The economic burden of psychiatric disorders and learning disability is assessed in order to aid decisions on priorities for research funding.

A wide variety of data sources both on prevalence and on the usage and costs of relevant services were used to measure the economic burden of each condition.

Despite methodological problems and problems with the data, an attempt is made to estimate the relative economic burden imposed by each condition. No attempt is made to sum up the costs for each condition across the agencies and individuals involved.

Our findings show that learning disability, schizophrenia and neurotic conditions (including depression) are major burdens on the National Health Service; senile dementia and depression in older people impact largely on local authority social services. Senile dementia, schizophrenia and learning disability are also heavy charges on the social security system. It is also notable that the large numbers with less severely disabling neurotic disorders generate a burden that, according to our figures, is comparable to schizophrenia and other psychotic disorders.

Computer-supported neural network models have been subjected to diffuse, progressive deletion of synapses/neurons, to show that modelling cerebral neuropathological changes can predict the pattern of memory degradation in diffuse degenerative processes such as Alzheimer's disease. However, it has been suggested that neural models cannot account for more detailed aspects of memory impairment, such as the relative sparing of remote versus recent memories.

The latter claim is examined from a computational perspective, using a neural associative memory model.

The neural network model not only demonstrates progressive memory deterioration as diffuse network damage occurs, but also exhibits differential sparing of remote versus recent memories.

Our results show that neural models can account for a large variety of experimental phenomena characterising memory degradation in Alzheimer's patients. Specific testable predictions are generated concerning the relation between the neuroanatomical findings and the clinical manifestations of Alzheimer's disease.

In a 10-year follow-up of a survey from Oslo, 503 persons were reinterviewed using the same questionnaire.

The questionnaire includes information about social support, ‘locus of control’ and mental health as well as negative life events and long-lasting mental strain during the year prior to the follow-up.

The study confirms the “buffer hypothesis”, that social support protects against the development of mental disorder only when the individual is exposed to stressors, like negative life events. This buffering effect was especially strong for depression.

The buffering effect only applies to the ‘externals’ –those who have personality-related feelings of powerlessness and lack of control over their own lives. The ‘internals’ do not have the same need for social support to cope with life stressors, and have low symptom scores even when negative life events are combined with relative weak social support.

Trends and availability of the methods used for suicide in Finland were analysed in order to base proposals for prevention of access to methods.

Finnish suicides from 1947 to 1990 were analysed by sex, age, time period and suicide method using confidence intervals for rates, χ2 test for trends and suicide risks for different medicines.

Suicide rate by parathion, a highly lethal pesticide and commonly used for suicide in the 1950s, decreased after its availability was restricted, but this was offset by an increased rate by other methods. Since 1982, the suicide risk for antidepressants and neuroleptics increased coincident with their availability, although that for barbiturates remained stable but high despite a reduction in availability. Suicide risk for antidepressants other than tricyclics decreased despite increased availability.

Restriction of a method reduces its use for suicide, but other methods tend to replace it. Restrictive measures should focus on some specific situations. Antidepressants other than tricyclics are recommended for the treatment of suicidal depressive patients.

The aim was to determine the extent, characteristics and timing of suicide in Oxford University students.

Students who died from suicide or undetermined cause between October 1976 and September 1990 were identified through University records and individual colleges. Information about each student was sought from coroners, college staff, general practitioners and hospital case notes.

There were 21 suicides (16 men and 5 women) and one open verdict (female). The observed number of suicides (0) was greater than the number expected (E = 11.09) on the basis of mortality statistics for England and Wales (O/E = 1.89; 95% CI 1.17 to 2.90). When deaths due to undetermined cause were included, however, the difference between O and E (17.03) was much reduced (O/E = 1.29; 95% CI 0.81 to 1.95). There was no evidence of an association with the Finals examination but two-thirds of the students had been worried about academic achievement or their courses. Nearly half appeared to have had a psychiatric disorder (mostly depression).

The much publicised apparent excess of Oxford University student suicides may be partly artefactual. Measures for preventing student suicides include careful induction upon arrival at university, means of alleviating academic stress and worries, and readily available and closely associated student counselling and psychiatric services.

The season of birth phenomenon in schizophrenia was reexamined in relation to place of birth, in order to test the hypothesis that a seasonal factor might operate preferentially among those who were urban-born.

The seasonal distribution of births was examined among 3253 patients in two case registers having an ICD–9 diagnosis of schizophrenia and compared with the distribution of births among the normal population born in those catchment areas over the same period; those subjects born in population centres greater than 50 000 were defined as urban-born.

