Background. In recent years, evidence has accumulated that a significant proportion of schizophrenic patients have severe memory impairment, which cannot be attributed to the effects of medication, chronicity or institutionalization. Our group has demonstrated that memory impairment is associated with poor psychosocial outcome and treatment resistance. Work on the classical amnesic syndrome has suggested that memory training is facilitated by adopting an ‘errorless learning’ approach, where subjects do not experience failure during learning. This is based on the theory that the preserved implicit memory of amnesic patients results in implicitly remembered incorrect responses interfering with target items, in the absence of a functioning explicit memory system to allow differentiation.

Method. We compared three groups of subjects, memory-impaired schizophrenic patients, memory unimpaired schizophrenic patients and healthy controls.

Results. An errorless learning approach conferred a significant advantage on the memory-impaired schizophrenic group, bringing their performance up to the level of both control groups. In contrast, adopting a traditional trial and error, or errorful approach resulted in markedly impaired performance in the memory-impaired schizophrenic group only.

Conclusions. We conclude that errorless learning approaches may be worthy of further evaluation in the cognitive rehabilitation of memory-impaired schizophrenic patients.

Background. Evidence on the adult adaptation of individuals with mild mental retardation (MMR) is sparse, and knowledge of the factors associated with more and less successful functioning in MMR samples yet more limited.

Method. Prospective data from the National Child Development Study were used to examine social circumstances and psychosocial functioning in adulthood in individuals with MMR and in a non-retarded comparison group.

Results. For many individuals with MMR, living circumstances and social conditions in adulthood were poor and potential stressors high. Self-reports of psychological distress in adulthood were markedly elevated, but relative rates of psychiatric service use fell between childhood and adulthood, as reflected in attributable risks. Childhood family and social disadvantage accounted for some 20–30% of variations between MMR and non-retarded samples on a range of adult outcomes. Early social adversity also played a significant role in contributing to variations in functioning within the MMR sample.

Conclusions. MMR appears to be associated with substantial continuing impairment for many individuals.

Background. We aimed to utilize tests of saccadic function to investigate whether cognitive abnormalities in obsessive–compulsive disorder (OCD) arise from a dysfunction of inhibitory processes or whether they reflect a more general difficulty in guiding behaviour on the basis of an internal representation of task goal.

Methods. Twelve patients with OCD and 12 matched controls performed a visually-guided saccade task, a volitional prosaccade task and an antisaccade task. The latency and gain of saccades was compared between groups for the three saccade tasks. The number of antisaccade errors was also calculated and compared between groups.

Results. There was no difference for antisaccade error rates between the groups. The latency of visually guided saccades did not differ between groups, however the latency of both volitional prosaccades and antisaccades was significantly slower in the patients with OCD than in controls. The difference in latency between volitional prosacades and antisaccades, however, was equal between groups.

Conclusions. These results suggest that patients with OCD have an abnormality in guiding behaviour on the basis of an internal representation of the task goal, rather than a problem with inhibiting reflexive behaviour.

Background. Fatigue and psychiatric symptoms are common in the community, but their association and outcome are sparsely studied.

Method. A total of 1177 patients were recruited from UK primary care on attending their general practitioner. Fatigue and psychiatric disorder was measured at three time points with the 12-item General Health Questionnaire and the 11-item Fatigue Questionnaire.

Results. Total scores for fatigue and psychiatric disorder did not differ between the three time points and were closely correlated (r around 0·6). The association between non-co-morbid (‘pure’) fatigue and developing psychiatric disorder 6 months later was the same as that for being well and subsequent psychiatric disorder. Similarly, having non-co-morbid psychiatric disorder did not predict having fatigue any more than being well 6 months previously. Between 13 and 15% suffered from non-co-morbid fatigue at each time point and 2·5% suffered from fatigue at two time points 6 months apart. Less than 1% of patients suffered from non-co-morbid fatigue at all three time points.

Conclusions. The data are consistent with the existence of ‘pure’ independent fatigue state. However, this state is unstable and the majority (about three-quarters) of patients become well or a case of psychiatric disorder over 6 months. A persistent, independent fatigue state lasting for 6 months can be identified in the primary-care setting, but it is uncommon – of the order of 2·5%. Non-co-morbid (pure) fatigue did not predict subsequent psychiatric disorder.

