Cholesterol plays an important part in cellular structure and function and changes in serum levels may affect neurotransmission in the central nervous system.

A medline literature search was made covering the period 1990–95 with systematic searching of citations from the articles identified. Representative articles were selected, focusing on those aspects which had not been thoroughly reviewed elsewhere, namely suicidal ideation, depression, personality and schizophrenia.

Lowering cholesterol levels have been associated with an increase in violent deaths in cardiovascular primary prevention studies. However, altered cholesterol levels have also been reported in relation to other psychiatric disorders.

There is substantial evidence that serum cholesterol levels may be associated with variations in mental state or personality. Further work is needed to clarify this and to elucidate the mechanisms involved.

In this first investigation of motor function in schizophrenia using transcranial magnetic stimulation (TMS), the general hypothesis tested was that this methodology could be used to investigate the disruption of corticospinal inhibitory processes suggested by cognitive and psychophysiological paradigms.

Nine drug-free DSM–IV schizophrenic patients were compared with nine age- and sex-matched normal subjects. Electromyographic (EMG) recordings were made from the thenar muscles of the dominant hand during sustained, weak voluntary contraction. TMS over a particular threshold applied to the motor cortex would elicit a compound motor evoked potential (cMEP) followed by a period of suppression of EMG.

The latency of cMEPs following TMS was significantly shorter in the schizophrenic patients. The two groups did not differ significantly with respect to mean latency of suppression of EMG activity, or stimulus thresholds for either cMEPs or EMG suppression.

These findings could be the result of a relative lack of corticospinal inhibition of motor responses; a change in the site of TMS activation; or an abnormality of peripheral nervous function in schizophrenia. Drug effects were unlikely since seven of the patients were drug-naïve.

The determinants of self-esteem have been little studied in non-clinic samples. It has been suggested recently that child sexual abuse (CSA) may be a major determinant of low self-esteem in adulthood.

The psychosocial circumstances associated with low self-esteem in two random samples of women, one reporting CSA, the other not were compared, with particular emphasis on characteristics of family of origin. A two-phase (postal-then-interview) random community study assessed self-esteem and related variables.

Psychosocial variables predicting low self-esteem were the same in the two groups. They included being a follower or a loner, having an overcontrolling mother, being poorly qualified, giving a history of depressive disorder and displaying current psychiatric disorder. In addition, the subject's CSA status led to low self-esteem but only when it was of the most intrusive type. The CSA women had a substantially lower mean total self-esteem score. However, not all aspects of self-esteem were diminished equally; 12/30 items differed between the two groups, and two of the five generated self-esteem factors, which we named Pessimism and Fatalism, which differed between the control group and the whole CSA group. There were no differences for Likeability and Determination.

Predictors of low self-esteem for women include childhood temperament, a poor relationship with the mother, low qualification attainment, psychiatric morbidity, both previous and current, and, only when it is the most intrusive, CSA.

An epidemiological study of anorexia nervosa and bulimia nervosa in primary care was performed using the General Practice Research Database (GPRD).

The GPRD was screened between 1988 and 1994 for newly diagnosed cases of anorexia nervosa and bulimia nervosa. The validity of the computer diagnosis was established by obtaining clinical details from a random sample of the general practitioners (GPs).

Incidence rates for detection of cases by GPs in 1993 was 4.2 per 100 000 population for anorexia nervosa and 12.2 per 100 000 for bulimia nervosa The relative risks of females to males was 40:1 for anorexia nervosa and 47:1 for bulimia nervosa A threefold increase in the recording of bulimia nervosa was found from 1988 to 1993. Eighty per cent of anorexia nervosa cases and 60% of bulimia nervosa cases were referred to secondary care.

There is a continuing expansion of service need for bulimia nervosa The majority of cases of eating disorders are referred to secondary services. There is scope for more effective management of bulimia nervosa in primary care.

This study is a three-month follow-up study in order to assess the short-term impact of traumatic stress among 53 Swedish survivors of the Estonia disaster.

A questionnaire consisting of general questions about conditions during and after the disaster and self-assessment by Post Traumatic Symptom Scale (PTSS–10), Impact of Event Scale (IES), Sense of Coherence–short version (SoC–12), and the DSM–IV list of dissociative symptoms of Acute Stress Disorder formulated as questions regarding individual reactions was distributed.

The response rate was 79.2% (n=42). The participants scored an average of 3.9 on PTSS–10, 28.5 on IES (‘intrusion’ and ‘avoidance’ subscales) and 62.8 on SoC–12, which shows elevated levels of post-traumatic stress reactions but a normal level of sense of coherence. The reported occurrence of dissociative symptoms during the disaster was as follows: emotional numbing in 43% of the survivors, reduction of awareness in 55%, derealisation in 67%, depersonalisation in 33%, and dissociative amnesia in 29%. Survivors scoring low in SoC scored significantly higher in both PTSS–10 and IES than those with high scores in SoC. All dissociative symptoms were predictive of post-traumatic reactions.

This study substantiates the importance of assessing dissociative symptoms during a life-threatening event as a possible predictor for later post-traumatic reactions and possible PTSD. The Sense of Coherence Scale may be useful as an instrument to sort out survivors at risk.

