Use of minor tranquillizers and hypnotics and the association with shift work was examined in a sample of French nurses interviewed in 1980, 1985 and 1990. Permanent night schedule was related to a higher use of hypnotics/tranquillizers, the relation being significant in 1990. At each follow-up date, the use of drugs increased with sleep disorders, symptoms of psychological disorders reported by the nurses themselves, an impaired health and fatigue. Age was linked to the use of hypnotics/tranquillizers; the older the nurses were, the more likely they were to take the drugs. Using a logistic analysis, the following variables were significant: time schedules, self-assessment of health, fatigue, age and marital status. Time schedules involving night work, especially permanent night schedule, were related to a higher proportion of drug use. These findings confirmed the general patterns of psychotropic drug use (age, sleep disorders, physical health and marital status) among women and emphasized the relation between time schedules involving night work and the use of hypnotics/tranquillizers.

The objective of the study was to determine whether the families of anorexia nervosa (AN) patients were more dysfunctional than those of cystic fibrosis (CF) patients and well controls. Data were collected from self-report questionnaires, from an interview rated for Expressed Emotion (EE) and from direct observation of a family problem solving task which was rated for evidence of Minuchin's ‘psychosomatic family’ dimensions. A total of 87 families participated. Most self-report measures of family functioning did not distinguish between groups. There were no differences in levels of EE criticism. AN and CF households showed more EE emotional over-involvement than did the well households. Over-involvement correlated with illness severity. More households in the AN group were enmeshed, over-protective and poor at problem solving than in the CF and well groups. Minuchin's conceptualization of the anorexia nervosa family was partly supported.

A stratified random sample of 3007 Australian adults completed a screening questionnaire 6 months after the 1989 Newcastle earthquake. Information was obtained on initial earthquake experiences and reactions, use of specific services, social support, coping strategies and psychological morbidity. This questionnaire was the first phase of the Quake Impact Study, a longitudinal project investigating the psychosocial impact of the earthquake. Two weighted indices of exposure were developed: a threat index, which measured exposure to injury or the possibility of injury; and a disruption index, which measured experiences of property damage, displacement and other losses. Levels of exposure to threat and disruption events were significant predictors of morbidity on both the General Health Questionnaire and Impact of Event Scale, as were coping style and gender. Effects of exposure to threat and disruption were largely additive, with higher exposure being associated with greater use of support services, higher perceived stressfulness and more severe psychological morbidity. Use of avoidance as a coping strategy, female gender, lower social support and being older were also associated with higher post-disaster psychological distress. It was estimated that 14·8% of the population was exposed to high levels of threat or disruption, of whom approximately 25% experienced moderate to severe psychological distress as a direct result of the disaster. It was further estimated that 18·3% of those exposed to high levels of threat were at risk of developing post-traumatic stress disorder, representing approximately 2% of the city's adult population.

This paper discusses minor psychiatric morbidity in the community and its relation to help-seeking. The research is aimed at identifying the demographic and social characteristics that enhance the likelihood of minor psychiatric morbidity, as measured by the General Health Questionnaire, and to reveal how these determinants relate to health status. In the second stage of the study, the same characteristics are related to their effect on the decision to consult a general practitioner and, more specifically, on presenting psycho-social problems to the GP. At the population level, the likelihood of a high GHQ score was greater for women, divorced persons and the unemployed, other variables remaining equal. However, GHQ score was contaminated by poor subjective health perception, especially for unemployed persons. Chronic physical illness did not have an independent effect on the GHQ score. Chronic physical illness did influence help-seeking. In addition, several socio-demographic characteristics showed an independent effect on consulting behaviour for both GHQ-positive and GHQ-negative patients. Women, unemployed persons and publicly insured patients with a minor psychiatric disturbance were more apt to visit their GP, regardless of their physical health status. However, no socio-demographic characteristics increased the likelihood that a GHQ-positive patient would present unambiguous psycho-social complaints as a reason to see their doctor.

The prevalence rate of subjective memory impairment (SMI) and its value as a predictor of future depression or dementia was studied in a community sample of elderly residents in one electoral ward using the short-CARE. SMI was found to be common, occurring in 25% of subjects. Subjects with SMI were more likely to be suffering from either dementia or depression than those without the complaint, although 60% of subjects with SMI did not have evidence of either disorder. When followed up over a 2-year period, subjects with SMI were found to be at four-fold greater risk of developing future dementia and two-fold greater risk of developing a depression compared with those without SMI. The SMI scale was not found to be useful as a population screen for dementia or depression, although two of the nine items might have value as screening questions in clinical circumstances to determine those with memory complaints at risk for dementia.

