Body weight in 42 obese and normal weight subjects was measured using a video TV monitor. Tasks included a continuous task where subjects manipulated the width of their body image on TV, and a discrete task, where they judged the accuracy of their TV image which was presented as either normal, too heavy, or too thin. Subjects rated their full body, body regions which included face, waist, and thighs, and two inanimate control objects. Results from the continuous task revealed that obese subjects overestimated body size more than normals. There was also a significant difference in the ratings of the four body regions, with all regions overestimated. Judgements were more accurate for body regions and control objects on ascending trials where the subjects had to increase the width of the image. No differences were obtained between obese and normals on judgements of the control objects. On the discrete discrimination task, a signal detection analysis revealed sensory sensitivity differences between obese and normal weight subjects. Obese subjects were poorer at detecting size distortions of the body regions. The thin/normal discrimination was more difficult than the heavy/normal discrimination. No response criterion differences were found between obese and control subjects, although subjects adopted a more strict criterion with the thin/normal discriminations. Implications of these findings for clinical intervention in eating disorders are discussed.

This study reports the psychiatric morbidity in 76 patients with clinically isolated lesions of the type seen in multiple sclerosis (optic neuritis, brain stem and cord lesions). The presence or absence of brain pathology was investigated using magnetic resonance imaging (MRI). A group of 33 patients suffering from rheumatic and neurological conditions not known to involve the brain was used for comparison. Normative MRI data were obtained from a group of 40 normal volunteers.

Over half of the patients with the clinical presentation of single lesions had MRI abnormalities in the brain, but past and present psychiatric morbidity were similar in patients and controls and no significant associations were found between the presence of MRI abnormalities and psychiatric morbidity. The degree of social stress experienced by the patients with clinically isolated lesions appeared to be highly relevant in the causation of psychiatric symptoms.

We measured urinary outputs of urinary-free cortisol in 28 medication-free depressed patients and 32 normal controls. Depressed patients had significantly greater urinary outputs of urinary-free cortisol than controls. Also, there were significant correlations among depressed patients, but not among controls, between urinary-free cortisol and urinary outputs of norepinephrine and its metabolite vanillylmandelic acid (VMA). These urinary data extend recent findings suggesting that dysregulation of both the hypothalamic-pituitary-adrenal axis and noradrenergic system occur together in depression.

Interaction of therapeutic drugs with a series of different biopathological substrates of psychosis might be expected to generate a series of different response patterns. Herein the authors suggest that multi-modal response patterns following lithium and neuroleptic treatment of psychotic patients may aid in resolving the heterogeneity of psychotic disorders and lead to a new nosology of the psychoses.

In the literature on dementia the presence or absence of language deficits has come to occupy a pivotal position with respect to certain nosological and nosographical issues. These are reviewed critically, together with the results of experimental investigations which have sought to elucidate the nature of the language deficit(s) in patients with dementia, especially that of the Alzheimer type. Attention is drawn to important gaps in current knowledge and suggestions are made regarding the direction of future research.

Several previous studies have reported increased rates of schizophrenia among Afro-Caribbean immigrants, although doubt has been cast upon the value of case-note diagnoses and retrospective case-finding. A prospective study was therefore undertaken, including all patients of Afro-Caribbean ethnic origin with a first onset psychosis presenting to the psychiatric services from a defined catchment area. Utilizing several diagnostic classifications, rates for schizophrenia were found to be substantially increased in the Afro-Caribbean community, and especially in the ‘second generation’ British born. Mode of onset and symptom profiles of psychoses suggest that atypical syndromes, and by implication ‘misdiagnoses’, do not account for reported higher rates of schizophrenic illness in these patients.

Seventy patients presenting to the gastroenterologist with upper abdominal pain were examined by a psychiatrist to establish the presence of psychiatric disorder, illness behaviour and to record in detail their symptom pattern. The 37 patients who had no organic cause for their abdominal complaints were subdivided into those with and without psychiatric disorder. The former (21 patients) demonstrated more illness behaviour, they complained of more abdominal symptoms and their pain was both more severe and more persistent than in the patients with organic disease and those with non-organic illness who did not have psychiatric disorder. The latter group reported no symptoms of ‘psychoneurosis’ and should probably be regarded as a separate group if the aetiology of functional abdominal pain is to be clarified. Those with non-organic abdominal complaints who had psychiatric illness could be distinguished by the presence of three symptoms, namely depression, anxiety and fatigue. Detection and treatment of their psychiatric disorder might lead to a decrease in their symptomatic complaints and illness behaviour.

