Reliability of a procedure for measuring and classifying "present psychiatric state"

SCAN and the PSE tradition

The development of a series of instruments that has so far culminated in SCAN version 2.0 began in the late 1950s because of the need for better tools for clinical measurement (including categorization and diagnosis). The basic principles of the PSE had long been decided by the time of first publication in 1974 and have remained the same since. Based on the glossary of differential definitions, the aim is to provide comprehensive, accurate and technically specifiable means of describing and classifying clinical phenomena in order to make comparisons. Insofar as it fulfils this aim, SCAN can be used to enhance clinical work and education and advance knowledge through its use in biomedical, epidemiological and psychosocial research.

Clinical characteristics of auditory hallucinations

We studied 25 clinical characteristics of auditory hallucinations by means of 3-point observer-rated scales in a sample of 60 inpatients with mainly schizophrenic or schizophreniform disorders. The interrater reliability of the scales was found to be satisfactory. High levels of conviction about the reality of the sensory stimuli, clarity of content, location of their source of origin and lack of volitional control were found to be the hallmarks of verbal hallucinations. This finding supports the hypothesis that the concept of auditory hallucinations represents many aspects of patients' hallucinatory experiences, which are relatively independent of one another.

Reliability of the Structured Clinical Interview for DSM-III-R: an evaluative review

Research evaluating the reliability of the Structured Clinical Interview for DSM-III-R (SCID) is reviewed. Reliability procedures and studies are examined. Several versions of the SCID are covered, including the SCID-I (axis I disorders), SCID-II (axis II disorders), SCID-Positive and Negative Syndrome Scale (SCID-PANSS; functional-dimensional assessment for psychotic disorders), and SCID-Upjohn Version (panic disorder). The SCID has been found to yield highly reliable diagnoses for most axis I and axis II disorders. Suggestions for future research on the SCID are offered, particularly with respect to (1) the lack of studies in which SCID diagnoses are compared with diagnoses from unstructured interviews or other structured-interview formats, and (2) the need for a more natural evaluation of this instrument. Also, the importance of establishing norms and obtaining reliability data for underserved clinical populations is discussed.

Semi-structured depression scale sensitive to change with treatment for use in the elderly

The construction of a semi-structured interview depression scale that is sensitive to change for use in the elderly is described. Depression items from a well validated diagnostic instrument, the Geriatric Mental State Schedule (GMSS), were used as the core items in the development of the instrument. Improvement in depression in 80 elderly patients was independently assessed with two standard rating scales for depression, the Hamilton Rating Scale for Depression and the Beck Depression Inventory, and by an independent clinician's judgement before and after standard antidepressant treatment. Depression items that were sensitive to change were retained from the core items to form the new instrument. Results indicate that this scale is reliable and valid, shows better correlation with both the clinician's and the patient's judgement of improvement than the standard instruments, and is sparing of the rater's time.

Development and validation of a Multiple Ability Self-Report Questionnaire

We present results from three studies on the development and validation of the Multiple Ability Self-Report Questionnaire (MASQ), a self-report measure comprising items from five cognitive domains; language, visuo-perceptual, verbal memory, visual memory, and attention. In Study 1, we determined the content relevance of the questionnaire items. In Study 2, we assessed the basic psychometric properties (i.e., internal consistency and test-retest reliability) of the MASQ in 118 individuals without neurologic or psychiatric disorder, aged 25 to 88 years. In Study 3 we provide validity data for the MASQ by comparing the ratings of normals to people with unilateral temporal-lobe epilepsy, and examining the relationship of self-report to objective test performance. The potential use of the MASQ to study the neurologic and psychological correlates of accuracy and unawareness in self-appraisal across different cognitive domains and various clinical groups is discussed.

Psychometric properties of the parental bonding instrument in a Spanish sample

The Parental Bonding Instrument was translated into Spanish and administered to a sample of 205 Spanish primiparae 3 days after childbirth. Reliability, factorial structure and predictive validity for affective disorders were evaluated. The Spanish version of the PBI has psychometric features similar to those described in other cultures. However, the results suggest that in future research the predictive power of the "Control" factor in affective disorders might be improved by splitting it into two subfactors: "Overprotection" and "Restraint".

