Latent class analysis on an epidemiologically based series of 447 first contact patients with a broad diagnosis of schizophrenia revealed evidence for two subtypes: a ‘neurodevelopmental’ type characterized by early onset, poor pre-morbid social adjustment, restricted affect and a male: female ratio of 7:3; and a ‘paranoid’ type characterized by later onset, persecutory delusions and an almost equal sex ratio. A third ‘schizoaffective’ subtype, whose existence was less clear cut, was almost entirely confined to females and characterized by dysphoria and persecutory delusions, and had negligible familial risk of schizophrenia. The aetiological, biological and clinical significance of this typology remains to be tested.

Latent trait models were fitted to data for 149 schizophrenic or schizophreniform in-patients rated on the Scale for the Assessment of Positive Symptoms (SAPS) and the Scale for the Assessment of Negative Symptoms (SANS) using the Rasch Extended Logistic Model. It was found that a reduction in the numbers of rating categories, from six to three or four led to consistencies in response while deletion of several items led to consistent scales of symptoms that accorded with an item response characterization. Behaviours included in the final scales varied in the numbers of categories, and in the range of symptom level covered by a category. Relationships between scores representing symptoms were found to be modelled better by a factor structure that included a third overlapping ‘cognitive’ factor in addition to the now traditional positive and negative factors, than by the original positive and negative factors alone.

Thirty-two consecutively admitted females with bulimia nervosa (purging type) according to DSM-IV and additional impulsive behaviours (multi-impulsive bulimia (MIB)) and 32 age-matched female controls with DSM-IV bulimia nervosa (purging type) (uni-impulsive bulimia (UIB)) were assessed longitudinally on admission and at discharge following in-patient therapy and at a 2-year follow-up. Multi-impulsive bulimics were defined as presenting at least three of the six of the following impulsive behaviours in their life-time in addition to their bulimic symptoms at admission: (a) suicidal attempts, (b) severe autoaggression, (c) shop lifting (other than food), (d) alcohol abuse, (e) drug abuse, or (f) sexual promiscuity. Multi-impulsive bulimics were more frequently separated or divorced, had less schooling and held less-skilled jobs. Except for interoceptive awareness (EDI), which was more disturbed in multi-impulsive bulimics, there were no differences concerning scales measuring eating disturbances and related areas. Multi-impulsive bulimics showed more general psychopathology – anxiety, depression, anger and hostility, psychoticism – differed in several personality scales from uni-impulsive bulimics (e.g. increased excitability and anger/hostility) and had overall a less favourable course of illness. Multi-impulsive bulimics also received more in- and out-patient therapy previous to the index treatment and during the follow-up period. The data support the notion that ‘multi-impulsive bulimia’ or ‘multi-impulsive disorder’ should be classified as a distinct diagnostic group on axis I or that an ‘Impulsive Personality Disorder’ should be introduced on axis II. The development of more effective treatment for multi-impulsive bulimia is warranted.

The problem of a possible lack of motivation to perform cognitive tasks, which is often encountered in psychotic patients, has been approached from the perspective of the ‘energetics’ of cognition (Hockey et al. 1986) and from the broader clinical context of psychosis as an ‘amotivational syndrome’ and its related negative symptoms.

The presence of motivational deficits was investigated in a group of psychotic in-patients (N = 73, and 40 had schizophrenia) compared with a control group of non-psychotic psychiatric in-patients (N = 23). The motivational deficit was operationalized in terms of Sanders's (1983) cognitive–energetic model as a large effect of ‘time-on-task’ during a simple, monotonous reaction test. Significantly more psychotic patients than control patients showed evidence of this type of motivational deficit. The deficit appeared to be related with negative but not with positive symptoms of psychosis. Furthermore, the deficit was shown to be related to the cognitive disorders of psychosis, which have been amply documented in the literature, i.e. disorders of vigilance, verbal memory and distractibility. These results suggest that the cognitive disorders of psychosis are not of a ‘computational’ but of an ‘energetical’, i.e. motivational nature.

