To determine whether the National Adult Reading Test (NART) would provide a valid estimate of premorbid intelligence in schizophrenia, two schizophrenic samples were recruited, one consisting of 35 patients resident in long-stay wards, the other of 29 patients normally resident in the community. Schizophrenic patients were individually matched for age, sex, and education with a healthy, normal subject. Both schizophrenic samples scored significantly lower on the Wechsler Adult Intelligence Scale (WAIS) than their respective control groups. NART-estimated IQ did not differ significantly between the community-resident schizophrenics and their controls, suggesting that the NART provides a valid means of estimating premorbid intelligence in such a population. NART-estimated IQ was significantly lower in the long-stay sample than in their controls. Although low NART scores in this latter sample could be a valid reflection of low premorbid IQ, the alternative explanation that NART performance was impaired by onset of the disease cannot be ruled out.

Studies of testosterone levels in patients with major depressive illness have produced varying results, plasma levels usually being reported. Saliva levels reflect ‘free’ plasma testosterone, and a pilot study of 11 men with major depression with melancholia, who underwent a standard dexamethasone suppression test, is described. There were no significant differences in testosterone levels compared with an age-matched control group. In the patient group, pre-dexamethasone levels correlated significantly and negatively with depression ratings on the 21–item Hamilton and the Montgomery and åsberg depression scales, and also with state anxiety measured on the Spielberger scale.

A summer peak was found in first admissions to hospitals in England and Wales between 1976 and 1986 for both affective psychoses and schizophrenia, but not for neurotic conditions or personality disorders. There was no significant relationship between age at first admission and season of admission. The summer peak was most prominent for mania, where it was present in both sexes; for schizophrenia, it was present only in females. These findings suggest that schizophrenia in females, and mania in both sexes, have some aetiological or precipitating factor in common.

Staff-patient relationships in long-term settings were examined in 35 staff and 61 patients. Measures were also taken of the staff's general health, their coping style in relation to work events, and job satisfaction. A range of ratings of EE was evident in staff descriptions of patients under their care. Strain and criticism in the relationship were not associated with identified stressors in the workplace, or the general health of the carer. When patients were grouped according to high-EE and low-EE interviews, there were no significant differences in their symptoms. Criticism was associated with other patient characteristics, including aggressive and attention-seeking behaviour, underactivity, and limited social interaction. The findings have implications for staff training and for the maintenance of optimal staff-patient relationships in services supporting severely disabled patients.

A group of 1070 community-living persons aged 65 and over was assessed using the GMS–agecat package and other interviews at years 0 and 3. Year 3 interviewers were ‘blind’ to the findings at year 0, and the prevalence of organic disorders and depression was very similar in both years. According to the results at year 3, minimum and maximum prevalence figures for dementia at year 0 were 2.4% and 3.8% for moderate to severe and 0.4% and 2.4% for mild or early cases, with a best estimate of 3.5% and 0.8%, or 4.3% overall, divided into: senile, Alzheimer's type 3.3%; vascular 0.7%; and alcohol-related 0.3%. The overall incidence of dementia, clinically confirmed by six-year follow-up, was 9.2/1000 per year (Alzheimer type 6.3, vascular 1.9, alcohol related 1.0). Three years later, 72.0% of those with depressive psychosis and 62.3% of those with depressive neurosis were either dead or had some kind of psychiatric illness. Nearly 60% of milder depressive cases (7.2% of the total sample) had either died or developed a chronic mental illness. The outcome of depressive pseudodementias is equivocal so far. Findings at year 3 provide validation of agecat computer diagnosis against outcome; organic and depression diagnoses are seen to have important implications for prognosis.

Converging lines of evidence suggest that attentional dysfunctions are indicators of a biological susceptibility to some forms of schizophrenia. More specifically, following the criteria outlined by Holzman (1983), impaired attention can be considered a potential biological marker because of the: (a) well replicated association between schizophrenia and attentional dysfunctions in patients, both when in episode and in remission (Nuechterlein & Dawson, 1984); (b) evidence that attentional problems can be detected in unaffected first-degree adult relatives of schizophrenic patients (Wood & Cook, 1979; Keefe et al, 1989, Steinhauer et al, 1991) (c) reports from a number of high-risk studies that attentional deficits pre-date clinical symptoms by many years (Rutschmann et al, 1977; Nuechterlein, 1983; Cornblatt & Erlenmeyer-Kimling, 1985; Mirsky et al, 1986; Erlenmeyer-Kimling & Cornblatt, 1987b; Mirsky, 1988) and (4) preliminary results suggesting that attention per se is genetically transmitted (Cornblatt et al, 1988).

