A population study was undertaken in two health districts of children with severe mental handicap. Prevalence figures for behaviour problems are presented. A stratified random sample of 200 families was drawn from the population. Detailed structured interviews were carried out with the children's parents. The children were divided into two groups comprising those with behaviour problems and those with no problems. There was a significant association between behaviour disorder and incontinence, lack of self-help skills, poor reading, writing and counting skills, and poor communication skills. Environmental correlates were few. There were no differences between groups in family size, birth order, age of parents, marital discord, social class or income. However, behaviour problems were more common in one-parent families. An association was found between maternal stress and problem behaviour. The possible mechanisms underlying this association are discussed

Background. The risk for panic disorder (PD) is substantially increased in relatives of probands with PD. Prior literature provides only limited information about the degree to which this increase is due to genetic factors or family environment.

Methods. In personal interviews with both members of 3194 twin pairs, we assessed the lifetime history of lifetime panic attacks and PD. Twin resemblance was assessed by tetrachoric correlation and single and multiple threshold biometrical model fitting.

Results. As fully syndromal PD, by DSM-III-R criteria, was too rare to analyse usefully we examined four other dichotomous definitions of increasing stringency: panic probe and very broad, broad and intermediate PD. For all four definitions and for the multiple threshold analyses, the best-fit model indicated that twin resemblance was due solely to genetic factors with a moderate heritability (33–43%). For the broad and intermediate dichotomous definitions of PD, however, a model with twin resemblance due to familial–environmental factors fit nearly as well. No gender effects were seen on the genetic risk factors for these PD-like syndromes.

Conclusion. Even with large epidemiological samples of twins, studying disorders as uncommon as PD is problematical. Despite these difficulties, our results suggest that: (i) narrowly and broadly defined PD are probably on the same continuum of liability; (ii) twin resemblance for these PD-like syndromes is likely due largely to genetic factors with a moderate level of heritability although a contribution of familial–environmental factors cannot be excluded; and, (iii) the same familial risk factors impact, to a similar degree, on the liability to PD in males and females.

Background. Previous studies have demonstrated impaired explicit and preserved implicit memory functions in schizophrenia. However, it is less clear whether schizophrenics can learn complex information (e.g. probabilistic stimulus–response associations) with or without access for conscious recollection. In this study we applied a classification learning task to assess explicit and implicit processes concurrently.

Methods. Two test procedures were administered to 40 schizophrenic subjects and 20 healthy volunteers: a probabilistic classification learning (PCL) task to evaluate implicit memory functions; and a category cue recognition test to investigate the explicit memory system. The PCL task included feedback guided category learning of geometrical shapes. These shapes were called category cues, predicting class membership with certain probabilities. The gradual increase of categorization performance during the feedback learning was a potentially implicit process, whereas the subsequent recognition of category cues required explicit memory functions.

Results. The schizophrenic patients improved their categorization performance to a similar extent to the controls, but they failed to recognize the category cues. Memory performances were independent of the positive and negative symptoms.

Conclusions. Patients with schizophrenia were able to establish representations of complex categories, but these remained unconscious. This is consistent with earlier reports, suggesting damaged explicit and spared implicit memory in schizophrenia.

Background. There is a common assumption that Black patients with a psychotic mental illness experience longer treatment delays during a first episode. We sought to investigate this issue in a large cohort of patients with a first episode of psychosis.

Method. All patients with a first episode of psychosis presenting to secondary mental health services within tightly defined catchment areas in south-east London and Nottingham over a 2-year period were included in the study. Data relating to duration of untreated psychosis (DUP) and clinical and sociodemographic characteristics were collected from patients, relatives and case-notes.

Results. There was no evidence that African-Caribbean or Black African patients experienced longer periods of untreated psychosis than White British patients prior to first contact with services. There was evidence that Black African patients experienced shorter periods of untreated psychosis than White British patients.

Conclusions. Contrary to what is commonly assumed, our study suggests that Black patients with a psychotic mental illness do not experience longer treatment delays prior to first contact with services than White British patients. This suggests that strategies to reduce treatment delays targeted specifically at Black patients will be of limited value.

Background. The DSM-IV cluster C Axis II disorders include avoidant (AVPD), dependent (DEPD) and obsessive-compulsive (OCPD) personality disorders. We aimed to estimate the genetic and environmental influences on dimensional representations of these disorders and examine the validity of the cluster C construct by determining to what extent common familial factors influence the individual PDs.

