Background. The differential diagnosis of early dementia of the Alzheimer's type from depression in the elderly is often made difficult by the presence of significant memory impairment in depressed patients. The Delayed Word Recall test (DWR) was developed to facilitate the early diagnosis of Alzheimer's disease. The DWR involves: (a) repeated elaborate encoding of ten separate words; (b) a filled delay; (c) delayed free recall. A recognition memory test has also been recently developed. The available evidence suggests impressive sensitivity and specificity when the DWR has been used to separate patients with early Alzheimer's disease from very well matched controls.

Methods. In the present study, the DWR was evaluated with regard to its ability to separate a group of 50 patients with early Alzheimer's disease from 50 elderly patients with major depression in a between-subjects experimental design.

Results. For both free recall and recognition indices, the between-group overlap was large. Using recommended cut-off scores for the detection of Alzheimer's disease, 44% of the depressed patients would have been misclassified as demented based on their free recall scores, and 48% of the depressed patients would have been misclassified on the basis of their recognition scores.

Conclusion. We conclude that the DWR is not specific enough to clearly distinguish patients with early Alzheimer's disease from elderly patients with major depression.

Background. We examined the phenomenology of depression in younger (<60 years old) versus older ([ges ]60 years) subjects and, more specifically, the interaction between age and psychomotor disturbance associated with depression.

Method. Two hundred and eighty-five patients with a DSM-III-R diagnosis of unipolar major depression referred to a mood disorders unit were assessed using the CORE rating scale, a sign-based system for defining melancholia. Subjects were also assessed using the Hamilton Rating Scale for Depression, Zung Depression Scale, Newcastle Endogenous Depression Inventory and the General Health Questionnaire.

Results. The total CORE score (and each of its subscales) was found to interact with age. Rates of psychotic and melancholic depression increased with age. Elderly depressives suffered more severe depression (higher HRSD scores), appetite loss and weight loss. Level of psychomotor disturbance and rates of psychosis did not differ between those elderly subjects with an early onset (before the age of 60 years) and those with a late onset (at or after 60 years) of depression.

Conclusions. There appear to be robust phenomenological differences in depression between older and younger subjects. The association between age and psychomotor change may assist our understanding of the neurobiology of depression.

Background. Experimental studies have demonstrated that alcohol has state-dependent effects on learning and memory. We, therefore, sought to determine if alcohol intoxication triggers selective retrieval of memories which could alter patterns of alcohol use.

Methods. Eighteen alcoholic patients were studied as well as a comparison group of 12 patients who abused cocaine, a drug not associated with memory state-dependence. Patients underwent a semi-structured interview to elicit information about recurrent personal memories experienced when intoxicated. Recurrent memories experienced during craving were also studied as a comparison condition.

Results. The prevalence of recurrent personal memories during intoxication was reported to be much higher for alcoholic patients compared with the cocaine-abusing patients. These experiences occurred more frequently than during craving, generally reflected prior disturbing events and were often reported to promote continued drinking.

Conclusions. The association of recurrently experienced personal memories with intoxication in alcoholic patients suggests, but does not establish, pharmacological state-dependence. Further studies of this memory phenomenon are indicated.

Background. The legal definition of suicide in England and Wales (E & W) gives rise to a high proportion of open verdicts and an underestimated suicide rate. We examined whether the ratio between open and suicide verdicts in E & W has changed between 1974 and 1991 and whether it varies according to coroners' qualifications.

Methods. Temporal changes of the ratio of open and suicide verdicts were examined using logistic regression adjusting for confounders such as changing age and gender distributions of suicide victims and the methods they use.

Results. Adjusted for age at death and suicide method, the ratio between open and suicide verdicts had, over successive 3-year time periods, increased with a factor 1·21 (95% CI 1·20–1·23) for male and 1·15 (95% CI 1·14–1·17) for female deaths. Medical coroners were 1·25 (1·08–1·44) times more likely than non-medical coroners to return open rather than suicide verdicts.

Conclusions. As a likely result of factors in the death registration system, the ratio between open and suicide verdicts has increased substantially in E & W since the early 70s. In 1990 it was higher than in any other comparable country. This has important implications for comparisons of time trends in suicide between E & W and other countries.

