This study examines the impact of pregnancy on the reported eating behaviour of 20 untreated normal body weight bulimia nervosa women; it also reports foetal and obstetric abnormalities and indicates the initial eating habits of the infants. The prevalence of binge-eating and self-induced vomiting reduced sequentially during each trimester of pregnancy. By the third trimester 15 women (75%) had stopped all bulimic behaviour and in the remainder the disturbed eating was less severe. Symptoms tended to return in the Puerperium and in nearly half the sample abnormal eating was more disturbed after delivery than before conception. However, the improvement associated with the pregnancy described by seven patients was maintained and for five it appears to have been curative. The common fear among pregnant bulimics that their abnormal eating behaviour may damage their unborn child cannot be dispelled by this study; the incidence of foetal abnormality (including cleft palate and cleft lip), multiple pregnancies and obstetric complications (including breech presentation and surgical intervention) was high. The nutrition and development of the infants was good although three mothers (15%) reported slimming their babies down within the first year.

This study attempted to use feedback from the Model Standards Questionnaires (a series designed to measure the quality of care) to improve care on a psychiatric hospital's rehabilitation wards. Both a controlled and quasi-experimental design were used. The controlled design provided evidence that feedback from the Questionnaire concerned with the Individual Programmes of Treatment and Care led to improvements in these practices but not for the remaining three questionnaires. The quasi-experimental design indicated that the significant generalised improvement in care, over all questionnaires, was most likely due to the feedback.

A structured sample of mobile elderly patients in a rural community practice was assessed on validated rating scales for depression, dementia and disability. A total of 62% of the sample was abnormal on at least one variable. The overall prevalence of depression was 13%; the overall prevalence of dementia was either 10 or 18% depending on the criterion of Mental Test Score (MTS). Depression and dementia were related, depression being more common in females. In depressed and demented patients, MTS was age-related in those over 60 years; in depression alone, MTS was not age-related. Dementia was age-related, particularly over the age of 75. Disability increased with age and was more common in females. Disability was associated with both depression and dementia.

This study describes 47 cases of paranoid psychosis occurring for the first time after the age of 60. Cases were drawn from the Camberwell catchment area and were followed up for 10 years or until death. The clinical picture of patients showed few differences from those described in earlier studies. Subgroups are described with contrasting clinical features and differing outcome. The findings suggest that late paraphrenia is a heterogenous syndrome giving the appearance of a spectrum of overlapping conditions with paranoid delusions.

During the period 1979–1982 the incidence of suicide and parasuicide for students aged 15–24 years was found to be lower than that of others of the same age in Edinburgh. A comparison of student parasuicides with matched non-student parasuicides shows similar parasuicide repetition rates, but some differences in respect of precipitants (twice as many students reporting no major event prior to the episode), agent of poisoning (analgesics more commonly used by students; hypnotics, tranquillisers and barbiturates, by controls), and social and clinical characteristics (a greater proportion of controls reporting parasuicide in the family, a criminal record and being the victim of violence).

The mental states of 92 inpatients with chronic schizophrenia were assessed on two occasions 4 years apart. The relationship between the two ratings was examined in the 84 patients who were either consistently on or consistently off neuroleptics. Negative features were more stable than positive, but were not irreversible. Every feature examined was shown to resolve in some cases.

A study of cerebral ventricular size measured as ventricle to brain ratio (VBR) using computerised tomographic brain scan in chronic schizophrenics provided no support for suggestions that there are significant differences between patients who fall into different clinical subtypes. We found no significant difference in VBR between patients with and without a family history of schizophrenia or between those with or without paranoid symptoms. Applying Crow's classification, contrary to expectations, Type 1 patients had significantly larger ventricles than those with ‘mixed’ symptomatology (both Type 1 and Type 2 features). We also applied a variety of operational criteria which attempt to define schizophrenia as a whole: of these only Schneider's first-rank symptoms (FRS) yielded conclusive results - FRS-positive patients had significantly larger mean VBR than those without such symptoms. Previously, it has been suggested that ventricular enlargement is more closely associated with ‘negative’ than with ‘positive’ symptoms.

