Cognitive decline in a sample of 64 elderly people was assessed by a standardised informant interview dealing with changes in memory and intelligence which had taken place in the previous 10 years. Scores from the interview were found to correlate (r=0.74) with the Mini-Mental State Examination. Moreover, the informant interview was found to be less affected by pre-morbid ability than the MMSE. Direct assessment of decline by informants may be a solution to the problem of contamination by pre-morbid ability which affects traditional cognitive screening instruments.

As work proceeds on the development of the Tenth Revision of the International Classification of Diseases (ICD-10) widespread interest has been expressed in the preparation of a multiaxial diagnostic schema for psychiatric patients. In consideration of this task, the present paper briefly notes pertinent international experience on multiaxial diagnosis, the discernible purposes of this approach, design requirements, and a specific multiaxial proposal.

The 28-item General Health Questionnaire (GHQ) has been validated against the criterion of the Clinical Interview Schedule (CIS) in Spanish patients in hospital with several types of endocrinological illnesses. The screening instrument correctly identified 91 of 100 respondents as exhibiting psychiatric disorder. The questionnaire's efficacy was similar at the time of medical discharge, when the rate of disorder was significantly lower. Significant correlations were found between GHQ total scores and endocrine blood measures in Addison's disease, and in Type I diabetes. The four subscales of the GHQ sum to provide additional information concerning somatic symptoms and anxiety.

In a study of the dexamethasone suppression test (DST) in patients with bulimia nervosa, a non-suppression rate of about 50% was found. The only clinical correlates of DST non-suppression were a previous history of weight loss and/or of anorexia nervosa. These results suggest that DST non-suppression in these subjects may be a trait rather than a state marker of anorexia nervosa.

The Morgan-Russell outcome assessment schedule is described and statistically analysed with reference to two independent series of patients suffering from anorexia nervosa. The value of check lists and simple scaling of data is emphasised as one way of improving the standards of routine case-note documentation in clinical psychiatric practice.

Three-hundred male alcoholics were selected from consecutive admissions to hospital. They were divided into three diagnostic sub-groups: primary alcoholics; alcoholics with unipolar affective disorder; and alcoholics with bipolar affective disorder. After three follow-up interviews over a 2-year period after hospital discharge, the three sub-groups reported differences in frequency of mood change, amount of treatment received, and hospital attendance, although there were no clear-cut differences in items associated with their alcoholism. There were, however, some indications that bipolar patients functioned at a better level during the follow-up period, particularly those who were older, had a previous history of longer periods of abstinence, and maintained more frequent contact with Alcoholics Anonymous (AA) and their family doctor.

A survey of the drug treatment of long-term mentally ill users of a district psychiatric service is described. The appropriateness of prescriptions was assessed against standard criteria after a detailed clinical review of each patient. Overprescribing, particularly of sedative/hypnotic and of anticholinergic and antipsychotic drugs, was common. Junior psychiatrists and general practitioners are in need of improved training in the management of chronic psychiatric illness: a review of treatment practices might be an appropriate medium for this training.

The authors report a patient whose Parkinson's disease and mania both responded well to electroconvulsive therapy (ECT) after failing to respond to chemotherapy. The authors review the literature and suggest that ECTis a safe and effective treatment for affective syndromes associated with Parkinsonism. The presence of dementia in these patients appears to be an indicator of poor prognosis. This paper is believed to be the first report of successful use of ECT in mania occurring together with Parkinsonism.

A prospective multi-agency survey of problem drug use associated with illicit drugs and solvents in the city of Bristol in 1984–1985 found 759 problem drug users, giving a period prevalence rate of 0.4–0.8% of those aged 10–44 years. The group was a young one, with 92% under the age of 35. Over half had problems associated with opiates, mainly illicit heroin; 17% had problems associated with solvents, 9% with cannabis, 13% with stimulants, mainly illicit amphetamine, and 3% with hallucinogens. There was little indication of problematic use of barbiturates or cocaine. The problems associated with drugs and solvents were wide-ranging and not specific for individual drugs. Future community surveys would find it cost-effective to concentrate on the five best sources identified here, and to supplement these with indications of drug-taking among teenagers. The difficulties of using the definition of problem drug use for research and the value of case-register surveys for community drug monitoring are discussed.

