The aim was to give estimates of the incidence of different mental disorders from a Finnish prospective epidemiological follow-up study, the UKKI Study.

The original probability sample consisted of 1000 persons, aged 15–64 years. The baseline survey took place in 1969–71, and follow-up surveys were conducted 5 and 16 years after the baseline survey. The research methods included a personal psychiatric interview and data collection from different registers. The diagnostic system was based on the ICD–8 classification.

The estimated annual incidence of all mental disorders was close to 15 per 1000 both between baseline and the 5-year follow-up as well as between the 5-year and the 16-year follow-up. During the entire 16-year follow-up period the annual incidence of all disorders was 14 per 1000 in men and 17 per 1000 in women. The annual incidence of neurotic disorders was 10 per 1000 in men and 14 per 1000 in women, and that of psychotic disorders 2 per 1000.

In the literature, there are huge differences in the results concerning incidence of mental disorders. The results of the present study were rather close to those of the Swedish Lundby Study, but nowhere near the results of the American ECA Study.

An age-related dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis is well recognised in animals, but still remains controversial in humans. There is increasing interest that raised corticosteroid levels, due to activation of the HPA axis, may cause both depressive symptoms and cognitive impairments. Steroid effects on cognition may be via the hippocampus, a major site of corticosteroid action and an important structure involved in learning and memory.

To investigate this further, we examined the relationship between the dexamethasone suppression test, cognitive function, depressive symptoms and hippocampal atrophy on magnetic resonance imaging (MRI) in 32 normal controls, 49 subjects with NINCDS/ADRDA Alzheimer's disease and 51 patients with DSM–III–R Major Depression.

Controlling for differences in dexamethasone concentrations, post-dexamethasone cortisol levels were related to advancing age in controls and depressed subjects. However, among subjects with Alzheimer's disease, post-dexamethasone cortisol levels were independently associated with both minor depressive symptoms and hippocampal atrophy on MRI.

An association between advancing age and increased HPA axis dysregulation is supported for controls and depressed subjects. In Alzheimer's disease, HPA axis changes were associated with depressive symptoms and hippocampal atrophy. Longitudinal studies are now needed to determine the causal direction of these associations.

We wished to establish whether the occurrence of schizophrenia among twins is the same as among the general population.

Through record linkage between the New Danish Twin Register and the Danish Psychiatric Case Register, the twins who have ever received a diagnosis of schizophrenia were identified. Through indirect standardisation for age, sex and dates of admission, the rate of first admission with diagnosis schizophrenia among twins is compared to the same rate in the general population.

A 28% increase in the rate of first admissions for schizophrenia in twins compared to the general population was found. This is statistically significant and does not seem to be caused by any known methodological problems. Twins also had an increased first-admission rate of any psychiatric disorders.

This increased risk does not seem to be explained by known methodological problems, but does differ from earlier studies.

The aim is to examine, in first episodes of schizophrenia the appropriateness of the simple two-dimensional model of schizophrenia (‘negative’ and ‘positive’ dimensions) and more complex variants.

All patients with a first episode of schizophrenia who, over a two-year period, made contact with any of the public mental health services of the autonomous region of Cantabria in northern Spain were investigated. The psychiatric evaluation included, among other instruments, the Present State Examination (PSE–9), and the scales for the assessment of the ‘positive’ and ‘negative’ symptoms of schizophrenia (SAPS and SANS respectively). The dimensionality of the SAPS/SANS item scores and sub-scales was examined through the use of principal component analysis.

The principal component solution that best fits the data obtained with the initial SANS/SAPS sub-scales reflects the existence of three different (‘negative’ ‘positive’, ‘disorganisation’) factors. The strategy adopted of repeating the analysis after extracting the principal components of the original sub-scales, revealed that although the nature and item composition of the initial ‘negative’ and ‘disorganisation’ factors were in general confirmed, the ‘positive’ dimension presented a more complex structure with at least two ‘positive’ (‘Non-Paranoid’ and ‘Paranoid’) independent factors.

The psychopathological structure of the early stages of schizophrenia, as evaluated by the SANS/SAPS, is characterised by the presence of four dimensions: two ‘positive’, one ‘negative’ and one ‘disorganisation‘.

Controversy surrounds the relationship between tardive dyskinesia (TD) and symptoms of schizophrenia. While some studies reported that negative symptoms of schizophrenia may be a risk factor for TD, others reported a relationship between TD and positive symptoms.

Eighty-four patients were studied, of whom 47 met criteria for TD. Clinical and instrumental procedures were used to increase the sensitivity of our assessments of the presence and severity of TD. Stepwise logistic and linear regression procedures were used to identify demographic variables, psychopathology, and motor parameters associated with the presence and severity of TD.

A 3-factor model consisting of age, clinical tremor, and negative symptoms explained 25% of the variance in clinical TD severity. A 6-factor model consisting of female gender, instrumental and clinical measures of parkinsonism, positive, and negative symptoms explained 49% of the variance in severity of instrumentally derived dyskinesia.

These results suggest that the presence of TD may be associated with positive symptoms; that the severity of TD may be related to negative symptoms; and that the relationship between negative symptoms and TD severity may be influenced by the presence of parkinsonism.

