The age-specific lifetime prevalence rate of a disease is the proportion of persons surviving to a given age who have experienced the disease at any time during their lives. This measure of morbidity has been used to report findings in many of the epidemiological surveys of mental disorders of the last 30 years. This paper presents a life-table method for estimating age-specific lifetime prevalence rates from incidence and mortality data. The method is applied to Monroe County, New York, case register data on the incidence of schizophrenia. Using this method, we estimate that at least 3% of the White population surviving to age 55 have experienced an episode of schizophrenia at some time during their lives. The difficulties of producing valid estimates of lifetime prevalence and the difficulties in interpreting differences reported in such rates make this morbidity measure of secondary importance to incidence and point-prevalence data.

Neuroendocrine tests are now available for studying monoamine function in the brains of patients with mental illness. Great care is required in the selection of drugs which act upon specific monoamine receptors to produce specific hormonal responses. Equal care is required in the control of biological variables which may influence hormonal release.

Recently reported neuroendocrine studies of depressive illness are assessed in these terms. The results of these studies support the hypothesis that there is defective noradrenergic function in the brains of some patients with depressive illness.

Blood pressure levels as recorded in a community-wide screening programme were compared with findings in an earlier mental health study for persons who participated in both programmes. Blood pressure was not related to previously ascertained psychosocial characteristics among persons who were not under treatment for hypertension, suggesting that depression, hostility, psychosomatic reactions to stress, or the felt need for help with emotional problems were not important in the pathogenesis of hypertension. Treatment for hypertension, however, was associated with an excess of psychosomatic symptoms, a factor which needs to be taken into account in assessing the benefits of treatment.

A population of professional dance (N = 183) and modelling (N = 56) students, who by career choice must focus increased attention and control over their body shapes, was studied. Height and weight data were obtained on all subjects. In addition, a questionnaire that is useful in assessing the symptoms of anorexia nervosa, the Eating Attitudes Test (EAT), was administered. Results of these tests were compared with those of normal female university students (N = 59), patients with anorexia nervosa (N = 68), and music students (N = 35).

Anorexia nervosa and excessive dieting concerns were overrepresented in the dance and modelling students. Twelve cases (6·5%) of primary anexoria nervosa were detected in the dance group. All but one case developed the disorder while studying dance. Within the dance group those from the most competitive environments had the greatest frequency of anorexia nervosa. These data suggest that both pressures to be slim and achievement expectations are risk factors in the development of anorexia nervosa. The influence of socio-cultural determinants are discussed within the context of anorexia nervosa as a multidetermined disorder.

The mechanisms responsible for the production of major extrapyramidal side-effects (parkinsonism, akathisia, acute dystonic reactions, chronic tardive dyskinesias) are reviewed in the light of the complex effects of these drugs on cerebral dopamine systems.

Forty-four young adults, admitted to a rehabilitation centre after very severe head injury, were followed-up 2 years after their accident. Comparison with a control group showed that the head injured had experienced marked changes in work, leisure activities, contact with friends and family life. Though these changes still created problems, the majority of patients and relatives appeared to have made a number of successful adaptations to their altered situation. Neurophysical status, personality change and memory loss all affected work capacity, while presence of personality changes was especially important in the loss of pre-accident friendships.

The application of Piaget's genetic psychology tests to schizophrenic patients yielded the following findings. The intelligence quotient of schizophrenics, although within the normal range, is slightly lower than that of a control population of similar age. This is due not to a loss of the operations of the intellect, but to a difficulty experienced by the patients in actualizing the operations. The difficulty is seen particularly in operations dealing with specific objects which require a constant maintenance of the equilibrium between assimilation and accommodation. The thought processes of hebephrenic patients oscillate between excessive assimilation, resulting in a distortion of observable data, and excessive accommodation which by adhering to the observable data distorts the reasoning process. The thought processes of paranoid schizophrenics are dominated by excessive assimilation. This predominance explains their tendency to distort observable data and their difficulty in the generalization of reasoning; it also has an impact on the assimilation/accommodation equilibrium of their logical operations, leading to (a) difficulties in delimiting reflecting abstractions, and therefore the comprehension and extension of concepts, and (b) loss of proof based on logico-mathematical reasoning and, as a result, a propensity to resort to magical thinking and subjective explanations.

A survey was made of studies reporting population prevalence rates for the different types of neurotic disorders in order to determine the utility of these rates for familial and genetic research. Rates varied considerably among studies both for all neuroses and for particular types of neuroses, even among studies using similar methods examining similar populations. The method of case ascertainment (personal interview versus record searches) and the threshold for defining an individual as affected are important contributors to variation. The use of the published prevalence rates for quantifying familial and genetic effects on the neurotic disorders would be premature.

The diagnoses were reviewed of 866 women interviewed in 5 community surveys carried out by the Bedford College team. The diagnoses matched commonly held conceptions of who is a case in terms of both severity and type of syndrome. Two methods of replicating the diagnoses are presented, one based on discriminant function analysis and the other based on a simple checklist.

A study of 32 patients meeting criteria for ‘schizomanic’ psychosis is described. These psychoses account for about 1 % of hospital admissions. Very few first-degree relatives had either schizophrenia or mania. Lithium seemed an effective treatment. Twenty-four patients made a full recovery, and the series as a whole was closer to manic depressive psychosis than schizophrenia on all outcome measures. Some diagnostic clues are suggested to help the clinician to recognize the patients with a poor prognosis.

These findings are in line with other studies, and suggest that most of these patients should be regarded as manic. This conclusion should lead to some revision of present ideas on the incidence and diagnosis of mania.