This study compares rates of comorbidity of lifetime psychiatric disorder in a clinical sample of women with bulimia, with general population base rates, and with rates of comorbidity among bulimic women in the general population. Eighty-four per cent of the clinical sample of bulimic women had a lifetime affective disorder, and 44% a lifetime alcohol or drug disorder. These rates of disorder were significantly higher than the base rates in the general population. Bulimic women in the general population also had more affective and substance-use disorders than the general population base rates, but the rates of these disorders were lower than found in the clinical sample. In the general population, quite similar rates of other disorders including generalized anxiety, panic, phobia and obsessive–compulsive disorder, are found among those with bulimia, substance-use disorder and depression. Furthermore, among those with depression and substance-use disorder in the general population, rates of eating disorder are comparable. Rather than suggesting a specific relationship between bulimia and either depression or substance-use disorder, the data from this study suggest that the presence of any disorder is associated with a non-specific increase in the likelihood of other psychiatric disorder.

The aim of this study was to determine whether HIV infection is associated with neurological or neuropsychological impairment in the asymptomatic and early symptomatic stages of disease. Subjects included 61 gay men (41 HIV −, 20 HIV +) who were assessed at the time of requesting their first HIV test and again 12 months later. The assessments at baseline were conducted double-blind to HIV serostatus. Measures included a neuropsychological battery, neurological examination and full psychiatric assessment. There were no differences between the asymptomatic HIV + and HIV − groups at baseline or at follow-up in terms of mean scores on neuropsychological tests. Mean scores were within the normal range for all neuropsychological tests for both groups. Multiple regression analysis was used to predict each individual's performance at follow-up on the basis of their baseline performance, psychiatric state, neurological history and drug use for each of the neuropsychological tests. HIV + subjects were more likely than control subjects to perform at a significantly lower level at follow-up on one or more tests than predicted on the basis of their baseline performance.

The effects upon regional brain function of infusing either saline or clonidine (1·5μg/kg) has been examined in 18 patients with alcoholic Korsakoff's psychosis using 99mTc-hexamethylpropyleneamineoxime (99mTc-HMPAO or 99mTc-Exametazime) and Single Photon Emission Tomography (SPET or SPECT). The hypothesis tested was that frontal lobe function would be increased by adrenoceptor stimulation. This was confirmed by an increase in the uptake of 99mTc-Exametazime into anterior cingulate regions of the frontal lobes. Patients were scanned before and after saline or clonidine infusion during performance of a verbal fluency task. There was a significantly increased performance of verbal fluency in patients given clonidine. This effect was variable and could not be unequivocably distinguished from increases in performance in the saline treated group. Nevertheless, the increase in neuropsychological performance was also correlated with increased function in left dorsolateral frontal cortex within the clonidine treated group. An exploratory examination of other brain areas suggested that relative increases in posterior cingulate cortex and changes in the symmetry of function within the thalamus may also be produced by acute infusion of clonidine in Korsakoff patients. The findings support the idea that adrenergic mechanisms may modulate cognitive performance by actions on attentional systems within the brain. These appear to be located primarily within limbic cortex. It is, of course, notable that this can occur in patients with profound and disabling amnesia.

This paper presents the results of a study of unemployment among British Asians living in the north of England. The sample comprises 139 employed and unemployed men. Using standardized psychological questionnaires with a semi-structured interview schedule, the psychological consequences of unemployment are examined in relation to other psychosocial variables. The results showed that the unemployed group had lower levels of psychological well-being, selfesteem, and employment commitment with high external beliefs, than the employed group. Length of unemployment was a significant determinant of psychological well-being and respondents with a longer period of unemployment had a lower level of psychological well-being than those who had been unemployed for a shorter period. The findings are examined in the context of existing empirical evidence, and the need to examine the psychological impact of unemployment among other British Asian groups is emphasized.

Information about contact with psychiatric services before imprisonment was obtained for a stratified random sample of sentenced prisoners, who were not receiving prison psychiatric care, in Melbourne's three metropolitan prisons. The sample of 158 men and 31 women was matched with the longitudinal person-linked records of state psychiatric service use in the Victorian Psychiatric Case Register (VPCR). Records of contact with the state services were found for 54 men (34%) and 19 women (61%), including records of in-patient treatment for 25 men (16%) and 15 women (48%). For 64% of individuals with a positive match, the case-note diagnoses were substance use disorders only. Diagnoses of psychotic disorders were recorded for four prisoners, and mood disorders for another six.

In addition, clinicians conducted standardized diagnostic interviews and enquired about treatment and personal history. A further 24 prisoners reported specialist psychiatric treatment outside the state treatment sector.

