We compared three groups of patients with panic disorder, generalised anxiety disorder and major depressive episode with a control group. Methods of comparison included a clinical profile of the patients, assessed by the Arabic version of the Present State Examination (PSE), a psychological battery of tests measuring personality traits and depressive and anxiety states, and the dexamethasone suppression test (DST) as a biological marker. Our data showed that psychological assessment and DST did not significantly differentiate between the three disorders. Despite a symptom overlap between the disorders, however, some symptoms were associated significantly more often with one disorder than another. Patients with panic disorder differed from patients with major depressive episode in showing more situational, avoidance and free floating anxiety, and more anxious foreboding. They showed less self-negligence, ideas of guilt, early awakening and social withdrawal. Compared with patients with generalised anxiety disorder, patients with panic disorder showed more loss of interest and muscle tension and less anxious foreboding, restlessness, inefficient thinking, social withdrawal and delayed sleep. Our conclusion is that the clinical course and the symptom profile of panic disorder justifies its existence as an independent diagnostic category.

Sixty surviving patients from a community-based stroke register who had computerised tomography (CT) scan evidence of a single brain lesion were interviewed three to five years after their first ever stroke. Depression (DSM–III–R major depression, partially resolved major depression, and dysthymia) was present in 11 (18%) of the patients and was associated with impaired physical and cognitive functioning, greater age, residence in an institution, absence of a close personal relationship, and larger original brain lesion. Of these variables, only functional dependence (odds ratio 16.4; confidence interval 1.6–170), larger lesion volume (6.6; 1–50), and female sex (8; 1.1–56) remained significantly associated with depression after controlling for all other variables. We conclude that depression in long-term survivors of stroke has many of the same associations as depression in non-stroke elderly populations. Depression in long-term stroke survivors may also be associated with larger original brain lesions, although this requires confirmation in a prospective study.

“Study objective - The aim was to examine why differences exist in schizophrenia prevalence and risk in some areas of Croatia, when schizophrenia incidence rates do not appear to vary. Design - Areas differing by schizophrenia admission rates in patients born in 1953 and admitted by the age of 31 years are compared using a number of indicators relating both to general population characteristics and to those of schizophrenic cases in these populations. Setting - The study covers the whole of Croatia (4 601 469 inhabitants, 1981 census). Subjects - By the age of 31 years, out of 80 445 individuals born in Croatia in 1953, 464 were admitted for and diagnosed as having schizophrenia. Main results - Admission risk rates are higher in those parts of Croatia where emigration rates are high and lower where immigration rates are high. There is also a positive correlation with schizophrenia prevalence and manic depressive psychosis rates. There is a negative correlation with age of onset of schizophrenia and with schizophrenic reproduction rates. In the study areas, hospital incidence rates are not significantly different. Conclusions - Economic migration and negative selection in the domestic population are likely to be the most significant factors leading to differences in schizophrenia prevalence. The approximately equal incidence rates in the population, with different prevalence and admission risks, are linked to differences in the disease onset among schizophrenics with a positive family history for this condition. In other words, these patients, when part of the population with a greater prevalence and a greater hereditary loading, experience the onset more often at an earlier age. Thus they have a lower reproduction rate than in a population with a lower prevalence and a lower hereditary loading. Thus incidence rates in populations with different prevalences and different hereditary loads are maintained roughly equal over generations.”

We tested the hypothesis that second-trimester exposure to influenza is a risk factor for schizophrenia in the child. The dates of birth of Dutch schizophrenic in-patients were examined for any effect of the 1957 A2 influenza epidemic. Individuals who were in their second trimester of foetal life at the peak of the epidemic were at no greater risk of developing schizophrenia than controls. As the present study has a larger sample size than all previous European studies, and is supported by a large study in the USA, it provides strong evidence against the hypothesis that second-trimester exposure to influenza is a risk factor for schizophrenia.

“Nature, in the production of diseases, is uniform and consistent; so much so, that for the same disease in different persons the symptoms are for the most part the same; and the self-same phenomena that you could observe in the sickness of a Socrates you would observe in the sickness of a simpleton. Just so the universal characters of a plant are extending to every individual of the species; and whoever (I speak in the way of illustration) should accurately describe the colour, the taste, the smell, the figure, etc. of the single violet would find that his description held good, there or thereabout, for all the violets of that particular species upon the face of the earth.”

