With genetic and neurochemical findings pointing to a biological aetiology, considerable effort has been devoted to finding direct evidence of brain abnormality in schizophrenia.

T, MRI, post-mortem and functional imaging studies are reviewed to assess which structural and/or functional brain abnormalities have been consistently demonstrated.

The only well-established structural abnormality in schizophrenia is lateral ventricular enlargement; this is modest and there is a large overlap with the normal population. There is no consensus on the presence of any localised structural abnormality from MRI and post-mortem studies, but the most promising findings concern temporal lobe limbic structures. Hypofrontality is not a well-replicated finding in schizophrenia under resting conditions, but the evidence is stronger for a selective association with negative symptoms. A number of studies have found hypofrontality under conditions of neuropsychological task activation. However, findings in these studies are divided and a recent methodologically sophisticated study has failed to confirm it, although this study suggested a decoupling of prefrontal and temporal function.

Schizophrenia is characterised by minor structural abnormality which, in the case of lateral ventricular enlargement, may be better understood as a risk factor than a causative lesion. The functional imaging findings are not transparent but suggest that, as a disorder, schizophrenia shows complex alterations in regional patterns of activity rather than any simple deficit in prefrontal function.

It was proposed to explore the longitudinal relationship between adverse experience and mental health; in particular, whether particular adverse experiences influence the form of subsequent expression of morbidity.

Three groups of women were selected: 64 whose marital partner had recently died, 143 whose husbands had recently experienced a myocardial infarction and a third group of 32 women who had sought protection in a Women's Aid refuge. An initial interview assessed psychiatric status according to the RDC for the six months before the event and up to the time of interview, and a second interview was completed four months after the event had occurred. The course was assessed using the Longitudinal Interval Follow-up Evaluation.

For the coronary group, the prevalence of psychiatric disorder doubled following the experience of the event, and was most pronounced for anxiety disorder. For the bereaved, rates increased over eight times for major depressive disorder and more than twice for anxiety disorder, following the loss; for the refuge group, prevalence rates were lower after entering the refuge than those before. Analyses that took account of the timing of the onset of disorders showed that in almost half of those experienced by the coronary group, and about 40% of the bereaved group, onset pre-dated the timing of the event.

The results further advance knowledge of the evolution and form of psychiatric conditions following the experience of severe adversity.

This paper reports further data from the Stoke study of postnatal depression and examines whether psychosocial characteristics and symptom profiles differ between postnatal and control depression.

Two hundred and thirty-two postnatal and non-postnatal control women were screened with the Edinburgh Postnatal Depression Scale; all high scorers and a sample of low scorers were interviewed with the Standardised Psychiatric Interview and modified Social Maladjustment Schedule. Depression was diagnosed using the Research Diagnostic Criteria.

Postnatal but not control depression was associated with a poor relationship with the woman's own mother and greater occupational instability. Depression in control women was associated with low income, having three or more children, performing manual work and occupational dissatisfaction, but postnatal depression was not. There were no differences in the symptom profiles of the postnatal and control women nor between early and late onset postnatal depression.

Depression is a common and socially disabling disorder affecting mothers of young children. Postnatal depression is more contingent on acute biopsychosocial stresses caused by the arrival of a new family member. Depression in women with older children is more closely related to longer term social adversity.

Prenatal and perinatal factors have been linked to affective disorders. We therefore undertook an exploratory study to determine whether prenatal exposure to severe famine was associated with an increased risk of affective disorders.

Monthly birth cohorts that were exposed and unexposed to the Dutch Hunger Winter of 1944–45 were identified. The cumulative incidences of affective psychoses and neurotic depression (ICD–9 criteria) were compared between exposed and unexposed cohorts during each trimester of gestation.

The relative risk (RR) of affective psychosis (broad and restricted definitions) among persons exposed to famine during the second trimester was significantly increased (broad: RR (95% confidence interval) = 1.62 (1.19, 2.20); restricted: 1.59 (1.14, 2.21)). Separate analysis by gender showed a significant association among males (broad: 2.26 (1.43, 3.57); restricted: 2.40 (1.49, 3.89)), but not females (broad: 1.28 (0.84, 1.94); restricted: 1.17 (0.73, 1.86)). The risk of neurotic depression was not increased after prenatal famine exposure.

These results suggest a possible relationship between prenatal famine during the second trimester and affective psychosis, lending plausibility to reports that have associated affective psychoses with prenatal exposures. Further studies of this relationship are warranted.

Sixty-eight patients with seasonal affective disorder participated in a 10 000-lux light treatment study in which two questions were addressed: do response rates differ when the light is applied at different times of the day and does short-term rank ordering of morning and evening light influence response rates?

