The present study examined a prominent symptom subtype conception of the psychopathology of schizophrenia. It analysed the presumed dichotomy between hallucinations, delusions and formal thought disorder as positive symptoms and flattening of affect and poverty of speech as negative symptoms, and tested predictions concerning the nature of the mediating processes of positive and negative symptoms. Four different analyses were applied to the transcripts of speech produced by 9 normals, 10 chronic schizophrenics with only positive symptoms of whom 7 had incoherence of speech, and 9 chronic schizophrenics with only negative symptoms of whom 4 had poverty of speech. The conception of the nature of the mediating processes of positive and negative symptoms was not supported by the results. Further, a clear dichotomy between positive and negative symptom groups was not shown to exist, because positive speech disorder and negative speech disorder did not follow the presupposed dichotomy. Thus, contrary to existing conceptions of speech disorder in schizophrenia, both positive and negative speech disorder are marked by poverty of thought, as measured by the production of fewer and shorter ideas and lower speech variability.

Forty-eight couples with a presenting problem of female sexual unresponsiveness were treated in a controlled study using a balanced factorial design. The factors varied in this design were medication (testosterone or placebo), treatment frequency (weekly or monthly sessions), and the number of therapists involved (one female or a male/female pair). All counselling was adapted from that described by Masters & Johnson (1970) and Heiman et al. (1976). Results were assessed before and after a 3-month treatment period, and again 6 months later. Contary to expectations from earlier work, there was no benefit attributable to testosterone or to the use two therapits; selfrating favoured weekly sessions with one therapist.

On the evidence of long-term follow-up studies of cohorts of patients in Europe the outcome of schizophrenia appears to be changing from chronicity to an episodic course with a more favourable outlook. While the reasons for this change are unclear it is suggested that schizophrenia is characterized essentially by a state of vulnerability to the disorder. This vulnerability may or may not give rise to an episode of illness, depending on the incidence of triggering life event stressors and on the moderating influences of social networks, ecological factors, and premorbid personality. The traditional view of schizophrenia as an essentially chronic condition reflects not so much the natural history of the disorder as iatrogenic influences, lack of satisfactory extra-mural care, the accumulation of a relatively small proportion of truly chronic illnesses and the failure to recognize the termination of an episode of illness in patients with poor premorbid personalities. Evidence for the episodic nature of schizophrenia is presented.

Forty-two patients with functional visual loss were followed for more than 4 years after presentation. Only 22 patients had a diagnosable psychiatric syndrome or personality disorder at follow-up. Twenty-three patients continued to have findings of functional visual loss at follow-up. Despite continued signs of functional visual loss, few were socially or economically impaired, and 8 of these 23 patients had no evidence of any psychiatric disorder. The implications of these findings are discussed.

This paper describes a study of the outcome of psychotherapy with patients disabled by chronic obstructive airways disease giving rise to dyspnoea. Forty-three men and 22 women with severe COAD were randomly allocated for 8 weeks to one of three types of psychotherapy or to an untreated control group, and were followed up six months later. The group treated by a medical nurse without training in psychotherapy experienced sustained relief of dyspnoea but tended to undergo less psychodynamic change; psychiatric symptoms were reduced in those receiving supportive, but not analytical, psychotherapy. The psychosomatic mechanisms involved and the implications for medical and nursing practice and for liaison psychotherapy are discussed.

The relative memorability of pleasant and unpleasant personal experiences was investigated by measuring their speed of recall. In keeping with most previous work, pleasant material was found to be more readily accessible than unpleasant material. In addition, the retrieval rates of both classes of material were found to be influenced by the intensity of affect associated with the memory.

Data from two studies, one naturalistic and the other a controlled trial, were analysed to clarify the relationships between independent life events, Expressed Emotion of a key relative, maintenance neuroleptics and the relapse of schizophrenia. It was found that patients in the community who are unprotected by medication are vulnerable either to acute stress in the form of life events or to chronic stress in the form of living with a high Expressed Emotion relative. Patients on regular medication are protected against one or other stress, but are very likely to relapse if the two forms of stress occur together. A model of schizophrenic susceptibility to environmental stress is constructed to incorporate these observations.