Patients who were urban-born showed an excess of winter births relative to controls that was absent among their rural-born counterparts. On comparing patient groups, those who were urban-born were more likely to be born in the winter, while those who were rural-born were more likely to be born in the spring; this urban–rural distinction was confined essentially to female patients.

These findings might be accommodated most readily in terms of a spatially as well as seasonally varying environmental factor that is associated with urbanicity and to which female offspring are more vulnerable.

Previous studies looking for evidence of viral infection in schizophrenics have yielded conflicting results. We searched for viral nucleic acids to test the hypothesis of the viral aetiology of schizophrenia.

We used the polymerase chain reaction (PCR) to search for cytomegalovirus (CMV), human immunodeficiency virus (HIV), influenza A, Borna disease virus (BDV), and bovine viral diarrhoea virus (BVDV) in: hippocampus from three schizophrenic and three non-schizophrenic subjects; cerebrospinal fluid (CSF) from 48 schizophrenic patients; CSF and peripheral blood mononuclear cells (PBMC) from nine sets of identical twins discordant for schizophrenia; and SK-N-SHEP cells co-cultured with schizophrenic and non-schizophrenic brain homogenates. All patients met DSM–III–R criteria.

Virus-specific nucleic acids were not found in any of the samples tested.

The absence of viral nucleic acids in the samples tested suggest that, in these patients, schizophrenia is not associated with a persistent or latent infection due to these viruses.

The clinical significance in schizophrenia of positive and negative symptoms at discharge was assessed.

Of schizophrenic patients fulfilling DSM–III criteria, 113 were recruited for this study. Personal, social and psychopathological data were collected and all cases were followed up at one and two years after discharge.

The presence of positive symptoms (64 cases), without concomitant negative symptoms, did not predict the follow-up social function and positive symptom score. Conversely, the presence of negative symptoms (31 cases) predicted worse social functioning (P < 0.05 to P < 0.005) and higher positive symptom scores (P < 0.01) at follow-up using MANOVA. Eighteen cases (15.9%) had neither positive nor negative symptoms and had the best clinical outcome.

Negative, but not positive, symptoms assessed at discharge are an important predictor of poor outcome. In addition, negative symptoms may themselves expose a biological vulnerability to the presence of positive symptoms.

The efficacy of low doses of certain neuroleptics in improving negative symptoms is still controversial. This study assessed the efficacy of amisulpride, a benzamide which increases dopaminergic transmission at low doses via presynaptic dopamine receptor blockade, on negative symptoms of schizophrenia.

The study was designed as a parallel-group, double-blind, placebo-controlled trial. Patients had to fulfil DSM–III criteria for schizophrenia, Andreasen's criteria for negative schizophrenia, and to have a total score of at least 75 on the SANS; those treated with neuroleptics or antidepressants underwent a six-week placebo wash-out. One hundred and four in-patients were randomly assigned to amisulpride 100 mg/d, amisulpride 300 mg/d, or placebo for six weeks; 85 patients completed the study.

Both amisulpride doses were significantly more effective than placebo on the primary evaluation criterion (SANS total score, MANOVA P < 0.02). No significant changes were found in positive symptoms or in extrapyramidal symptoms.

Negative symptoms can be improved by low doses of amisulpride, favouring the hypothesis of dopaminergic hypofunction as one of the causes of negative symptoms.

We examine the dopamine receptor supersensitivity hypothesis of puerperal psychosis, and explore puerperal changes in the functional sensitivity of this receptor system.

Dopamine receptor sensitivity was estimated using growth hormone (GH) response to apomorphine challenge following delivery in 37 control women, and 11 deliveries in 10 women at ‘high risk’ of puerperal psychosis (previous history of puerperal affective or nonpuerperal manic psychosis). Tests were on days 4 or 5, 11 or 12 and at six weeks postpartum.

Three women developing puerperal psychosis had subsensitive GH responsiveness on day 4. GH response to 67 challenge tests (in control and ‘high risk’ women) increased between days 4 or 5 and six weeks postpartum (P < 0.05). GH response at six weeks correlated with free thyroxine levels (P < 0.01).

These three cases do not support the stated hypothesis. Hypothalamic dopamine receptor sensitivity increases during the puerperium; thyroxine might influence this.

This study was designed to establish whether (as suggested in a number of open and relatively small controlled trials) lithium augmentation is more effective than continued antidepressant alone, where response to a standard course of antidepressant treatment has been absent or partial.

Lithium or placebo was added on a double-blind basis for six weeks to the drug regime of 62 patients with major depressive illness (in both hospital and primary care settings) who had failed to respond to a controlled trial of fluoxetine or lofepramine. Response was defined as a final Hamilton Depression Rating Scale (HDRS) score of < 10.

