Multidimensional scaling, in the form of principal coordinates analysis and two-way correspondence analysis, is used to illustrate inter-practice variation in patterns of psychiatric diagnoses provided by data from the longitudinal file of the Second National Morbidity Survey. The results strongly support the view that general practitioners' diagnostic habits should be validated before their records are used to provide data on ‘official’ estimates of psychiatric morbidity. It is recommended that, whatever the quality of the data, large tables of official socio-economic or medical statistics should be supplemented by graphical summaries, as they quite often are in France.

The Geriatric Mental State and a new computerized diagnostic system, AGECAT, are briefly described. A nomenclature for designating cases for epidemiological work is introduced. Concordance between AGECAT and psychiatrists' diagnoses for these studies, hospital and community based (total of 541 subjects), achieved overall kappa values of 0·84 for a psychiatric hospital sample and 0·74 for a community sample. The values for depression and organic illness specifically in these settings were psychiatric hospital 0·80/0·86, and community 0·80/0·88, respectively.

Nearly one hundred subjects completed two Type A behaviour questionnaires twice. First, they were asked to complete them honestly, reporting accurately on their behaviour patterns. Half of the subjects were then asked to fake good, presenting themselves in a positive light, and half to fake bad, presenting themselves in a negative light. There was only a marginal difference on one questionnaire's total score, with fake good subjects having lower Type A (i.e. higher Type B scores) yet nearly every individual question revealed large significant differences. The subjects' own A/B classification did not effect the way in which they faked the questionnaires. The results are discussed in terms of the literature on faking, lay concepts of psychological phenomena and the multidimensionality of the Type A concept.

The effects on serum electrolytes of carbamazepine, an acute and prophylactic treatment for manic-depressive illness, were assessed in subjects with primary affective disorder. Carbamazepine caused statistically significant, but clinically insubstantial, reductions in serum sodium and calcium, but not in the other electrolytes measured. Decreases in serum sodium and calcium were not related to carbamazepine dose, blood levels, or the degree of clinical improvement. The theoretical implications of these findings are discussed.

Choline influx and choline content were measured in healthy volunteers (N = 36), patients with unipolar affective disorder (N = 28), and bipolar patients before and during treatment with lithium (N = 14, N = 13 respectively). Erythrocyte choline content was not found to be significantly elevated in any of the groups studied, except in patients taking lithium. Choline influx into the erythrocytes of healthy controls was found to decrease with increasing age, while choline influx into lithiated erythrocytes increased with increasing age in patients. An inverse relationship between erythrocyte choline influx and content was found to exist only in the erythrocytes of elderly healthy volunteers (≥ 60 years old).

The age at onset of dementia of the Alzheimer, Pick or senile type in relatives of probands with early onset dementia was examined using survival analytical techniques applied to data collected by Sjögren et al. (1952). Female relatives were found to have a higher risk of dementia than males, and there was a deficit of affected brothers compared with fathers of probands. In these comparisons due allowance was made for age at the last observation of each relative. Relatives of probable and definite Pick probands had a higher risk than relatives of probable and definite Alzheimer probands, but the difference was not significant and dementia did not occur at an earlier age to the former group.

For the relatives as a whole, and for subgroups of relatives, the risk of dementia increased with age, at least up to age 80. It is hypothesized that the pattern of the age-related hazard of dementia is due to the nature of the dementing process; that this slow degenerative process is widespread; and that individual differences in the rate of the process are under the influence of genes. The statistical methods are explained in detail as they have rarely been applied to dementia before, though Chase et al. (1983) have used life tables and survival analysis in testing genetic hypotheses, with an application to Alzheimer's disease.

A prospective study of 400 largely working-class women with children living at home has used measures of self-esteem and ‘social support’ to predict the risk of depression in the following year once a stressor had occurred. Actual support received at the time of any crisis in the follow-up year was also measured. Self-esteem was correlated quite highly with some of the measures of support.

