Background. Post-traumatic stress disorder (PTSD) is a multisystem neurobiological disorder with chronic alterations in various neurochemical systems. Levels of the GABAA – antagonistic neurosteroids plasma dehydroepiandrosterone (DHEA) and its sulphate derivate, dehydro-epiandrosterone sulphate (DHEAS) may be relevant to depressive and anxiety disorders, including PTSD.

Methods. We assessed the circulatory levels of morning plasma DHEA and DHEAS in 21 male out-patients with untreated chronic combat-related PTSD (CR-PTSD), and 18 healthy control male subjects.

Results. Compared with the control subjects, the PTSD patients showed significantly higher plasma DHEA and DHEAS levels.

Conclusions. Chronic CR-PTSD may be associated with increased circulatory level of neuroactive steroids with inhibitory activity at the GABAA receptors. Neurosteroid-induced decreased GABA-ergic tone may be relevant to the symptomatology and pathophysiology of chronic PTSD, as well as to the frequent co-morbidity of PTSD with depression and anxiety disorders.

Background. The general practitioner (GP) has traditionally been the first port of call for people with psychiatric morbidity but increasingly other members of the primary care team see the patients first, particularly practice nurses. The numbers and roles of practice nurses have expanded greatly over the past decade and it is important that practice nurses are able to recognize patients with psychiatric morbidity. This paper reports a study to determine the abilities of 24 practice nurses to detect psychiatric morbidity in patients attending their clinics.

Methods. Twenty-four practices were randomly selected from 41 practices recruited from South London and Kent. One nurse per practice took part in the study. Patients were asked to complete a 12-item General Health Questionnaire (GHQ-12) while waiting for their appointment with the practice nurse. Following their consultation, the practice nurse rated the patients' level of psychological distress on a five-point rating scale.

Results. The response rate of patients was 97% (N = 1710). The GHQ case rate was 36%. The mean detection rate by practice nurses when identifying significant distress was 16% (between nurse variation, 0% to 61%). The mean specificity was 96% (variation 77% to 100%). A second analysis, changing the nurse criterion to recognition of distress increased the mean sensitivity rate to 58% (variation 31% to 84%) but the mean specificity rate decreased to 66% (variation 26% to 95%).

Conclusions. These results demonstrate that practice nurses' caseloads include a high proportion of patients with psychiatric morbidity and that agreement with the GHQ classification of psychiatric morbidity is modest. Therefore, training in detection will be crucial for the nurses.

This conference will be held in Kuala Lumpur, Malaysia on 26–30 September 2001. The purpose of the conference, which will include a workshop in epidemiological methods, is to bring together clinicians and scientists who are engaged in epidemiological or health service research into mental disorders, to review progress especially in the Asian and Pacific regions and to help to promote international collaboration in this field.

Further details are given on the IFPE home page at http://www.humv.es/uipcs/ifpe Those interested should contact: Professor Saroja Krishnaswamy, Department of Psychiatry, Hospital University Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +60 3787 46634. Fax: +60 3787 56304 or +60 3973 784. E-mail: saroja54@hotmail.com