A prospective neuropsychiatric study of 31 consecutive subjects with Wilson's disease is reported. Exploratory factor analysis yielded four factors: neurological, cognitive, hepatic/depressive and psychiatric. Significant associations were found between a ‘psychopathic’ personality factor and neurological and dysarthria scores. The d’ and β coefficients of a signal-detection memory task dissociated: the former correlated only with Mini-Mental State and Benton visuospatial task; and the latter with depressive symptoms. Using discriminant function analysis, there was efficient classification of ‘psychopathic’ personality by dysarthria, and of individual depressive symptoms by disturbance of gait. Biochemical markers of hepatic dysfunction were significantly associated with certain depressive symptoms. No evidence emerged to support the putative association with schizophrenia-like psychosis.

A new scale for the detection and assessment of maternity blues was completed by 56 women daily for ten days after elective gynaecological surgery. When their responses were compared with those of 87 post-natal women, they differed significantly in frequencies of different symptoms at different times. The findings suggest that post-natal mood changes (‘maternity blues’) are characteristic of the puerperium and not simply non-specific reactions to physical and emotional stress.

The effect of moclobemide, a short-acting, reversible, preferential monoamine oxidase-A inhibitor in a 4-week therapeutic trial, on the sleep of ten depressed patients, was assessed by polysomnographic recordings. Compared with their time on placebo, patients receiving moclobemide showed improved sleep continuity, particularly during the intermediate and late stages of drug administration. The total increase in sleep time was comprised of larger amounts of stage 2 non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. Withdrawal of moclobemide was followed by a further increase of REM sleep, although values did not surpass those sometimes observed in adults with normal sleep. In these patients, the symptoms of depression were rated as being significantly improved during the study period.

In making these ratings the psychiatrist is expected to use his clinical judgement to make overall assessments about the patients in each particular area. For example, in making the rating for depression the rater should be expressing his own clinical assessment of the severity of depression, based on both the patient's demeanour and behaviour during the interview, and the history that the patient has given concerning depression. It should be emphasised that a morbid rating (2, 3, or 4) for depression does not imply that the principal diagnosis made will necessarily be an affective illness.

In a prospective study of late-life onset psychosis, five of the first 27 patients studied had extensive white-matter lesions demonstrated by MRI and/or CT. None of 60 age-matched psychiatrically healthy controls demonstrated such lesions. All five patients had a mild dementia and a frontal behavioural syndrome. In addition, every patient performed poorly on neuropsychological tests of frontal function. Dysfunction of the frontal cortex associated with white-matter lesions appears to contribute to the clinical picture of some cases of late-life psychosis.

We have used a novel technique to assess the transport of cations across the erythrocyte membrane in vivo in unmedicated patients suffering an acute manic illness. The results show that erythrocyte cation transport via the sodium-pump enzyme Na+,K+-ATPase is increased in manic patients compared with healthy controls.

Sixty-seven women were interviewed four weeks after spontaneous abortion. As determined by the Present State Examination, 32 of these women were psychiatric cases. This rate is four times higher than in the general population of women. In each case the diagnosis was depressive disorder, a finding confirmed by scores on three depression rating scales. Many women showed typical features of grief. Depressive symptoms were significantly associated with a history of previous spontaneous abortion, and less so with childlessness.

This paper reports a test of the hypothesis that winter birth is a risk factor for childhood psychosis. All psychotic children (n = 208) admitted to a day-treatment facility in Paris from 1960 through to 1986 were compared with 1040 controls matched by sex and year of birth. Risk ratio estimates were computed for each month, and a significant increase was observed for boys born in December. This association was stronger in some years than in others. The fact that there were no excesses in contiguous months detracts from the persuasiveness of this association.

This paper attempts to describe some of our electrodermal data and its relationship with environmental factors and the outcome of a psychosocial intervention study with families of schizophrenics. In the context of the heuristic vulnerability/stress model of the development and course of schizophrenic episodes described by Nuechterlein & Dawson in 1984, there is an interaction between individual vulnerability factors and external environmental stressors with resulting effects on the hypothesised transient intermediate states of: processing capacity overload, autonomic hyperarousal and a deficient processing of social stimuli. Accelerating dysfunctions in these systems result in the reappearance of characteristic schizophrenic psychotic symptoms. The purpose of our work has been to investigate the interface between the individuals' biological and environmental systems.

A study of 365 women aged 70–79 in a rural community was carried out using the Cambridge Examination of Mental Disorders in the Elderly (CAMDEX). Prevalence rates of dementia are reported by severity for the 70–74 and 75–79 age groups. Differential diagnosis was made according to CAMDEX guidelines. Senile dementia of Alzheimer type accounted for half the dementia cases. The prevalence rates overall did not differ from those reported in other recent studies, but the rates for levels greater than mild/moderate were lower, despite the inclusion of subjects in institutions.