This paper presents an approach to estimating the prevalence of cocaine use, based upon a new ratio estimation technique. This method can be applied to random samples of overlapping populations for which no sampling frames exist. When the ratio estimation method is applied to the two study samples (drawn from populations of people using cocaine and people using heroin) the ratio of cocaine users to heroin users (C/H) was 1.55, with a 95% confidence interval of ±0.48. Such estimates should be applied with caution. However, if used with reference to national estimates of about 75 000 heroin users, application of the present estimate suggests that there may be about 116 000 cocaine users in the UK.

About 10% of women show elation and associated features of hypomania in the first 5 days following childbirth. These symptoms can be detected using a self-rating scale (the ‘Highs’) based on SADS-L criteria. This phenomenon has been confirmed using the observer-rated Comprehensive Psychopathological Rating Scale, which also revealed a high degree of related irritability. Significantly more women scoring ⩾ 8 on the Highs scale at 3 days postpartum went on to manifest depression at 6 weeks than did subjects with no psychopathology in the early puerperium. It is suggested that the ‘highs’ followed by depression may be a mild and common form of bipolar disorder.

The paper describes a study based on the Nordic multi-centre research project NIPS. In the Norwegian part, based on one-year screening and sampling of all new schizophrenic cases in a catchment area in Oslo, patients and therapists were interviewed after 2–3 years. Some patients seemed to have played a much more active part in establishing and breaking therapeutic contacts and in setting the terms for the relationship than is usually acknowledged. In the interviews at five-year follow-up, many patients produced viewpoints on their psychotherapeutic experiences that seem to be very important in relation to therapy.

“Assessment of the physiological effects of physical and emotional stress has been hampered by a lack of suitable laboratory techniques. Since hypnosis can be used safely to induce specific emotional states of considerable intensity, we studied the effect on distal colonic motility of three hypnotically induced emotions (excitement, anger, and happiness) in 18 patients aged 20–48 years with irritable bowel syndrome. Colonic motility index was reduced by hypnosis on its own (mean change 19.1; 95% CI 0.8, 37.3; P < 0.05) and this change was accompanied by decreases in both pulse (12; 8, 15) and respiration (6; 4, 8) rates (P < 0.001 for both). Anger and excitement increased the colonic motility index (50.8; 29.4, 72.2; and 30.4; 8.9, 51.9, respectively; P < 0.01 for both), pulse rate (26; 22, 30; and 28; 24, 32; P < 0.001 for both), and respiration rate (14; 12, 16; and 12; 10, 14; P < 0.001 for both). Happiness further reduced colonic motility although not significantly from that observed during hypnosis alone. Changes in motility were mainly due to alterations in rate than in amplitude of contractions. Our results indicate that hypnosis may help in the investigation of the effects of emotion on physiological functions; this approach could be useful outside the gastrointestinal system. Our observation that hypnosis strikingly reduces fasting colonic motility may partly explain the beneficial effects of this form of therapy in functional bowel disorders.”

This study investigates sex differences in patterns of drug taking and related injecting and sexual behaviour among 355 patients attending a London community drug team. The majority of cases attending the service presented with heroin problems. Men were more likely to use heroin by injection and women were more likely to use heroin by inhaling/smoking (‘chasing the dragon’); there was no sex difference in the overall incidence of needle sharing. The delay between first use of the problem drug and first presentation to services was the same for both men and women. Women were more likely to have a sexual partner who was a drug user and to be living with another user than men. This closer social attachment to other drug users was seen as presenting a high risk factor for women with regard to prognosis and treatment.

Prescription-event monitoring (PEM) is one of two national systems of drug safety monitoring practised in Britain. The objective of this PEM study was to assess the safety of fluvoxamine and to monitor the occurrence of untoward and other events during treatment. A total of 10 401 patients treated with the drug in general practices throughout England were studied and data were analysed in the Drug Safety Research Unit, Southampton. The main outcome measures were the overall incidence of events per 1000 patients; the incidence during the first month of treatment; the mean incidence for months 2–6 of treatment; and the ratio of these rates as a signal that an event could be drug related. The most commonly reported category of events was neuropsychiatric while the most commonly reported individual events were nausea and vomiting. Fluvoxamine was shown to be a safe drug and no unexpected or previously undetected drug-related events were encountered. There was a relatively high incidence of gastro-intestinal symptoms, but other adverse reactions often encountered during treatment with tricyclic antidepressants were not frequently reported.

A prospective study was undertaken of physical assaults over six months in a newly opened psychiatric intensive care unit. There were 58 admissions of 48 patients, and 37 assaults, three against other patients, and 34 against nursing and medical staff. Features which correlated with committing assault were a criminal record and previous drug abuse. Assaults occurred most frequently during the week, at times when staff were actively involved with the patients.

