Jenkins et al. (1981) published data on rates of admission to three psychiatric hospitals for 12 large samples of people living near London's Heathrow Airport. The percentages of people who were classified as being affluent, living alone, males having moved within last five years, unemployed, and immigrants, as well as the levels of aircraft noise to which they were exposed, were given for each of the samples. Multiple-correlation analyses revealed the following: (1) movement of males in the previous five years was not generally associated with hospital admission rates; (2) immigrant status, living alone, and affluence were negatively, and generally statistically significantly, associated with admission rates; and (3) unemployment and level of exposure to aircraft noise were positively, and generally statistically significantly, associated with admission rates. Unlike the conclusion reached by Jenkins et al., it is concluded from the present analysis of their data that there are statistically significant associations between psychiatric hospital admission rates and level of exposure to aircraft noise. This difference in findings appears to be due to a more comprehensive assessment of the interrelations of all the tested socioeconomic and aircraft noise variables by the multiple-correlation procedure used in the present analysis, in comparison with the graphic modelling assessment applied by Jenkins et al. to a limited portion of the socioeconomic data. Together, the five socioeconomic and aircraft noise variables correlate at about 0·98 with hospitalization rates for most population groups.

Thirty-one patients with atypical non-cardiac chest pain which had persisted despite negative medical investigation were treated in a controlled trial of cognitive-behavioural therapy. The average duration of pain was 4·7 years. Patients were randomized to either immediate treatment or as a control to assessment only. Treatment involved teaching patients how to anticipate and control symptoms, and modification of inappropriate health beliefs. The average number of sessions given was 7·2. There were significant reductions in chest pain, limitations and disruption of daily life, autonomic symptoms, distress and psychological morbidity in the treated group as compared with the control group who were unchanged. The assessment-only group were treated subsequently and showed comparable changes. Improvements were fully maintained by both treated groups at four to six-months follow-up.

The steps to setting up a population register of elderly residents are described. Based upon this, 87·2% of the elderly residents of an inner-city electoral area were screened for memory disorder, depression and activity limitation using the Short CARE. Contact with medical and social agencies was also recorded; 4·7% were classed as cases by the dementia diagnostic scale, sufferers being older and not living alone. Of the residents 15·9% were classed as depressed, this state being more prevalent in those not currently married. The depresse were, in contrast to the demented residents, likely to be in recent contact with hospital and general practitioner. Thirty-two per cent of the population showed impairment in daily activity, these individuals were usually older, not married and receiving hospital care. Sleep disorder and compliant of many somatic symptoms were associated with a diagnosis of depression. In contrast, most respondents with a subjective complaint of memory disorder, which was common in this population, were neither suffering from depression nor dementia.

With this accurate sampling frame and a good response rate, the prevalence rate of clinical depression must be seen as disturbingly high. The prevalence rate of dementia approximated to that of other surveys. This study also indicated that general practitioners' lists may be inaccurate and that non-responders to first approaches for interview, although similar in demographic features to those responding, may contain among them many suffering from dementia.

This study, reporting a ten-year investigation of suicide in Kildare, found that the suicide rate based on clinical assessment of coroner's records was very close to the Central Statistics Office (CSO) figure for Kildare and for Ireland as a whole for the same period. Dublin data for 1977–1981 confirmed these findings. Since in the 1960s similar clinical assessment concluded that CSO rates underestimated suicide by a factor of two or over, we believe that changes in CSO coding procedures whereby more deaths are now coded to suicide than was the case in the past have resulted in current CSO data reflecting accurately the rate of clinical suicide. There has been more than a three-fold increase in CSO suicide rates in Ireland between 1968 and 1987. Even allowing for improved CSO practices there still remains a considerable excess of suicide deaths which indicates a doubling of ‘real’ suicide in Ireland over these twenty years.

One hundred and thirty men and women attending psychiatric hospitals with depressive disorders were interviewed at the time of their initial contact. After a mean four month interval, 119 were reassessed in order to test the hypothesis that initial levels of social support predict clinical improvement even when other potential risk factors such as age, sex, diagnosis and severity of depression are controlled. Severity and duration of the episode emerged as the only significant background predictors of recovery. The explained variance in recovery from depression due to social support was equal in men and women, and was not diminished by the background clinical predictors. According to subset analyses however, the aspects of personal relationships and perceived support that predict recovery in men and in women appear to be different. The available multiple regression models of outcome favoured a main effect of social support and provided persuasive if inconclusive evidence for a statistical interaction effect with sex. The implications for further research and for theory are discussed.

The Symptom Check List (SCL-90R) is a self-report questionnaire which is designed to be suitable for use as a psychiatric case-finding instrument, as a measure of symptom severity, and as a descriptive measure of psychopathology. Scores obtained using the instrument were compared with those obtained from the investigator-based interview, the Present State Examination, in two samples of patients: a sample of patients with chronic physical disease (diabetes mellitus) and a sample of patients with bulimia nervosa. There was good agreement between the two methods of measurement in both samples, suggesting that the SCL-90R performs well in the assessment of neurotic symptoms.