Background. Understanding the role of obstetric complications (OCs) in schizophrenia could potentially shed light on the heterogeneity in the aetiology and course of schizophrenia. Many investigators have reported an association between OCs and schizophrenia, but few have examined the association between OCs and treatment outcome. We investigated this question in a sample of patients studied during their first episode of schizophrenia, schizoaffective or schizophreniform disorder.

Method. OC histories were obtained for 59 patients participating in the Hillside First Episode Study. Cox proportional hazards regression analysis was used to estimate the effect of OCs on treatment response during the first episode of schizophrenia.

Results. Twelve of the 59 patients (20%) had positive histories of OCs. This group exhibited lower rates of treatment response than those with negative OC histories (hazard ratio controlling for sex = 0·28; 95% CI = 0·13, 0·62). The positive OC group also had significantly greater lateral ventricle volume, baseline disorganization and number of live births. The effect of OC history on treatment response held when these three variables were controlled for.

Conclusion. A history of obstetric complications predicted poor response to treatment in the first episode of schizophrenia. This large effect was based on a small sample of 59 patients. Thus, replication is called for.

Background. Two previous studies from the United Kingdom have suggested that rates of attempted suicide in Asian women are higher than in the native population.

Method. Over a 1-year period we identified 434 patients presenting from one catchment area to four hospitals, after episodes of self-harm. These patients were assessed using the GHQ, CIS-R, and Life Events Inventory, and by collecting details of the attempt itself.

Results. Asian women had the highest overall rates ; 1·6 times those in White women and 2·5 times the rate among Asian men. The rates were lowest among older women. Among younger Asian women (less than 30 years) the rates were 2·5 times those of White women and seven times those of Asian men. The rates among black groups were lower than expected. Self-poisoning was the commonest method of self-harm.

Conclusions. Younger Asian women are vulnerable to increased rates of attempted self-harm and deserve to be studied further.

Background. The performance of the CES-D in a sample of elderly community residents was assessed. The influence of dementia on test performance and the necessity for the use of four factor scores instead of a single summary score of the CES-D were studied.

Method. Two hundred and eighty-seven subjects out of the general population aged 60–99 years were personally interviewed with standardized diagnostic tools and completed the CES-D. Best-estimate diagnoses served as ‘gold standards’ for receiver operating characteristics (ROC) analysis.

Results. The CES-D discriminated well between depressive and non-depressive subjects. Exclusion of demented subjects from the sample did not markedly increase test performance. Current depressive illness and dementia led to high scores on the CES-D. Unlike the factors ‘depressive affect’, ‘somatic/vegetative complaints’, and ‘interpersonal relations’, the factor ‘positive affect’ of the CES-D discriminated well between demented and non-demented participants.

Conclusions. The CES-D is a valid instrument for screening for depression in a community sample of elderly subjects. Its use can be recommended even if the presence of dementia is likely. The use of factor scores of the CES-D does not substantially contribute to an improvement of overall test performance, but, nevertheless, allows a more detailed insight and better interpretation of test results.

Background. The hippocampus, amygdala and related functional circuits have been implicated in the regulation of emotional expression and memory processes, which are affected in major depression. Several recent investigations have reported abnormalities in these structures in adult and elderly depressives.

Methods. Elderly DSM-III-R unipolar depressives (N=40) and normal controls (N=46) participated in a magnetic resonance imaging study (1.0T). Brain images were obtained in the coronal plane. Using established anatomical guidelines for structure delineation, volumetric measurements of left and right hippocampus and anterior hippocampus/amygdala complex were completed under blinded conditions using a semi-automated computer mensuration system, with patients and controls in random order.

Results. Medial temporal volumes did not significantly distinguish either elderly depressed and age-similar normal control subjects, or late onset and early onset depressed patients (ANCOVA). Major overlap of measured volumes existed between patient and control groups. In depressives, hippocampal volumes significantly correlated with age, and cognitive and depression ratings, but not with number of prior depressive episodes or age-at-onset of first depression.

Conclusions. Hippocampal volumes do not discriminate a typical clinical population of elderly depressed patients from age-similar normal control subjects. If hippocampal dysfunction contributes to a diagnosis of syndromal depression in the elderly, such dysfunction does not appear to be regularly reflected in structural abnormalities captured by volumetric measurement as conducted. On the other hand, relationships between hippocampal volumes and clinical phenomena in depressives, but not controls, suggest potentially meaningful interactions between hippocampal structure and the expression of major depression in the elderly.

Background. The literature documents that functional impairment is associated with affective disorders. Nevertheless, the choice among thorough, yet brief, well-validated assessments of functional impairment is limited. The objective of this study was to evaluate the psychometric properties of a brief scale of functional impairment, the Range of Impaired Functioning Tool (LIFE–RIFT).