The purpose of this study was to investigate patterns of mental disorders comorbid with PTSD symptoms in young Israeli men exposed to combat.

Six hundred and seventeen subjects were selected via a general population sample and evaluated in a two-phase case-identification procedure, culminating in a modified SADS–L interview, administered by psychiatrists.

Major depressive disorder (OR=3.2), substance use disorders (OR=1.9) and personality disorders (OR=3.0) occurred more frequently in men reporting symptoms of PTSD than in men who had been under fire who did not report symptoms. With the possible exception of personality disorders, comorbid disorders did not constitute risk factors for PTSD. Comorbid PTSD and RDC disorders were associated with increased help-seeking.

The results suggest similar rates and types of PTSD comorbidity in Israeli war veterans as in veterans in the US assessed in general population studies, and are consistent with shared risk factors for PTSD and comorbid disorders.

Refugees have long been considered at risk for mental disorder. We sought to characterise this risk in an out-patient refugee sample by analysing the relationship between psychiatric symptoms and dysfunction, and between symptoms and the socio-demographic background and stressors specific to this refugee sample.

A consecutive sample of 231 refugee patients referred to the psychiatric out-patient unit at the Psychosocial Centre for Refugees, University of Oslo, was examined with a semi-structured interview guide, Brief Psychiatric Rating Scale (BPRS), Hopkins Symptom Check-List (HSCL-25) and a check-list for post-traumatic symptoms (PTSS-10). Global Assessment of Function (GAF) scores were obtained; and the data were analysed using nine predictor variables.

It was found that 46.6% of the patients had a post-traumatic stress disorder according to the criteria for DSM–III–R as the main diagnosis, while the mean GAF score for the patients was 57.3. Analysis of the GAF and BPRS data did not reveal any predictor of psychotic behaviour. However, torture emerged as an important predictor of emotional withdrawal/retardation. Also, age, gender and no employment or education predicted for anxiety/depression, while refugee status and no employment or school predicted for hostility/aggression.

The results confirm earlier findings that refugees constitute a population at risk for mental disorder. Past traumatic stressors and current existence in exile constitute independent risk factors. However, stressors other than those discussed here appear to be important also, particularly with regard to psychotic symptoms.

In the past psychiatric in-patients suffered increased cardiovascular and respiratory mortality. The present study investigated whether increased risks persist among patients in the community and are being addressed in general practice.

A survey of 101 long-term mentally ill adults in 16 general practices in the South Thames (West) Region.

Twenty-six patients were found to be obese (body mass index > 30 kg/m2), 53 were current smokers and 11 were hypertensive (mean systolic blood pressure > 160 mmHg or mean diastolic blood pressure > 100 mmHg, or both). Twenty-one reported daily cough and sputum, 24 shortness of breath, 11 wheezing and seven chest pain on exertion. These rates were significantly higher than population rates in a contemporary national survey. Nearly all the risk factors were recorded in the general practice records but few attempts to intervene were apparent.

Long-term mentally ill patients remain at increased risk of cardiovascular and respiratory problems in the community. Primary care teams should make special efforts to tackle risk factors among this group.

Women take sick-leave more often than men, both in general and because of psychiatric disorders. The aim of the present study was to introduce the new dimension of sick-leave duration in the analysis of gender differences in minor psychiatric disorders.

A population-based register was used which included all sick-leave spells exceeding seven consecutive days, 1985–1987, in a Swedish county.

Sick-leave duration was longer for men. The greatest gender differences were found in the youngest and oldest age-groups. Women had higher incidence also in the longest spells. An increase in duration over the three years was found among women, leading to decreased gender differences.

Contrary to other studies on minor psychiatric disorders, small gender differences were found. It is suggested that sick-leave duration can be used as a quantitative measure of health-related working capacity.

Identifying predictors of treatment outcome can suggest ways to improve treatment delivery and understanding of its mechanism of action.

Predictors of treatment outcome were sought among 46 out-patients with obsessive–compulsive disorder who completed a nine-week randomised controlled trial of two forms of exposure therapy with ritual prevention.

In both exposure conditions the best predictor of good outcome at the end of treatment (week 9) and of follow-up (week 32) was early compliance in doing exposure homework within a week of starting treatment. A weaker predictor of good outcome at follow-up was within-session reduction in anxiety from weeks 0 to 4.

The strongest and most consistent predictor of better outcome to weeks 9 and 32 was compliance with exposure and ritual prevention in the first week of treatment.

Secondary depression is common among primary alcoholics. However, its aetiology is poorly understood.

Forty men with primary alcoholism, abstinent for two weeks or more, with a secondary major depressive episode were compared with forty matched never-depressed primary alcoholic controls for risk factors for depression and recent life events.

In the six months before the onset of depression depressed alcoholics had experienced significantly more life events, more life events with negative impact more dependent events caused by alcohol, and more independent events. Significantly more depressed alcoholics than controls had a family history of depression, a family history of suicidal behaviour and had themselves attempted suicide.

Having recent life events, particularly events with negative impact, and a family history of depression are risk factors for secondary depression in alcoholics.