In conjunction with the Epidemiological Catchment Area (ECA) survey conducted in Baltimore, MD, a two-stage probability sample of community subjects was developed with a full psychiatric examination employing DSM-III criteria. This report details the observations on those subjects diagnosed with the DSM-III diagnosis Histrionic Personality Disorder. The results indicate that this condition can be diagnosed reliably and that it is a valid construct. It has a prevalence of 2·1 % in a general population. Males and females are equally affected, suggesting that prior reports of an increased prevalence in females was an expression of ascertainment bias found in hospital-based studies. The diagnosis is associated with clear evidence of disturbance in the emotional, behavioural, and social realms. Individuals with this disorder tend to use health care facilities more frequently than others.

The parental representations of male-to-female and female-to-male transsexuals were rated using the EMBU inventory. Scores on the measure were compared against ratings returned by controls of similar biological sex, matched on age, educational level and number of female siblings in an ANCOVA design. In line with previous findings by Parker & Barr (1982), who studied male-to-female transsexuals only, these patients were found not to differ from the male controls in their scoring of their mothers, but did score their fathers as less emotionally warm, more rejecting and more protective. Extending the findings by Parker & Barr (1982), female-to-male transsexuals rated both parents as more rejecting and less emotionally warm, but only their mothers as more protective than their female control equivalents rated theirs. Parental divorce distinguished both patient groups from controls, although further analyses revealed this not to imply more parental absence in patients than in controls. Male and female transsexuals differed from each other in some respects (e.g. lower scores on parental emotional warmth and higher scores on maternal rejection for the female patients), while being comparable in other respects (e.g. parental divorce).

An attempt was made to assess in detail subjects screened as suffering from dementia among a North London community sample of elderly people. Forty-eight (80 %) subjects were interviewed, 7 (12%) were found to have died and 5 (8%) either refused interview or were lost to follow-up. By clinicians' diagnosis of the 48 interviewed, 22 subjects (46%) had probable Alzheimer's disease, one had multi-infarct dementia, five had mixed dementia, five had secondary dementia, 10 had a dementia which could not be further classified and 5 were not demented. No subject had a reversible condition. The prevalence rate for clinical dementia was 6·1 %, and for Alzheimer's disease 3·1 %. According to AGECAT diagnosis the prevalence of organicity was 5·7%. The AGECAT diagnoses and psychiatrists' diagnoses were significantly associated (P < 0·003) and AGECAT was more likely to identify as organic those subjects with dementia diagnosed by psychiatrists as Alzheimer's disease, than those not so diagnosed (P < 0·04). A short psychometric battery, including the MMSE in two versions, was administered and its acceptability to a community sample evaluated. This detailed clinical investigation showed that the Dementia Diagnostic Scale of the Short-CARE was a specific predictor of clinical dementia or death at the time of follow-up, whereas the more inclusive Organic Brain Syndrome scale was a more satisfactory first phase screening instrument.

This paper presents evidence that on an information processing task, designed to investigate putative inhibitory mechanisms in selective attention, obsessive compulsive disordered individuals can be clearly distinguished from other anxiety disorder clients and show significantly higher scores on questionnaire measures designed to detect schizotypy in the normal population. It is suggested that these results provide some support for the idea that obsessive compulsive disorder may be misclassified as an anxiety disorder and may in fact be categorically more closely aligned to the schizophrenic constellation of disorders.

Two hundred and ten psychiatric patients with one of three DSM-III diagnoses, generalized anxiety disorder (N = 71), panic disorder (N = 74) or dysthymic disorder (N = 65), were included in a clinical trial in which diazepam, dothiepin or placebo tablets, cognitive and behaviour therapy, or a self-help package were given over ten weeks. Personality status was assessed independently using a structured interview, the Personality Assessment Schedule. One hundred and ninety-eight patients had personality assessments, 89% with a close informant. Thirty-six per cent had a personality disorder and these patients had more severe psychopathology than those with no personality disorder. Personality disorder was more common in patients with dysthymic disorder and this group responded less well to treatment. The category of personality disorder had no apparent influence on symptoms.

Research on the role of life events in the onset of depression has suggested that certain vulnerability factors can increase the risk of disorder in the face of a threatening event. The role of vulnerability factors to increase the likelihood of severs events occurring in the first place has remained largelu unexplored. The vulnerability factor which has received the most attention is a lack of social support, particularly lack of a confiding relationship with a husband for women. A reanalysis of a number of published studies is undertaken; this shows that there is a positive relationship between lack of intimacy and the occurrence of adversity. The implications of this finding are briefly discussed, with emphasis on the need for a life-span developmental perspective in future life events research.

