This paper compares the pathway to psychiatric care of patients contacting the South-Verona Community Psychiatric Service (CPS) with the pathways described in other countries, using the method of the WHO cross-cultural study of pathways in psychiatric care. One hundred and sixteen South-Verona residents starting new episodes of care were traced and included in the study. The first port of call for 92% of patients was a doctor. More than one-third arrived at the CPS directly, not filtered by other carers. One-third went first to the GP and then straight to the CPS. Both the median total interval since onset of symptoms and the median interval between onset of the problem and first seeking care was 8 weeks. Patients presenting first at the two major ports of call tend to have a quite similar latency period before seeking care. Problems presented are represented mostly by depression and anxiety. The diagnosis of affective disorders occurred in more than half of the sample, followed by neurotic and somatoform disorders and schizophrenia and related disorders. The intervals after seeing the first carer are short and quite homogeneous among all patients. More than three-quarters of the patients said that they received some form of treatment for their presenting problems prior to arrival at the CPS, mostly psychopharmacotherapy with sedatives/hypnotics. These results are discussed in the light of those obtained in the WHO cross-cultural study.

Of an original sample of 705 elderly (aged over 65) community residents 71% were rescreened after two years and four months using Short CARE. Thirty-one (6·7%) subjects were identified as possible new cases of dementia, implying a mean annual inception rate among the survivors of 26 per 1000. These were subjected to full clinical assessment, which yielded 10 cases of Alzheimer's disease (8 per 1000) and 5 multi-infarct dementia (4 per 1000). The remainder of the cases consisted of 6 with a dementia secondary to other causes, 1 case of mixed dementia and there was insufficient information to classify the remaining 3. Six were found not to be suffering from dementia. This yields an overall annual incidence rate for dementia among the survivors of 20 per 1000.

Three adults with Asperger syndrome were invited to talk about their inner experiences, using an experience sampling and interview technique. They reported thoughts primarily or solely in the form of images. By contrast, normal adults previously tested with this technique reported inner experiences of a variety of forms. The present report suggests the feasibility and potential interest of the experience sampling method with high-functioning individuals with autistic disorder.

We measured multiple dimensions of distress among spouses (N = 440) of patients hospitalized for serious illness or elective surgery and compared the course of distress over 2 years of follow-up among five groups according to whether and when spouses were bereaved. Distress was related to the severity of the patient's illness, the actuality and timing of the bereavement, as well as the gender and age of the respondent.

To isolate determinants of any female preponderance in depressive disorder, we earlier selected a sample of young adults, then similar in terms of several potential social determinants of depression and with equivalent rates of lifetime depression. We now report a 10-year review, which initially suggested a female preponderance in DIS-generated RDC and DSM-III lifetime depressive categories. The presence of sex differences in rates of lifetime depression was influenced by the definition of caseness used and the vantage point from which rates were determined. The longitudinal design and earlier corroborative witness reports established, however, clear evidence of instability in prevalence estimates, together with a sex effect on stability. Men were more likely to ‘forget’ episodes, while women were more likely to ‘remember’ episodes that had generally not previously reached ‘case’ criteria. When correction was made for such artefactual influences, a sex difference in lifetime depression rates was no longer evident. Such findings require review in general community samples, and suggest modifications to ‘case’ definition in epidemiological enquiries.

Two hundred and fifty patients attending primary care with glandular fever or an upper respiratory tract infection were studied prospectively up to 6 months after onset. Of these patients 228 were interviewed with the Life Events and Difficulties Schedule and the Schedule for Affective Disorders and Schizophrenia, giving Research Diagnostic Criteria for psychiatric disorders. The experience of severe social adversity (provoking agents) had a significant association with psychiatric disorder at 2 months (odds ratio = 5·3) and 6 months (odds ratio = 5·8) after onset of infection. This association was especially significant for depressive illness (odds ratio = 9·1 at 2 months and 11·9 at 6 months). In contrast, social adversity had little association with the development of the post-infectious fatigue syndrome, or delayed physical recovery. Social adversity may be an important maintaining factor for psychiatric disorders, especially depressive illness, following acute infections.