Positive, negative, and disorganisation factors from the Schedule for Affective Disorders and Schizophrenia and the Present State Examination. A three-factor solution

The use of items from the Schedule for Affective Disorders and Schizophrenia and from the Present State Examination scales for assessing positive and negative symptoms in schizophrenia was examined using factor analysis. The factorial structure of the items which putatively assess positive and negative symptoms was examined. A three-factor solution was obtained with factors identified as: a negative symptom factor (factor 1); a positive symptom factor (factor 2); a 'disorganisation' factor (factor 3), consisting primarily of items related to disordered thinking. A solution which was highly similar in important loadings was obtained with an independent sample of patients. High correlations of the rotated factors with the external criteria supported the interpretations of the factors. The results indicate that symptoms generally classified as negative or positive are factorially independent. Furthermore, a disorganisation factor, consisting of items previously included in positive and negative symptoms factors, is necessary for a full representation of the factor structure.

Diagnostic agreement in psychiatry. A comparative study between ICD-9, ICD-10 and DSM-III-R

A random sample of 100 new patients referred consecutively to the psychiatric hospital was assessed using the Arabic translation of the PSE. An abstract form was designed to include all PSE scores as well as the necessary extra data to make ICD-9, ICD-10, and DSM-III-R diagnoses. Kappa correlation was calculated for inter-rater and intra-rater reliability. Overall reliability and reliability of each major psychiatric diagnosis were compared between the three systems. The use of the PSE helped in achieving good agreement between Arab psychiatrists for all the three systems, but ICD-10 was found to have the highest reliability figures both for three-digit and four-digit psychiatric diagnoses.

Neurotoxicity of solvent mixtures in spray painters. II. Neurologic, psychiatric, psychological, and neuroradiologic findings

A multidisciplinary cross-sectional study was performed to examine the chronic neurotoxicity of organic solvents. Participating in the study were 105 persons employed as spray painters and having long-term solvent exposure (10-44 years) and a control group consisting of 58 construction workers, electricians, and plumbers without occupational contact to solvents. Samples were matched for age, preexposure intelligence level, occupation, and socioeconomic status. After controlling for potentially non occupational confounding factors (neuropsychiatric diseases, metabolic disorders, high blood pressure, alcohol intake) 83 spray painters and 42 controls were entered finally into the study. The evaluation included work history, self-rating questionnaire, neurologic investigation, psychiatric analysis using the Present State Examination (PSE), psychological testing, and computerized axial tomography (CAT) of the brain. Physical and neurologic examinations demonstrated no case of overt disorders of the central or peripheral nervous system. An important result of the psychiatric analysis was that the syndromes "special features of depression" and "loss of interest and concentration" occurred significantly more frequently among spray painters than among controls. Further analyses demonstrated an association with chronic exposure over 30 years and repeated acute neurotoxic effects during solvent exposures. Neither psychological nor performance tests demonstrated any statistically significant differences in the performance sets after adjustment according to premorbid intelligence level; this finding supports the presumption of only a low grade of mental dysfunction. Correlation analyses indicated a relationship between subjective health complaints and long-term solvent exposure; however, the effect of age cannot be completely ruled out.(ABSTRACT TRUNCATED AT 250 WORDS)

A longitudinal psychopathological schedule

A schedule is described for rating the symptoms of mental illness over a period of time which includes several episodes. The reliability was measured in a study involving six raters. The sources of information required were studied, in 20 patients, by comparing an interview with the patient, a similar interview with an informant and an analysis of the case records. A synopsis of interview and record data are necessary to obtain adequate information about longitudinal psychopathology and 'lifetime' diagnosis.

The epidemiology of psychiatrist-ascertained depression and DSM-III depressive disorders. Results from the Eastern Baltimore Mental Health Survey Clinical Reappraisal

Psychiatrists used a semi-structured Standardized Psychiatric Examination method to examine 810 adults drawn from a probability sample of eastern Baltimore residents in 1981. Of the population, 5.9% was found to be significantly depressed. DSM-III major depression (MD) had a prevalence of 1.1% and 'non-major depression' (nMD), our collective term for the other depressive disorder categories in DSM-III, had a prevalence of 3.4%. The two types of depression differed by sex ratio, age-specific prevalence, symptom severity, symptom profiles, and family history of suicide. Analyses using a multiple logistic regression model discerned that both types of depression were influenced by adverse life events, and that nMD was influenced strongly by gender, marital status, and lack of employment outside the home. Neither type of depression was influenced by income, education, or race. This study validates the concept of major depression as a clinical entity. Future studies of the aetiology, mechanism, and treatment of depression should distinguish between these two types of depression.

