Showing papers in "Psychological Medicine in 1977"
TL;DR: The probability of having symptoms of depression was highest among persons who were young adults, unmarried, not employed outside the home, poorly paid, and not well educated.
Abstract: Histories of depression-related symptoms were obtained from 3845 randomly selected adult residents of Kansas City, Missouri, and Washington County, Maryland. Depressed persons were slightly more common in Kansas City than in Washington County but within the latter area no urban–rural differences were observed. More depressed persons were found among blacks than among whites. Slightly more white females than males were depressed; no significant differences were found between black females and males. After adjustment for the effects of other independent variables, the probability of having symptoms of depression was highest among persons who were young adults, unmarried, not employed outside the home, poorly paid, and not well educated.
712 citations
TL;DR: Thirty-one females with primary anorexia nervosa were studied by means of a retrospective analysis of hospital notes, and those who had become emaciated solely because of dieting, food refusal and excessive exercising were divided into "dieters" and "vomiters and purgers".
Abstract: Thirty-one females with primary anorexia nervosa were studied by means of a retrospective analysis of hospital notes. The patients were divided into 2 groups. The first group consisted of subjects who had become emaciated solely because of dieting, food refusal and excessive exercising (‘dieters’); the second of those who had used additional means to bring about weight loss such, as habitual vomiting and the abuse of purgatives (‘vomiters and purgers’).Most ‘dieters’ were intense, introverted, socially withdrawn individuals whose anorexic behaviour had started in response to psychological stress. They had become completely preoccupied with thoughts of food, eating and losing weight. Several did well in treatment, and recovered fully from their anorexic symptoms. ‘Vomiters and purgers’, on the other hand, were more outgoing in respect to personality. Most had previously been obese and, as they had been unable to keep themselves thin by simply abstaining from food, they had learnt to use other means to control their weight. These latter patients did less well in treatment. They continued to experience difficulty in controlling their weight, and the majority persisted with their abnormal behaviour.
280 citations
TL;DR: It is concluded that non-medical interviewers can obtain as high reproducibility as psychiatrists on most of the non-psychotic sections of the PSE if they have appropriate training.
Abstract: A random sample of 237 women in a south-east London area were seen by non-medical interviewers, trained to use a standard technique (the Present State Examination) to elicit and record psychiatric symptoms. Ninety-five were interviewed a second time by psychiatrists, who also rated audiotape recordings. The reproducibility of the techniques is adequate though not as high, in some respects, as that obtained from out-patient or in-patient samples. This is true at the level of symptom, syndrome, total score, and index of definition of psychiatric disorder. It is concluded that nonmedical interviewers can obtain as high reproducibility as psychiatrists on most of the non-psychotic sections of the PSE if they have appropriate training. Repeatability is lower than reproducibility, partly due to fluctuations in clinical condition, partly to environmental changes between interviews, and partly to differential responses to medical and non-medical interviewers. Over a short period of time, such as a week, repeatability is satisfactory.
257 citations
TL;DR: The former belief that immigrants always suffer from an excess of mental disorder is no longer valid, and the old rivalry between social selection and social causation hypotheses has lost much of its relevance.
Abstract: The former belief that immigrants always suffer from an excess of mental disorder is no longer valid, and the old rivalry between social selection and social causation hypotheses has lost much of its relevance. The mental health of a migrant group is determined by factors relating to the society of origin, factors relating to the migration itself, and factors operating in the society of resettlement; and all three sets need to be considered if one seeks to reduce or merely to understand the level of mental disorder in any immigrant group. Illustrations from each set of factors are presented, with indications of whether they appear to have general relevance or be related to specific mental disorders.
216 citations
TL;DR: Those attending a general practitioner are shown to be more psychiatrically disturbed than a random sample of the practice population, and this difference remains when those attending for psychological symptoms are discounted.
Abstract: The "General Health Questionnaire" was used to assess the psychiatric morbidity among 365 consecutive attenders at a general practice and to compare this with a systematic random sample of 213 patients drawn from the lists of the same practice. Those attending a general practitioner are shown to be more psychiatrically disturbed than a random sample of the practice population, and this difference remains when those attending for psychological symptoms are discounted. Various social and demographic characteristics which distinguish between those who do and those who do not attend a doctor with a given set of psychological symptoms are described.