One hundred and one patients with late paraphrenia were examined using the Present State Examination. The established high prevalence rates of female gender, the unmarried state and sensory impairment were confirmed. All of the symptoms of schizophrenia, with the exception of formal thought disorder, were found in the subjects with approximately the same prevalence as reported in schizophrenics with a symptom onset in younger life. The presence of visual hallucinosis was significantly associated with visual impairment, but the same association was not found between auditory hallucinations and deafness. Mean age at onset of symptoms was high at 74·1 years. Using ICD-10 diagnostic criteria the patients were categorized as schizophrenia (61·4%), delusional disorder (30·7%) and schizoaffective disorder (7·9%). Patients in these diagnostic categories differed in their pre-morbid IQ estimations, current cognitive state measured by the Mini-Mental State Examination and in the number of scored positive psychotic PSE symptoms and their systematization of and preoccupation with delusions and hallucinations. There were no significant differences between the patients in the ICD-10 schizophrenia and delusional disorder groups in terms of age at symptom onset, sex ratio, response to treatment, being unmarried, the presence of insight or sensory impairment. The high degree of clinical similarity between patients with late paraphrenia combined with the inability of ICD-10 to define diagnostic subgroups that correspond to patient clusters derived from clinical symptoms or which are meaningfully different from each other in terms of demographic and prognostic factors provide a strong argument for the retention of late paraphrenia as the most appropriate diagnosis for such patients.

This study examines psychological symptomatology in a cohort of 72 heart transplant recipients followed longitudinally during their first year post-transplant. In keeping with research on other domains of life stressors and illnesses, a central study goal was to identify pre-transplant and perioperative psychosocial factors associated with increased vulnerability to, and maintenance of, elevated psychological distress levels post-transplant. Average anxiety and depression levels, but not anger–hostility symptoms, were substantially elevated in the early post-transplant period, relative to normative data. Average symptom levels improved significantly over time, although one-third of the sample continued to have high distress levels at all follow-up assessments. Recipients with any of seven psychosocial characteristics at initial interview were particularly susceptible to continued high average distress levels over time: a personal history of psychiatric disorder prior to transplant; younger age; lower social support from their primary family caregiver; exposure to recent major life events involving loss; poor self-esteem; a poor sense of mastery; and use of avoidance coping strategies to manage health problems. Recipients without such factors showed improvement in average distress levels across the assessment period. These effects were stronger for anxiety than depressive symptoms, with the exception of a sizeable relationship between loss events and subsequent depression. The findings suggest that clinical interventions designed to minimize prolonged emotional distress post-transplant need to be closely tailored to heart recipients' initial psychosocial assets and liabilities.

A three-phase longitudinal design was used to study bereavement phenomena in a cohort (N = 78) of recently widowed elderly Australian men. One group of 57 widowers was compared with a second group of 21 widowers on a waiting list. A brief, interviewer-administered, structured questionnaire was used to rate the frequency of 22 self-reported bereavement phenomena. The prevalence and temporal evolution of these phenomena are described. Half of a subgroup of elderly widowers reporting high levels of bereavement phenomena at 6 weeks post-bereavement went on to exhibit persistent or chronic grief at 13 months post-bereavement. The prevalence of persistent or chronic grief throughout the first 13 months post-bereavement was 8·8%. Income, education and expectedness of the death were all negatively correlated with frequency of self-reported bereavement phenomena at 6 weeks post-bereavement. In a multiple regression analysis only expectedness of the death contributed significantly to prediction of the frequency of bereavement phenomena at 6 weeks post-bereavement. Widowers who were unable to anticipate their wife's death, even when their wife had suffered a long final illness, had a more severe bereavement reaction.

Patients attending five Health Centres in areas of NW London with a high Asian population were asked to complete a questionnaire screening for non-psychotic psychiatric illness and to state why they had come to see their doctor. The GPs were also asked to rate the purpose of the consultation for those patients who scored above the cut-off point on the questionnaire. The screening questionnaire revealed equivalent rates of non-psychotic psychiatric morbidity in the White and Asian samples and no differences in the way their symptoms were presented. The differences that did emerge showed that Asian patients scoring above the cut-off for psychiatric caseness were more likely to state that they were consulting their GP about a physical problem and GPs were more likely to identify psychiatric morbidity in White than Asian patients who exceeded the cut-off threshold. The results suggest the possibility of an interaction between the ways in which patients experience and communicate psychological distress, their ethnic origin, and their GP's mode of responding.

This study investigated the number and severity of life events, Type A behaviour, coping strategies and social support differences between chronic fatigue and irritable bowel syndrome patients prior to illness and between these groups and healthy controls. Although few differences were found between the groups for life events, a number of interesting results emerged with regard to different aspects of Type A behaviour, various coping strategies and social support. These findings are discussed with respect to existing research in the field.