Three groups of patients received a 4-day light treatment: (I) in the morning (8.00–8.30 a.m., n = 14), (II) in the afternoon (1.00–1.30 p.m., n = 15) or (III) in the evening (8.00–8.30 p.m., n = 12). Two additional groups of patients received two days of morning light treatment followed by two days of evening light (IV, n = 13) or vice versa (V, n = 14).

Response rates for groups I, II and III were 69, 57 and 80% respectively, with no significant differences between them. Response rates for groups IV and V were 67 and 50% respectively; this difference was not significant and these percentages did not differ significantly from those of groups I and III.

The results indicate that the timing of light treatment is not critical and that short-term rank ordering of morning and evening light does not influence therapeutic outcome.

Previous research in the elderly has linked threatening life events with depression. Dementia sufferers are known to be sensitive to stressful changes in their daily life such as relocation. This study investigates whether threatening life events are associated with depressive symptoms in dementia sufferers.

Using the Life Events and Difficulties Schedule, this study examined life events before admission in a group of 70 dementia patients compared with two control groups: dementia sufferers in the community and mentally fit elderly people matched for age and sex.

Life events with severe threat were not significantly more frequent in the dementia patients than in two control groups. However, depressive symptoms in the dementia sufferers were significantly associated with independent severe life events. This strong association was maintained when a multivariate analysis was used to control for the effects of other social factors and severity of cognitive impairment. This association appears to be specific to the threat aspect of life events since there was no association between depressive symptoms and events relating to change in the social environment.

In dementia sufferers, threatening life events are associated with depressive symptoms. This means that dementia sufferers are responsive to stress in the same way as cognitively intact individuals, and clinicians need to be more aware of the social influences on them.

The study focuses on the prevalence of dementia in the oldest old.

A community sample (n = 402) of the oldest old in Munich (≥ 85 years) was assessed with different methods. Four instruments and a clinical examination were used for case identification: (a) the Geriatric Mental State Interview (GMS-A); (b) the Structured Interview for the Diagnosis of Dementia (SIDAM); (c) the Global Deterioration Scale (GDS); and (d) the Mini Mental State Examination (MMSE). The clinical examination was performed by the interviewing physicians, who made their diagnoses according to ICD–10 and DSM–III–R.

The structured interviews (GMS-A: 25.4%; SIDAM/SISCO: 28.0%; SIDAM/DSM–III–R: 27.8%; SIDAM/ICD–10: 16.1 %) gave lower point prevalence rates of dementia than physicians' clinical diagnoses (43.1 %). The rates were 21.2% based on the MMSE. Depressive syndromes and anxiety syndromes were the most frequent psychiatric disturbances associated with dementia in the very old.

Dementia rates were high in the oldest old, showed an increase with age but no sex differences. Interview methodology has a major impact on results.

Severe cognitive impairment affects many patients with schizophrenia, especially geriatric in-patients. Little is known about the course of this impairment, however.

Two hundred and twenty-four geriatric schizophrenic in-patients were examined for changes in cognitive functioning over a one-year follow-up period, and 45 of them were assessed over a two-year period. In addition, the subset of 45 patients participated in a one-week and one-month test-retest reliability study of the instrument used to assess cognitive impairment, the Mini-Mental State Examination (MMSE).

The average MMSE scores did not change over a one- or two-year follow-up period. The test-retest reliability of the scale was extremely good at both retest intervals.

Among the implications of these data are that cognitive changes in geriatric schizophrenic patients are very slow and are more consistent with a neurodevelopmental process than a neurodegenerative course.

The long-term symptom profile of chronic out-patients was studied.

Method. 242 out-patients receiving neuroleptic medications (109 with schizophrenia and 133 non-schizophrenics), were studied for positive (SAPS) and negative (SANS) symptoms at baseline and at 24 months to investigate whether these symptom groups changed over out-patient maintenance treatment.

Overall and within groups, negative symptoms decreased and positive symptoms increased. While the sums of the SANS scores for the schizophrenic patients were initially higher, their mean SANS score dropped more over time (P< 0.001), to show no difference from non-schizophrenics at follow-up. Positive symptoms increased in both groups, although schizophrenics were higher at both times; sub-scales within the SANS showed different patterns of change.

Support is found for a multidimensional view of both positive and negative symptoms and for a reconsideration of the notion of ‘progressive downward course’ in schizophrenia.

Clozapine is an effective antipsychotic that has high affinity for serotonin type 2 (5-HT2) receptors. The importance of 5-HT antagonism in the overall clinical efficacy of clozapine is unclear. Using a neuroendocrine strategy we tested the hypothesis that clinical response to clozapine is related to alteration in 5-HT function.

Ten treatment-resistant schizophrenic subjects were treated with clozapine for a mean of 10.3 (s.e. 0.9) weeks; d-fenfluramine (DFEN) challenge tests were performed before and after treatment with concurrent clinical ratings (BPRS, SAPS, SANS) made at the time of testing.