Diffuse loss of cortical volume and ventricular enlargement have been demonstrated in schizophrenia using imaging. In addition, histological studies have provided evidence that the number of neurons in the medial temporal lobe structures is reduced and that the cytoarchitecture is abnormal. In an attempt to correlate these histological findings with in vivo estimates of neuronal integrity we have studied the concentration of the neuronal marker N-acetyl aspartate (NAA) in the hippocampi of schizophrenics using in vivo Magnetic Resonance Spectroscopy (MRS). Compared with a group of healthy volunteers schizophrenics showed a 22% loss of NAA in the left hippocampus. Two other metabolites, choline and creatine showed bilateral reduction in schizophrenics and these achieved significance in the left hippocampus. These results indicate a significant depletion of NAA in schizophrenia and are in close agreement with the reported neuronal loss in the hippocampus detected histologically. We propose that in vivo MRS is a valid measure of integrity of neuronal populations in schizophrenia.

Bipolar disorder and alcoholism are familial disorders. The familial–genetic relationship between both is controversial and has received insufficient study. This study explores whether bipolar disorder and alcoholism share familial risk factors, and whether the co-occurrence of lifetime diagnosis of bipolar disorder and alcoholism is familial. We report on first-degree relatives of 146 consecutively admitted patients with either bipolar disorder or/and alcoholism; relatives of the patients (in total 728 relatives directly interviewed) were compared with first-degree relatives of 109 general population probands (320 relatives directly interviewed). Overlap between the familial components underlying bipolar disorder and alcoholism was not observed if the analysis was restricted to ‘pure’ diagnostic groups. Excess comorbidity between bipolar disorder and alcoholism was observed in relatives. Multiple sources for this excess of comorbidity between major affective disorders and alcoholism in families of probands with bipolar disorder are likely; in particular, we found evidence for a distinct subgroup of comorbid cases with familial comorbidity; however, excess comorbidity was also found in absence of familial loading with alcoholism.

We studied the effect of acute tryptophan (TRP) depletion in a group of eight abstinent bulimic (BN) subjects and in 12 healthy female controls. Despite being free of episodes of bingeeating and vomiting for a prolonged period, the abstinent BN subjects still appeared to practice dietary restraint as judged by their food intake in a test meal. In addition, their plasma TRP concentrations were significantly lower than those of the controls. Administration of a TRP-free amino acid load (52 g) significantly lowered plasma total and free TRP. However, compared to a balanced amino acid load, this procedure did not have significant effects on mood, appetite or food intake in either the abstinent BN subjects or the healthy controls.

In the course of a large twin study of Alzheimer's disease we used a two-stage telephone screening procedure. The modified Telephone Interview for Cognitive Status (TICS-m) served as an initial screen for dementia in 12709 individuals. The telephone Dementia Questionnaire (DQ) was then asked of collateral informants for subjects with TICS-m scores below 28, as well as for samples of persons with higher TICS-m scores. Based upon DQ responses, individuals with cognitive impairment not attributable to focal causes underwent assessment for the clinical diagnosis of Alzheimer's disease (‘Alzheimer's dementia’), as did their twins. Well-defined Alzheimer's dementia was apparent in 39 subjects. Employing a cut-off of 27 or lower as indicative of cognitive impairment, the sensitivity of the TICS-m in the detection of Alzheimer's dementia was estimated at >99% and specificity at 86%. Inclusion of the DQ increased the specificity at the 27/28 cut-point to 99%. The TICS-m score was associated with an area under the receiver operating characteristic (ROC) curve of 0·88 (95% confidence interval 0·81 to 0·94). The maximum number of cases of Alzheimer's dementia remaining undetected in the sample was estimated to be 34.

High energy phosphate metabolites were measured using phase-encoded in vivo phosphorus-31 magnetic resonance spectroscopy (31P-MRS) in both the left and right frontal lobes of 25 patients with bipolar disorder. Eleven patients were examined in the depressive state, 12 in the manic state, and 21 in the euthymic state. Twenty-one age-matched normal volunteers were also examined. The phosphocreatine (PCr) peak area percentage in the left frontal lobe in the patients in the depressive state was decreased compared with that in the normal controls. It was significantly negatively correlated with the Hamilton Rating Scale for Depression score evaluated at the time of 31P-MRS examination. The PCr peak area percentage in the right frontal lobe in the patients in the manic and the euthymic states was decreased compared with that in the controls. These results are compatible with previous reports describing reduction of glucose metabolism in the left frontal lobe in depressive patients with bipolar disorder and trait-dependent right hemisphere dysfunction in bipolar disorder.