The mechanism of the antidepressant action of electroconvulsive therapy (ECT) remains unknown. Based on previous work with antidepressant drugs and their effects on the noradrenergic system, we undertook this study to further determine the effects of ECT on selected indices of peripheral adrenoceptor function in depressed patients.

Binding parameters (Bmax and Kd) of platelet α2- and leukocyte β2-adrenoceptors, plasma noradrenaline (NA), 3-methoxy-4-hydroxy-phenylglycol (MHPG) and cortisol levels were determined in 18 patients, prior to treatment and 14 days after the last of a series of ECTs, and compared with samples obtained from 18 matched control subjects.

Platelet α2-adrenoceptor sites were significantly elevated in untreated patients compared with controls (P < 0.03), but leukocyte β2-adrenoceptor numbers did not differ. Treatment with ECT led to a significant reduction in platelet α2-adrenoceptor numbers, whereas leukocyte β2-adrenoceptor densities increased. Pre-ECT plasma NA, MHPG, and cortisol levels were elevated in patients, compared with controls, and decreased following ECT, but these differences were not statistically significant. Post-ECT plasma NA and β2-adrenoceptor numbers were significantly, negatively correlated (P < 0.05).

These results suggest that platelet α2-adrenoceptors are supersensitive in depressed patients and treatment with ECT results in down-regulation of these receptors, which may be interpreted as a primary therapeutic, ‘normalising’ effect. The post-ECT changes in leukocyte β2-adrenoceptors are probably only secondary to the lower circulating plasma NA levels.

Schizophrenia is associated with expanded CAG/CTG trinucleotide repeats. We wished to determine whether the presence of such expansions correlated with specific subsyndromes or other clinical features of schizophrenia.

Seventy patients from England and Wales and 44 patients from Portugal with a DSM–III–R diagnosis of schizophrenia were rated on the opcrit checklist Patients' maximum CAG/CTG repeat length was measured using repeat expansion detection (RED). Significant differences were sought for repeat lengths in subjects categorised according to dimensional and categorical schizophrenia subsyndromes, affective episodes, individual symptoms, and a range of demographic variables.

Maximum CAG/CTG repeat length did not differ significantly for any of the clinical or demographic variables studied.

There are no subsyndromes or other clinical features of schizophrenia associated with CAG/CTG repeat expansion. Therefore, the identification of the gene(s) that contain expanded CAG/CTG repeats and which are associated with schizophrenia is unlikely to be facilitated at present by using any subsyndromes of schizophrenia as phenotypes.

It has previously been reported that births of individuals who later develop schizophrenia vary by birth year.

Birth data were analysed on 34 024 individuals diagnosed with DSM–III–R disorganised, catatonic, and undifferentiated schizophrenia using time series analysis.

Minor yearly fluctuations were observed but did not achieve statistical significance. Thus earlier findings reported in the literature could not be replicated using a different statistical approach.

The findings do not support theories which assume major yearly fluctuations in the births of individuals with schizophrenia. Such theories include the perinatal effects of influenza, temperature variation, and the effects of severe weather.

The high rate of schizophrenia among the second-generation African–Caribbean population in Britain has prompted much concern and speculation. Sugarman and Craufurd have reported that the morbid risk in the siblings of second-generation African–Caribbean schizophrenic patients was unusually high compared with that of the siblings of White patients.

We sought to replicate these findings by comparing the morbid risk for schizophrenia in the first-degree relatives of 111 White and 73 African–Caribbean psychotic probands. The latter comprised 35 first-generation (bom in the Caribbean) and 38 second-generation (born in Britain) probands.

The morbid risk for schizophrenia was similar for the parents and siblings of White and first-generation African–Caribbean patients, and for the parents of the second-generation African–Caribbean probands. However, the siblings of second-generation African–Caribbean psychotic probands had a morbid risk for schizophrenia that was seven times that of their White counterparts (P=0.007); similarly, the siblings of second-generation African–Caribbean schizophrenic probands had a morbid risk for schizophrenia that was four times that of their White counterparts (P=0.05).

These findings replicate those of the earlier report of Sugarman and Craufurd, and suggest either that the second-generation African–Caribbean population in Britain is particularly vulnerable to some environmental risk factors for schizophrenia, or that some environmental factors act selectively on this population in Britain.

Despite 30 years of research, some surprisingly fundamental gaps remain in our understanding of schizophrenic input dysfunctions.

In a provisional test of a ‘hyperattention’ hypothesis, schizophrenic patients and control subjects performed a behavioural test that was adapted from a paradigm originally developed for characterising vigilance or sustained attention in animals. On this computerised operant testing procedure, subjects discriminated between signals of various salience and non-signal presentations. Hits and correct rejections resulted in monetary rewards while misses and false alarms entailed monetary costs.

Data from in-patients with schizophrenia and age, education and gender-matched controls support hypotheses not only about hyperattentional dysfunctions in schizophrenia with respect to overall signal detectability but also in terms of resistance to the vigilance decrement that normally occurs over trials.

The theoretical importance of impairments of this sort are discussed with respect to the cognitive and perceptual consequences of hypervigilance and ‘input dysfunction’.