In view of the very extensive and often prolonged use of benzodiazepines in therapeutic practice, this study was designed to investigate whether or not cognitive ability is impaired in longterm benzodiazepine users, and to determine the nature and extent of any deficit. Fifty patients currently taking benzodiazepines for at least one year, thirty-four who had stopped taking benzodiazepines, and a matched control group of subjects who had never taken benzodiazepines or who had taken benzodiazepines in the past for less than one year were administered a battery of neuropsychological tests designed to measure a wide range of cognitive functions. It was found that patients taking high doses of benzodiazepines for long periods of time perform poorly on tasks involving visual-spatial ability and sustained attention. This is consistent with deficits in posterior cortical cognitive function.

Lycanthropy, the belief that one has been transformed into an animal (or behaviour suggestive of such a belief), has been described by physicians and clerics since antiquity, but has received scant attention in the modern literature. Some have even thought the syndrome extinct. However, in a review of patients admitted to our centre since 1974, we identified twelve cases of lycanthropy, ranging in duration from one day to 13 years. The syndrome was generally associated with severe psychosis, but not with any specific psychiatric diagnosis or neurological findings, or with any particular outcome. As a rare but colourful presentation of psychosis, lycanthropy appears to have survived into modern times.

The expressed emotion (EE) measure is a robust predictor of relapse in schizophrenia. At least twelve studies from a range of cultures have now shown this, although the authors of one maintain their findings are the result of confounding factors. A thirteenth study which failed to demonstrate a predictive effect was seriously weakened by methodological defects. There is now also evidence for the construct validity of EE, which has been shown to reflect ongoing family interactions. High EE relatives display less effective coping responses, and may adversely affect the patient by creating an unpredictable environment. EE may change with time, and probably reflects the interaction of external stresses, the real problems with the patient, and inappropriate coping responses. The association of high EE with arousal in the patient, as indicated by skin conductance abnormalities, has now been replicated. Although the EE phenomenon can be subsumed under a vulnerability-stress model, the way in which it might mediate relapse has not as yet been specified. Interventions have been successful in reducing relapse, and do so by increasing the tolerance and coping skills of the relatives, and by establishing more realistic expectations. As most have also involved the patient in the process of treatment, they have not fully resolved the question of causal direction.

Future studies will clarify these issues, but will not detract from the value that EE has already had in energizing research. It has also provided a framework within which clinicians have begun to recognize and deal with the disabling problems that beset schizophrenic patients and their families.

A survey was conducted to investigate the presence of psychiatric symptoms and associated factors affecting psychiatric impairment among 2190 Japanese tax workers. The Japanese translated version of the General Health Questionnaire (GHQ) was used as a measure of psychiatric symptomatology. Several sociodemographic and psychosocial factors (interpersonal factors and perceived stress) were examined as being related to psychiatric impairment. As with all other language versions, the percentage distribution of the GHQ scores was considerably skewed. Females exhibited more psychiatric symptoms than males. No significant differences were found among four age-groups for both sexes. Perceived stress related to the workplace was correlated more with psychiatric impairment than with other psychosocial factors. It was also observed that the ‘long-distance marriage’ (‘business bachelorhood’) peculiar to Japanese occupations had little influence on the impairment levels.

The Eysenck Personality Questionnaire, the trait scales of the Leyton Obsessional Inventory, the Spielberger State Trait Anxiety Inventory, and a questionnaire assessing marital status and harmony were completed by 100 torticollis patients and a control group of 49 cervical spondylosis sufferers. Information regarding employment status, and events preceding onset of their complaint was also obtained. The two groups did not differ in terms of any of the personality dimensions evaluated, or in their self-reports of events prior to onset of their illness. The groups differed significantly with regards to marital status (a higher proportion of the torticollis patients were single) but not marital harmony. A significantly higher proportion of the torticollis patients were in the permanently sick category of employment status. Findings of previous studies evaluating personality in torticollis and in sufferers of other disabling physical conditions are considered, and the results are discussed in terms of the effects of disabling chronic physical disorders.