204 citations
TL;DR: No associations were observed between plasma dopamine beta-hydroxylase activities and the personality variables and, in contrast, the amine oxidase results showed positive correlations between psychological test scores and personality variables.
Abstract: Altered activities of biogenic amine-related enzymes have been reported in some studies of patients with affective disorders and chronic schizophrenia. To evaluate whether any relationship between personality variations, including non-diagnosed psychopathology, and these enzymes might occur in non-psychiatric patients, 95 young adult volunteers were studied. Higher MMPI and Zuckerman sensation--seeking scale scores were found in male, but not female, volunteers with lower platelet and plasma amine oxidase activities. Males generally exhibited negative correlations, while females had positive correlations between the psychological test scores and amine oxidase activities. In contrast to the amine oxidase results, no associations were observed between plasma dopamine beta-hydroxylase activities and the personality variables.
181 citations
TL;DR: Thirty married agoraphobic women referred to out-patient clinics in Edinburgh were compared with 'normal' controls matched on age, sex social class and marital status, and the 2 groups were strikingly similar.
Abstract: Thirty married agoraphobic women referred to out-patient clinics in Edinburgh were compared with ‘normal’ controls (selected from GP records and screened for the absence of psychiatric symptoms) matched on age, sex, social class and marital status. The agoraphobics' husbands were similarly compared with the husbands of the controls. On most measures of attitudes, behaviour, domestic organization and marital interaction, the 2 groups were strikingly similar.
177 citations
TL;DR: Dopaminergic hyperfunction, induced by amphetamines or dopa, may lead to a disturbance mimicking paranoid schizophrenia, lending further support for a key role of dopamine in mental functions.
Abstract: Inhibition of central dopamine functions appears to be a common basic property of antipsychotic drugs. The mesolimbic and nigrostriatal portions of the dopaminergic system are probably the main targets of these drugs for the mental and the extrapyramidal actions respectively. Dopaminergic hyperfunction, induced by amphetamines or dopa, may lead to a disturbance mimicking paranoid schizophrenia, lending further support for a key role of dopamine in mental functions. While a primary disturbance in dopamine function in schizophrenia cannot be ruled out, the intimate relationship between dopaminergic and other neuronal systems must be emphasized. The possible involvement of other amine, aminoacid or peptide transmitters in schizophrenia cannot be disregarded.
157 citations
TL;DR: Four hundred "new" long-stay patients were studied and assessments of their needs for treatment and accommodation were made: about one third appeared to need further care in hospital and a further third could possibly be discharged if suitable accommodation in the community were available.
Abstract: Four hundred "new" long-stay patients were studied and assessments of their needs for treatment and accommodation were made. About one third appeared to need further care in hospital. A further third could possibly be discharged if suitable accommodation in the community were available: most of this group were more handicapped than present residents in hostels. The remaining third had diverse needs; many were multiply handicapped--for example, by physical disability or mental retardation in addition to psychiatric disorder. At the moment the psychiatric hospital is virtually the only agency to accept the care of such people.
154 citations
TL;DR: The demographic groups found to be at significantly higher risk for minor psychiatric morbidity included women, the young, non-British migrant women, and lower social class men.
Abstract: The method is described of a point-prevalence survey of minor psychiatric morbidity among a sample of healthy community residents. The General Health Questionnaire was used as the sole means of case identification. The demographic characteristics of the sample were compared in detail with those of the total population. The factors mainly responsible for sample bias were difficulty with the English language, the varying degree of personal contact made with residents, and the difficulty in contacting the employed population during working hours. The overall response rate of the survey was 66-2%. The demographic groups found to be at significantly higher risk for minor psychiatric morbidity included women, the young, non-British migrant women, and lower social class men.
153 citations
TL;DR: Investigation of body perception amongst anorexic and normal females suggests that body perception disturbance is not specific to anorexia nervosa and may reflect an abnormal sensitivity about body size associated with such factors as the anticipation of an undesired change in weight, extreme concern about slimness and anxiety about putting on weight.