Background. The histological basis of schizophrenia is unknown, but it appears to affect the hippocampal and neocortical cytoarchitecture. Some cytoarchitectural parameters normally differ between the two cerebral hemispheres. Moreover, schizophrenia is associated with altered structural cerebral asymmetry. However, few cytoarchitectural studies of schizophrenia have taken the question of asymmetry fully into account.

Methods. We performed a morphometric post mortem study of neuronal density in sections from the left and right hippocampus (dentate gyrus, CA4, CA3, CA1 and subiculum) of 22 schizophrenics and 18 normal subjects. We also determined the correlations of neuronal density between pairs of subfields as an index of their inter-relationship; a previous study had found correlations in the left but not the right hippocampus of normal subjects.

Results. There were three differences in the schizophrenics compared to the controls. (1) neuronal density was increased in right CA3 (by 25%) and right CA1 (by 22%); (2) neuronal density correlated strongly between homologous left and right subfields (i.e. inter-hippocampally) for CA4, CA3, CA1 and subiculum, in normals this occurs only for dentate gyrus and CA4; and (3) intra-hippocampal correlations of neuronal density between pairs of subfields were similar in both hippocampi of the schizophrenia cases, unlike their asymmetrical distribution in controls.

Conclusions. The alterations may be part of the histological substrate of schizophrenia. The nature of the findings is consistent with a neurodevelopmental origin, and with a disease process that affects cerebral asymmetry and leaves its imprint upon the hippocampal cytoarchitecture.

Background. Delusional disorder (DD) and obsessive–compulsive disorder (OCD) have been investigated in previous studies using probabilistic reasoning paradigms and abnormalities in each group have been reported. No study to date has compared results between these groups. This study compares patients with these disorders with those who have both phenomena.

Methods. Thirty subjects with DD, 29 with OCD and 16 with obsessive and delusional features were compared with 30 normal controls in a study of probabilistic reasoning using two different computer-based tasks involving a Bayesian paradigm.

Results. Deluded subjects showed a ‘jump to conclusions’ reasoning style, but on a test that added a consequence to their choices did not differ from normals. OCD subjects deviated from Bayesian and control norms to a greater degree than did DD subjects. In subjects with mixed psychopathology, the presence of both phenomena appeared to ‘normalize’ these probability estimates.

Conclusions. Our findings extend those of others but require cautious interpretation as to the role of probabilistic reasoning in the genesis of delusions or obsessions. Obsessionals in both the OCD and Mixed groups, showed substantial deviation from Bayesian norms, suggesting that obsessionality leads to a reasoning style that is less ‘normal’ than that of delusionals. Further work is required to investigate clinical correlates of these findings which provide modest support for the proposal that the combination of obsessions and delusions confers greater functional advantages than simply having delusions or obsessions.

Background. Previous research has shown that parasuicides' view of the future is characterized by an absence of anticipation of positive experiences rather than the presence of anticipation of negative experiences. The present study aimed to replicate this finding and examine whether it would also be found in parasuicides who were not depressed.

Method. Depressed parasuicides (N=27), non-depressed parasuicides (N=17) and matched controls (N=34) were assessed on their anticipation of future positive and negative experiences using an adapted fluency paradigm, where they were given a set time to generate future positive and negative anticipated experiences.

Results. Consistent with previous findings, parasuicides showed an overall reduced anticipation of positive experiences and no overall increased anticipation of negative experiences. However, the parasuicides did show evidence of increased negative anticipation for the immediate future. The results for depressed and non-depressed parasuicides were essentially the same.

Conclusion. Lack of positive anticipation in the absence of increased negative anticipation is a feature of parasuicide. Although this lack of positive anticipation can occur in depression, it appears to be an independent feature of parasuicide.

Background. Previous studies have shown that individuals with autism show impaired performance on tests of executive function (Ozonoff et al. 1991, 1993; Hughes & Russell, 1993; Hughes et al. 1994). There is also strong evidence for genetic involvement in autism (see Rutter, 1991 for review). If executive dysfunction is a core impairment in autism, then similar impairments are hypothesized to exist in a subtler form among the parents of autistic children.

Methods. Forty parents of autistic children were compared with 40 parents of learning disabled children and 36 adults from unaffected families on three computerized tests of executive function. These tasks tapped attentional-shifting skills, visuospatial planning and working memory. Participants also received a computerized control test of spatial memory-span. In addition, the interviewer's initial impressions of family members were coded using a new 33-item questionnaire.