Forty-six patients with chest pain but normal or near-normal coronary arteries were assessed using standardized interviews and rating scales at the time of angiography, after 1 year, and again 11·4 years later. Psychological morbidity was substantial and enduring: 61% of patients were designated as psychiatric cases at angiography and 49% at 11·4 years. Both at the time of angiography, and 1 year later, levels of morbidity were significantly greater than in a control group of 53 patients with coronary artery disease. Anxiety disorders were common at all three interviews, with panic disorder (15% of patients) the most common current diagnosis at final follow-up. Current somatoform disorders were diagnosed in 9 patients (22%), and 11 (27 %) reported previous episodes of major depression. Psychological morbidity was associated with continuing chest pain, which was reported in 74% of patients, and with ongoing functional incapacity. These findings suggest that, in a sub-group of these patients, psychological factors contribute in part to the development of chest pain and other physical symptoms, and are also important in maintaining the disorder over long periods. Further research is now required to identify more fully the nature of these psychological factors, and how they interact with cardiac and non-cardiac physical pathology. There is also an urgent need to examine the clinical and economic benefits of specific psychological interventions.

Criteria for the diagnosis of ICD-10 Mild Cognitive Disorder (MCD) were applied to a sample of 897 community dwelling elderly participants. Criterion A (the presence of a physical disorder) was met by 44%, Criterion B (report of a cognitive disorder) by 17%, Criterion C (an abnormality in quantified cognitive assessments) by 60%, and Criterion D (exclusion on basis of dementia and other conditions) by 74%. A total of 36 cases (4%) met all four criteria. Correlations between Criteria A and B, and B and C were weak (r = 0·18), and the correlation between Criteria A and C was almost zero (r = 0·02). This suggests that no syndrome exists. Membership of MCD was predicted by a report that memory or intelligence interfered with daily life but not by performance on cognitive tests or by a report of physical illness. Cases of MCD had higher anxiety, depression and neuroticism scores than normal elderly, but did not differ substantially on tests of cognitive functioning. These findings call into question the validity of the ICD-10 diagnosis of MCD.

Subjects who meet the criteria for an affective syndrome possibly are aetiologically heterogeneous. An approach to this possibility involves examining affectively ill subjects obtained by different methods of ascertainment. This study compares depressed and manic subjects who are related to affectively ill probands with affectively ill subjects who were obtained from a study of a control population, and, therefore, were less likely to be familial. The subjects were identified in a large collaborative study of depression where both family members as well as controls were personally interviewed and followed up for 6 years after admission to the study. Data were obtained on subtypes of affective disorder using the Research Diagnostic Criteria and information was gathered about psychiatric hospitalizations, suicide attempts, alcoholism and psychological functioning prior to admission. Similar assessments were made for the comparison groups for the 6 year period between intake and follow-up. Relatives of bipolar I/schizoaffective manic probands were more likely to show mania than affectively ill controls or relatives of unipolar/schizoaffective depressed probands. Affectively ill controls were less likely to be hospitalized and less likely to suffer from an incapacitating depression. They were also likely to have functioned in a more healthy fashion than the affectively ill relatives of the bipolars and unipolars, in the 5 years before admission to the study. In the 6 year follow-up, both the subjects themselves and raters assessed the depressed controls as functioning better than the affectively ill relatives of the probands. Further, assessment of global adjustment during the 6 year period was worse for the relatives of affectively ill probands than for the depressed controls. Length of major depression was longer in relatives of bipolar and unipolar probands than in controls. Though all of the subjects in this study met research criteria for an affective illness, there were marked differences in the qualitative aspects of these illnesses with the relatives of affectively ill probands, who functioned less well and had longer and more severe episodes and more hospitalizations.

Abnormal patterns of cerebral hemispheric asymmetry have been inconsistently reported in association with schizophrenia. Radius of gyration (Rg) is a measure of the mean dispersion of points in a radially organized structure about that structure's centre of gravity. We developed computerized methods for estimating Rg of the magnetic resonance image (MRI) boundary between cortex and subcortex, and applied these methods to measurement of cerebral hemispheric asymmetry in 37 schizophrenics (SZs) and 30 controls (CONs). In right-handed CONs, Rg of right brain boundaries was significantly greater than Rg of left brain boundaries; in left-handed CONs, Rg of left brain boundaries was significantly greater than Rg of right brain boundaries. In right-handed males (both SZ and CON), there were significant differences in Rg between hemispheres; whereas in females (both SZ and CON) there were no such differences. Right-handed male SZs (N = 26) were distinguished by reversal of the right-handed male CON pattern of interhemispheric difference in Rg, and by global reduction in Rg of right brain boundaries. There was no evidence for significant abnormality of Rg in right-handed female SZs (N = 7). These findings suggest an important interactive effect of gender and schizophrenia on lateralized cerebral structure.