Method. The study sample included subjects who presented with major depressive disorder at intake into the NIMH Collaborative Depression Study (CDS). The LIFE–RIFT is composed of items that are included in the Longitudinal Interval Follow-up Evaluation (LIFE). The reliability and validity were examined using data from LIFE–RIFT assessments conducted at four points in time: 6, 12, 18 and 24 months after intake into the CDS.

Results. Cross-sectional one factor models accounted for the covariance structure among the four scale items. A longitudinal factor model, with an invariant factor structure over time, also fitted the data well and indicated that the scale items are measures of one construct, namely functional impairment. The internal consistency reliability of the scale was supported with alpha coefficients ranging from 0·81 to 0·83. The inter-rater reliability intraclass correlation coefficient (ICC) was 0·94. Mixed-effect linear regression models showed that those in episode were significantly more impaired than those in recovery. Furthermore, in analyses of predictive validity, impairment was positively associated with subsequent recurrence and negatively associated with subsequent recovery.

Conclusions. This psychometric evaluation provides empirical support for the reliability and validity of the LIFE–RIFT, a brief measure of functional impairment.

Background. Previous studies of attempted suicide have suggested that cultural and social factors play a significant role in the causation of deliberate self-harm.

Method. In order to measure elements of culture conflict two inter-group comparisons were undertaken. In the first, 27 Asian women who had presented to hospital services following attempted suicide (Asian group) were matched with a group of similar age Asian women attending GP surgeries for other reasons (Asian GP attenders group). The second comparison was between the Asian and 46 White attempters.

Results. On comparing Asian attempters with Asian GP attenders group the former were more likely to have a history of previous suicidal behaviour, to have a psychiatric diagnosis, and be unemployed. Their parents were more likely to have arrived in the United Kingdom at an older age. In addition, those who attempted suicide were more likely to have been in an inter-racial relationship and to have changed religions. In the second inter-group comparison, the characteristics of Asian and White suicide attempt patients were examined. White attempters were more likely to have mental illness, and were more likely to use alcohol as part of the method of attempted suicide. By contrast, Asian attempters had experienced life events pertaining to relationships, took fewer tablets and yet expressed greater regret at not succeeding in the attempt.

Conclusions. Although numbers are small, social stress and other cultural factors play an important role in the act of deliberate self-harm.

Background. This paper reports prevalences, sociodemographic correlates and psychiatric co-morbidity of substance use disorders (SUDs) among adolescents in Taiwan.

Methods. A random sample of ninth grade students (N=774) was selected from an urban, a suburban and a rural community. Two-stage case identification was employed with a brief screening tool and a modified Chinese version of the Kiddie-SADS conducted by child psychiatrists.

Results. The overall prevalence of any SUD was 11·0%, with nicotine (96·0%) as the most prevalent substance. The prevalences of SUDs were significantly higher in boys, rural community and classes with poor academic performance. Sixty-two per cent of all SUD cases suffered from other concurrent psychiatric disorders. The most common co-morbid conditions were conduct disorder, attention deficit hyperactivity disorder and mood disorders.

Conclusions. High prevalences of SUDs were found among adolescent school children in Taiwan. Effects of urbanization, selective migration and the availability of substances are possible explanations for the urban-rural difference on the risk for SUDs. Psychiatric co-morbid conditions for SUD among adolescents in Taiwan were similar to those in Western societies.

Background. This study examined whether traumatic grief, depressive and anxiety symptoms formed three distinct factors for widows and widowers. In addition, we examined whether high symptom levels of traumatic grief, depression and anxiety predicted different mental and physical health outcomes for widows and widowers.

Method. Ninety-two future widows and 58 future widowers were interviewed at the time of their spouse's hospital admission and then at 6 weeks, 6, 13 and 25 month follow-ups. Principal axis factor analyses tested the distinctiveness of traumatic grief, depressive and anxiety symptoms, by gender. Repeated measures ANOVA tested for gender differences and changes over time in mean symptom levels of traumatic grief, depression and anxiety. Linear and logistic regression models estimated the effects of high symptom levels of traumatic grief, depression and anxiety at 6 months on health outcomes at 13 and 25 months post-intake by gender.