Response was seen more frequently in patients taking lithium (15/29) than in those remaining on antidepressant alone (8/32; P < 0.05). Rapid response to lithium augmentation (LA) was not consistently observed in this cohort. Mean HDRS scores after six weeks were significantly lower (P < 0.01) in the lithium group after excluding those who had not achieved significant exposure to lithium (arbitrarily defined as two or more lithium levels ≥ 0.4 mmol/1). No differences in the efficacy of LA were apparent between fluoxetine and lofepramine.

Our results confirm that LA is a useful strategy in the treatment of antidepressant-resistant depression. Partial response was, however, frequently observed with continued antidepressant treatment alone, and the superiority of LA appears to depend on achieving adequate serum lithium levels.

There are few long-term follow-up studies of panic disorder treatments, particularly when patients have been treated by behavioural methods only and have recovered.

110 consecutive patients satisfying the DSM–III–R criteria for panic disorder with agoraphobia were treated in an out-patient clinic with behavioural methods based on exposure. After 12 sessions of psychotherapy, 81 patients became panic-free. A 2–9 year follow-up was available. Survival analysis was employed to characterise the clinical course of patients. Regular assessments by a clinical psychologist were based on the Clinical Interview for Depression.

The estimated cumulative percentage of patients remaining in remission was 96.1% for at least two years, 77.6% for at least five years, and 67.4% for at least seven years. These outcomes greatly improved in the absence of a personality disorder or residual agoraphobia after treatment.

The findings suggest that, even though one patient in four is unable to complete treatment or does not benefit sufficiently from it, exposure treatment can provide lasting relief for the majority of patients. Disappearance of residual and subclinical agoraphobic avoidance, and not simply of panic attacks, should be the aim of exposure therapy.

This study explores the incidence and nature of mental illness among persistent somatisers, and analyses their use of mental health services.

Individuals with at least ten admissions to non-psychiatric departments during an 8-year period were studied. Persistent somatisers (n = 56) were compared with other frequent users (n = 57) of non-psychiatric services.

Of the persistent somatisers, 82% had been examined by a psychiatrist at least once (median, 3 times). Sixteen per cent were mentally retarded, 48% were dependent on alcohol or drugs, and 48% had DSM–III–R personality disorder. The most prevalent ICD–10 diagnoses were anxiety states (54%), depressions (30%), phobias (18%) and psychoses (20%).

Persistent somatisation is associated with severe mental illness and a broad spectrum of heterogeneous psychiatric diagnoses and syndromes. Persistent somatisers impose a serious burden on the mental health care system.

This study reports the prevalence of psychiatric disorder in women from a Canadian community. The GHQ and the CES–D were compared for their utility.

A thousand women over the age of 18 were mailed the GHQ and the CES–D. Our return rate was 44.4%; 24% were personally interviewed by interviewers blind to screening information. The CIDI was used to establish DSM–III–R diagnoses. Four versions of the GHQ and one version of the CES–D were calibrated against the CIDI.

The prevalence of general psychiatric disorder was estimated as between 15% and 19%, anxiety disorders between 10% and 13%, and depression occurring with anxiety between 3% and 4%. The calibrated GHQ was the most reliable instrument.

Prevalence of DSM–III–R psychiatric disorder can be reliably determined with the calibrated GHQ. Anxiety disorders are most prevalent in this community, and were best detected using calibrated versions of the longer form GHQ.

Simultaneous diagnosis of more than one personality disorder (PD) has been termed ‘comorbidity’ or ‘co-occurrence’ implying that single diagnoses are the norm and multiple diagnoses interesting exceptions. Surveys of PD subjects in fact show 1.5–5.6 diagnoses per subject. Our study explores the hypothesis that multiple PD diagnosis is common and increases with increasingly personality disordered populations.

The PDQ–R questionnaire was administered to three UK samples: referrals for specialist PD in-patient treatment (n = 275); high tariff offenders attending a probation centre (n = 57); and undergraduate students (n = 274).

Means of 6.0 (95% CI 5.7–6.3), 4.0 (3. 1–5.0) and 3.4 (3.0–3.8) PDQ–R diagnoses per subject were found respectively. High rates of PD diagnosis in individual subjects suggest that multiple diagnosis is the norm rather than the exception.

Multiple diagnosis of PD is better construed as ‘breadth’ of psychopathology rather than comorbidity and is a function of sampling frame. High rates of multiple diagnoses question the interpretation of studies of any single PD. The graded construct of ‘breadth’ of axis–II pathology may further our understanding of PD.