Abstract: Previous research has suggested that patients suffering from anorexia nervosa tend to overestimate their body size, whereas normal females tend to be very accurate in this respect. This paper presents the results of further investigations of body perception amongst anorexic and normal females. The results, in contrast to earlier findings, indicate no such difference between groups. Detailed analysis of the data, however, points to the likelihood of certain differences between the present group of anorexic patients and previous groups. Moreover, it seems that body perception disturbance is not a consistent feature of anorexia nervosa and is only present amongst some patients at certain stages during their illness. On subdividing the anorexic group it was demonstrated that patients who vomit tend to overestimate their size more than do non-vomiters. It also seems likely that normal females are far from homogeneous in terms of body perception. In line with previous findings, a direct relationship was found between marked overestimation of body size and an early relapse. Evidence is also discussed which suggests that body perception disturbance is not specific to anorexia nervosa and may reflect an abnormal sensitivity about body size associated with such factors as the anticipation of an undesired change in weight, extreme concern about slimness and anxiety about putting on weight.
TL;DR: Results indicate that patients diagnosed as schizophrenic on the basis of standardized assessments and clearly specified diagnostic criteria demonstrated very marked variations of course and outcome over a 2-year period.
Abstract: Over 90% of the 1202 patients investigated in the 9 centres collaborating in the International Pilot Study of Schizophrenia were traced 2 years after the initial examination and on the average over 75% of them were re-examined, using standardized instruments and methods. Results indicate that patients diagnosed as schizophrenic on the basis of standardized assessments and clearly specified diagnostic criteria demonstrated very marked variations of course and outcome over a 2-year period. Schizophrenic patients in the centres in developing countries had considerably better course and outcome than schizophrenic patients in the centres in developed countries.
TL;DR: An interview assessment of marriage relationships is shown to have good inter-rater reliability, high consistency across the accounts of both marriage partners and to be resistant to methodologic bias.
Abstract: An interview assessment of marriage relationships is described. It is shown to have good inter-rater reliability, high consistency across the accounts of both marriage partners and to be resistant to methodologic bias. A four-year follow-up study demonstrated high predictive validity to later marriage breakdown. The marriage measure also showed a strong association with behavioural deviance in the children. The intercorrelations between individual measures of various aspects of the marriage and the summary are given. A shortened version of the interview is described and preliminary findings are given on its validity.
TL;DR: It is suggested that techniques of this kind can be scientifically useful in comparing the level of morbidity in various populations, both referred and non-referred, and in testing theories concerned with the causes and treatment of various types of psychiatric disorders.
Abstract: Many surveys of general populations have suggested a high untreated psychiatric morbidity, vairously referred to as mental illness, pre-clinical neurosis, minor neurosis, untreated depression, etc. An Index of Definition psychiatric disorders is described which incorporates cut-off points on the basis of symptoms rated in the Present State Examination. Eight degrees of definition are specified. At the "borderline disorder" level and above, disorders are sufficiently well defined to apply the CATEGO program of clinical classification. This procedure enables in-patients, out-patients and samples of the general population to be compared. Data from surveys in south-east London are presented in order to illustrate the technique. The main conclusion at this stage is that it is possible to identify, by strictly defined and repeatable procedures, a substantial proportion of people in the general population who have "borderline disorders" that can be tentatively classified in terms of the ICD. Whether it is clinically useful to do so requires further investigation. It is also suggested that techniques of this kind can be scientifically useful in comparing the level of morbidity in various populations, both referred and non-referred, and in testing theories concerned with the causes and treatment of various types of psychiatric disorders.
TL;DR: This shows that with proper training, non-psychiatric interviewers can achieve standards of inter-rater reliability that are comparable to those previously reported between psychiatrists.
Abstract: The Present State Examination (PSE) is discussed with regard to its use in surveys of subjects who are not psychiatric patients. Although the PSE was originally developed for use by psychiatrists with patients with obvious mental illness, the interview also contains sections dealing in considerable detail with the commoner and less severe complaints and symptoms that are found in a significant proportion of ‘normal subjects’. A shortened version of the PSE (8th edition) is described, limited to these sections, which has been used in population surveys, by interviewers who are not psychiatrists. The training of such interviewers is described, and information on a reliability and repeatability study is presented. This shows that with proper training, non-psychiatric interviewers can achieve standards of inter-rater reliability that are comparable to those previously reported between psychiatrists.