Results. Three distinct symptom clusters (i.e. traumatic grief, depressive and anxiety symptoms) were found to emerge for both widows and widowers. Widows had higher mean levels of traumatic grief, depressive and anxiety symptoms. High symptom levels of traumatic grief measured at 6 months predicted a physical health event (e.g. cancer, heart attack) at 25 months post-intake for widows. High symptom levels of anxiety measured at 6 months predicted suicidal ideation at 25 months for widowers.

Conclusions. The results suggest that there are gender differences in the levels of psychological symptoms resulting from bereavement and in their effects on subsequent mental and physical health for widows and widowers.

Background. Mental disorders are major risk factors for suicide. Not all those who suffer from mental disorders kill themselves. Additional information is required to differentiate higher and lesser risk patients.

Methods. Retrospective case–control comparison was made of cases of suicide/undetermined death with living controls using psychological autopsy in South East Scotland. Cases and controls were matched for age, sex and mental disorder. Informants were those closest to cases and controls. The subjects were 45 cases of suicide/undetermined death and 40 living controls.

Results. Cases and controls did not differ significantly in severity of mental disorder. The main factors independently associated with undetermined death or suicide were: a history of deliberate self-harm (adjusted OR 4·1); physical ill health (adjusted OR 7·8); and engagement by mental health services (adjusted OR 0·01). Other antecedents associated with increased risk (criminal record, police involvement, financial problems and failure to vote) and those associated with decreased risk (contact with a doctor and in-patient care) did not exert effects after controlling for confounding.

Conclusions. Controls were receiving more care of whatever kind. Treatment of mental disorder co-morbid with physical illness and a history of deliberate self-harm may be especially important. Factors that separate those with mental disorder at high risk from those at lesser risk relate to care levels provided, which may be a function of engagement by and with health services. The role of mental health professionals is beneficial in suicide prevention. The focusing of that role towards engaging alienated or ‘difficult’ patients should be addressed.

Background. Using 31P and 1H magnetic resonance spectroscopy (MRS) we previously reported that phosphocreatine was decreased in the left frontal lobe and choline-containing compounds were increased in the basal ganglia in the depressive state in patients with bipolar disorder. We applied quantitative 1H-MRS for further characterization of biochemical alteration in the frontal lobes of bipolar patients.

Methods. Twenty-three bipolar patients and 20 normal controls were examined by 1H-MRS with a 1.5T MR system. All patients were examined in the euthymic state, and eight patients were also examined in the depressive state. Volumes of interest of 2·5×2·5×2·5 cm were selected in the left and right frontal lobes. Absolute concentrations of N-acetyl-l-aspartate, creatine plus phosphocreatine, and choline-containing compounds were calculated from each metabolite peak.

Results. Creatine concentration in the left frontal lobe in bipolar patients in the depressive state was significantly lower than that in the euthymic state. Creatine concentration in the right frontal lobe in the male patients was significantly higher than that in the female patients and a similar trend was also found in the control subjects.

Conclusions. We found a state-dependent change of creatine metabolism in the left frontal lobe of bipolar patients. The present results are compatible with our previous report of decreased phosphocreatine measured by 31P-MRS in the left frontal lobe in bipolar disorder. We also found an effect of gender on the creatine concentration. There may be a gender difference in creatine transport function into the brain.

Background. Scales to measure the severity of different dimensions of auditory hallucinations and delusions are few. Biochemical and psychological treatments target dimensions of symptoms and valid and reliable measures are necessary to measure these.

Method. The inter-rater reliability and validity of the Psychotic Symptom Rating Scales (PSYRATS: auditory hallucination subscale and delusions subscale), which measure several dimensions of auditory hallucinations and delusions were examined in this study.

Results. The two scales were found to have excellent inter-rater reliability. Their validity as compared with the KGV scale (Krawiecka et al. 1977) was explored.

Conclusions. It is concluded that the PSYRATS are useful assessment instruments and can complement existing measures.

Background. This study investigated whether individuals with borderline personality disorder (BPD) tend to be overgeneral in their autobiographical recall and whether the extent of their overgeneral recall covaries with their susceptibilities to dissociative experiences, as expected on theoretical grounds.

Methods. Twenty-three patients with BPD and 23 matched controls completed the Autobiographical Memory Test (AMT) and self-report measures of depression, anxiety, trait anger and dissociative experiences.

Results. Participants with BPD scored significantly higher than the control group on the measures of depression, anxiety, trait anger, and dissociative experiences and also retrieved significantly more general memories on the AMT. The number of general memories retrieved by the BPD group correlated significantly with their dissociation scores but not with their scores on mood measures.