Results. A significant proportion of parents of autistic children (especially fathers) showed impaired executive function. By contrast, parents did as well as both comparison groups on a control test of spatial span, and on other ‘non-executive’ measures from the tasks, indicating that the autism group were as able and motivated as comparison groups. Interestingly, impairment of executive function was significantly correlated with the interviewer's pre-test impression of social abnormality among parents of autistic children.

Conclusions. The hypothesis that a significant proportion of parents of autistic children show impaired executive function was supported. Parents showed good memory ability, but relatively poor planning skills and attentional flexibility. The extent to which this is an inherent trait in family members, rather than a reflection of the difficulties involved in caring for an autistic child, remains to be examined.

Background. Reports of adolescent suicidal behaviour have generally derived from clinical settings but population-based studies are likely to provide a clearer epidemiological view.

Methods. Non-fatal suicidal behaviours were studied in 1699 Australian 15- to 16-year-old secondary school students at 44 schools in the state of Victoria, Australia. Self-reported episodes of self-harm were characterized using items from the Beck Suicide Intent Scale.

Results. The 12 month weighted prevalence estimate for deliberate self-harm was 5·1%. The commonest forms were self-laceration (1·7%), self-poisoning (1·5%) and deliberate recklessness (1·8%). Self-poisoning and self-laceration were commoner in girls. The prevalence of ‘true suicide attempts’ was 0·2%. Most self-harmers did not perceive death as likely, plan self-harming episodes at length or inform others of the episodes. Psychiatric morbidity had the strongest association with self-harm, an association which held for all subtypes. Antisocial behaviour and substance abuse were associated with self-harm in girls but not boys. Sexual activity was independently associated with self-harm in both genders.

Conclusions. Deliberate self-harm was common but the great majority of episodes were not ‘true suicide attempts’. It is, therefore, possible that attributable mortality and morbidity may be greater in self-harmers without definite suicidal intent.

Background. The General Health Questionnaire (GHQ) has been validated in different languages and cultures and in diverse settings. However, the validity of the 12-item version, increasingly used for screening for psychiatric morbidity in primary care, has not been established among ethnic Indians living in the United Kingdom.

Methods. The GHQ-12 was used to screen for psychiatric morbidity in a study of patterns of consultation and explanatory models of mental illness in a general practice in West London. All individuals who scored 2 or more and an equal number of individuals who scored 0 or 1 were interviewed using the Revised Clinical Interview Schedule (CIS-R) to confirm psychiatric morbidity. Hindi versions of the both these instruments were also employed. Thresholds of GHQ were compared against the standard of the CIS-R using the recommended threshold of 12 and above as indicating caseness. A receiver operator characteristic curve was drawn to obtain the best threshold value for screening.

Results. The optimal threshold for screening as assessed by receiver operator characteristic analysis was 2/3. This threshold had a sensitivity of 96·7% and a specificity of 90%.

Conclusions. The sensitivity and specificity of the 12-item General Health Questionnaire among women of ethnic Indian origin living in the United Kingdom is high. It can be employed as a screening instrument to identify individuals with psychiatric morbidity in this population.

Background. The possibility that monoaminergic neurotransmission is altered in pathological gambling was examined.

Methods. Monoamines and their metabolites were measured in CSF obtained at level L4–5 from ten pathological gamblers and seven controls.

Results. A decrease in dopamine and an increase in 3,4-dihydroxyphenylacetic acid and homovanilic acid was found. Noradrenaline and its metabolite 3-methoxy-4-hydroxyphenylglycol was also increased but 5-hydroxytryptamine and 5-hydroxyindoleacetic acid were unchanged.

Conclusion. It is suggested that the function of the dopaminergic system, possibly mediating positive and negative reward, and the noradrenergic system, possibly mediating selective attention, is changed in pathological gambling.

Background. Previously it was shown that during a series of out-patient consultations dysfunctional complaint-related cognitions and anxiety diminished significantly in patients with functional abdominal complaints (IBS). The aim of the present study was to assess the maintenance of positive changes initiated during medical consultations in the patients' complaint-related cognitions and anxiety, as well as the influence of these cognitions on the severity of the complaints, 6 months after the first visit to the out-patient clinic.

