings indicate that patients with internal locus of control adjust and adapt better than those with external locus of control. The number of years on dialysis did not correlate with locus of control. It might be suggested that the shift from internal to external locus of control occurs prior to dialysis in the stage of chronic kidney disease.

Serum folate and B12 estimations were carried out on 272 admissions to a psychiatric unit during 1972 and 1973. 21–3% had serum folate below 2 ng/ml and 26–1% serum B12 below 150 pg/ml. The organic psychosis patients had a significantly lower mean B12 than the others, and were over-represented among the low B12 group. Low B12 status was also associated with low RBC and WBC. Low folate status was linked with depression, malnutrition, physical illness and low Hb, RBC and WBC. There were more chronic alcoholics than others with serum folate > 4·9 ng/ml, low RBC and macrocytosis. The presence of one or more haematological abnormalities (macrocytosis, low Hb, low RBC or low WBC) predicted low folate in 76%, and low B12 in 79%, but these were also found in 40% of the normal folate and 41% of the normal B12 patients. Macrocytosis may prove to be a reliable sign of alcoholic abuse.

There is controversy over how best to classify eating disorders in which there is recurrent binge eating. Many patients with recurrent binge eating do not meet diagnostic criteria for either of the two established eating disorders, anorexia nervosa or bulimia nervosa. The present study was designed to derive an empirically based, and clinically meaningful, diagnostic scheme by identifying subgroups from among those with recurrent binge eating, testing the validity of these subgroups and comparing their predictive validity with that of the DSM-IV scheme.

A general population sample of 250 young women with recurrent binge eating was recruited using a two-stage design. Four subgroups among the sample were identified using a Ward's cluster analysis. The first subgroup had either objective or subjective bulimic episodes and vomiting or laxative misuse; the second had objective bulimic episodes and low levels of vomiting or laxative misuse; the third had subjective bulimic episodes and low levels of vomiting or laxative misuse; and the fourth was heterogeneous in character. This cluster solution was robust to replication. It had good descriptive and predictive validity and partial construct validity.

The results support the concept of bulimia nervosa and its division into purging and non-purging subtypes. They also suggest a possible new binge eating syndrome. Binge eating disorder, listed as an example of Eating Disorder Not Otherwise Specified within DSM-IV, did not emerge from the cluster analysis.

Background. Despite an increased prevalence of depression among people of low socio-economic position, it remains unclear whether their treatment with antidepressants appropriately matches their increased need compared with people from more affluent backgrounds. This study examined socio-economic differences in antidepressant prescriptions and mortality related to depressive disorders.

Method. A longitudinal register study of 17947 male and 47458 female local government employees with linked information on socio-economic indicators (education and occupational status) and data on antidepressant use and mortality associated with depressive disorder (suicide, alcohol-related deaths) during the years 1994 to 2000.

Results. In men, antidepressant treatment was less common among low educational groups than among high educational groups (OR 0·87, 95% CI 0·76–0·99) and a corresponding difference was seen between occupational statuses (OR for manual v. upper non-manual 0·72, 95% CI 0·62–0·84). In women, socio-economic position was not associated with antidepressant use. However, both among the men and women, employees with low socio-economic position had increased risk for mental-health-related mortality, as indicated by suicides, deaths from alcohol-related causes, and all-cause mortality.

Conclusions. These data suggest a mismatch in the treatment of depression relative to apparent clinical need, with the lowest levels of treatment concentrated in the lower socio-economic groups, despite evidence of their increased prevalence of depression and suicide.