Schizophrenia: gender and familial risk

The morbid risks for schizophrenia and any nonaffective psychosis in the first degree relatives of male and female schizophrenic probands were compared utilizing Cox proportional hazards models. The schizophrenic probands (275 male; 106 female) were drawn from a larger sample of hospitalized patients obtained by systematically screening all psychiatric admissions to 15 facilities over a six-year period. Proband diagnoses (DSM-III) were based on a direct assessment of the patient and a review of medical records. The family history method was used to obtain information about the first degree relatives of the probands. Cox proportional hazards models were adjusted for duration of illness of the proband and gender of the relatives. First degree relatives of female probands had significantly higher morbid risks for schizophrenia and nonaffective psychosis than relatives of male probands. The differential risk for schizophrenia in the relatives of male and female probands demonstrated in this study, as well as others, suggests that males and females may be at different risk for subtypes of the disorder.

Schizophrenia, bipolar disorder and depression. A discriminant analysis, using 'lifetime' psychopathology ratings

Discriminant and canonical variate analyses were performed using 302 patients, on whom ratings of lifetime psychopathology and course of illness has been made. DSM-III diagnoses were used to form the criterion groups. Bipolar disorder emerged as a distinct grouping, but there are reasons for dissatisfaction with its definition. The remaining patients formed a 'schizodepressive continuum', but this also had a tendency to bimodality. It is possible that the distinction between schizophrenia and depression was obscured by inadequacies in the data and the inclusion of excessive numbers of patients with schizoaffective depression in this study.

Object-name selection in psychiatric patients before and after neuroleptic therapy

An object-name selection test was administered to 16 newly admitted schizo phrenic, non-schizophrenic psychotic and non-psychotic patients on admission when they were drug-free, and again 4-6 weeks later, following treatment with neuroleptics. Sixteen healthy, drug-free age-matched and sex-matched controls were similarly tested on two occasions 4-6 weeks apart. Schizophrenic and non-schizophrenic psychotic subjects made significantly more association-type errors than non-psychotic subjects and controls. A signifi cant reduction in association-type errors which was observed in both psychotic patient groups on the second testing occasion may be attributed to medication. The data suggest that overinclusive thinking, as measured by the object-name selection test, is a feature of both schizophrenic and non-schizophrenic psychosis. It is concluded that tests of overinclusion are therefore of limited diagnostic utility although they may be of value in monitoring response to treatment.

Behavioral abnormalities and psychiatric symptoms in Alzheimer's disease: preliminary findings

Behavioral abnormalities and psychiatric symptoms were assessed in 178 patients diagnosed as having Alzheimer's disease by NINCDS/ADRDA criteria. The subjects were selected from a defined catchment area and therefore were representative of a group of patients with Alzheimer's disease of varying severity. Auditory hallucinations were found in 10%, visual hallucinations in 13%, and delusions in 16%. Symptoms suggestive of depression were reported by 39% of the patients and features of depression observed in 25%. Twenty percent were aggressive, and 7% were sexually disinhibited. Nineteen percent exhibited excessive walking behavior and 10% binge eating. Nearly 50% of the sample were incontinent. Patients in the hospital were more often aggressive, incontinent, and seemingly less depressed. Patients with severe dementia displayed excessive walking behavior, were more likely to be incontinent, and reported less depressive symptoms than those with moderate or mild dementia.

Isle of Wight revisited: twenty-five years of child psychiatric epidemiology

Child psychiatric epidemiology over the last 25 years is reviewed in terms of conceptual and methodological issues arising out of substantive findings. The Isle of Wight surveys undertaken in the mid-1960s are briefly described to establish a starting point, and progress since then is reviewed in terms of topics not originally covered--especially problems in preschool children and specific psychiatric disorders. The use of epidemiology to study causal hypotheses is considered, methodological advances are noted, and challenges for the future are discussed.

