In this article we address the relationship between behavioural assessment and psychiatric diagnosis. We argue that a diagnostic formulation should be made prior to behavioural assessment but consider diagnosis as complementary to traditional behavioural assessment. Implicit in our proposal, is the notion that behavioural practitioners should be thoroughly conversant with the various forms of psychopathology, and be able to identify the signs and symptoms that cluster together to constitute a clinical syndrome or disorder. The same practitioners should be able to differentiate the signs and symptoms of one syndrome or disorder from another. It is further proposed that behavioural practitioners need to be aware of the limitations and boundaries of their particular approaches and concede the value of other treatment approaches (especially chemotherapy) derived from different theoretical perspectives (Hersen 1979, 1981; Kazdin and Hersen, 1980). Such approaches may assume priority in the treatment of certain disorders, e.g., the first-rank symptoms of schizophrenia.

The term diagnosis means “to know through” and is simply a hypothesis about the nature of a problem (Rush, 1982). Ideally, a diagnosis should simplify complex data; provide information about the likely outcome of a particular psychiatric disorder with and without treatment; allow improved prognostic judgements; assist in the selection of appropriate treatments; allow communication between professionals; and lead to improved clinical strategies (Kendell, 1974; Rush, 1982).

This article describes the Early Psychosis Prevention and Intervention Centre (EPPIC) — an innovative and comprehensive service that attempts to address the needs of older adolescents and young adults experiencing their first episode of psychosis. Some of the key theoretical concepts and philosophical tenets which underpin the service delivery model are adumbrated. Furthermore, the historical antecedents of the current service, and the “successive approximations” approach taken in developing the same, are delineated. Given the evolutionary nature of the program, the perceived future needs and developments are stipulated.

Cognitive factors, such as the accessibility of schematic categories, have been shown to bias interpretation of information about other's behaviour. In this study, the effects of diagnostic category accessibility on subjects' causal attributions for an interviewee's behaviour were investigated. In order to activate a specific diagnostic category, making it more accessible for information encoding, mental health students completed a short test. Half answered questions about victims of rape attacks; the other half answered questions about the diagnosis of histrionic personality disorder. All subjects then rated their attribution for a female interviewee's non-verbal behaviour along four dimensions: Internality, Stability, Globality, and Controllability. Results indicated an interaction between type of course and experimental condition. Psychology undergraduate students in the Rape Victim condition tended to make more stable and global attributions than did Psychiatric Nursing and Masters of Psychological Medicine students. In addition, a significant main effect was found on the Controllability dimension. The subjects in the Personality Disorder condition rated the cause as significantly more controllable than did the subjects in the Rape Victim condition. Implications of the results are discussed.

It is fitting that the first mini-series issue of Behaviour Change should be devoted to an exposition of current cognitive-behavioural treatments for various aspects of schizophrenia. The disorder has a surprisingly high incidence in the population. Approximately 1 in 100 people will develop schizophrenia during the course of their life-time (Cancro, 1980). Arieti (1981) observes that more hospital beds are occupied by individuals suffering from schizophrenia than from any other psychiatric or medical problem, including cancer or cardiovascular disease.

The introduction of the phenothiazines in the 1950s resulted in dramatic increases in hospital discharges for schizophrenic patients but did little to change the “revolving-door” phenomenon. This chronic relapsing population is characterized as “the patient's having been admitted to an inpatient mental health facility several times and/or having been hospitalized for a period of at least a year on a single admission,” as well as possessing “a number of deficits in adaptive behavior” (Matson, 1980, p. 169). Indeed, whilst the schizophrenic individual's most florid symptoms e.g. delusions, hallucinations and thought disorder, may be well controlled on even minimal dosages of the neuroleptics (generally leading to that person's discharge from hospital), other social and self-care deficits may remain prominent reminders of the patient's difficulties in everyday living.

The chronic schizophrenic patient's deficits are characterized by an ambivalent relationship with the outside world. On the one hand he displays a lack of willingness or ability to interact appropriately with other people, and on the other hand, he depends on significant others such as a parent, other relative, or even a health professional. Despite this, he has a poor social network. He has reduced expectations of himself, is unable to effectively problem-solve, and his lifestyle reflects a desire to have an uneventful existence, free from harrassment. He becomes alienated from society, and may be unable to seek and gain employment, live independently, or manage routine responsibilities, e.g. financial budgeting.

Background: High quality randomized controlled trials (RCT) of psychotherapeutic interventions should ensure that the therapy being tested is what is actually delivered. However, contamination of one therapy into the other, a critical component of treatment adherence, is seldom measured in psychotherapy trials of psychosis. Aims: The aim of the study was to determine whether a purpose-designed measure, the ACE Treatment Integrity Measure (ATIM) could detect therapy contaminations within a controlled trial of cognitive behavioural therapy (CBT) versus Befriending for first-episode psychosis and to compare the ATIM to a more traditional adherence measure, the Cognitive Therapy Scale (CTS). Method: Therapy sessions were audio-recorded and at least one therapy session from 53 of the 62 participants in the RCT was rated by an independent rater using the CTS and ATIM. Results: Ninety-nine therapy sessions were rated. All Befriending sessions and all but three CBT sessions were correctly identified. The ATIM showed that 29 of the 99 (29%) sessions were contaminated by techniques from the other therapy. Within the CBT sessions, 19 of the 51 sessions (37%) were contaminated by one or more Befriending techniques. Of the Befriending sessions, 10 of 48 (21%) were contaminated by ACE techniques. The mean CTS score was higher in the CBT than the Befriending group. Conclusions: The ATIM was able to detect contaminations and revealed more meaningful, fine-grained analysis of what therapy techniques were being delivered and what contaminations occurred. The study highlights the benefit of employing purpose-designed measures that include contamination when assessing treatment adherence.