The development of a 10-item self-report scale (EPDS) to screen for Postnatal Depression in the community is described. After extensive pilot interviews a validation study was carried out on 84 mothers using the Research Diagnostic Criteria for depressive illness obtained from Goldberg's Standardised Psychiatric Interview. The EPDS was found to have satisfactory sensitivity and specficity, and was also sensitive to change in the severity of depression over time. The scale can be completed in about 5 minutes and has a simple method of scoring. The use of the EPDS in the secondary prevention of Postnatal Depression is discussed.

To evaluate qualitative differences in the nature of thought disorder, the ‘cloze’ procedure and the Scale for the Assessment of Thought, Language and Communication were used to compare speech samples from schizophrenic, depressive, manic, schizo-affective and normal subjects at two different times. At the acute phase, thought-disordered subjects (schizophrenics, manics and schizo-affectives) were less communicable than non-thought-disordered subjects (depressives and normals). Communicability increased with remission of the more flagrant features of disturbance. Comparison of the thought-disordered diagnostic groups in the rate and pattern of remission of specific features of thought disorder indicated that factors reflecting goal-disrupted cognition distinguished the groups.

Recent debate about the place of psychotherapy in the National Health Service, while emphasising the importance of economic evaluation, has concentrated almost exclusively on issues of clinical outcome. This paper argues that the debate has focussed on too narrow a definition of psychotherapy and too limited a view of the possible effects of psychotherapy, both good and bad. It reviews evidence concerning the demand and need for psychotherapy services in a number of clinical settings, and discusses the economic implications of the provision of such services. Economic studies of psychotherapy are reviewed and a conclusion drawn that it might be possible to justify the provision of psychotherapy services on economic grounds, but that considerably more research needs to be done in this area. The directions such future research might take are outlined.

A review of all known schizophrenics (n = 142) in Nithsdale, Scotland, found 50% were living with relatives or friends. Of these, 32% had high contact with a relative showing high expressed emotion (EE); put another way, 87% of all Nithsdale schizophrenics were not living in a high contact/high EE family. Parents were more critical than spouses, and more showed emotional over-involvement. A retrospective review showed a trend, not of statistical significance, towards a higher admission rate to in-patient care in patients from high EE homes. Of relatives believed by a consultant psychiatrist to be neither critical nor hostile, 80% fell into the low EE category, but only 44% thought hostile or critical belonged to the high EE category; that is, the clinician had a wider view of high EE than the Camberwell Family Interview. Relatives' scores on a short patient-rejection scale were higher in high EE than in low EE relatives, but the wide scatter of scores suggested the scale could not be used to identify an individual relative with high EE.

We followed up 30 recovered depressives for an average of 2 years. At 18 months, despite prophylactic medication, 30% had relapsed. Persistent DST suppression during the index illness was found to be a predictor of good prognosis.

Forty-nine first episode schizophrenics were identified and considered to be representative of the parent schizophrenic population. Patients were rated before treatment with the Present State Examination. Findings are presented with regard to Catego classes, prevalence of first rank symptoms, conformity to ICD diagnoses, Feighner and Research Diagnostic Criteria and presence of a depressive syndrome. Physical examination revealed isolated neurological signs; in addition two neuroleptically naive patients had abnormal involuntary movements.

The calls to a telephone counselling service at Louvain, during a 21-month period, from one telephone zone were analysed. Data were studied in relation to the type of weather, which was recorded every day. Calls made by women about health and interpersonal problems showed a relationship to the weather, while calls apparently motivated by masturbation intentions from male callers increased when the weather improved.