Diagnostic interviewing with children: the use and reliability of the diagnostic coding form

There have been few attempts to standardize assessment methods in Child Psychiatry. This paper describes a semi-structured approach to diagnostic interviewing of the child. Thirty-four children six to 13 years of age, and their parents, were interviewed two weeks apart by two different psychiatrists. A diagnostic coding form consisting of 29 clinical symptom items, eight summary items, and nine positive health ratings was used. Three diagnostic items were also included: "severity of clinical condition," "probability of disorder," and "adjustment status." Twelve of the Time 2 interviews with the child and parent were videotaped and rated by three different psychiatrists. Results indicated that summary items had higher reliability than individual symptom items and the three diagnostic items had the highest reliability, suggesting reliability is better for broad classes of behaviour. Interrater reliability was higher for the face-to-face rating than videotaped ratings. This suggests first that face-to-face interviews are reasonably stable over a two week period and second, since videotaped ratings had lowest reliability on items that depended on inferences about the child's feedlings, an important source of variance in assessment may be the clinician's ability to empathize with the child and draw inferences about internal feeling-states. It was concluded that this interview schedule can be a part of routine clinical practice. It ensures a reasonably standard, yet flexible and reliable approach to diagnostic interviewing.

Life events and psychopathology severity: comparisons between psychiatric outpatients and inpatients

Relationships between life events stress variables and seven indices of psychopathology severity for a group of 97 never-hospitalized outpatients were compared with those of a previously studied group of 217 first-admission functional disorder psychiatric inpatients from the same geographical catchment areas. The hypotheses tested were that degree of life events stress would be correlated positively with indices of psychopathological severity and that the magnitudes of association would be higher for the outpatients. Bivariate correlations and stepwise multiple regression with other potential demographic and prognostic moderator variables provided evidence for significant, but somewhat differing, patterns in outpatient vs. inpatient stress/pathology relationships. Contrary to prediction, the magnitudes of significant and near-significant associations between life events and pathology severity were not different in the two samples.

Psychiatric screening of alcohol and drug patients: the validity of the GHQ-60

The 60-item General Health Questionnaire (GHQ) and the National Institute of Mental Health Diagnostic Interview Schedule (DIS) were administered to 501 patients presenting for assessment or treatment of alcohol or drug problems at the Addiction Research Foundation, Toronto, Canada. The GHQ proved to be a useful, if limited, instrument for routine screening for psychiatric disorders other than substance abuse in this population. The sensitivity or "utility" of the test at the optimum threshold score was considerably lower in this sample than in medical or community samples. Receiver Operating Characteristic (ROC) analysis suggests a need for an upward revision of the cut-off score to 23/24 inpatients with alcohol or drug problems. At this threshold, sensitivity was 69%, specificity 75%, positive predictive value 77%, negative predictive value 66%, and overall misclassification rate 29%. A definition of "caseness" was used that included all DIS Axis I disorders with the exception of substance use and "cognitive impairment." Sensitivity of the GHQ was highest for the affective disorders (79%). False negatives accounted for the bulk (61%) of the misclassification rate. At the threshold score of 23/24, positive predictive values were greater for the unemployed and for patients with either no current substance use disorder or with both alcohol and drug disorders.

Psychiatric epidemiology

In this paper, some of the basic concepts of epidemiology are presented. Their applicability to psychiatry is outlined, and the definitions of terms are given. Various methods of epidemiological investigation are discussed. The background for the development of recent prevalence studies, including advances in diagnostic methods and case ascertainment, are given in some detail, and some recent results are presented. Additional areas of investigation are discussed more briefly.

The Last-Weiss Rorschach Ego-Strength Scale as a prognostic measure for psychiatric outpatients

This study tested the hypothesis that the Last and Weiss (1976) Rorschach Ego-Strength Scale (sigma E) would predict outcome among a representative sample of never-hospitalized psychiatric outpatients. 78 patients were assessed with structured symptom, psychiatric history, and social data interviews at the time of initial clinic contact and at 2-yr. follow-up. Outcome measures included the Menninger Health-Sickness Scale, a multidimensional variable involving social and work functioning and recent symptom level, symptom measures, and an index of diagnostic severity. sigma E, controlled for number of responses, correlated significantly with Health-Sickness, neurotic symptoms, diagnostic severity, and psychotic symptomatology. Among the components of sigma E, M+, and FC+ had significant relationships or contributed to significant relations with outcome variables. Considered with an earlier study of inpatients, in which S+ sigma E component correlated inversely with outcome, this study suggested that sigma E components have differing prognostic significance, depending on adaptational level of the patient.