Ninety-six people of pensionable age from an inner-London electoral ward who had been identified by short-CARE screening as having ‘probable pervasive depression’ were interviewed further to ascertain their GMS-AGECAT and self-CARE status, comorbid features, and current primary-care psychiatric management. Estimated incidence rates of 30.8 per 1000 per year for ‘probable pervasive depression’ and 15.4 per 1000 per year for GMS diagnostic depression were calculated using results from a short-CARE screen in 1988. Among GMS diagnostic depression cases, anxiety was the major psychiatric comorbid feature (95%) and organic features were uncommon (8.4%). Of 66 self-CARE cases, 48 (73%) were also GMS–AGECAT cases; of 24 self-CARE non-cases, 15 (62.5%) were not GMS–AGECAT cases. Among subjects who had ‘probable pervasive depression’, 38% said that they had declared their symptoms to their general practitioner. Only 14% of subjects were prescribed antidepressants; 24% were prescribed hypnotics. Half the GMS–AGECAT-case subjects who stated that they had declared to their general practitioner were on specific therapy. Screening for depression and health education aimed at increasing psychological declaration are seen as ways forward in the management of this depression.

We report five cases of delusions of pregnancy of whom three were women and four had chronic schizophrenia. We draw the attention of clinicians to this symptom which is not as rare as has previously been thought.

This study investigates whether there is any difference in the month of birth between people with schizophrenia and controls in Korea. When 1606 patients with schizophrenia were compared with 4582 age- and sex-matched controls, there was no statistically significant difference in the month of birth, the season of birth of schizophrenic patients was not related to sex, family history or handedness.

The construction of a semi-structured interview depression scale that is sensitive to change for use in the elderly is described. Depression items from a well validated diagnostic instrument, the Geriatric Mental State Schedule (GMSS), were used as the core items in the development of the instrument. Improvement in depression in 80 elderly patients was independently assessed with two standard rating scales for depression, the Hamilton Rating Scale for Depression and the Beck Depression Inventory, and by an independent clinician's judgement before and after standard antidepressant treatment. Depression items that were sensitive to change were retained from the core items to form the new instrument. Results indicate that this scale is reliable and valid, shows better correlation with both the clinician's and the patient's judgement of improvement than the standard instruments, and is sparing of the rater's time.

Data were analysed from 62 schizophrenic patients between 18 and 30 years of age, treated at the community mental health centres in Navarra, who had relapsed and then completed a one-year follow-up study. Factors influencing the course of illness during follow-up were: continuing cannabis consumption; previous cannabis intake; non-compliance with treatment; and stress.

This hypothesis-generating study had the objective of dissecting the process of psychiatric care in an attempt to understand outcomes for patients and their families. In all, 24 patients who carried a DSM–III diagnosis of major affective disorder were identified 12–18 months after hospital admission. The patients, their families, and their doctors were interviewed using instruments measuring delivery of treatment and achievement of treatment goals; findings were then correlated with resolution of the index episode and patient global outcome. Delivery of patient and family psychoeducation was associated with better resolution of the index episode and better global outcome.

Need-adapted treatment of schizophrenia is an integrative treatment model developed in the Turku Schizophrenia Project. It is based on the interactional viewpoint and understanding on the interactional level. Experience of family and network therapy has shown that immediate interactions-oriented intervention is an essential starting-point for the treatment. It creates the possibility for the treatment as a whole to become a therapeutic process. For clinical purposes, it has seemed logical to divide the patients into three groups; the methods and focus of the family-oriented work differ somewhat between the groups. The main separator between these is the level of social functioning before the psychosis.

The aim of the study reported here was to develop psychotherapeutic in-patient treatment for acute schizophrenia, following the principles of a need-adapted approach. To improve the integration of experiences which hospital staff have with acutely psychotic patients and their families, systematic supervision sessions were organised. In these sessions, it was possible to achieve shared psychological images through which the whole staff could integrate patients' behaviour and symptoms, both symbolic and non-symbolic. Such an image was called ‘the shared image guiding the treatment process’ (SIGTP). The process of achieving the SIGTP was interpreted through Peircean semiotics, especially the concepts of indexical, iconic, and symbolical signs. An SIGTP was considered to have been achieved in the early phase of the supervision process in 32 of the 54 cases. For the patients, SIGTP and the need-adaptation connected with it meant achieving a more realistic and more functional ordering of their experiences.