A core tie was defined as a husband, lover or someone named as very close at first contact. Negative evaluation of self (i.e. low self-esteem), and various indices of lack of support from a core tie at the first interview, were associated with a greatly increased risk of subsequent depression once stressor occurred. Lack of support from a core tie at the time of the crisis was particularly highly associated with an increased risk. There was also a high risk among those who were ‘let down’ - that is, for those who did not receive the support which they might have expected in terms of the first interview material. It is concluded that it is essential for prospective enquiries to take account of the actual mobilization of support in the follow-up period.

The inter-rater reliability of Brown's measure of ongoing difficulties (‘severity’) is shown to be comparable with that of the measure of life events (‘long-term threat’) when using data from an elderly subject pool. Test–retest reliabilities for both the life event and difficulty measures are shown to be adequate if based on ‘consensus’ ratings. The question is raised of generalizability of the concepts of ‘threat’ and ‘severity’ across the lifespan.

A systematic survey of in-patient accidents and injuries in an inner London hospital over 9 years established that, after incisions and overdoses, self-incineration was one of the commoner methods of violent self-harm. A case-controlled study of in-patient suicide attempts compared a series of 12 self-incinerators with 12 patients using other methods. Irrespective of method, the suicide attempt was predominantly a psychotic act of young single people with chronic, severe disorders and considerable past parasuicide, in a setting of escalating self-harm. Younger age, greater psychiatric morbidity, absence of alcoholism, a history of childhood arson, past and current self-burning were the features specific to self-incineration, which had a 25% mortality rate.

The hunger perceptions and satiety responses to a high-calorie, carbohydrate-rich food among 10 normal-weight females who met the DSM-III criteria for bulimia were compared with 10 normal-weight females who denied a current or past history of eating or weight disorders. As indicated by self-report responses on the Hunger–Satiety Questionnaire, bulimics did not differ from the normals in their perceptions of hunger sensations. Differences, however, were detected the responses following eating. Most notably, the bulimics reported feelings of irritability, nervousness, tenseness and depression which persisted 30 minutes later. These findings and directions for future research are discussed.

The authors examine somatization disorder in a community population, using grade of membership analysis, a new multivariate analytical technique for the analysis of medical classification. The technique is used to examine whether somatic symptoms will cluster into a clinical syndrome resembling somatization disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), if no a priori assumptions are made about the interrelationship of somatic symptoms or their clustering into clinical syndromes. Grade of membershp analysis is applied to all respondents in the US National Institute of Mental Health Epidemiological Catchment Area Project of the Piedmont region of North Carolina reporting three of more somatic symptoms from the somatization disorder section of the Dagnostic Interview Schedule. The analysis indicates that seven ‘pure’ types, roughly analogous to clusters in cluster analysis, best describe the interrelationship of the symptoms included in the analysis. One ‘pure’ type in the analysis is nearly identical to DSM-III somatization disorder and is associated with demographic characteristics consistently found among patients with DSM-III somatization disorder. The present results demonstrate that symptoms associated with this disorder do cluster in a highly predictable fashion and represent a strong validation of the natural occurrence of an entity resembling somatization disorder.

Clinical psychiatric and medical assessments were carried out on a randomly selected sample of Australian prisoners of war captured by the Japanese in 1942 and a sample of combatants from Pacific theatres of war who were not captured. Prisoners of war had significantly more anxiety and depressive ‘neuroses’ and more major affective illness, although the latter finding was not statistically significant. The two groups did not differ in the risk of alcohol abuse and dependence.

Psychotropic drug sales data for Italy were examined for the years 1975–84. The principal findings were of more-or-less consistent annual increases in sales of antidepressants, minor tranquillizers and, to a lesser extent, of neuroleptics. These trends are interpreted in the context of the characteristics of the Italian National Health Service (NHS), and in relation to findings from psychotropic drug utilization studies in other Western countries.