The Eating Attitudes Test (EAT) and General Health Questionnaire (GHQ) have been validated in an unselected population of 15-year-old South London schoolgirls. Scores on the questionnaires were compared with the results of standard interview. The EAT was found to be an efficient screening instrument for abnormal eating attitudes and behaviour, whereas the GHQ was less satisfactory in its ability to screen for psychiatric morbidity in this age group than in adults. At the optimal cutting points, 6·9% of this population gave a positive response to the EAT and 19·3% gave a positive response to the GHQ. There was a statistically significant positive correlation between the two sets of scores

Family histories obtained from 27 patients with obsessive-compulsive disorder failed to find a single parent with the disorder. To augment the family history data the Leyton Obsessional Inventory was completed by a subset of 10 patients and by their 20 parents. Although as a group parents showed lower Leyton Obsessional Inventory symptom scores than their obsessional offspring, 3 parents who had not been identified by family history were distinguished by high symptom scores in the absence of significant resistance or interference.

A number of studies have attempted to explain obstetric difficulties on the basis of psychosocial conditions which exist during pregnancy. In addition, recent research in the field of life event stress has indicated that life experiences occurring prior to a pregnancy may influence pregnancy outcome. The present study examines the ability of life event stress as well as a variety of medical, social and psychological variables to predict complications of pregnancy. In contrast to previous small-sample research, the present study examines 782 subjects. Multivariate statistical techniques are employed to analyse the numerous variables measured. Results suggest that ‘age at birth of first child’, ‘education level’, ‘menstrual history’, ‘attitudes to pregnancy’ and ‘age at menstruation’ best predict obstetric difficulties. However, only a small percentage of the variance of pregnancy complication scores is explained by these factors.

Patients meeting criteria for Briquet's syndrome (N = 20) and patients diagnosed as having hysterical personality disorder (N = 20) were assessed clinically and with personality inventories to test the hypothesis that, while in many respects patients with Briquet's syndrome would resemble those with hysterical personality disorder, they would also be more obsessional. The comparison showed that both groups had highly disordered family, personal, medical and psychiatric histories, and that the Briquet's patients, though manifesting similar hysterical traits, had more obsessional features than did the patients with hysterical personality disorder. The possible role of the combination of obsessional and hysterical traits of personality as a vulnerability factor in the behaviour of complaining is discussed.

Six hundred people diagnosed as schizophrenic by the specialist psychiatric services in Oxfordshire, between 1971 and 1973, were identified from the Oxford Psychiatric Case Register (OPCR). The person records of deaths and hospital discharges held by the Oxford Record Linkage Study (ORLS) were used to examine the following items of information for members of this group: details of discharges from and surgical operations performed in Oxfordshire non-psychiatric hospitals in a 6-year period before and a 4-year period after the date of first inclusion in the OPCR, and details of deaths in a 4-year period after the date of first inclusion in the OPCR.

The numbers of deaths, discharges and operations so observed in the study group were compared in age, sex and major diagnostic groups with the expected numbers derived from rates prevailing in the Oxfordshire population over the same periods. Observed deaths were twice as numerous as expected in both sexes, and the numbers of general hospital discharges were also higher than expected. Ischaemic heart disease was the commonest cause of death in both sexes, but did not account for the excessive numbers of hospital discharges. Trauma and poisoning accounted for the excess both of deaths in younger members of the study group and of general hospital discharges overall. Social and environmental difficulties associated with the diagnosis schizophrenia are likely to have contributed more than any inherent biological disadvantage to this excess.

This is an introductory report for the Brief Symptom Inventory (BSI), a brief psychological self-report symptom scale. The BSI was developed from its longer parent instrument, the SCL-90-R, and psychometric evaluation reveals it to be an acceptable short alternative to the complete scale. Both test-retest and internal consistency reliabilities are shown to be very good for the primary symptom dimensions of the BSI, and its correlations with the comparable dimensions of the SCL-90-R are quite high. In terms of validation, high convergence between BSI scales and like dimensions of the MMPI provide good evidence of convergent validity, and factor analytic studies of the internal structure of the scale contribute evidence of construct validity. Several criterion-oriented validity studies have also been completed with this instrument

A total of 1921 consecutive adult patients seen in the Departments of Internal Medicine and Obstetrics–Gynaecology at a prepaid group practice completed a self-administered depressive symptomatology questionnaire, the Centre for Epidemiologic Studies Depression Scale (CES-D). New health practitioners and physicians, who were not mental health specialists, blindly judged the presence or absence of depressive symptomatology. Twenty-one per cent of the patients suffered from depressive symptoms according to the CES-D, but only 15% of these were judged to be depressed by their physician or new health practitioner. The variables which predict the recognition of depressive symptomatology are discussed.