This study links the findings from an interview survey of psychiatric morbidity in prisoners with the records available in the VPCR, and emphasizes a number of matters important to the public health. The high rates of previous treatment for substance abuse disorders, the apparent pool of prisoners with largely untreated major depression, and the service needs of those with chronic psychotic disorders are discussed.

This survey examines changes in depressive symptomatology (CES-D) during bereavement in 1046 elderly subjects, of whom 139 became widowed during follow-up. Depression scores increased during the first year of bereavement, but generally returned to pre-widowhood levels thereafter. However, depression scores remained elevated among young-old widows (65–74year-olds) well after the first year of widowhood. Using cut-off scores, rates of high depressive symptoms remained somewhat elevated over baseline levels. Increases in depression scores during bereavement were not explained by socio-economic variables, health habits and health status. It is concluded that particularly young-old widows are at risk of developing chronic depressive symptomatology during bereavement that may warrant clinical attention.

The aim of this study was to determine whether HIV infection is associated with increased psychosocial distress in the asymptomatic and early symptomatic stages of disease and to determine the factors associated with reporting health symptoms. Subjects included 61 gay men (41 HIV −, 20 HIV +) who were assessed at the time of requesting their first HIV test and again 12 months later. Measures included a detailed standardized psychiatric interview (Present State Examination, PSE), a range of psychosocial self-report measures and a physical symptom checklist. There were no differences between the HIV + and HIV − groups in terms of self-reported symptoms. Multiple regression analysis showed that the symptom reporting was not associated with clinical or immunological markers of disease progression but was associated with measures of psychosocial distress. Although both groups showed elevated levels of psychosocial distress at the time of HIV testing, there were no differences between serostatus groups at follow-up. Multiple regression analysis indicated that the best predictors of PSE scores at follow-up were baseline PSE score and a history of psychiatric illness. Early HIV disease is not associated with increased psychosocial distress and symptom reporting is more closely related to psychological measures than to clinical or immunological markers of disease.

A group of patients suffering from chronic fatigue (CF) attending a medical clinic were compared with a group of muscular dystrophy (MD) patients from the same clinic and a psychiatric control (PC) group who were attending a psychiatric unit. A checklist was used to assess the patients' subjective physical and psychological state before and after exposure to a psychological stressor. For both physical and psychological symptoms the CF group had the largest response, the PC group was intermediate, and the MD group had the least response. Explanations may involve physiological arousal and attentional focusing.

The study investigated whether reductions in hostility and criticism in the relatives of psychiatric patients would be associated with changes in their beliefs about the causes of the patients' symptoms and negative behaviours. Twenty-six relatives of patients with schizophrenia were assessed both before and after taking part in interventions designed to reduce levels of expressed emotion. Over the course of the interventions there was a general reduction in relatives' criticism and hostility, a shift towards making more universal attributions for patients' negative behaviours and more use of attributions to illness. Reductions in criticism were not related to attributional change, but reductions in hostility were associated with shifts towards more universal and uncontrollable attributions.

In a community survey, subjects and their informants were asked the same questions about memory and intellectual decline in the subjects. Subjects and informants both commonly reported cognitive decline, although in most cases the decline was not seen as interfering with daily life. However, when responses from subjects and informants were cross-tabulated, agreement was found to be poor. For subjects, reports of cognitive decline were correlated with anxiety and depression symptoms and with trait neuroticism. Subjects' reports were uncorrelated with age and only weakly correlated with cognitive test performance, indicating little validity. By contrast, informants' reports were correlated with the subjects' cognitive test performance and age, but also with the informants' own anxiety and depression symptoms. Although informants' reports have validity, they may also be contaminated by the informants' affective state.

This paper applies data from a family study of depression to assess patterns of comorbidity and co-transmission of alcoholism, anxiety disorders, and major depression. We found that all three disorders were strongly transmissible; however, alcoholism demonstrated the greatest degree of familial aggregation. The pairwise associations among depression, anxiety and alcoholism indicated that the traits are co-transmitted in families, especially depression and anxiety. Individual associations between traits (or comorbidity) were entirely explained by transmitted (perhaps genetic) agents, because the correlations between traits due to random environment were not significant. These findings have important implications for treatment, psychiatric nosology, and aetiological investigations of these conditions.