Method. PDs were assessed using the Structured Interview for DSM-IV Personality (SIDP-IV) in a sample of 1386 young adult twin pairs from the Norwegian Institute of Public Health Twin Panel (NIPHTP). A single-factor independent pathway multivariate model was applied to the number of endorsed criteria for the three cluster C disorders, using the statistical modeling program Mx.

Results. The best-fitting model included genetic and unique environmental factors only, and equated parameters for males and females. Heritability ranged from 27% to 35%. The proportion of genetic variance explained by a common factor was 83, 48 and 15% respectively for AVPD, DEPD and OCPD. Common genetic and environmental factors accounted for 54% and 64% respectively of the variance in AVPD and DEPD but only 11% of the variance in OCPD.

Conclusion. Cluster C PDs are moderately heritable. No evidence was found for shared environmental or sex effects. Common genetic and individual environmental factors account for a substantial proportion of the variance in AVPD and DEPD. However, OCPD appears to be largely etiologically distinct from the other two PDs. The results do not support the validity of the DSM-IV cluster C construct in its present form.

Background. This paper reports on a two-stage community-based epidemiological study of selected minor psychiatric disorders conducted on an adult African population in South Africa.

Methods. Using a modified random cluster sampling method, 354 adults were identified as the first-stage sample, with the SRQ-20 being used as a first-stage screen. Clinical interviews based on DSM-IV checklists for generalized anxiety disorder, major depression and dysthymia were administered as the second-stage criterion to 81 subjects from the sample.

Results. The weighted prevalence for generalised anxiety and depressive disorders was 23·9% (95% CI 15·1%–32·7%), comprising: generalized anxiety 3·7%, major depression 4·8%, dysthymia 7·3%, and major depression and dysthymia 8·2%. Statistically significant associations were found between caseness and age, marital status, employment, income and educational level.

Conclusions. The results are discussed in relation to comparative local and international data as well as in the context of the current restructuring of the mental-health care system in South Africa from tertiary curative care to integrated primary mental-health care.

Basic cognitive function was assessed at initial and at 5- and 10-year follow-up assessments among 41 primarily middle-aged in-patients manifesting the severest form of schizophrenia; additionally, the presence and severity of tardive dyskinesia was evaluated on each occasion. Overall, there was a modest but significant deterioration in cognitive function over the decade, particularly among older men. Longitudinally, patients with persistent tardive (orofacial) dyskinesia continued to show poorer cognitive function than those consistently without such movement disorder, though within neither group did cognitive function change over the decade. Those patients demonstrating prospectively the emergence of orofacial dyskinesia showed a marked deterioration in their cognitive function over the same time-frame within which their movement disorder emerged, but this decline did not progress further thereafter. There appears to exist some modest, progressive deterioration in cognitive function even late in the chronic phase of severe schizophrenic illness which appears to derive primarily from patients showing de novo emergence of tardive orofacial dyskinesia.

While many of the characteristics of psychotropic drug consumers have been established by means of cross-sectional studies, little is known about new consumers and the factors which predispose to long-term treatment. We report on a longitudinal study of 153 general practice patients beginning a new course of psychotropic drug treatment and characterized by extensive physical and psychological morbidity. About 1 in 5 were still receiving psychotropic drugs 6 months later and this prolonged treatment was associated with increased age, previous psychotropic drug-use, higher levels of psychological morbidity at the inception of treatment and, for the women only, social problems as perceived by the general practitioners.

Background. GPs' attitudes towards depression vary, as do their abilities to detect and manage it effectively. Associations between attitudes and clinical behaviour have not yet been demonstrated directly. We tested two hypotheses: (1) that questionnaire measures of GPs' confidence in identifying depression predict their ability to identify depression in their patients; and (2) that GPs who prefer antidepressants prescribe more than those who prefer psychotherapy.

Methods. Forty GPs in Liverpool and Manchester completed the Depression Attitude Questionnaire (DAQ) and were asked for prescribing (PACT) information. Attender surveys using the General Health Questionnaire (GHQ-12), in combination with GP ratings of patients' psychological status, generated indices for GPs' case identification, bias and accuracy. We tested associations between these indices and the four DAQ components, in particular GPs' confidence in diagnosis, across a total of 1436 patients. We also compared the DAQ component on attitudes to treatment with relevant PACT data.