91 women were assessed early in pregnancy and again 3 and 6 months postpartum. Women who persisted in breastfeeding were less neurotic on the EPI but did not differ from artificial feeders in psychiatric history or sexuality before pregnancy. Breast feeders showed greater impairment of sexuality and slightly more depression at 3 months postpartum. These differences had largely disappeared at 6 months. Possible reasons for these negative effects of breast feeding are discussed and are likely to be multifactorial.

A new data set concerning suicide in relation to marital status for Scotland, 1973–83, is presented. The effects of age-standardization on marital status rates and of marital status standardization on age-specific rates are both elucidated. The difficulties of drawing conclusions from marital status rates for suicide are outlined. Nevertheless, the data suggest that the importance of the widowed state has been underestimated and that it appears that the relative risk for suicide associated with divorce has probably been decreasing among Scottish men over the study period.

Autistic and non-autistic mentally retarded adolescents and young adults were individually matched for age and verbal ability and were given tasks in which they chose photographs of faces for emotionally expressive voices, and photographs of non-emotional things or events to accompany recorded sounds. The results were that relative to control subjects, autistic individuals performed less well on the emotion tasks than on the non-emotion tasks. The findings suggest that autistic individuals have a disability in recognizing bodily expressions of emotion, and that there is a degree of task-specificity to this impairment.

In this study it was possible to prove the Werther effect in suicides after watching fictional models for the first time. A twice-broadcast (1981, 1982) six-episode weekly serial showing the railway suicide of a 19-year-old male student provided a quasi-experimental ABABA design to investigate differential effects of suicide imitation. Imitation effects were most clearly observable in the groups whose age and sex were closest to those of the model. Over extended periods (up to 70 days after the first episode), the number of railway suicides increased most sharply among 15- to 19-year-old males (up to 175%); the effect steadily decreased in the older age groups, so that no effect was observable for males over 40 years and females over 30 years. Also, the imitation effects remained detectable for longer periods in the groups closest in age to the model. The increases observed after the first and second broadcast for males aged > 30 years closely corresponded with the respective audience figures for the two showings.

Cohort analysis has become a popular method of examining national trends in suicide rates. Most of the studies investigating this phenomenon have reported a cohort effect to be present. Using a graphical approach, this paper places cohort analysis within the broader framework of age-period-cohort analysis. It is shown that published reports may have failed to identify cohort effects due to using only portions of the available data. With a simple mathematical model it is demonstrated that what appears to be a cohort effect may be a period effect, and conversely. It is recommended that suicide rates be examined for both period and cohort effects before conclusions are drawn regarding trends, and that the complete data set be used for this purpose.

The relationship between adversity, distress and psychiatric impairment was examined in a group of 469 firefighters who had an intense exposure to an Australian bushfire disaster. The data suggested that psychiatric impairment measured by the General Health Questionnaire and distress measured by the Impact of Event Scale were relatively separate phenomena. Psychiatric impairment in these people appeared to be related more to their level of distress after the fires than to the severity of their exposure and losses.

Eighty-five patients with idiopathic, persistent spasmodic torticollis were compared to a control group of 49 patients with cervical spondylosis to assess (1) the prevalence of psychiatric disorder prior to and following the onset of their physical complaint, and (2) to establish the effect of torticollis on self-reports of depression on the Beck Depression Inventory, and self-rated hopelessness on the Hopelessness Scale. The prevalence of psychiatric disorder in the two groups did not differ. The torticollis patients had significantly higher mean scores on the Beck Depression Inventory, but did not differ from the control group in terms of hopelessness. Self-referent negative cognitions such as self-blame, self-accusation, self-punitive thoughts, and negative body-image emerged as the prominent component of depression in torticollis, which has implications for the management of depression in torticollis.

Measures were obtained of features of social network structure and the mobilization of instrumental and expressive support from a sample of 301 unemployed men. Findings showed dependence on a restricted number of family members and close friends, with high levels of expressive support (for example, 71 per cent of the sample reported that someone had ‘let you know that he or she is always around if you need help with something’). Follow-up interviews were obtained on two further occasions over a period of one year, and significant changes in network structure and support mobilization were found. A decrease in non-family network size suggested greater reliance on close family and friends and a withdrawal from weaker ties with members of the community. Finally, the findings of this study emphasize the importance of incorporating a time dimension into research on the mobilization of support following a stressful life event such as job loss.