HIV infection has been associated with decline in a number of cognitive functions that are components of ‘working memory’. Thus, tests of working memory that require the interaction of these components may be particularly sensitive to cognitive dysfunction that arises from HIV infection. To assess this possibility, working memory was examined in 147 HIV-seropositive (HIV+) and 38 HIV-seronegative (HIV−) males using the Reading Span Test and the Digit Span subtest from the Wechsler Memory Scale-Revised (WMS-R). Speed of information processing, a component of some working memory tasks, was assessed with a version of the Sternberg Memory Scanning task. Results indicated that symptomatic HIV+ subjects were impaired relative to HIV− control subjects on the Reading Span and Digit Span tests. Asymptomatic and mildly symptomatic HIV+ groups exhibited a trend toward impairment on these tests, and on the whole, a greater proportion of HIV+ subjects than HIV− subjects were impaired. The groups did not differ significantly in information processing speed. These results indicate that deficits in working memory are apparent in at least a subset of HIV-infected individuals. These deficits are most apparent in symptomatic HIV+ individuals, but the decline may begin during the asymptomatic phase of infection.

We sought studies which have attempted to test whether memories of childhood sexual abuse can be repressed. Despite our broad search criteria, which excluded only unsystematic anecdotal reports, we found only four applicable studies. We then examined these studies to assess whether the investigators: (1) presented confirmatory evidence that abuse had actually occurred; and (2) demonstrated that their subjects had actually developed amnesia for the abuse. None of the four studies provided both clear confirmation of trauma and adequate documentation of amnesia in their subjects. Thus, present clinical evidence is insufficient to permit the conclusion that individuals can repress memories of childhood sexual abuse. This finding is surprising, since many writers have implied that hundreds of thousands, or even millions of persons harbour such repressed memories. In view of the widespread recent public and scientific interest in the areas of trauma and memory, it is important to investigate further whether memories of sexual abuse can be repressed.

In one of a continuing series of studies, the cognitive performance of normal weight female dieters was compared on two sessions, 3 weeks apart. Those who reported themselves as being on a weight-reducing diet on only one of the two sessions displayed poorer vigilance performance, slower reaction times and poorer immediate recall of words when they were dieting. In contrast, performance on a low processing load tapping task was unaffected. Self-report measures showed that dietary restraint, but not state anxiety or depression was increased during dieting. These results are interpreted in terms of an association between dieting behaviour and high levels of distractibility, and extend earlier findings by demonstrating that these deficits in cognitive performance are closely related to dieting or the perceived need to diet per se.

The characteristics and concurrent predictors of eating problems were identified. Ninety-seven per cent of a representative sample of Norwegian adolescents (N = 11315) completed a questionnaire containing a 12-item version of the Eating Attitudes Test (EAT) and measures of a large number of physiological, psychological and social factors previously suggested to be of aetiological importance. Social class, drug use and indicators of ‘the model child’ (high grades, high occupational aspirations and much homework) were not related to eating problems. Logistic regression analyses identified perceived obesity as the strongest associated factor, followed by gender, depression, excessive exercise and unstable self-perceptions. In addition, adopting idols with perfect bodies, body dissatisfaction, low self-worth, feminine sex-role orientation, lack of parental care, early pubertal timing, age and number of alcohol intoxications all added to the probability of eating problems. About 6% perceived themselves as obese in spite of subnormal BMI. Such misperceptions increased the risk of high scores on EAT.

There has been much debate about the exact nature and time of onset of the cognitive impairments associated with infection by the human immunodeficiency virus type 1 (HIV-1). Studies to date have not reached consistent conclusions. The present study comprised 22 asymptomatic and 18 symptomatic HIV-1 seropositive men, whose only risk factor for contraction of the virus was sexual intercourse, and 18 seronegative controls matched for age and IQ. Subjects were given computerized neuropsychological tests from the CANTAB battery, which assessed visuospatial memory, attention and executive function. Both the asymptomatic and the symptomatic HIV-1 seropositive subjects showed a selective pattern of deficits relative to the controls. In addition, the seropositive subjects were subtly but significantly impaired on tests of executive function but unimpaired on certain tests of visual memory. This finding supports an hypothesis that frontostriatal dysfunction occurs in HIV-1 infected individuals prior even to the expression of clinical symptoms.

It is now beyond question that the symptoms observed in schizophrenia include a range of cognitive neuropsychological deficits that may be more enduring than psychotic symptoms (Cassens et al. 1990; Goldberg et al. 1993) Goldberg et al. (1993) found that a group of patients treated with clozapine whose psychotic symptoms improved significantly over a 15 month study period showed no improvement in cognitive impairments. He argued that the enduring cognitive deficits are responsible for failure of patients to rehabilitate socially even when psychotic symptoms are in remission. Clearly an understanding of neuropsychological deficits is Important from a clinical as well as a theoretical viewpoint. There is, however, still much debate about the nature of these deficits and how they related to the psychotic symptoms of schizophrenia and also to the neurobiological substrate of this disorder.