Eighty-three patients with schizophrenia and 47 healthy controls received positron emission tomography (PET) with 18F-2-deoxyglucose uptake while they were executing the Continuous Performance Test (CPT). The entire cortex was divided into 16 regions of interest in each hemisphere, four in each lobe of the brain, and data from corresponding right and left hemispheric regions were averaged. Data from the schizophrenic patients were subjected to a factor analysis, which revealed five factors that explained 80% of the common variance. According to their content, the factors were identified and labelled ‘parietal cortex and motor strip’, ‘associative areas’, ‘temporal cortex’, ‘hypofrontality’ (which included midfrontal and occipital areas) and ‘frontal cortex’. Hemispheric asymmetry was only confirmed for the temporal cortex. Factor weights obtained in the schizophrenic group were applied to the metabolic data of the healthy controls and factor scales computed. Schizophrenics were significantly more hypofrontal than the controls, with higher values on the ‘parietal cortex and motor strip’ factor and a trend towards higher values in the temporal cortex. A canonical discriminant analysis confirmed that the ‘hypofrontality’ and ‘parietal cortex and motor strip’ factors accurately separated the schizophrenic group from the healthy controls. Hemispheric asymmetry was only confirmed for the temporal lobe. Significantly higher factor scores for the left temporal lobe in schizophrenics than in normals were obtained when calculated for the right and left hemisphere separately. Taken together, our results confirm the importance of hypofrontality as a pattern of cortical metabolic rate and point to the potential importance of parietal and motor strip function in schizophrenia.

Savant artists represent a conundrum to our understanding of the nature of high level specific talents as well as to the concept of general intellectual impairment. In the present paper, we are particularly concerned with the relationship between general perceptual-motor functions in relation to drawing aptitude. Drawing is by definition a perceptual-motor operation, yet mental handicap tends to be associated with some degree of impairment in this area. The following study seeks to isolate such aspects of performance on general perceptual-motor skills that might be associated with drawing ability, and may thus be regarded as building blocks underlying the manifestation of graphic talent. The results are discussed in terms of the relationships between graphic talent, non-verbal intelligence and visual-motor functions.

Animal models suggest a relationship between disturbed striatal dopaminergic function and stereotyped behaviour. Several studies show increased stereotypy in schizophrenic patients compared to normal controls. We investigated the performance of 12 antipsychotic-drug-free schizophrenic patients, and 15 healthy control subjects on a neuropsychological measure of stereotypy – the two-choice guessing task – and correlated this with in vivo striatal dopamine D2 receptor binding, as measured by 123I-iodobenzamide single photon emission tomography. Patients and controls did not differ with respect to the measures of stereotypy derived from the task. However, there was a significant correlation between one of these measures (RR Information) and the degree of striatal D2 receptor binding asymmetry in the patient group only. In view of research connecting striatal and frontal lesions with stereotypy in animals and cognitive inflexibility in humans, these data could suggest a similar disturbance underlying the phenomenon in schizophrenia.

Dubai, an Emirate in the Gulf region, has experienced spectacular social change as a result of the exploitation of its oil reserves. The Dubai Community Psychiatric Survey was designed to study the effects of this social change on the mental health of female nationals.

In this paper, we approach the problem by quantifying social change in two main ways: the first focused on social change at the individual level as measured by the Socio-cultural Change Questionnaire (Bebbington et al. 1993). The second examined the effect of social change at the community level by identifying areas of residence at different levels of development. We hypothesized that attitudes and behaviours markedly at odds with traditional prescriptions would be associated with high rates of psychiatric morbidity.

On the individual level, the association between psychiatric morbidity and the amount of social change reflected in the behaviours and views of the subjects was not significant. However, there was a significant association between morbidity and between social attitudes and behaviours. At the community level, in contrast, the relationship between psychiatric morbidity and social change was significant: there was more psychiatric morbidity in areas at the extremes of the social change continuum. The hypothesis put forward in this study must be modified accordingly.

This study was intended to establish the pathogenic significance of sport and exercise in the development of eating disorders. Hospitalized eating disordered patients and an age-matched control group were assessed. Historical and current physical activity data were collected. An in-depth interview was also conducted to ascertain the age of onset of the diagnostic symptoms for eating disorders, and to determine whether: (i) exercising predated dieting; (ii) patients had been involved in competitive athletics; (iii) exercise was excessive; and (iv) weight loss was inversely related to level of exercise. The results indicated that patients were more physically active than controls from adolescence onwards, and prior to the onset of the primary diagnostic criteria for anorexia nervosa. A content analysis of the interview data indicated that 78% of patients engaged in excessive exercise, 60% were competitive athletes prior to the onset of their disorder, 60% reported that sport or exercise pre-dated dieting, and 75% claimed that physical activity levels steadily increased during the period when food intake and weight loss decreased the most. Together our results suggest that overactivity should not be routinely viewed as a secondary symptom in anorexia nervosa, equivalent to other behaviours. For a number of anorexic women, sport/exercise is an integral part of the pathogenesis and progression of self-starvation.