TL;DR: Differences in inception rates are generally greater between West Africans and West Indians than between the latter and the British, and for each major diagnostic caterogy, with the exception of reactive depression and paranoid states.
Abstract: All West Africans and West Indians living in Camberwell who made a psychiatric contact between 1 January 1965 and 31 December 1968 were selected using the Camberwell Psychiatric Register as a sampling frame. Inception rates of psychiatric illness were then calculated using the 1966 10% census figures for West Africans and West Indians in Camberwell. The rates found were compared to those among the British living in Camberwell. For each major diagnostic category, with the exception of reactive depression and paranoid states, the inception rates are significantly higher among West Africans than West Indians. They are also significantly higher among West Indians than the British. However, the differences in inception rates are generally greater between West Africans and West Indians than between the latter and the British.
TL;DR: The rapid growth of studies of risk research in the study of schizophrenia, an area that follows in a tradition set by investigators of predisposition to other forms of disorder such as delinquency or cognitive and adaptational deficits induced by pregnancy and birth complications, lacks historical precedent.
Abstract: Schizophrenia is essentially a disorder of development one in which genes and environment in interaction are the prime determiners of its developmental course. Although this framework for theory has had a lengthy history, the empirical, efforts to trace such development have been heavily biased by an overemphasis on retrospections provided by patients, parents and family members. This method has origins that are rooted in the history of psychiatry (Garmezy & Streitman, 1974), and, although widely used, its biasing properties have been long known to psychiatric researchers. It required, however, the systematic accounts of normal mothers reflecting on the early years of their normal children to render unequivocal the dangers inherent in leaning on parental memory for a reconstruction either of significant life events or of personality attributes characteristic of the growing offspring (Yarrow et al. 1970). These studies have revealed the distortions in recall produced by the passage of time, the biasing influence of contemporary adaptation of an offspring on a parent's recital of earlier adjustment, and the effect of contemporary child-care values on the remembrance of things past. The likelihood that such distortions would be heightened in parents recalling the early life patterns of an offspring who had subsequently developed a psychosis simply accentuated the need for systematic ongoing evaluations of children who were presumed to have a heightened predisposition for subsequent psychopathology. Hence the growth of risk research in the study of schizophrenia, an area that follows in a tradition set by investigators of predisposition to other forms of disorder such as delinquency or cognitive and adaptational deficits induced by pregnancy and birth complications (Birch & Gussow, 1970; Pasamanick & Knobloch, 1961). The rapid growth of studies of risk for schizophrenia has been chronicled elsewhere (Garmezy & Streitman, 1974; Garmezy, 1974), but it would be inappropriate to suggest that this specific research focus lacks historical precedent.
TL;DR: The level of mental 'distress' was assessed for a sample of mothers with pre-school children in Inner London and Variables correlating with distress were identified and replicated in a second sample.
Abstract: The level of mental ‘distress’ was assessed for a sample of mothers with pre-school children in Inner London. Fifty-two per cent of mothers had a moderate or severe distress problem in the 12 months prior to interview. Variables correlating with distress were identified and replicated in a second sample. Social class was not found to be related, and the question of the general relationship between social class and distress is considered.
TL;DR: The results show the practical importance of informing patients about their medication and of paying attention to the difficulty level of any leaflets issued.
Abstract: Eighty anxious and eighty depressed patients were assigned randomly to receiving one of three versions of an information leaflet about their medication, or to receiving no leaflet at all. Mean medication errors were reduced from 15 to 4% by provision of suitably constructed leaflets. The results show the practical importance of informing patients about their medication and of paying attention to the difficulty level of any leaflets issued.
TL;DR: Evidence from a number of different disciplines shows that the presence of meaning in the noise is of critical importance in determining the persistence of physical reactions to the noise.
