The study tested specific hypotheses that (a) there is an increased incidence of psychiatric disorders in asymptomatic heterozygotes for Huntington's disease (HD) compared with the normal homozygotes, and (b) there is an increased incidence of psychiatric disorders in the adult offspring of Huntington's disease patients compared with their partners.

A controlled study was made of 93 apparently healthy individuals (at 50% risk), who had given DNA samples for the predictive test, and 70 of their partners. Current and past psychopathology was assessed and compared with the DNA predictive test results based on linkage analyses. The results of psychiatric assessments of the two groups were compared.

DNA test results were available for 53 subjects (of 93). Five subjects at risk for HD were omitted from the study. The asymptomatic heterozygotes (n = 20) showed no significant increase in the incidence of any psychiatric episode, depression, schizophrenia or behavioural disorder when compared with the normal homozygotes (n = 33). The whole tested group showed a significantly greater number of psychiatric episodes than their partners (n = 43).

Asymptomatic HD gene carriers do not have a greater incidence of psychiatric disorders than the non-gene carriers born to a HD parent.

A prospective quasi-experimental design was used to evaluate the effect of training CPNs to undertake psychosocial intervention with families caring for a relative with schizophrenia.

Patients meeting predetermined criteria were allocated to either an initial waiting-list control group or a delayed intervention group. The CPNs were trained to offer family interventions to a total target group of 48. Treatment was eventually accepted by 85%, of whom 81 % (n = 34) were followed-up for 12 months. Families received a weekly mean session of 47 minutes (compared with 33 minutes in the controls). The main outcome measures are frequency and severity of symptoms (KGV), social functioning (SFS) and days in hospital. Carers' minor psychiatric morbidity (GHQ) and knowledge (KASI) are also reported.

In the patient group both the positive and negative symptoms of schizophrenia improved significantly (P ≤ 0.001 and P ≤ 0.01 respectively) to 12-month follow-up, as did a global measure of social functioning (P ≤ 0.001). Tentative evidence was also collected that family intervention reduced in-patient episodes. Benefits for relatives included a decrease in minor psychiatric morbidity (P ≤ 0.05) and an increase in knowledge about neuroleptic drugs (P ≤ 0.001).

The study offers some evidence that CPNs can be taught to improve the outcome for families who care for a relative with schizophrenia.

Low birth weight has been postulated to be a risk factor for schizophrenia.

Obstetric history, premorbid adjustment, and cognitive function during admission were assessed in 167 patients with DSM–III schizophrenia or affective psychosis.

A birth weight of less than 2500 g was significantly more common in patients with schizophrenia than in those with affective psychosis. Schizophrenic patients as a group had significantly lower mean birth weight, a finding which was particularly marked after controlling for sociodemographic confounders. In schizophrenic men, lower birth weight was highly significantly correlated with poorer premorbid social and cognitive ability, and with impairment of adult cognitive function.

Neurodevelopmental impairment may cause poor foetal growth, and schizophrenia in adult life.

Community psychiatric nurses (CPNs) are increasingly working in primary health care with non-psychotic patients. This study was designed to test the efficacy of this work.

The study was carried out in six health centres in north London with a total of 36 participating general practitioners (GPs) and 11 CPNs. Using a randomised controlled trial, 177 patients were referred by their GP and randomly allocated to continuing GP care, immediate community psychiatric nursing intervention, or placed on a 12-week waiting-list, after which time the patient was offered CPN intervention. A range of measures of symptoms and social function were used, and ratings were carried out at assessment and at 24 weeks.

Patients improved on all measures over time (P < 0.001 for all measures). However, there was no difference between the group of patients receiving GP care and patients seen by the CPN. Improvements seemed to be independent of the amount of contact. Drop-out rates from CPN intervention were high (50%). CPN drop-outs were more disabled to start with, but did as well as CPN treatment completers. Patients were more likely to drop out with trained than untrained CPNs. There was no evidence that referral to a CPN saved GP time.

The results add weight to the argument that CPNs should refocus their activity on people with serious mental health problems, and indicate that CPN education should focus on skill acquisition and interventions of proven effectiveness.

The induction agent propofol is known to reduce electroconvulsive therapy (ECT) seizure duration. It is assumed that outcome from depression is adversely affected by this agent. This study compares propofol and methohexitone as induction agents for ECT.