The assessment of lifetime psychopathology: a comparison of two interviewing styles

A structured respondent-based version of the SADS-L interview was compared with a semi-structured investigator-based version of the same interview in terms of efficiency in assessing lifetime psychopathology. There was substantial agreement across most Research Diagnostic Criteria (RDC) categories, but there was less agreement on the rating of symptoms. The implications of these similarities and differences between the techniques are discussed.

Effect of 5-hydroxytryptophan on H-reflex recovery curves in normal subjects and patients with affective disorders

The effect of the serotonin precursor DL-5-hydroxytryptophan (5-HTP) on the Hoffmann reflex recovery curve (HRRC) was studied in normal subjects and patients with affective illness. 5-HTP significantly decreased the HRRC in normal controls and in depressed and manic patients receiving treatment with lithium or antidepressants. 5-HTP increased the HRRC in unmedicated depressed and manic patients. These results provide further evidence for a serotonergic abnormality in the affective disorders.

The Last-Weiss Rorschach Ego-Strength Scale as a prognostic measure for psychiatric inpatients

This study tested the hypothesis that the Last-Weiss (Last & Weiss, 1976) Rorschach Ego-Strength Scale would predict outcome among a representative sample of first-lifetime psychiatric admissions. One hundred seventeen patients were assessed with structured symptom, psychiatric history, and social data interviews at hospital admission, and 2-year follow-up. Outcome measures included a multidimensional variable involving rehospitalization time, social and work functioning, and recent symptom level and symptom measures. Unexpectedly, the Last-Weiss Sum E variable correlated significantly with negative multidimensional outcome, a result that was strengthened when any possibly confounding effects of social class, IQ, and number of Rorschach responses were partialled out. It was found that Sum E's predictive value for poorer outcome was due to the space response (S+) component of the ego-strength variable. Possible explanations of the findings and implications for the previously validated Klopfer's Rorschach Prognostic Rating Scale are discussed.

Residents performance on the mental status examination

Twenty-six residents watched a videotape of the mental status examination of a psychotic patient, then wrote their assessment of the patient's mental status. The residents' reports were independently graded by the authors. The residents' marks were compared to performance on departmental oral examinations. Results showed that global or qualitative assessment of mental status performance was reliable. Excellent interrater reliability was achieved when the assessment criteria for sub-items of the mental status were well defined.

The impact of maternal depression in young children

An urban working class sample of depressed mothers with two-yr-old children was compared with a control group of non-depressed mothers using maternal interviews, home observation of mother/child interaction, and developmental assessment of the children. Measures were repeated after six months. Children of depressed mothers showed more emotional and behavioural disturbance and delay in expressive language development. Depressed mothers had more past and current adverse experiences, particularly in close relationships. In general depressed mothers were less responsive to their children and less able to sustain social interaction: their children were more often distressed, but there was a big variation in quality of mother/child interaction within the depressed group.

Family-genetic studies and identification of valid diagnostic categories in adult and child psychiatry

Family-genetic studies of child and adult psychiatric disorders have become increasingly fashionable over the past decade. The development of structured diagnostic interview schedules, the emergence of uniform diagnostic criteria such as DSM-III, and the use of refined design and analytic techniques from the field of chronic disease epidemiology have made substantial contributions to the methodology of such studies. Advances in molecular genetics, particularly our emerging capacity to perform chromosomal linkage studies throughout the human genome, have renewed hope that the constitutional underpinnings of some psychiatric disorders can be identified and that the pathophysiology of these disorders can be elucidated. Family-genetic techniques in child and adult psychiatry are discussed with a particular focus on their potential value in validating diagnostic categories spanning developmental epochs.