The literature on the place of hostile emotion in obsessional neurosis is reviewed. In the main study 11 obsessional neurotic and 11 depressive patients matched for severity of illness were given questionnaires to measure experienced hostility and anger, and a repertory grid of standard form. The obsessional group showed a qualitatively distinct correlational pattern of measured aspects of hostility–anger, including a high correlation between outwardly directed aspects of hostility and anger; this pattern was replicated in a validation study. In contrast, the obsessional group was not differentiated by a negative cognitive set. Treatment implications for obsessional neurosis are briefly discussed.

Although most chronically impaired psychiatric patients now reside in community-based residential homes, a substantial number show little progress in their social rehabilitation. To establish the rehabilitative needs of this population, the current study sought to examine the social behaviour of residents of a large residential care facility. After an analysis of the social behaviour of all residents, two groups were selected for detailed study on the basis of their contrasting patterns of social interaction.

These two groups were found to differ significantly with respect to their interpersonal activity, social contact, conversation skill, employment, and participation in community rehabilitation programmes. Psychiatric status was substantially different in each group. The implications of these findings for rehabilitation strategies in the management of severe mental illness are discussed.

This paper describes a study to assess the validity of a brief household survey measure of psychic distress (PSYDIS). The measure classifies persons according to their pattern of scores on four dimensions, including anxiety and depression. Study subjects were interviewed first respondents from the general population in a cross-sectional household survey. Then, according their ratings on PSYDIS, subsamples were selected for psychiatric evaluation in a clinic a few weeks later. The survey ratings of 287 persons were compared with evaluations of the same persons experienced psychiatrists. Overall levels of concordance ranged from 76% to 80%, depending the psychiatric criterion used. Concordance was very high for women; it was lower for men for persons classified as High on PSYDIS

We then applied two analytic strategies for increasing agreement between the clinical judgements and the clinical ratings. Strategy number I augmented the symptom checklist data with additional survey data on the subject's history of episodes of distress. Strategy II revised procedures for constructing the PSYDIS typology by (1) using more rigorous cutting point scores on the component scales, and (2) using a non-typological method of classification. The first strategy improved agreement between the clinic and survey measures; the second did not. The paper also compares PSYDIS with other brief symptom checklist measures.

Validity coefficients of the 30-item, 28-item and 12-item versions of the General Health Questionnaire (GHQ) were determined by comparison with the Present State Examination (PSE) in a sample of 200 17-year-olds. The PSE classified 7 people (3·5%) as cases, although only 47% were identified as free of symptoms. Misclassification rates, sensitivity and specificity values are presented for different cutting scores for the three versions of the GHQ. The GHQ-28 had superior values, especially with a cutting score of 5/6; the GHQ-12 with a 2/3 cutting score also had acceptable values. All versions of the GHQ correlated highly with the PSE Index of Definition and total scores, providing support for the treatment of GHQ scores as a continuous variable in this kind of population. Correlations between sub-scales of the GHQ-28 give further evidence for a general factor and the relative independence of the social dysfunction sub-scale.

The present study compared families of patients with anorexia nervosa with families of non-anorexic adolescent daughters of a similar social class. All anorexics and adolescent comparison girls and their parents were studied using a variety of psychometric measures. Body size estimation and physical anhedonia were also measured. Family characteristics were assessed using the Family Assessment Measure (FAM). Contrary to the hypotheses, no abnormalities were found in terms of parental attitudes to weight control or dieting. The mothers of anorexics displayed no increase in psychopathology on any of the measures. The fathers scored very similarly to controls but with higher degrees of conscientiousness. Neither fathers nor mothers displayed abnormalities of their own body size estimates or body satisfaction. On the FAM the anorexic families reported an increased pathology on several sub-scales. It is not possible to say whether these disturbances are part of the pathogenesis or are sequelae to the illness.

A review of the literature on atypical depression indicated three relatively separate usages for the term: anxiety or phobic symptoms additional to depression, reversed functional shift, and non-endogenous depression. A sample of 160 out-patient depressives was rated on a variety of diagnostic systems measuring these concepts. Inter-relationships between groups selected by the three definitions were found to be low. In addition, although there was moderate consistency within different definitions of endogenous depression and of additional anxiety, reversed functional shift symptoms did not correlate well with each other. These findings suggest that atypical depression may be of limited value as a specific diagnosis within non-psychotic depression.