In a prospective, randomised, double-blind study 20 subjects with major depressive disorder (DSM-III-R criteria) received propofol or methohexitone anaesthesia. The Hamilton Depression Rating Scale and Beck Depression Inventory were used to assess depression before therapy, at every third treatment, and at the end of therapy. Seizure duration was measured using the cuff technique.

Mean seizure durations (P < 0.01) and mean total seizure duration (P < 0.01) were shorter in the propofol group. There was no difference in outcome.

Use of propofol may not adversely affect outcome from depression and it is not necessarily contraindicated as an induction agent for ECT. Our results should be interpreted cautiously, and larger studies are needed.

Information on risk factors associated with high rates of suicide is necessary, if suicide rates among the mentally ill are to be reduced.

We used ICD-9 E-codes to define deaths on which suicide or open (undetermined death) verdicts were returned, among residents of a catchment area defined by OPCS area codes. Relative risks of suicide and undetermined deaths for recent patients (those in contact with a psychiatric service in the year preceding death) were calculated.

Of the 286 persons, 108 were recent patients. Eighty-four per cent suffered from schizophrenia or depression. Risks of suicide and undetermined death for these patients were 31 and 20 times, respectively, those of other residents. Social risk factors varied with diagnosis.

Over 90% of recent patients were receiving medical care at time of death; not all were treated appropriately. Recognising medical and social risk factors in recent patients, and effective monitoring of treatment, is important.

One of the most important outcomes following an episode of non-fatal deliberate self-poisoning is its repetition.

In a prospective follow-up study the subjects were 992 people responsible for 1096 consecutive episodes of deliberate self-poisoning recorded at a teaching hospital accident and emergency department. Risk factors examined were socio–demographic variables, psychiatric and self-harm history, aspects of the self-poisoning episode, and appearance and behaviour at accident and emergency; the frequency of each was compared between those patients who repeated within one year (n= 116) and those who did not (n = 876).

Those who repeated were more likely to have ingested more than one drug, to report a previous episode of self-poisoning, to be aged 25–54, and to have experienced previous psychiatric care or psychiatric admission. They were less likely to be in paid employment, or to have expressed a threat to another person or written a note. The best predictor – previous psychiatric contact – only had a positive predictive value of 21 % (95% confidence interval 16–25%).

Risk factors for repetition of self-poisoning should be kept up-to-date despite modest predictive power. More attention might be paid to clinical rather than socio–demographic aspects of self-harm.

The Ward Daily Behaviour Scale is a new rating instrument that can be used to measure all the daily noteworthy behaviour of patients of various ages and diagnoses on psychiatric wards.

The reliability and validity of the scale were tested on 40 patients.

This instrument proved to be both reliable and valid for use on adult acute in-patient wards.

The scale will be a valuable tool in a wide range of ward-based studies.

The co-occurrence of panic disorder and major depression in the same individual is common. A question to be answered is whether the comorbid disorder is a distinct one or may resemble one or other disorder. In this paper we examine whether the comorbid disorder is a distinct condition.

We examined the symptom profiles and rates of comorbidity of panic attacks and DIS/DSM–III major depressive disorder in a population-based sample from four sites of the National Institute of Mental Health (NIMH) Epidemiologic Catchment Area Program (n = 12 668).

The co-occurrence of panic attacks and major depression over the lifetime was 11 times higher than expected by chance (OR = 11.4, 95% CI 9.5 to 13.6). Subjects with both panic and depression had worse symptoms than those who had only one disorder. However, the pattern of symptoms was remarkably similar, after overall severity was taken into account. Depressive symptoms associated with more severe forms of depression (e.g. guilt, suicidal thoughts or attempts, and motor disturbance) were more frequent in the comorbid group.

These findings may indicate a worse severity when the two disorders occur in the same individual.

Following reports of recent increases in adult male suicides in England and Wales, suicide rates for children and adolescents are reviewed.

By using estimated mid-year populations for five-year age bands, the suicide rates for 10–14 year-olds and 15–19 year-olds are calculated between 1960–1990. The same method is used to obtain rates for ‘undetermined’ death and ‘accidental’ death by causes comparable to suicide.