The Scale for the Assessment of Negative Symptoms (SANS) was the first instrument developed in order to provide for comprehensive assessment of negative symptoms in schizophrenia (Andreasen, 1982, 1983). It consists of five scales that evaluate five different aspects of negative symptoms: alogia, affective blunting, avolition-apathy, anhedonia-asociality, and attentional impairment. Each of these negative symptoms can be rated globally, but in addition detailed observations are made in order to achieve the global rating. It is complemented by a Scale for the Assessment of Positive Symptoms (SAPS), which permits detailed evaluation and global ratings of hallucinations, delusions, positive formal thought disorder and bizarre behaviour (Andreasen, 1984). Taken together, the two scales provide a comprehensive set of rating scales in order to measure the symptoms of schizophrenia and to assess their change over time.

Variation in quarter of birth was examined in patients with a clinical diagnosis of AD. There was a significant excess of first-quarter births among AD patients as compared with the expected birth rates derived from an age-matched census sample. This finding was due entirely to the significant excess of first-quarter births in AD patients without a family history of dementia. No seasonal variation was found in the birth dates of other clinical groups.

We have investigated cation transport in vivo in patients being treated with lithium for bipolar affective illness by studying the disposition of rubidium after an oral load of rubidium chloride. The rate of erythrocyte cation transport was increased in the patients when compared with matched healthy volunteers. However, the rate of in-vivo erythrocyte rubidium accumulation in the euthymic treated patients was significantly lower than in a matched group of unmedicated manic patients. The regulation of specific pathways for cation transport may be altered in individuals predisposed to affective illness.

The older monoamine oxidase inhibitors (MAOIs) are mechanism-based, irreversible inhibitors of MAO; most inhibit both the A and B forms of MAO. Several of the drugs are hydrazine derivatives which have non-specific effects other than MAO inhibition. These properties convey disadvantages, which may be seen as serious, though infrequent, adverse events — the ‘cheese effect’, hepatotoxicity, amphetamine-like activity, orthostatic hypotension and anticholinergic effects. New, reversible MAOIs stem from a variety of chemical classes and are more specific in their effects, with relatively rapid onset of action, direct relationship between plasma concentration and pharmacological effect, and no prolonged carry-over phenomena.

One hundred and six women were assessed psychiatrically in the 14–16th and 36–38th weeks of pregnancy and the 12th week after childbirth. They also completed a maternity blues questionnaire daily in the ten days after delivery. Blues scores were significantly associated with: neuroticism; anxiety and depressed mood during pregnancy; fear of labour; poor social adjustment; and retrospective severity of pre-menstrual tension. Blues scores were not associated with obstetric factors, with previous history of psychiatric disorder, or with case status on the PSE in pregnancy or 12 weeks after delivery.

Ninety-three patients with acute stroke lesions restricted to the right hemisphere were examined for the presence of mood changes. While 46 patients showed no mood changes, 19 were unduly cheerful, 17 had developed major depression, and 11 had developed minor depression. Although there were no significant between-groups differences in other demographic variables, neurological deficits, activities of daily living, cognitive impairment, or quality of social support, patients with major depression had a significantly higher frequency of familial history of psychiatric disorder and lesions of the parietal cortex than patients with either no mood change or major depression following left-hemisphere lesions. On the other hand, undue cheerfulness was significantly associated with lesions of the right frontal operculum. These findings suggest that major depression following right-hemisphere lesions may have a different aetiology and mechanism than major depression following left frontal or basal ganglia lesions.

Around the turn of the last century, Kraepelin and Bleuler developed the theory that some schizophrenic symptoms can be traced back to attentional disorders and in contemporary experimental research on attention, this reappears in the thesis that attentional disorders cause a vulnerability to schizophrenia. Empirical studies (Nuechterlein & Dawson, 1984) showed that attentional deficits before, during, and after an episode of such illness are consistent with the vulnerability model. However, if attentional disorders really do play a fundamental role in the development of schizophrenic symptoms, how do patients handle their more-or-less intact attentional capabilities? Thus, at the current level of research, the relevant question is not only whether attentional disorders occur, but – more and more – how such patients process information in the presence of these disorders.

A psychiatric consultation was requested in 51 in-patient cases of HIV infection. Reasons for referral included counselling, the evaluation of depressive symptoms, and the treatment of delirium. The most common DSM–III diagnoses included: delirium (n = 13), major depressive disorders (n = 12), dementia (n = 5), and adjustment disorders with depressive or anxious mood (n = 5). The psychiatric treatment of patients with HIV infection does not differ fundamentally from that of other medically ill patients with similar psychiatric symptoms. However, the psychiatric treatment of patients with HIV infection can be hampered by the fear of contagion, negative attitudes towards homosexuals and drug users, and overidentification or avoidance reactions.

We evaluated the dexamethasone suppression test (DST) as a predictor of response to drugs and placebo in 105 patients, in a large double-blind placebo-controlled out-patient trial to determine the efficacy of paroxetine HCI, a selective serotonin reuptake inhibitor, compared with that of imipramine HCI and placebo. The presence of a positive or negative DST did not predict response to either paroxetine or imipramine. However, a positive DST predicted a poorer response to placebo: only 3 out of 18 patients who showed DST non-suppression responded to placebo, as opposed to 11 out of 21 who exhibited DST suppression (P<0.05). A positive DST was associated with a 61% response to drugs and a 16% response to placebo. This finding suggests that the presence of a positive DST implies the need for active somatic treatment.