An autistic young man and a normal control were asked to factorize numbers and to recognize and generate primes. Both subjects made a similar of errors and employed similar strategies, but they differed markedly in the speeds at which the arithmetical operations were carried out.

Modern reports on lycanthropy mainly concentrate on the content of patients' beliefs in being transformed into an animal. By contrast, an interest in the form of the symptomatology is usually minimal. This paper draws on Karl Jaspers' phenomenological views and focuses on some important albeit neglected psychopathological issues related to form which are relevant to any comprehensive consideration of lycanthropic phenomena.

Whakama is a psychosocial and behavioural construct in the New Zealand Maori which does not have any exact equivalent in Western societies although shame, self-abasement, feeling inferior, inadequate and with self-doubt, shyness, excessive modesty and withdrawal describe some aspects of the concept. It is an important construct in order to understand the interaction of the Maori with each other and with the Caucasian New Zealander, the behaviour of the Maori in cross-cultural settings, and the clinical presentations of some Maori patients. This paper examines some of the meanings of Whakama, its various behavioural manifestations and its possible causes. The clinical relevance to psychiatry is emphasized.

Waiho ma te whakama e patu!

‘ Leave him alone he is punished by whakama ’ (Maori saying)

In this paper four principal topics are addressed: (a) the policy and political contexts in which demands arise for cost information; (b) the nature and phasing of those demands; (c) the basic rules of empirical costs research for meeting those demands; and (d) concomitant implications for the design, execution and interpretation of their research. Mental health care policy or practice changes which ignore costs, or which embody cost information without obeying or recognizing the four basic rules, can only be of dubious validity, or can only be used to answer a limited range of questions. But, as the illustrative studies show, it need not be an horrendous, or ideologically compromising or scientifically complex task to add a cost dimension to the evaluation of mental health services. There are enough examples in the literature of bad costs research to demonstrate that it is not as simple as some people think, but there are also enough examples of good research t o encourage further attempts.

This article addresses the issues of recognition and labelling of psychological disorders (PDs) by general practitioners (GPs), and he association of recognition with management and outcome. Nearly 2000 attenders of 25 GPs were screened with the GHQ and a stratified sample of 296 patients was examined twice, using the Present State Examination (PSE) and Groningen Social Disability Schedule (GSDS).

Prevalence rates of PDs according to the GHQ, GP and PSE were 46%, 26% and 15% respectively. For the 1450 ‘new’ patients, i.e. patients who had no PD diagnosed by their GP in the 12 months prior to the enrolment visit, these rates were 38%, 14%, and 10%. GPs missed half of the PSE cases and typically assigned non-specific diagnoses to recognized cases. Depressions were more readily recognized than anxiety disorders, and the detection rates for severe disorders were higher than those for less severe disorders.

Recognition was strongly associated with management and outcome. Recognized as compared to non-recognized cases were more likely to receive mental health interventions from their GP and had better outcomes in terms of both psychopathology and social functioning. Initial severity, psychological reasons for encounter, recency of onset, diagnostic category, and psychiatric comorbidity were related to both better recognition and outcome. However, these variables could not account for the association of recognition with management and outcome, but some did modify the association. A causal model of the relationships is presented and possible reasons for non-recognition and for the beneficial effects of recognition are discussed.

Almost all previous studies of the psychological sequelae of hypertension labelling have lacked a prospective, longitudinal design which could allow for causal interpretations. The present study relies on questionnaire data from a hypertension screening carried out on the entire adult population of a medium-sized, Norwegian county (total number of participants = 74977). ‘Labelled’ individuals, i.e. previously unaware hypertensives (N = 173), false positives (N = 233), and patients in need of continued BP control (N = 474) have been followed up after 1–3 years, and comparisons are made with aware hypertensives (N = 206), patients previously treated for hypertension (N = 118), and a random sample of normotensives (N = 2326). ‘Pre-labelling’, baseline measures of subjective well-being had been carried out on all comparison groups in connection with the screening. Changes in psychological well-being are not significantly related to labelling or BP-status. However, there is a deterioration in psychological well-being among participants who have been subjected to one or more negative life events/stresses (other than labelling) in the preceding 12 months.

Interviews were conducted with parents of 100 children taken to a ‘School attendance committee’, because of persistent failture to attend School. Clinical assessmen t of the attendance problem was carried out so that children were categorized as ‘School refusers’ (N = 24), ‘truants’ (N =53), ‘both refusers and truants’ (N =9), or as ‘neither’ (N =14). Any ICD-9 psychiatirc disorder was separately identified. Cluster analysis of information collected in a standard way indicated that there was a group of children with the features of ‘School refusal’ who often had genralized neurotic disorders as well and who were mostly girls, another group with the feature of ‘truancy’ all of whom had conduct disorders who were mainly boys, and a third cluster of childrsen who were usually ‘truants’ but less often psychiatrically disturbed. The study provided evidence for the existence of School refusal with and without generalized neurotic disturbance in a non-clinical population.