The only group to show an increase in suicide rate since the 1970s has been males aged 15–19 years. This increase persists even when ‘undetermined’ and ‘accidental’ death rates for causes similar to suicide are examined. The increase is associated with an increase in hanging and self-poisoning with vehicle exhaust gas.

The increase in suicide rate in 15–19 year-old males may indicate increased psychosocial stress, particularly affecting this age/gender group.

Although previous studies have attempted to identify predictors of outcome in schizophrenia, few have prospectively studied first episode patients for an adequate follow-up period.

The psychopathological predictors of outcome were investigated in a subgroup of 51 subjects, originally included in the Northwick Park study of first episode schizophrenia who were followed up 7.3 years (s.d. 1.1, range 5.3– 10.3) after first admission in the Harrow study. Forty-four subjects (24 men, 20 women) were traced. Outcome measures were time to first readmission, occupational level and total duration of hospital admission at five years after first admission.

A survival analysis of time to first relapse revealed that the presence of subjective feelings of depression (CATEGO syndrome SD) during the first admission was associated with early relapse while the presence of depressive delusions (CATEGO syndrome DD) and higher educational attainment protected against early relapse. Total duration of hospitalisation at five years after first onset was positively associated with the presence of CATEGO syndromes SD and OD (biological features of depression) and negatively associated with female sex. Poor occupational outcome was not significantly associated with any psychopathological predictors.

Our findings challenge the conventional view that symptoms of depression are associated with better outcome in schizophrenia.

We developed and evaluated a comprehensive, ongoing intervention for families of schizophrenic patients appropriate for China's complex family relationships and unique social environment.

Sixty-three DSM–III–R schizophrenic patients living with family members were enrolled when admitted to hospital and randomly assigned to receive standard care or a family-based intervention that included monthly 45-minute counselling sessions focused on the management of social and occupational problems, medication management, family education, family group meetings, and crisis intervention.

At 6, 12, and 18-month follow-ups by blind evaluators, the proportion of subjects rehospitalised was lower, the duration of rehospitalisation was shorter, and the duration of employment was longer in the experimental group than in the control group; these differences were statistically significant at the 12 and 18-month follow-ups and were not explained by differences in drug compliance. Family intervention was associated with significantly lower levels of family burden.

This intervention is less costly than standard treatment, is suitable for urban families of schizophrenic patients in China and feasible given the constraints of the Chinese mental health system.

A multi-dimensional approach was used to examine coping in chronic pain. The following hypotheses were tested: (a) patients who cope maladaptively also cope generally in a similar way; (b) patients' maladaptive coping is associated with childhood adversity.

Cross-sectional and retrospective data were collected from 68 consecutive patients (aged 18–70) at a pain clinic where their disease was non-systemic and the pain had lasted for at least three months. Sixty-one patients were interviewed using the Structured Clinical Interview for DSM–III–R, and the Measure of Parental Care in Childhood. All patients completed questionnaires on their pain and personality.

Two coping styles emerged from factor analysis. One was associated with chronicity, psychiatric morbidity, harm avoidance, immature defence style and reporting parental indifference.

Patients may be predisposed to cope maladaptively after the experience of parental indifference in early life. Such coping is likely to reflect more general patterns.

The role of clonidine in the management of opioid-dependent individuals undergoing gradual detoxification.

A double-blind placebo-controlled trial was conducted on 86 voluntary in-patients (59 male, 27 female) aged 18–47 years, at a specialist drug-dependence treatment unit. Patients entered the trial when on 40 mg of methadone daily or less, and were randomised to receive incremental doses of clonidine (increasing from 0.2 mg daily to 1.2 mg daily) during a 14-day period of gradual methadone detoxification and for four weeks thereafter. Blood pressure was monitored and severity of opioid abstinence was assessed by questionnaire and by clinical examination.

Half the subjects were withdrawn or defaulted from the trial by the end of two weeks, those receiving clonidine earlier than those receiving dummy medication (9 of the former and only one of the latter because of systemic hypotension). Similar proportions of subjects completed detoxification in the two groups. In those who completed detoxification, clonidine did not significantly reduce either the symptoms or objective signs of opioid withdrawal.

These findings suggest that clonidine has no place as an adjunct to a programme of gradual opioid detoxification.

We investigated whether a new non-benzodiazepine anti-anxiety drug, alpidem, produces weaker withdrawal symptoms than alprazolam.