Conclusions. Patients with BPD have difficulties in recalling specific autobiographical memories. These difficulties are related to their tendency to dissociate and may help them to avoid episodic information that would evoke acutely negative affect.

Background. Evidence is conflicting as to whether the association between marital status and psychological distress is due to selection (i.e. distress influences marital status) or causation (marital status influences distress). We investigate: (i) whether differences in psychological distress pre-date marital transitions; (ii) whether levels of distress change following transitions; and (iii) potential mediating and moderating factors.

Methods. Data on psychological distress (indicated by the Malaise Inventory) and marital status at ages 23 and 33 were analysed for 4514 men and 4842 women from the 1958 birth cohort.

Results. Higher levels of distress were found among the divorced and lower levels among the single and the married. Selection was seen in the lower initial mean symptoms of those who married (1·69 for men; 2·84 for women) compared to those remaining single (2·41 for men; 3·26 for women). Causation was indicated by the relative deterioration in distress of those who divorced compared to the continuously married (an increase of 0·31 and 0·03 respectively for men), especially in women (a decrease of 0·18 versus 0·71). This was most evident in women who were downwardly mobile and those with children. Recently separated men and women showed especially large increases in distress.

Conclusions. The relationship between marital status and psychological distress involves selection and causation. Findings failed to support ideas of marriage being protective (through social support), or detrimental (through family roles). Divorce increased distress, with both acute and longer-term components moderated by secondary factors such as childcare and declining socio-economic status.

Background. Breathlessness in asthma often cannot be explained with objective variables indicating airways obstruction. The hypothesis that unrealistic breathlessness results from false interpretation of sensations was tested.

Methods. Sixty-four children and adolescents with asthma, aged 9–18 years, were randomly assigned to: (1) standardized physical exercise for induction of general symptoms; (2) equipment causing itching through skin irritation; or (3) physical exercise combined with equipment causing itching through skin irritation. Pre-test and post-test measures were: lung function; breathlessness; general symptoms; itching; state anxiety; and worry.

Results. Lung function decreased within normal parameters (3·8%, 1·1%, 2·6%, respectively) and did not differ significantly between conditions. Breathlessness increased significantly after exercise, particularly in condition 3. Breathlessness correlated with general symptoms and worrying, but not with changes in lung function, age, or asthma severity.

Conclusion. Biased symptom perception can explain unrealistic breathlessness. Prerequisites are situational cues triggering selective perception and ambiguous sensations associated with the anticipated (feared) physical state. Excessive breathlessness may often warrant objective confirmation by means of lung-function testing.

Background. Conflicting evidence exists on causes of vulnerability to post-natal depression. We investigated genetic and environmental influences on variation in post-natal depressive symptoms (PNDS) following first live birth, and sources of covariation with the personality trait Neuroticism and lifetime major depression occurring post-natally (DEP-PN) and at other times (DEP-XPN) to test for shared genetic influences.

Method. Retrospective interview and questionnaire data from 838 parous female twin pairs (539 monozygotic, 299 dizygotic) from the Australian National Health and Medical Research Council volunteer adult twin register were used for multivariate genetic model-fitting. Data on PNDS were evaluated for consistency with diagnostic interview assessment.

Results. Genetic factors explained 38% of variance in PNDS (95% confidence interval 26–49%) and 25% of the variance in interview-assessed DEP-PN. The genetic correlation between PNDS and lifetime major depression (DEP-PN and DEP-XPN) was low (rg = 0·17, 95% confidence interval = 0·09–0·28), suggesting that the questionnaire was measuring a construct other than post-natally occurring major depression, possibly post-natal dysphoria. Associations between PNDS and obstetric factors were very modest.

Conclusions. Findings suggest modest genetic influences on major depression occurring post-natally. Independent and stronger genetic influences identified for post-natal symptomatology or dysphoria (PNDS) justify further investigation.

Background. Children with autistic spectrum disorders typically show impairments in processing affective information within social and interpersonal domains. It has yet to be established whether such difficulties persist in the area of music; a domain which is characteristically rich in emotional content.

Methods. Fourteen children with autism and Asperger syndrome and their age and intelligence matched controls were tested for their ability to identify the affective connotations of melodies in the major or minor musical mode. They were required to match musical fragments with schematic representations of happy and sad faces.

Results. The groups did not differ in their ability to ascribe the musical examples to the two affective categories.

Conclusions. In contrast to their performance within social and interpersonal domains, children with autistic disorders showed no deficits in processing affect in musical stimuli.