A brief educational intervention with families living with a schizophrenic relative is described and evaluated in terms of benefits for relatives' well-being and patient recovery. Education led to considerable knowledge gains and to reductions in relatives' reported stress symptoms and fear of the patient. There was a trend for relatives to be more optimistic concerning their role in treatment. At 6 months follow-up, only knowledge gains were maintained; however, relatives' perceptions of family burden were significantly reduced. The evidence suggests that family education may be useful both as a cost-effective intervention in its own right and in facilitating a more receptive attitude to subsequent family intervention.

In a randomised double-blind study, 46 first episode schizophrenics were given pimozide or flupenthixol for up to 5 weeks; the mean daily dose at the end was 18.8 mg pimozide and 20 mg flupenthixol. There were no significant between-drug differences in the effect on mental state or behaviour; positive schizophrenic symptoms responded to treatment, negative symptoms did not. Most patients required anti-Parkinsonian medication. Poor response was associated with ‘organicity’. A switch to maintenance therapy after 5 weeks, the outcome of successful treatment and patient cooperation, was achieved in only 54%. There was no relationship between plasma prolactin levels and severity of schizophrenic symptoms in unmedicated patients. Pimozide produced greater elevation of plasma prolactin. Plasma neuroleptic levels showed drug compliance was satisfactory throughout in only 54%.

There was no relationship between plasma prolactin levels and severity of schizophrenic symptoms in unmedicated patients. Pimozide produced greater elevation of plasma prolactin. Plasma neuroleptic levels showed drug compliance was satisfactory throughout in only 54%.

As a test of the social support hypothesis, highly anxious primiparous mothers were assigned in the post-natal stage to either a professional intervention, a lay intervention or to a control group. It was hypothesised that those receiving an active intervention (be it lay or professional assistance) would become less anxious as a consequence of a central therapeutic ingredient – social support. Improvement was assessed by measuring state anxiety levels at baseline and at 12 months, while the degree to which therapists were incorporated into the social network was assessed by the Interview Schedule for Social Interaction (ISSI), given at baseline and at 12 months. While we established that anxiety levels were significantly lowered in those receiving the professional intervention and moderately (but not significantly) lowered in those receiving the lay intervention, ISSI scores for the separate groups appeared stable over the study. Reasons are considered why ISSI scores remained unchanged while intervention groups showed a reduction in anxiety levels.

The pathophysiology of hypercortisolaemia in major depression was examined. ACTH was measured using a novel immunoradiometric assay of high specificity and sensitivity. Twenty-eight patients with major depression and 18 control subjects were studied. Blood samples for basal hormone concentration were taken at 09:00, 16:00 and 23:00 on day 1, followed by administration of 1 mg dexamethasone at 23:00. Further samples were taken at 09:00 and 16:00 on day 2. Dexamethasone concentration was measured in day 2 samples and no significant difference was found between the depressed group and control subjects. In the depressed group Cortisol concentration was elevated at 23:00 on day 1, and ACTH concentrations were elevated in post-dexamethasone samples. ACTH and Cortisol concentrations were not directly correlated in individual patients. The elevated plasma Cortisol associated with major depression is not solely mediated by changes in ACTH.

Numerous surveys have attempted to estimate the prevalence of dementia. Despite difficulties of measurement, evidence suggests figures may be lower than is generally realised. Factors which are likely to affect prevalence rates are discussed. Forthcoming changes in the demography of old age indicate that increases in the prevalence of dementia may have been seriously underestimated.

In a survey of psychotropic drug prescribing for in-patients in three different types of psychiatric hospitals, the prevalence of combinations of more than one psychotropic drug varied from 45% in one hospital to 94% in another, with significant consistent differences between the use of drug combinations in the various hospitals. Combinations of two antipsychotic drugs were particularly frequent; the hospital with the lowest prevalence of polypharmacy was the only one with an associated psychopharmacology unit. Access to clinical pharmacology teaching may be an important factor in determining appropriate drug-prescribing habits.