Abstract: The published work relating to the effects of noise on man and animals is reviewed from the standpoint of mental health. Evidence from a number of different disciplines shows that the presence of meaning in the noise is of critical importance in determining the persistence of physical reactions to the noise. The existing evidence linking noise with mental illness is found to be unsatisfactory. The concept of annoyance and the relevance of noise annoyance to mental illness are discussed. Some specific suggestions for further work are put forward.
TL;DR: Body image estimations in 86 normal-weight adolescent girls showed a tendency to overestimate body width and underestimate body length and an association between the younger ages and the extent of overestimation of body width.
Abstract: Body image estimations in 86 normal-weight adolescent girls showed (a) a tendency to overestimate body width and underestimate body length and (b) an association between the younger ages and the extent of overestimation of body width. In particular there is a sharp drop in overestimation between ages 10 and 11 and thereafter a more gradual and non-significant decline. These age-specific normative data are useful in assessing body image distortions in a variety of medical and psychiatric disorders.
TL;DR: A modified version of the Manic State Rating Scale comprising 28 items with a glossary has been tested on 16 manic patients and appears to be valid.
Abstract: A modified version of the Manic State Rating Scale comprising 28 items with a glossary has been tested on 16 manic patients. The scale has satisfactory inter-rater reliability and appears to be valid.
TL;DR: The review deals with the possibility of diffuse brain damage, not always clinically obvious, in chronic alcoholics and some of its implications are discussed with special reference to the role of frontal lobe damage.
Abstract: The review deals with the possibility of diffuse brain damage, not always clinically obvious, in chronic alcoholics. Some of its implications are discussed with special reference to the role of frontal lobe damage. The main areas of enquiry--neuropathological, neuroadiological and psychological - are considered in detail.
TL;DR: A major factor determining the effects of the separation experience in the weeks following reunion is the degree to which the mother-infant relationship has been disturbed by it.
Abstract: Some experiments, reported in detail elsewhere, on the effects of mother–infant separation in rhesus monkeys are here reviewed and compared. They involved 4 groups – one in which mothers were removed for 13 days leaving the infant in the social group; one in which infants were removed; one in which mothers and infants were removed and separated; and one in which mothers and infants were removed but not separated. The nature of the separation experience had a profound effect on the infant's response: infants left in a familiar environment while their mothers were removed showed marked but brief ‘protest’ and then profound ‘despair’, whilst infants removed to a strange cage showed more prolonged ‘protest’. A major factor determining the effects of the separation experience in the weeks following reunion is the degree to which the mother–infant relationship has been disturbed by it. The multiplicity of factors affecting the outcome of a separation experience are discussed.
TL;DR: The results are consistent with the hypothesis that these drugs exert their therapeutic effects by dopamine receptor blockade in the nucleus accumbens, and are in the rank order in which these drugs produce extrapyramidal side effects.
Abstract: The hypothesis that neuroleptic drugs exert their therapeutic effects by blocking dopaminergic transmission has been investigated by examining the effects of 3 neuroleptic drugs on dopamine turnover in 2 dopaminergically innervated regions of brain – the neostriatum and nucleus accumbens. The drugs chlorpromazine, thioridazine and fluphenazine, known to be therapeutically active in the treatment of schizophrenia, but to have differing incidences of extrapyramidal side effects, were administered to rats in dose ratios approximating to those effective in man. All 3 drugs induced a similar rise in the content of the dopamine metabolite homovanillic acid (HVA) in the nucleus accumbens, whilst the changes in HVA observed in the neostriatum were in the rank order in which these drugs produce extrapyramidal side effects. While the concentrations of dopamine metabolites in the frontal cortex were too low to assess the possibility that neuroleptic drugs have actions at this level, our results are consistent with the hypothesis that these drugs exert their therapeutic effects by dopamine receptor blockade in the nucleus accumbens.
TL;DR: It was concluded that a more satisfactory typology of 'attempters' is likely if types of relationship problems are investigated in more detail, and an attempt was made to look for 'syndromes' or groupings of problems.