Self-report measures were completed by 59 individuals with motor neurone disease (MND) in order to assess whether: (a) MND affects patients' psychological well-being and quality of life; (b) if greater affective disorder is associated with greater physical disability; (c) whether accepting the illness and ways of coping have an impact on psychological distress, and (d) if beliefs over control of their health shift as the disease progresses. Results indicated that the effects of MND on everyday functioning accounted for incidence of depression and low self-esteem. Acceptance of illness was related to severity of symptoms and was a significant factor irrespective of level of physical symptomatology. Ways of coping with the illness did not relate in any significant way to severity of symptoms. Mild physical impairments were associated with an ‘internal’ view of control over health.

Several large-scale epidemiological surveys have reported increasing lifetime rates of psychopathology among recently born cohorts. In the case of Major Depressive Disorder (MDD) younger cohorts tend to manifest higher lifetime prevalences of the condition than older cohorts, at any given age. In some studies, cohort differences are so large that the youngest cohort exceeds the lifetime prevalence of the oldest cohort well before passing through their total period of risk. The data on lifetime prevalences that support the existence of secular differences, however, has typically been collected in cross-sectional studies. Thus, individuals are interviewed at a single point in time and asked to recall all prior psychopathology. Due to poor recall, this design may greatly underestimate earlier experiences. In fact, cohort differences are not limited to MDD; similar results have been reported for a wide range of psychopathology, suggesting methodological problems at data collection. We have conducted a simulation study to examine the magnitude of annual rates of forgetting that could produce the secular trends reported for MDD. Small, but constant annual rates produce striking, ‘cohort effect-like’ curves. The rates needed to reconstruct the reported effect are compatible with published values for test–retest studies of lifetime recall of MDD.

This simulation study does not rule out the existence of a cohort effect in some psychiatric disorders, but stresses the possible limitations of using cross-sectional studies to investigate secular trends.

One hundred and two first-year students at an independent college in Taiwan participated in a questionnaire study. Measurements of stressors (major life events, minor daily hassles and perceived university stress), personality (locus of control, extraversion and neuroticism) and mental health (depression, anxiety and somatic symptoms) were taken. Using multivariate analyses, we found that: (1) life events predicted anxiety, while daily hassles predicted depression; (2) locus of control and extraversion correlated negatively, while neuroticism correlated positively with university stress; and (3) neuroticism had a main effect on symptom reportings across the board, while extraversion had a vulnerability effect on somatic symptoms. Relationships between life events and daily hassles, and the roles of personality in the stress process, are discussed.

A study was conducted using data from the Health and Lifestyle Survey, a population based community survey of England, Wales and Scotland in which psychiatric morbidity was assessed using the General Health Questionnaire. An association was found between urban residence and the prevalence of psychiatric morbidity (odds ratio 1·54, 95% CI 1·32–1·80) which persisted after adjustment for various confounding factors (odds ratio 1·34, 95% CI 1·13–1·58). The discussion mentions the need for further study into the psychologically harmful elements of urban life.

Temporal lobe Magnetic Resonance Imaging (MRI) was performed in 43 patients with NINCDS/ADRDA Alzheimer's disease (AD) (33 probable, 7 possible, 3 definite) and 32 subjects with DSM-III-R Major Depression (DEP) matched for age, sex and level of education. Hippocampus (anterior and posterior, right and left), amygdala, entorhinal cortex, para-hippocampal gyrus and cerebral cortex were rated for atrophy on a 4-point scale. Good discrimination between groups could be achieved using a cut-off of 2 or more on anterior hippocampal atrophy rating (sensitivity 93%; specificity 84%; 89% cases correctly grouped overall). Even among a subgroup of 9 mild AD subjects and 10 cognitively impaired DEP subjects (matched on mini-mental state score), the same cut-off correctly grouped 84% (16/19) cases. Hippocampal atrophy increased with age in both AD and DEP subjects leading to a reduction in specificity (but not sensitivity) for those aged over 75. Within the AD group a significant correlation was observed between length of history and atrophy of the entorhinal cortex (r = 0·39, P = 0·009). We conclude that temporal lobe atrophy on MRI can provide good discrimination between AD and DEP subjects, including those DEP patients with cognitive impairment apparent on screening tests of cognitive function.