The validation of the GHQ-28 and the use of the MMSE in neurological in-patients

The routine use of screening instruments for psychiatric and cognitive impairment in hospital in-patients has been recommended in the United States. The validity of the scaled version of the General Health Questionnaire (GHQ-28) and the clinical utility of the Mini-Mental State Examination (MMSE) were therefore evaluated in a consecutive series of neurological in-patients (N = 102). Using Receiver Operating Characteristic (ROC) analysis, the discriminating power of the GHQ was very good, and best when using a threshold score of 11/12. The patient sample turned out not to contain any with generalised cortical damage, which casts some doubt on whether the MMSE should be used routinely in all neurological in-patients units in the UK.

The Glasgow Assessment Schedule: clinical and research assessment of head injury outcome

A new rating instrument, the Glasgow Assessment Schedule (GAS), is described for the evaluation of head injury outcome. The instrument, which has been used in samples of head-injured men, provides for a comprehensive assessment, and can distinguish mildly and severely injured patients and rate change over time. Inter-rater reliability and concurrent validity with a global rating scale has been found to be satisfactory. It is expected that the GAS will mainly be of use in clinical and research settings in which longer-term management is envisaged.

Presidential address. Evaluation of our patients; our pupils; and ourselves

Respectfully dedicated to the memory of Robert Orville Jones, Psychiatrist Extraordinary, A Great Canadian, A Distinguished Internationalist, And Our First President.

Methodological considerations in smoking research with children and adolescents

THIS PAPER critically assesses the most popular methodological approach used to obtain data on the prevalence of smoking amongst children and adoles ments. It suggests that questionnaires are unlikely to enlarge further the body of knowledge on this topic and that an alternative approach, interviewing, is needed to improve our understanding of the problem. A diversity of research approaches should inform more successful preventive interventions.

Parental psychiatric disorder: effects on children

A 4-year prospective study was undertaken of the families of 137 newly referred English speaking psychiatric patients with children at home aged under 15 years. The group comprised a representative sample of such patients living in one inner London borough. Teacher questionnaires were obtained yearly for all children of school age in the families, and for age-, sex- and classroom-matched controls. Detailed standardized interviews were undertaken yearly with parent-patients and with their spouses. A comparison was also made with a control group of families in the general population with 10-year-old children. Patients' families differed in terms of a higher rate of psychiatric disorder in spouses and a much higher level of family discord. Both parental mental disorder and marital discord tended to persist over the 4-year period, but persistence of both was much more marked when the parent had a personality disorder. The children of psychiatric patients had an increased rate of persistent emotional/behavioural disturbance, which tended to involve disorders of conduct. The psychiatric risk to the children was greatest in the case of personality disorders associated with high levels of exposure to hostile behaviour. Boys showing temperamental risk features were most vulnerable to the ill-effects associated with parental mental disorder.

Psychiatric aspects of diabetes mellitus

A descriptive study of the psychiatric findings in 50 insulin--dependent diabetics is presented. Among the symptoms found were a marked reduction in energy level, increased fatigue and irritability, depression, and delayed psychosexual maturation. Diabetes mellitus is commonly considered to be a disease that, if properly controlled, allows the patient to lead a relatively normal life. We found, however, that these symptoms often made the patients' lives uncomfortable, reduced their functional capacity, disrupted their family life, and disturbed the adolescence of those who were affected at an early age.

Residents training in the mental status examination

One hundred and ninety-two Canadian psychiatry residents (43% of the total Canadian resident population) completed a questionnaire concerning their training in and use of the mental status examination (MSE). Residents perceive a number of deficiencies in their training for the mental status examination. They employ a wide variation in tests, and show a lack of sophistication in how to test for special dysfunctions. We discuss these data in the context of accumulated research on MSE. It should be possible to provide more systematic training in the MSE and we suggest modifications in resident training which might produce a more uniform and reliable MSE.

Validity and utility of the present state examination in assessing neurosis: empirical findings and critical considerations

The validity and clinical utility of the Present State Examination was investigated in 70 neurotic patients referred for inpatient behavioural treatment. We conclude that the instrument is reasonably valid and can be helpful in everyday clinical practice. Suggested for refinement of the PSE are given.