Abstract: A representative sample of 130 people was interviewed shortly following self-poisoning or self-injury. The interview method is described. Events in the week prior to the attempt, and the incidence of various kinds of chronic problems are reported. Events involving key relationships were much more common than other kinds. The most important event was a quarrel, particularly in the 48 hours prior to the attempts and more common with female than with male attempters. The possible relevance of quarrels to understanding overdose behaviour is discussed.Nearly a third were receiving non-psychiatric treatment at the time of the ‘attempt’ Approximately one quarter were currently receiving psychiatric treatment and a half had received it at some time. A substantial proportion had been admitted to either psychiatric or non-psychiatric hospitals within the past year.The proportions indicating the need for various kinds of help are reported. Most people said they needed ‘someone to talk to’. More than half had been in contact with some form of helping agency during the week prior to the attempt. The possible significance of these findings is discussed.An attempt was made to look for ‘syndromes’ or groupings of problems. The resulting analysis, whilst of interest, did not lead to a satisfactory method for classifying individuals. It was concluded that a more satisfactory typology of ‘attempters’ is likely if types of relationship problems are investigated in more detail.
TL;DR: It was concluded that the phenomenon of body-image disorder is not specific to anorexia nervosa, extending not only to patients with obesity and to some normal women, but also to women during pregnancy.
Abstract: Two alternative explanations of the body-image abnormality in anorexia nervosa patients are outlined: namely, the 'abnormal sensitivity' and 'adaptational failure' hypotheses. Evidence relating to these 2 conflicting hypotheses was obtained from body-perception measurements carried out on groups of pregnant women. In the first study 40 pregnant women, at approximately 4 month's duration, were found to overestimate their bodily dimensions, albeit to a lesser extent than the previously tested group of anorexia nervosa patients (Slade & Russell, 1973a). When they were subdivided on the basis of a history of weight change over the previous 12 months, the 'stable weight' subgroup was found to overestimate significantly more than the 'weight gain' and 'weight loss' subgroups. In a second study 16 of the original group of pregnant women were retested at approximately 8 month's duration. Although their weight and bodily dimensions had increased on retesting, their tendency to overestimate was found to be significantly reduced. It was concluded that the phenomenon of body-image disorder is not specific to anorexia nervosa, extending not only to patients with obesity and to some normal women, but also to women during pregnancy. Moreover, the 'abnormal sensitivity' hypothesis was considered to fit these and other recently accumulated data better than the alternative 'adaptational failure' hypothesis. Some of the theoretical and clinical implications of these findings are discussed.
TL;DR: The relationship between symptom change and change in prolactin secretion was consistent with the hypothesis that increasing symptom severity is associated with increasing dopamine release from the tubero-infundibular system.
Abstract: Prolactin, FSH, LH and TSH were determined in repeated samples of serum from 16 unmedicated male patients with chronic schizophrenia. Changes in the mental states between the 2 occasions were related to changes in hormone levels. Significant inverse correlations were established between prolactin and incoherence of speech, between prolactin and total positive symptoms and between FSH and poverty of speech. A significant positive correlation was established between FSH and delusions. These findings are discussed in the context of evidence concerning the role of monoamines in the control of anterior pituitary function, and of the dopamine and other monoamine hypotheses of schizophrenia. Although prolactin secretion was not as low, as would be predicted on the basis of the dopamine overactivity hypothesis of schizophrenia, the relationship between symptom change and change in prolactin secretion was consistent with the hypothesis that increasing symptom severity is associated with increasing dopamine release from the tubero-infundibular system.
TL;DR: Using a double-blind placebo-controlled cross-over design, the effect of equine conjugated oestrogens tablets (Premarin) was studied in 20 women with the climacteric syndrome and only 2 patients had an improved sense of well-being on oestrogen and not on placebo.
Abstract: Using a double-blind placebo-controlled cross-over design, the effect of equine conjugated oestrogens tablets (Premarin) was studied in 20 women with the climacteric syndrome followed during 15 months. Sixteen women were equally improved on placebo and oestrogen. Only 2 patients had an improved sense of well-being on oestrogen and not on placebo. The psychological diagnosis was unrelated to the subjective response to oestrogen or placebo. Performance in psychological tests administered before and during treatment periods was not changed by oestrogen or placebo.