Diurnal changes in the frequency of panic attacks and symptoms of generalised anxiety, phobic anxiety and phobic avoidance in 34 panic-disorder patients and 40 normal controls were evaluated. The panic-disorder patients had significant diurnal changes in generalised and phobic anxiety, but not phobic avoidance. Increased severity of symptoms and prominent diurnal changes were most evident in the panic-disorder patients with a history of depression. Although panic attacks were distributed throughout the 24–hour period, patients with a current episode or history of depression tended to have more frequent panic attacks in the morning or early afternoon. These observations challenge the traditional belief that ‘anxious neurotic’ patients are relatively asymptomatic upon awakening in the morning and then develop more severe symptoms of anxiety later in the day.

Suicide levels in England and Wales during 1979–83 were low among males from the Indian subcontinent (SMR 73) and significantly high in young Indian women (age-specific ratios 273 and 160 at ages 15–24 and 25–34 respectively). Suicide levels were low in Caribbeans (SMRs 81 and 62 in men and women respectively) and high in East Africans (SMRs 128 and 148 in men and women respectively). The excess in East Africans (most of whom are of Indian origin) was largely confined to younger ages. Immigrant groups had significantly higher rates of suicide by burning, with a ninefold excess among women of Indian origin. The pressures leading to higher suicide levels among young women of Indian origin highlight the need for making appropriate forms of support and counselling available to this community.

Fifty-five patients with primary major depression were followed up prospectively from time of onset of the index illness episode until recovery. The course of depression in hospital-treated patients was protracted, with a median length of episode of one year. Two factors significantly predicted persistence of symptoms: interval between onset and receipt of treatment, and premorbid neuroticism, which accounted for 55% of the variance in length of episode.

The recent exposure of the plight of inmates living in poor conditions at the state asylum on the Greek island of Leros has caused public and professional outrage. If Greece is to avoid mistakes made by other countries, the plans for rehabilitating the patients and closing the hospital should from the outset include identification of the precise needs of patients for support and care. This survey of the patients' characteristics and needs for care found that most patients had no outside friends or relatives, and most were unable to perform basic daily skills. They shared many basic characteristics, however, with a large sample of the long-stay population in the UK, and 25% were thought to be able to live independently.

Cortisol and prolactin responses to d-fenfluramine were measured in 10 drug-free normothymic patients with obsessive-compulsive disorder (OCD). The results were compared with these responses in 10 healthy controls and in 10 major depressives. The endocrine responses in OCD were significantly attenuated when compared to the healthy controls; however, the results were not specific to OCD as the depressives' responses were similarly blunted.

A multidimensional measure of children's perception of control was administered to 56 adolescents before and after admission. Different sources of control (‘internal’, ‘powerful others' and ‘unknown’) were analysed by domain (sphere of behaviour) and outcome (‘success' or ‘failure’). There were changes across domain and outcome for all three sources of control with significant changes away from ‘powerful others' and ‘unknown’ control. The trend towards internality was also evident in significant changes in the adolescents' perceptions in the ‘general’ domain and for a ‘success' outcome. Changes towards ‘internal’ source of control were associated with higher cognitive ability, whereas changes away from ‘powerful others' were most marked in girls, and changes away from ‘unknown’ were greatest in the older adolescents. These preliminary observations may help us understand beneficial effects of in-patient care and plan strategies for sustained change in these patients.

This study reports the demography, weight, and alcohol and psychiatric histories of the sexual partners of 112 consecutive patients with bulimia nervosa, all from an urban catchment area. Seventy-three patients (65%) had a current sexual partner. The partners were of similar social background, but slightly older. On average, partners were overweight (110% of MMPW) and over 27% reported having an eating or weight problem. A quarter of the partners had been treated for a psychiatric or emotional disorder. Nearly 40% drank more than 36 units of alcohol a week, and 14% had received treatment or consulted a doctor for alcohol-related problems. Heavy-drinking partners and multi-impulsive bulimics sought out each other. A quarter of partners had themselves been raised in a nuclear family in which a member had received psychiatric treatment; 12% had had a mother or sister with an eating disorder. Thirty-seven per cent of patients used a ‘safe man’, their fear of being hurt stemming from low self-esteem and a general sense of ‘failure’, and for 11% the relationship was abusive.