Use and misuse of the PSE

The principles underlying the development of the Present State Examination and the instruments and computer programmes associated with it are discussed in the light of comments made in three recent papers by psychiatrists trained in the German tradition of clinical phenomenology. Many of their comments are cogent and highly relevant to the future development of the system. Some common misunderstandings are also considered; in particular, those that lead to results being interpreted outside the limits of the specifications laid down. The potential for improvement in the system is emphasized and the next stage of development briefly described.

A comparison of clinical methods for assessing dementia

General practice physicians and clinical specialists use various methods for assessing dementia, including the Mental State Questionnaire (MSQ), Face-Hand Test (FHT), Dementia Rating Scale (DRS), tests for developmental reflexes and focal neurologic signs, and examination for evidence of clinical depression, stroke, or other physical health problems. In order to determine how these various methods concur, a sample of elderly persons living in the community were evaluated on eight indices. When MSQ scores were used as criteria, the DRS and FHT concurred with classification of impairment in 76 per cent and 45 per cent of cases, respectively. Positive focal signs and developmental reflexes were significantly related to cognitive impairment but were not common features in this sample. Physical health, drug use, and demographic variables did not appear to be related to cognitive function. Although dysphoric mood was related to cognitive impairment, pseudodementia was not identified. After one year the subjects were retested with the MSQ and the DRS; 14 per cent and 20 per cent, respectively, had improved, indicating a lack of predictive validity of these measures. Results are discussed in the context of the utility of clinical methods for screening and staging cognitive impairment, and recommendations are made regarding a standardized battery.

Development of a structured psychiatric interview for children: agreement between child and parent on individual symptoms

To test the reliability of children's reporting as compared with that of their mothers, a highly structured psychiatric diagnostic interview was used with 307 subjects, ages 6 through 16. Another interviewer gave each mother a similar interview about the child. Responses of each mother-child pair to 168 questions were compared using the kappa statistic. Highest agreement was found on questions concerning symptoms that are concrete, observable, severe, and unambiguous. Mothers tended to report significantly more behavioral symptoms, and children more subjective symptoms. Reasons for low kappas and asymmetrical reporting of symptoms are discussed.

The psychoses of epilepsy and the functional psychoses: a clinical and phenomenological comparison

Sixty-nine patients, each with a combined diagnosis of epilepsy and psychosis, were compared with 53 patients with a diagnosis of functional psychosis. The epileptic affective patients often lacked convincing psychotic features; ECT and lithium were rarely prescribed; only three showed evidence of bipolarity. The epileptic schizophrenic patients were judged to have the better premorbid personality; experienced more paranoid delusions and delusions of reference, and showed less catatonic features than the functional schizophrenic patients. The course of the epileptics' illness was more variable. The concept that the schizophrenia-like psychosis associated with epilepsy is a distinct nosological entity is supported, but not the suggestion of a relationship between affective psychosis and epilepsy.

The Present State Examination: experiences with Xhosa-speaking psychiatric patients

Language, conceptual, and cultural factors are discussed in relation to a Xhosa translation of the Present State Examination which was administered to a series of 120 consecutive new admissions to a psychiatric hospital.

The experiential events of psychiatric disturbance as defined by the PSE exist in Xhosa-speaking patients and it is a valid instrument.

The course and outcome of cycloid psychosis

Thirty patients with cycloid psychosis were found among 244 general psychotic and schizo-affective patients studied in London. The main clues to the diagnosis were the presence of "confusion', a pleomorphic clinical picture or an acute onset. Most of the patients were classified as schizophrenic by British psychiatrists and the Catego system, and as schizo-affective or mood-incongruent affective psychotics by the American Research Diagnostic Criteria and DSM-III. There was little overlap between the cycloids and any Anglo-American category, and cycloid psychosis is not synonymous with schizo-affective psychosis. The outcome of the cycloids was better than that of psychotic patients as a whole, and much better than schizophrenia as defined by Catego, Schneider's, Langfeldt's or Carpenter's rules, or by the guidelines set by the International Classification of Diseases. Compared with manic-depressive patients (defined by the presence of mania at some stage), cycloids had more schizophrenic and fewer depressive and manic symptoms. There was a negligible concordance between the diagnosis of cycloid psychosis and the final diagnosis of manic-depressive disease. It is concluded that these patients should not be diagnosed as schizophrenic, but that the relation of cycloid psychosis to manic-depressive disease is not yet resolved.