Various problems are associated with schizophrenia which may theoretically lead to impaired educability about treatment.

The Understanding of Medication Questionnaire, designed to measure knowledge about treatment in schizophrenia, is described and presented. An educational programme based on a specially designed information booklet was developed. Sixty-four patients with DSM–III–R diagnosis schizophrenia were randomly allocated to groups receiving none (control), one session or three sessions of education.

Pre-intervention low levels of knowledge about illness and treatment increased significantly immediately after a standard education session. Three education sessions led to significantly greater knowledge gain than one session. There was no significant change in the control group. Only the PANSS negative syndrome score independently and consistently explained a significant proportion of the education effect. The influence on educability of attitudes to education, impaired insight, cognitive impairment and other variables were considered. Three sessions of education led to significantly increased insight, but no change in compliance.

Techniques appropriate for educating schizophrenic patients were discussed, and the value of involving patients in education emphasised. A series of patient education sessions is needed to consolidate learning, rather than a single informing process. The strong association between impaired learning and more severe negative schizophrenic syndrome emphasises the need for responsible prescribing of antipsychotic treatment in schizophrenia.

There is a paucity of research into the relationship between insight and variables including cognitive function, educational background and symptomatology in schizophrenia.

Sixty-four patients with DSM–III–R diagnosis schizophrenia were assessed with the Schedule for Assessment of Insight, Mini Mental State cognitive test, a new measure of knowledge about treatment (the Understanding of Medication Questionnaire), and educational background and compliance assessments.

Insight scores correlated significantly with a range of variables. In a multiple regression analysis only knowledge about treatment and number of years in education explained a significant proportion of insight.

Educational background and the intellectual ability required to learn complex concepts, such as models of mental illness, appear to be more important than previously considered. Research is limited by the lack of a generally accepted definition of insight.

Severe personality disorder (SPD) is an imprecise but useful term referring to some notoriously difficult to treat psychiatric patients. Their long-term psychiatric treatment is often unsuccessful, in spite of hospitalisation. The specialist expertise of in-patient psychotherapy units (IPUs) can successfully meet some of SPD patients' needs.

Relevant literature on the subject is summarised and integrated with the authors' specialist clinical experience.

Many clinical problems with SPD patients are interpersonal and prevent any effective therapeutic alliance, which is necessary for successful treatment. With in-patients, inconsistencies in treatment delivery and issues surrounding compulsory treatment reinforce patients' mistrust of professionals, compromising accurate diagnosis and an assessment of the need for specialist IPU referral.

General psychiatric teams are well-placed to plan long-term treatment for SPD patients which may include IPU treatment. Timely referral of selected SPD patients to an IPU maximises a successful outcome, especially if there is appropriate post-discharge collaboration with general psychiatric teams to consolidate gains made.

The psychosocial correlates of depression during pregnancy were explored.

Pregnant women attending the antenatal clinic of a general hospital (n=1329) received a set of questionnaires including Zung's Self-Rating Depression Score (SDS). SDS high scorers (>49) (the cases: n=179) were compared with low scorers (<38) (the controls; n=343).

The cases were characterised by: first delivery; more nausea, vomiting, and anorexia; more menstrual pains and premenstrual irritability; early paternal loss; lower maternal care and higher paternal overprotection; higher public self-consciousness score; more smoking and use of medication in pregnancy; unwanted pregnancy; negative psychological response to the pregnancy by the woman and husband; poor intimacy by the husband; and having remarried.

Depression in early pregnancy is determined mainly by psychosocial factors.

We assessed associations of mood at 5–6 weeks postpartum with peripartum saliva cortisol and progesterone profiles.

A prospective study involved 120 primiparous women free of major marital, socioeconomic and health problems, who collected saliva twice daily from 2 weeks before delivery to day 35 postpartum. This allowed intensive characterisation of cortisol and progesterone profiles. At the conclusion of the study, mood was assessed according to standard criteria.

Seven women developed major depression according to DSM–III–R criteria No associations emerged between progesterone and mood at 5 to 6 weeks. Lower levels of evening cortisol in the immediate peripartum period, were associated with postnatal depression.

The study provides no support for the treatment strategy of progesterone augmentation following delivery, as a prophylactic against postnatal depression. The HPA axis and its associations with postnatal mood warrants further investigation.

This community-based epidemiologic study of dementia in a rural population in India investigated the prevalence of various dementing disorders in the community, psychosocial correlates of the morbidity, and assessment of the risk factors associated with dementia.

A door to door survey was conducted to identify elderly people aged 60 and above. A total of 2067 elderly persons were then screened with a vernacular adaptation of the MMSE. All those who scored 23 and below had a detailed neuropsychological evaluation by CAMDEX–Section B, and the care-givers of the people with confirmed cognitive impairment were interviewed using CAMDEX–Section H to confirm the history of deterioration or impairment in social or personal functioning. In the third phase the subjects with confirmed cognitive impairment were evaluated at home as to whether they satisfied the DSM–III–R criteria for dementia. Subcategorisation of dementia was done based on ICD–10 diagnostic criteria. Five per cent of those whose screening was negative were randomly selected and evaluated during each stage.