Methods. One hundred and five consecutive patients with IBS referred by their general practitioners to the out-patient clinic for internal medicine completed questionaires about their complaints and their complaint-related cognitions and anxiety before the first and after the last out-patient visit and again at follow-up, 6 months after the first out-patient consultation.

Results. Positive changes in the patients' complaint-related cognitions during the consulting period were found to persist during the follow-up period. Improvement in abdominal complaints at follow-up was found to be related to the level of the patients' state anxiety, fear of cancer, and catastrophizing cognitions at the last out-patient visit.

Conclusions. Medical consultations can bring about long-lasting positive changes in prognostically unfavourable cognitions and anxiety. These changes appear to be related to a better outcome of IBS.

Background. Aggression has been suggested to be related to abnormal brain 5-HT activity. This amine is synthesized in brain from tryptophan, which is transported through the blood–brain barrier in competition with other amino acids. The relationship between tryptophan and its endogenous amino acid competitors in plasma might thus influence the availability of tryptophan in the brain and consequently brain 5-HT activity.

Methods. Plasma amino acids were determined in 89 offenders who had committed various violent and non-violent crimes and in 14 healthy controls.

Results. Both tryptophan and its competitors were higher in offenders who had committed violent crimes compared both with non-violent offenders and with controls. No difference was, however, seen in the relationship between tryptophan and its competitors.

Conclusions. The results support the contention that violent behaviour is related to biochemical deviations but could not explain a possible decreased brain 5-HT activity.

Background. Suicide mortality among medical practitioners is in many countries significantly higher compared with other professionals and the general population. Differences between male and female physicians are difficult to estimate reliably because previous comparisons are mainly based on crude mortality rates.

Methods. Age-specific mortality rates were calculated for physicians, other professionals and the general population, males and females separately, as well as standardized mortality ratios (SMR) comparing physicians with the other groups. Crude mortality rates were calculated for the specialist groups.

Results. The SMR for male (female) physicians was 0·9 (2·4) compared with the general male (female) population and 2·4 (3·7) compared with other male (female) professionals. The SMR between male and female physicians was 1·2 (95% CI 0·9–1·7).

Conclusions. Our results do not support the claim that female physicians have a greater risk of suicide than their male colleagues, but are concordant with previous observations of a higher suicide rate in female physicians compared with the general population and other female professionals.

Background. The aim of the present study was to investigate neuropsychological functions in dementia of the Alzheimer type (DAT) with respect to morphological changes that were revealed by quantitative magnetic resonance imaging (MRI).

Methods. Twenty patients with DAT (NINCDS-ADRDA criteria) and 10 healthy age and sex matched controls were included. The neuropsychological function was evaluated on a test battery covering the severity of dementia, verbal and visual memory, concentration and attention, language skills and general intelligence as well as activities of daily living. 3D MRI sequences were acquired using a 1.5 T Siemens MAGNETOM. Whole brain volume, total intracranial volume (TIV), volume of the frontal and temporal lobes and volumes of the amygdalahippocampus complex (AHC) were assessed using the newly developed software NMRWin.

Results. Apart from TIV all morphometric parameters differed significantly between the diagnostic groups. AHC volumes discriminated best between the groups, with only a small overlap. AHC atrophy exceeded generalized atrophy. These findings were confirmed when the data were reanalysed after dividing the DAT patients into a mildly and moderately affected group. The severity of dementia was significantly correlated with the volumes of the AHC and the volumes of the temporal lobes bilaterally, but not with the whole brain volume and the volumes of the frontal lobes.

Conclusions. These results underline the important role of the temporal substructures for aetiology and progression of DAT. They indicate that the volume of the AHC can be monitored by MRI and may be used to follow up the disease process.

The Center for Epidemiologic Studies Depression scale (CES-D) has been widely used in studies of late-life depression. Psychometric properties are generally favourable, but data on the criterion validity of the CES-D in elderly community-based samples are lacking. In a sample of older (55–85 years) inhabitants of the Netherlands, 487 subjects were selected to study criterion validity of the CES-D. Using the 1-month prevalence of major depression derived from the Diagnostic Interview Schedule (DIS) as criterion, the weighted sensitivity of the CES-D was 100%; specificity 88%; and positive predictive value 13·2%. False positives were not more likely among elderly with physical illness, cognitive decline or anxiety. We conclude that the criterion validity of the CES-D for major depression was very satisfactory in this sample of older adults.