A multiple criterion screen was developed as part of a study which was designed to assess different types of intervention for school children with psychiatric disorder. The foremost requirement was that false positives be kept to a minimum, with selected children being unequivocally disturbed. Children were identified for treatment by the following measures: (a) teacher rating on the Rutter B2 Scale, giving a total score and subscores for neurotic and antisocial behaviour; (b) peer ratings on a sociometric measure, yielding isolation and rejection scores; and (c) self ratings on the Junior Eysenck Personality Inventory, specifically the neuroticism dimension. A weighting system was developed so that children could be selected on the basis of extreme scores on either teacher or self-rating measures alone, or by a combination of less extreme scores on more than one measure. The results are presented and discussed.

Family history, response to treatment and outcome are reported in a series of 76 patients presenting with both depression and schizophrenic or paranoid symptoms. About 10% of psychotic admissions to the Maudsley and Bethlem Royal Hospitals met a study definition of ‘schizodepressive’ illness. The patients were highly heterogeneous in history, clinical picture and outcome. Many followed a typical schizophrenic course, and others a typical course for affective disorders, but only 4 were given a final diagnosis of manic depressive disease. The best predictors of poor outcome were a mode of onset as an exacerbation of previous psychotic symptoms and the presence of schizophrenic symptoms at some time without depression. The best predictors of good outcome were Stephens' criteria of good prognosis schizophrenia and Kasanin's concept of ‘acute schizo-affective psychosis’. These findings are not easily reconciled with Kraepelin's two entities principle but suggest a continuum of outcome between schizophrenia and unipolar depressive psychosis.

Twenty-two boys with schizoid personality were followed-up some 10 years later and compared with a matched control group with other diagnoses who had been referred to the same child psychiatry department. The diagnostic category is shown to have predictive validity. A start has been made towards an operational definition of the syndrome.

A family of 6 affectively ill siblings is described. Two suffered from bipolar illnesses, 2 from recurrent unipolar illness, and the remainder showed alcoholism, depression and schizo-affective disorder. HLA typing revealed that all the tested members shared the antigens A3 and B7. Because only ill members were available for testing, there was insufficient information in the family to draw any definite conclusion as to whether these antigens were linked to the illness. However, the observation is of some interest in the light of other recent reports which have suggested that these 2 antigens are associated with affective disorder.

Principal component analysis was applied to data relating to depressive experiences collected from a general population sample. The structure of depression found in the general population showed strong similarities to that found in the psychiatric population. There were, however, important differences. Four substantial syndromes of depression were identified: ‘anxiety depression’, ‘cognitive depression’, ‘vegetative depression’ and depression characterized by the classic endogenous triad of diurnal variations, early wakening, and weight loss. These syndromes were essentially independent for this sample. Examination of component score distributions suggested that people simultaneously experience differing degrees of each syndrome. It was concluded that depression was most parsimoniously classified in dimensional rather than categorical terms within this sample.

Twenty-nine published ward rating scales for long-stay psychiatric patients are reviewed according to a standard set of criteria. Attention is paid to details of the rating setting, the rating procedure, and scale construction and evaluation, and some detailed recommendations are made. Only 4 scales meet a subset of 5 minimal criteria.

A domiciliary survey (sample size circa 6000) was conducted in areas of different aircraft exposure affected by London (Heathrow) Airport. Respondents were urban dwellers age 16+. Since no differences were found in the prevalence of manifest psychiatric disorders, the frequency of 27 individual acute and chronic symptoms was investigated. Many acute symptoms showed an increase with noise, and this was particularly evident for waking at night, irritability, depression, difficulty in getting to sleep, swollen ankles, burns/cuts/minor accidents, and skin troubles. Two chronic symptoms, tinnitus and ear problems, showed evidence of an increase with noise, while most chronic symptoms were more common in low noise conditions. Results are controlled for the effects of age, sex and other standard epidemiological variables. Irrespective of their association with noise, most symptoms, chronic and acute, were more frequent among those respondents who also reported high annoyance. Suggestions for the analysis of surveys of health effects by noise are put forward.

Psychiatric epidemiology has advanced considerably since early studies of hospital populations. The direction of this advance has been away from the study of populations of hospital psychiatric patients towards the study of psychiatric disorder in general practice and the community as a whole. Just as the populations under study have different defining characteristics, so have the individuals who comprise them. Psychosis becomes less and less common at greater distances from the hospital patient, and in the community the epidemiologist is faced with large numbers of respondents who present with fewer, minor and non-specific symptoms.

In this review, we present evidence to indicate that concepts of case definition and case identification are insufficiently advanced so far, and are still rooted in ideas derived from hospital psychiatry. Foremost among these is an exclusive preoccupation with diagnosis and symptoms. We suggest that this may be inadequate for the study of non-psychotic disturbance in the community, and discuss other models of case definition, encompassing personality and social functioning as well as psychiatric symptomatology.

The authors review the evidence that parental death in childhood predisposes to depressive disorders in later life. The findings in general are quite inconsistent; this is due in part to the methodological limitations of most studies, principally that of inadequate control of potentially confounding variables. Where experimental and control samples were most rigorously matched, no association was found between childhood parental bereavement and depression in later life. Parental death in childhood appears to have little effect on adult depressive morbidity.

In-patient data show high rates for mental illness in the Republic of Ireland, particularly for schizophrenia. ‘One-day prevalence’ figures from the Three County psychiatric case register have been compared with similar data from the Camberwell register. The results confirm much higher contact rates in Ireland.