We recently completed a case–control study of 100 literally homeless and 100 never homeless indigent schizophrenic men in New York City, in which concurrent substance abuse and antisocial personality disorder were widespread. In this paper we probe the correlates of ‘pure’ schizophrenia (single disorder, N = 60), schizophrenia and substance abuse (double disorder, N = 89), and schizophrenia, substance abuse, and antisocial personality disorder (triple disorder, N = 50), across the homeless/never homeless distinction. Subjects were recruited from a homeless shelter and mental health service programmes in Upper Manhattan. Psychologist and social worker interviewers administered the Structured Clinical Interview for DSM-III-R, I, and II and other structured instruments to explore social, family and illness history, the current illness, and aspects of treatment and family support. Codisorder subjects emerged from more disadvantaged family backgrounds, experienced greater school difficulties, began drug use in early adolescence, were more prone to hyperactivity in childhood, and were more likely to have spent time in jail. While codisorder groups did not differ on key aspects of schizophrenia, the triple disorder group was found to suffer from a more severe form of substance abuse than double disorder subjects, associated with an earlier age of onset and abuse of a wider array of substances.

The widespread prevalence of codisorders among indigent schizophrenic men has major significance for clinical psychiatry. Study of the correlates of codisorders has revealed important differences in social, family, and illness history which may guide the development of more effective treatments and improved service delivery.

The Grade of Membership (GoM) model is a classification procedure which allows a person to be a member of more than one diagnostic class. It simultaneously quantifies the degrees of membership in classes while generating the discrete symptom profiles or ‘pure types’ describing classes. The model was applied to the symptomatology, history, and follow-up of 1065 cases in the WHO International Pilot Study of Schizophrenia. The model produced an eight diagnostic class or ‘pure type’ solution, of which five were related to the diagnostic concepts of schizophrenia and paranoid disorder, two types were affective disorders, and one asymptomatic type. A subtype of paranoid schizophreniform disorder found primarily in developing countries was identified. There was a strong association between pure types and the original clinical and computer generated (CATEGO) diagnoses. A GoM based psychiatric classification might more clearly identify core disease processes than conventional classification models by filtering the confounding effects of individual heterogeneity from pure type definitions.

While spouse similarity for psychiatric morbidity has been the object of numerous studies, most of these focused on clinical samples and, consequently, the interpretation of their results is limited by the existence of a selection bias. In this study, conducted on a sample of 845 general population couples, significant spouse similarity was observed for psychological distress and well-being, characterized by a marked symmetry in the relation between spouses' scores. The sex differences observed in many earlier studies would appear essentially to be artefactual. Spouse similarity was also found to be significant in the subpopulation of couples married less than two years, which pointed to assortative mating for psychological distress and well-being. While many studies have found educational dissimilarity and age difference between spouses to be associated with certain health variables, such as high blood pressure and coronary heart disease, these variables do not have a significant influence on individual levels of psychological distress and well-being. Spouse similarity for socio-demographic characteristics does not play a significant role in explaining spouse similarity for mental health. Consequently, assortative mating for psychological distress and well-being would appear to be primarily due to personal preference.

Benzodiazepines (BZs) produce transient anterograde amnesia when given to normal subjects. The present longitudinal study assessed whether BZs impair memory functions in a clinically anxious group. Eighty-two agoraphobics with panic disorder were randomly allocated to one of four treatment groups resulting from a combination of two drug treatments (alprazolam or placebo) and two psychological treatments (exposure or relaxation). Of these, 38 subjects were assessed on a range of objective and subjective indices of memory and mood at three time points: before treatment, after 8 weeks of treatment and again at 24 weeks when patients had been free of medication from 5–8 weeks.

Alprazolam produced pronounced impairments on a word recall task. At the 24-week medication-free follow-up, alprazolam patients were still impaired on the task compared with placebo patients. Alprazolam did not impair performance on an implicit memory task and did not affect digit span. Differences between psychological treatments emerged mainly in subjective memory effects. Findings are discussed in terms of the specificity of BZ-induced amnesia and differential tolerance to the varying effects of BZs. Implications are drawn out for the patient's ability to function optimally in daily life while taking alprazolam.