Regional differences in psychotropic drug sales for 1983/4 were also examined. Marked differences were found and, in general, levels of use were higher in North/Central Italy than in the South. Factors influencing regional differences were explored using regression analysis. Regional NHS expenditure (excluding that on drugs) was found to influence strongly the sales of all categories of psychotropic drug, whereas there was also a marked urban > rural difference in the sales tranquillizers.

A postal survey with selected follow-up interviews was conducted on a complete population of females aged 18–22 registered with two group general practices in Leicestershire. The mailing included the Eating Attitudes Test (EAT) and the Crown—Crisp Experiential Index (CCEI). There was a 70% response rate and 411 usable questionnaires were returned. Twenty-eight respondents (6·8%) produced EAT scores of 30 or more. One case of anorexia nervosa and one of bulimia were identified. Interviews of high EAT scoring subjects revealed several subjects with partial syndromes which failed to fulfil diagnostic criteria for either clinical eating disorder.

An assessment of the long-term outcome for depression and anxiety disorders in a general population was made as part of the Stirling County Study. Measuring outcome as a dichotomy between experiencing recurrent episodes or not during a 17-year cohort interval, it was found that 56% of the ‘cases’ had a poor prognosis. While sex, age and level of severity were not significantly related to outcome, an initial diagnosis of depression was predictive of unfavourable prognosis. Only a few of these ‘cases’ received psychiatric specialty treatment. Some disorders in the community appear, however, to be as serious as those that come to the attention of psychiatrists.

In a Danish community psychiatric service the patients referred from general practitioners (GPs) to the community psychiatric service (CPS) are compared with matched individuals with conspicuous psychiatric morbidity treated in general practice only. The psychopathology of the referred patients is more severe, as estimated by two different methods. They make fewer social contacts and their work situations are unfavourable. It was found that to a great extent the GPs refer their patients with mental disorders to the CPS so that the ‘filter’ between the GP and the CPS is very permeable. Of the patients treated by the GPs only (the matched group), no more than 54% were assessed by a psychiatrist as psychiatric ‘cases’. Psychopathology thus only partly determines the GPs' assessment of psychiatric ‘caseness’, in which social impairment plays an important part. The GPs diagnose more mental disorder than the psychiatrists, possibly because of an intimate acquaintance with the anamnesis.

In the first section a controlled treatment study of male sexual dysfunction is described. ‘Unlucky’ randomization of subjects yielded treatment groups which differed with respect to variables of possible prognostic significance. Hence the results are largely uninterpretable.

In the second section the predominantly negative or inconsistent findings in sex therapy outcome research are reviewed and methodological problems, such as those described in the first part, are considered as possible reasons for these negative findings. The interrelationships are explored between (i) small treatment groups, (ii) prognostic variability, (iii) bias, (iv) power, and (v) small expected treatment effects. A strategy for future research is proposed, with particular emphasis on the recognition and use of relevant prognostic indices.

All severely mentally handicapped children aged 5–19 years from the city of Manchester were identified in a cross-sectional study. A standardized Disability Assessment Schedule was used to assess the variety and degree of disabilities experienced by each child and by specific subgroups of the children. This paper focuses upon differences between groups of European and Non-European ethnic origin. Boys showed more disabilities than girls in both groups, but non-European children had more severe disabilities in virtually all categories.

Two matched samples of Arab female undergraduate students attending London and Cairo Universities were recruited to determine the relative prevalence of abnormal eating attitudes and the effect of exposure to Western culture upon this prevalence. A positive response was reported on the Eating Attitudes Test (EAT-40) in 22% of the students in the London group and 12% in the Cairo group, indicating that abnormal attitudes occur in this non-Western population. Six cases among the London sample fulfilled diagnostic criteria for bulimia nervosa, but no cases of either anorexia or bulimia were identified in the Cairo sample.

There is an increasing need for early detection strategies to take a part in the daily routine of general practice. A cost—benefit analysis is performed for the use of the CAGE questionnaire in case finding for at risk drinkers among general practice attenders. The questionnaire is shown to be of advantage to the general practitioner over and above his usual diagnostic methods.