Results. The DAQ assessment of GPs' ability to identify cases of depression bore no relationship to their observed ability, as measured by accuracy, bias, or identification indices. However, there were significant associations between observed diagnostic ability and: preference for psychotherapy; ease in managing depression; and, belief in successful treatment. PACT data were available for 26 (65%) GPs. There was an association between preference for antidepressants and prescription of SSRIs (rs 0·3981, P < 0·044), but not for overall antidepressant or tricyclic prescribing, or for dose of dothiepin.

Conclusions. The DAQ measure of ease of identification is not valid when compared to actual clinical practice. The ability of GPs to identify depression may not be an independent variable, but may rather reflect other beliefs, attitudes and skills. This has considerable implications for educational interventions in primary care.

One hundred psychiatric emergencies presenting to an inner London teaching hospital had formal assessments of psychopathology, personality disorder (using both ICD-10 and the Personality Assessment Schedule), social networks and social functioning before being randomly assigned to a multidisciplinary community-based team (Early Intervention Service (N = 48) or conventional hospital-based psychiatric services (N = 52) and treated for a period of 12 weeks. The ICD-10 classification yielded a higher proportion (50%) of personality disordered patients than the Personality Assessment Schedule (34%) and those from ethnic minorities (mainly Afro-Caribbean) and upper social classes had a lower incidence of personality disorder. Social networks were smaller in personality disordered patients and there were fewer attachment figures. Improvement in social function, and to a lesser extent with depressive symptomatology, was better in patients with no personality disorder referred to the community service compared with the hospital service. No differences were found between the numbers and duration of social contacts in the two services and it is concluded that the better outcome in the community-treated patients was independent of changes in social networks.

This paper presents some results from a survey conducted in West London in 1977. The 2-week prevalence of psychotropic drug consumption was found to be 10·9 %, an almost identical figure to that obtained in an earlier survey conducted 8 years previously. The reasons for the absence of the expected rise in prevalence of consumption are discussed.

Consumption was found to be strongly associated with various measures of health, and there was a marked sex difference in drug consumption (females > males) which was independent of health.

Depressive disorders are amongst the leading causes of disability and mortality worldwide and, as such, it is predicted that by 2010 only cardio-ischaemic disorders will provide a greater burden. In addition to the sizable emotional, individual and social burden, depressive disorders cost an estimated US$83·1 billion per year in the United States alone. In spite of effective treatments, a large proportion of sufferers go on to experience recurrences. With successive recurrences, the likelihood of subsequent episodes increases. Despite this, research to date has tended to focus on first episodes or else has not distinguished between episodes. This editorial review highlights a number of differences between first and recurrent episodes which, in turn, recommend more longitudinal, recurrence-oriented, treatments. We also examine the findings from acute tryptophan depletion studies which, it is speculated, help to understand the differences between successive episodes. The overall aim, however, is to highlight the importance of recurrence in depression and to stimulate debate.

Background. The histological basis of schizophrenia is unknown, but it appears to affect the hippocampal and neocortical cytoarchitecture. Some cytoarchitectural parameters normally differ between the two cerebral hemispheres. Moreover, schizophrenia is associated with altered structural cerebral asymmetry. However, few cytoarchitectural studies of schizophrenia have taken the question of asymmetry fully into account.

Methods. We performed a morphometric post mortem study of neuronal density in sections from the left and right hippocampus (dentate gyrus, CA4, CA3, CA1 and subiculum) of 22 schizophrenics and 18 normal subjects. We also determined the correlations of neuronal density between pairs of subfields as an index of their inter-relationship; a previous study had found correlations in the left but not the right hippocampus of normal subjects.

Results. There were three differences in the schizophrenics compared to the controls. (1) neuronal density was increased in right CA3 (by 25%) and right CA1 (by 22%); (2) neuronal density correlated strongly between homologous left and right subfields (i.e. inter-hippocampally) for CA4, CA3, CA1 and subiculum, in normals this occurs only for dentate gyrus and CA4; and (3) intra-hippocampal correlations of neuronal density between pairs of subfields were similar in both hippocampi of the schizophrenia cases, unlike their asymmetrical distribution in controls.

Conclusions. The alterations may be part of the histological substrate of schizophrenia. The nature of the findings is consistent with a neurodevelopmental origin, and with a disease process that affects cerebral asymmetry and leaves its imprint upon the hippocampal cytoarchitecture.