Sixty-six cases of dementia were identified from 2067 persons aged 60 and above, a prevalence rate of 31.9 per thousand After correction this rate was 33.9 per thousand. Fifty-eight per cent of the dementia cases were diagnosed as vascular dementia and 41% satisfied the criteria for ICD–10 dementia in Alzheimer's disease. There were more women in the Alzheimer's disease group; smoking and hypertension were associated with vascular dementia while a family history of dementia was more likely in the Alzheimer's group.

Dementia is an important cause of morbidity in the geriatric population in this community, where families take responsibility for the care of relatives with dementia.

Home care services maintain people in their own households by providing practical help such as with housework, shopping and personal care. In this study associations between mental disorder and health and social service use, demographics and activity limitation are investigated.

A cross-sectional study with random cluster sampling of people over 65 receiving home care in Lewisham. Mental disorder was rated using the GMS/AGECAT system.

We interviewed 169/177 eligible individuals, a response rate of 96%. Forty-six percent of this population were rated as cases of mental disorder (15% organic and 26% depressive). Most (84%) of those with depression did not appear to be receiving appropriate treatment. Home care provision to those with depression (unlike dementia) was only partially explicable in terms of activity limitation.

There is a high level of depressive disorder in this population with little in the way of appropriate primary or secondary care management. Those in sheltered housing seem particularly at risk; depression may lead to increased service use independent of disability.

The aim was to assess the clinical usefulness and economic viability of an aftercare worker for psychotic patients discharged from half-way houses in Hong Kong.

A sample of 32 chronic psychotic patients was provided with a full-time aftercare worker. A matched control group received no such service.

The experimental group was found to have greater and better employment prospects, better mental status with less hospitalisation and less law-breaking behaviour than the control group. Some of these benefits were converted into economic terms and the tangible costs incurred in the project were calculated.

The provision of an aftercare service is clinically useful and economically viable.

Previous population association studies have indicated that certain alleles of alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) may reduce the risk of alcoholism in Asian populations. The association of ALDH2 and ADH2 with the development of alcoholism was found to be independent of each other and has been replicated in different Asian populations, while the effect of ADH3 is less studied.

We genotyped the alcohol metabolism genes among Han men with alcohol dependence (n=46) and their ethnically matched normal controls (n=63) in Taiwan. Multiple logistic regression was then applied to assess the contribution of ADH3 to alcoholism by controlling the effect of ALDH2 and ADH2.

The results of multivariate analyses demonstrated that the odds ratios for an increment of one allele of ADH2∗1, ADH3∗2 and ALDH2∗1 in the development of alcoholism were 4.18, 3.82, and 6.89, respectively.

These findings clearly indicate that all three alcohol-metabolising genes contribute to susceptibility to alcoholism.

It is estimated that treating diagnosed depression costs £420 million annually in England and Wales. This economic study analyses treatment of major depression with nefazodone v. imipramine.

The study updates a previously published model using data obtained from the continuation phase of a double-blind one-year placebo-controlled comparison of nefazodone with imipramine.

Annual costs for nefazodone are lower than those for imipramine, £218 compared to £254; the cost per successfully treated patient is also lower for nefazodone than for imipramine, £242 v. £323. Varying the resources included in the treatment patterns still results in lower costs for nefazodone treatment.

Based on clinical trial data for patients completing six to eight weeks of depression treatment and followed for at least one year, the model shows that the annual costs of nefazodone are lower than those for the less expensive imipramine.

Several studies, mainly non-UK based, have reported higher than expected mortality for individuals with mental illness. This investigation in Salford (England) was undertaken to determine local experiences.

An historical cohort design was employed with record linkage to determine status at study end: maximum follow-up was 18 years. All 6952 individuals with schizophrenia, neuroses, affective or personality disorders, enrolled on the psychiatric case register between 1 January 1968 and 31 December 1975 were recruited: there were 199 exclusions. Death was the study end-point.

Observed mortality was 65% higher than expected and elevated throughout the whole of follow-up. Mortality was highest in younger ages, females and subjects born locally. Circulatory disorders, injury and poisoning each caused approximately one-third of the excess deaths.

Documenting mortality risk has important applications for prioritisation, resource allocation, developing control programmes, evaluating service effectiveness, disease forecasting and future research.

There is a dearth of information on the motivational aspects of serious suicide attempts, in particular those which involve violent methods. Clarification of the reasons which lie behind such acts may suggest appropriate preventive strategies.

Interviews were carried out with 20 individuals who had attempted suicide by jumping in front of a railway train. Demographic and psychiatric data were collected for each case and the Suicidal Intent Scale was administered.

In most cases the act had been impulsive and was characterised by an extremely high level of suicidal intent. The majority were receiving psychiatric treatment at the time of their suicide attempt. In some cases, survival and the aftermath of the attempt appeared to have a beneficial effect on mental state.

While high levels of psychiatric morbidity and high suicidal intent were common, impulsivity and improved mental state indicate that there are similarities between high and low suicide intent survivors.