Under a double-blind procedure, 122 patients suffering from general anxiety disorders were randomly allocated to either alpidem (50 mg, three times a day) or alprazolam (0.5 mg, three times a day) for six weeks, followed by a two-week placebo withdrawal phase. The diagnosis of withdrawal syndrome (WS) was made, in blind conditions, on the basis of the Withdrawal Symptom Check List (WSCL), after one or two weeks of discontinuation of active treatment.

The WS occurred significantly less frequently in the alpidem group (n = 10, 18%) than in the alprazolam group (n = 26, 48%). Typical withdrawal symptoms on the WSCL were also significantly less severe (P = 0.044) in the alpidem group compared with the alprazolam group.

Alpidem may be a valid alternative to current benzodiazepine anxiolytic therapy because it produces fewer and weaker withdrawal symptoms than alprazolam and is better tolerated.

The utility of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument for anxiety and depressive disorders in non-psychiatric units (medical & surgical wards; gynaecology & antenatal clinics of a teaching hospital) and a community sample in Nigeria was investigated.

A two-stage screening procedure was employed. This involved the use of GHQ–12/GHQ–30 and HADS against the criteria of a standardised (PSE schedule) psychiatric interview, with psychiatric diagnosis assigned in accordance with ICD–9 criteria.

Sensitivity for the anxiety sub-scale ranged from 85.0% in the medical and surgical wards to 92.9% in the ante-natal clinic, while sensitivity for the depression sub-scale ranged from 89.5% in the community sample to 92.1% in the gynaecology clinic. Specificity for the anxiety sub-scale ranged from 86.5% in the gynaecology clinic to 90.6% in the community sample, while specificity for the depression sub-scale ranged from 86.6% in the medical and surgical wards to 91.1 % in the ante-natal clinic and community sample. Misclassification rates ranged from 9.9% in the community sample to 13.2% in the medical and surgical wards. Relative Operating Characteristic (ROC) analyses showed the HADS and the GHQ–12 to be quite similar in ability to discriminate between cases (anxiety and depression) and non-cases.

The HADS is valid for use as a screening instrument in non-psychiatric units and although initially developed for use in hospital settings, it could be usefully employed in community settings of developing countries to screen for mental morbidity.

The aim was to investigate the effect of tiapride (100 mg three times a day for at least one month) on outcome following detoxification.

The setting was a tertiary referral centre. The study design was randomised, double-blind, and placebo-controlled. One hundred routinely admitted alcohol-dependent patients were entered, and 54 completed the trial. Outcome was assessed by considering drinking status at three months and six months follow-up, and by comparing psychological status at intake and follow-up using the Crown-Crisp Experiential Index, the Litman Self-esteem scale and a Satisfaction with Life Situations scale. We also compared performance over the six months before admission with the three and six months of follow-up on measures of health, social and drinking variables.

Tiapride proved better (usually at statistically highly significant levels) than placebo at promoting: abstinence, self-esteem, and satisfaction with life situations; and at reducing: alcohol consumption, use of health service resources, and levels of neuroticism.

Tiapride merits serious consideration in the longer-term treatment of alcoholic patients.

Autoscopy is defined here as a visual experience where the subject sees an image of him/herself in external space, viewed from within his/her own physical body. This paper reviews the literature both historically and conceptually, and includes a quantitative study of accumulated cases.

Cases published since 1935 and meeting the above definition for autoscopy (n = 53) were included, together with three personally-observed patients. A clinical protocol was completed for each case, including information about the autoscopic image. Cases were compared using non-parametric statistics on dichotomised variables.

There were 38 men and 18 women, with a mean age of 39.5 years (range 13–78). Of the subjects, 33 (59%) had a neurological illness, most frequently epilepsy (18 cases). Right and left sided lesions were equally represented. Psychiatric disorder was often present (33 cases, 59%), most commonly delirium, depression or psychosis. The features of the images seen were diverse, but speaking images were associated with younger age, male sex, psychotic illness, longer duration of image, and hypnagogic/hypnopompic experiences.

Autoscopy may arise from a convergence of several variables, including gender, personality factors, neurological and/or psychiatric disease, exhaustion and dissociation, whose interaction may override the normal inhibition of temporal lobe activity. A cognitive neuropsychological hypothesis is proposed, together with avenues for future research.