All patients showed clinical improvement following treatment with clozapine. In addition, clozapine produced a significant attenuation of prolactin (PRL) and cortisol (CRT) response to DFEN challenge. Change in symptom ratings correlated significantly with reduction in PRL response to DFEN challenge.

These data show that functional alterations occur in the 5-HT system following response to clozapine and lend support to studies suggesting that 5-HT is an important component to the spectrum of action of clozapine.

This exploratory study addresses the question of whether expressed emotion (EE) is a response characteristic of the parent (trait) or a parental response to specific circumstances or persons (state).

Seventeen parents participated in two audiotaped interviews, using modified versions of the Camberwell Family Interview. One interview concerned the child with chronic schizophrenia and the other a well sibling. Subsequent ratings of the EE variables of critical comments (CC), emotional overinvolvement (EOI) and warmth were completed and compared.

E response patterns directed towards patients, as compared with towards siblings, were significantly different on two measures: EOI (P=0.01) and warmth (P=0.02). The parents showed significantly more emotional overinvolvement with the child with schizophrenia and significantly more warmth towards the well child.

These data suggest that the EE variables of EOI and warmth are related to the state of child, and the lack of a significant difference in CC suggests that this is a parental trait.

A study was conducted to validate a comprehensive self-rating scale for measuring side-effects of neuroleptic drugs.

The Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS), which includes ‘red herring’ items, was twice administered to 50 DSM–III–R schizophrenic patients, who were also interviewed using the UKU side-effect rating scale; 50 unmedicated controls also completed the LUNSERS.

The test-retest reliability of the LUNSERS was good (r = 0.811, P< 0.001) as was its concurrent validity against the UKU (r = 0.828, P< 0.001). Scores correlated with chlorpromazine equivalent doses (r = 0.310, P< 0.02). ROC analysis demonstrated that the scale discriminated between patients and non-medicated controls, who scored differently for real side-effects but not for ‘red herring’ items.

The LUNSERS is an efficient, reliable and valid method of assessing neuroleptic side-effects.

The Global Assessment of Functioning (GAF) is a quick and simple measure of overall psychological disturbance. However, there is little research on the reliability and validity of this measure in severely mentally ill populations.

Multidisciplinary keyworkers assessed 103 patients at monthly intervals over a 6-month period. Overall GAF scores were obtained, with additional separate ratings for symptoms and disability. These were compared with changes in antipsychotic medication and support needs over the same period.

Satisfactory reliability was obtained for total GAF score and for symptom and disability measures, in spite of raters having only one brief training session. All GAF scores were associated with current support needs of patients. Symptom and disability scores were associated with changes in antipsychotic medication in the previous month. Only symptom score was associated with increases in antipsychotic medication at time of rating.

AF proved to be a reliable and, within the limits of the indicators used, a valid measure of psychiatric disturbance in our sample of the severely mentally ill. Differences in relationships between the three GAF scores and medication/support needs indicate the usefulness of obtaining all three scores for monitoring levels and type of psychiatric disturbance in this population.

A large collaborative 8-week study has shown fluoxetine to be effective and safe in treating patients with bulimia nervosa. The present study evaluated fluoxetine over 16 weeks.

Fifteen US out-patient psychiatry clinics conducted a double-blind parallel study in men and women with DSM–III–R bulimia nervosa (483 patients entered, 398 randomised [3:1 ratio, fluoxetine 60 mg/day or placebo], 225 completed). Outcome measures included change in vomiting and binge-eating episodes per week, Eating Disorder Inventory, Clinical Global Impressions and Patient's Global Impression.

Compared with placebo, fluoxetine treatment resulted in significantly greater reductions in vomiting (F [1,360] = 14.73, P< 0.0001) and binge-eating (F [1,360] = 14.39, P=0.0002) episodes per week at endpoint and improvement in other outcome measures. Adverse event, vital sign and laboratory analyses indicated that fluoxetine was safe.

Fluoxetine appeared to be safe and effective in patients with bulimia nervosa for up to 16 weeks.

Using improved methods, findings of higher criminality in a psychiatric population were tested.

An unselected sample of 1265 Swiss in-patients and a matched control group drawn from the general population were studied. Detailed accounts of conviction records served as a measure of criminal behaviour.

Apart from traffic law violations by men, and violent crimes and sexual offences by women, patients were more frequently registered in all crime categories. However, there were significant differences between the diagnostic groups. Alcoholics and drug users of both sexes had a significantly higher criminality rate. A higher rate was also found among female, but not male, patients suffering from schizophrenia or related disorders and other, mostly organic, disorders.

Alcoholism and drug abuse contribute significantly to criminal behaviour, independent of sociodemographic factors; however, with a few exceptions, mental disorders such as schizophrenia and affective disorders do not contribute to criminal behaviour.