The prevalence of alexithymia in 48 female anorexia nervosa patients was 77.1% compared with a prevalence of 6.7% in 30 normal female subjects, matched by age and education. Alexithymia correlated negatively with education in the anorexic patient group, but was unrelated to duration of illness, amount of weight loss, and levels of depression and of general psychoneurotic pathology.

Psychiatric disorders are psychopathologically characterised by signs and symptoms. Although diagnosis and classification rely heavily on the patient's report of subjectively experienced symptoms, the assessment of the underlying psychopathological process can be impaired by the patient's distorted self-image, his cognitive abnormalities, and his limited capacity to express himself verbally. Non-verbal behaviour, however, lends itself to objective and generalisable assessments: it can be reliably and accurately observed and measured, and although subject to cultural influence, it is the infant's most elementary form of self-expression (Gaebel, 1990). In addition, it plays a major role in interpersonal communication, which is disturbed in all psychiatric disorders. Therefore, the analysis of non-verbal behavioural dysfunction offers an important approach to the complex biopsychosocial framework of mental disorders.

A group of 156 psychiatric patients from an urban community psychiatric unit for chronic psychiatric patients was routinely medically screened and reported on. Re-evaluation of the medical diseases found in those patients was carried out three years later. Those who were still being treated – 73 patients (47%) – were interviewed, as were their psychiatrist and, where necessary, their general practitioner (GP). The implementation of medical recommendations given following the physical screening by the specialist in internal medicine was also assessed. Re-evaluation of the diagnoses confirmed that 36% of this population had one or more physical diseases, rather than the 53% found earlier. The results show that the majority of physical complaints and diseases as well as functional illnesses were as persistent as the psychiatric diagnoses in this patient group. The patients' GP seems to be the person best suited as the primary physician responsible for the patient's physical health.

‘Hysterical conversion’ dates from a century before Freud, from an important attempt to rationalise the nosological status of hysteria. Freud's own concept of ‘conversion’ followed as a quite independent synthesis of 19th-century medical thinking on the subject. Subsequent analytical usage of ‘conversion’ which has influenced the description of hysterical syndromes within mainstream psychiatry, has not been consistent with Freud's own.

Among patients being treated for specific behaviour-control problems, there exists an important subgroup of ‘multi-impulsive’ patients whose treatment might be facilitated if the full range of their problems were recognised and dealt with as one general issue of impulse control. In women in particular, loss of control of eating may be prevalent and easily concealed from staff, and may thwart treatment. This survey of 50 women attending an alcoholic-treatment unit explored the prevalence of behavioural-control problems other than those of alcohol. Three-quarters of the women also had other behavioural problems. Over half the sample had thought of taking an overdose and just under half had actually taken one; about a quarter had cut themselves deliberately; half described impulsive physical violence; half acknowledged a period of ‘promiscuity’; and at least 16% had had a clinically diagnosable eating disorder. More research is needed but we believe that all self-damaging behaviour should be addressed simultaneously to prevent ‘revolving door’ relapses as emotional distress is transferred from one behaviour to another.

In Oxford during the late 1970s and early 1980s a decline in rates of deliberate self-poisoning and self-injury in older female teenagers was followed by a steady increase between 1986 and 1989. Rates for male adolescents and young female adolescents remained relatively stable throughout 1976–89. Applying the Oxford rates to England and Wales suggests a total of 18 000–19 000 hospital-referred cases per year. While self-poisoning with minor tranquillisers and sedatives has declined, there has been a marked increase in paracetamol self-poisoning, such that by 1988–89 it was involved in 48.3% of overdoses. Relationship difficulties were the most frequent problems faced by these adolescents, especially the females, with unemployment and alcohol and drug problems also being common, especially in males, but psychiatric disorders relatively rare. Substantial proportions of the adolescents, especially the males, were not living with either relatives or friends, and had a history of violence or a criminal record. The annual rate of repetition of attempts, which was 8.9% overall, was higher in adolescents not admitted to the general hospital, and in females not referred to the hospital psychiatric service. Adolescent attempted suicide clearly continues to be a major health problem for which both effective preventive and therapeutic strategies are badly needed.

The career of the diagnosis of conversion hysteria is reviewed at a time when it is threatened with expulsion from classifications of psychiatric disorder. Criticism of its face validity has not led to adequate diagnostic alternatives, and has been insensitive to its unusual form as a category as well as the contribution it has made to the stability of the classificatory system around it.