The effects of a series of six ECT treatments were observed on the CSF concentrations of HVA, MHPG, and 5-HIAA in 12 patients suffering from schizophrenia. Four patients were previously neuroleptic drug-free, and eight had received only oral neuroleptic drugs at the same dose for more than 4 weeks. A significant increase in the concentration of HVA was observed after the first ECT treatment but not after the final treatment. No significant changes were observed in the concentrations of MHPG and 5-HIAA. The patients improved clinically, and the results suggest that ECT has important effects on dopaminergic systems.

Monthly rates of admission of manic patients to the Department of Psychiatry in Galway Regional Hospital were examined for a five-year period. Monthly variation in admission rates was compared with monthly levels of sunshine, temperature and daylength. Results indicated a significant seasonal variation in the prevalence of mania: admission rates were higher in the sunnier months and in months with a greater average daylength. It is suggested that the presentation of mania in this fashion is due to an abnormal response to light in these patients.

To clarify a controversy as to whether melatonin secretion is related to body weight, urinary sulphatoxymelatonin (aMT6s) excretion was estimated in 10 patients with anorexia nervosa before and after weight gain, and compared with 10 age-matched controls. There was no change in aMT6s excretion after weight gain, and no significant difference between the patients and control groups at either point. Significant increases in plasma LH, FSH, and estradiol were detected after weight gain in anorexic patients, independent of aMT6s excretion.

A dexamethasone suppression test (DST) was carried out in a heterogeneous sample of 174 depressed patients. In a subsample of 130 patients in whom biological antidepressive treatment had been commenced either because of an initial clinical judgement of ‘endogenicity’ or because of subsequent evidence of DST non-suppression, the response to treatment was globally assessed. The results showed no significant differences between the two groups in the numbers of patients responding favourably to treatment. The positive predictive value of DST non-suppression for a favourable response was no higher than that of clinical judgement, and there was little difference between the sensitivity and specificity of the two predictors.

Of 336 newly referred neurotic patients, 80 were not offered continuing psychiatric treatment. The factors associated with patients' not being offered continuing treatment were: short duration of illness; history of alcohol abuse and/or deliberate self-harm; age over 50 years; being widowed; and living more than 20 miles from the main hospital complex. The implications of these findings are discussed.

The treatment of obsessive–compulsive disorders with a behavioural therapeutic program consisting of response prevention has proved to be rather successful. A prospective study of the potentialities of predicting the outcome of such a treatment program is described. The results of this research could possibly lead to the development of a decision model for use in the treatment of obsessive–compulsive neurosis.

The effects of two experimental interview styles, designed to differ in the extent of their use of active feeling-oriented techniques but similar in their use of active fact-oriented techniques, were compared in initial diagnostic interviews with the mothers of children referred to a psychiatric clinic. The style that employed a higher level of actively responsive feeling-oriented techniques elicited more emotional expression and more often obtained certain feelings of potential diagnostic significance. The actively responsive style was more effective in increasing the amount of feeling expressed if mothers' spontaneous rate of expression was relatively low.

Consecutive attenders (525) presenting at the Nottingham Accident and Emergency (A & E) department with deliberate self-poisoning were identified retrospectively. Their case-notes were examined for patient characteristics and clinical management. The Nottingham Psychiatric Case Register was examined for previous contact and use of psychiatric services over a 2-year follow-up period. Significant differences were found between those patients admitted to a ward and those who returned home from the A & E Department, in respect of likelihood of psychiatric morbidity and use of psychiatric services. One in three self-poisoning patients returns home directly from the accident department, and there seemed to be appropriate selection.

The reliability and validity of the Chinese version of the 17-item Hamilton Depression Rating Scale (CHDS) was assessed. Interrater reliability was excellent, the item total-score correlations were good, and the internal reliability was satisfactory. The concurrent validity was tested by correlating the CHDS score with the Global Assessment Scale score; the strong negative correlation found indicated that the CHDS reflects the overall level of disability. Five distinct factors were generated by principle-component analysis; these factors account for 52.4% of the total variance. Rigorous evaluation of the numerous translated scales being used in clinical and research settings of non-Western countries is important.