Depressive symptoms in stable chronic schizophrenia: prevalence and relationship to psychopathology and treatment.

The prevalence and correlates of the depressive syndrome were explored in a population of 120 patients with stable, chronic schizophrenia living in the community. The presence of clinically significant depressive symptoms was defined by a score of 17 or greater on the Beck Depression Inventory. Patients were examined to assess severity of schizophrenic symptoms and medication side-effects. Sixteen of the 120 patients (13.3%) had significant depressive symptoms. Depressive symptoms were significantly correlated with the hostility/suspiciousness (P<0.0001), the positive symptom (P=0.0009) factor of the BPRS and with scores on the Significant Others Scale, a measure of patients' perceived lack of social support (P=0.0004). The association between depression and akathisia approached significance (P=0.007). There was no correlation with demographic variables, alcohol intake, antipsychotic dosage or anticholinergic dosage. Using a scale that rates the subjective aspects of the depressive syndrome, we found no evidence of a relationship between depression and negative symptoms in this population. These results indicate that persistent depressive symptoms in stable patients in the community are related to the degree of persistent positive psychotic symptoms, patient perceptions of social support and, weakly, to the degree of akathisia but not other aspects of antipsychotic treatment.

The postconcussional syndrome: social antecedents and psychological sequelae.

The study consisted of a prospective investigation of 45 consecutively admitted patients who had sustained a mild head injury. In all cases the duration of post-traumatic amnesia was less than 24 hours. Head injury patients had an average of three adverse life events in the year preceding injury compared with 1.5 for controls. Using the PSE, 39% of the group were diagnosed psychiatric cases at six weeks after the injury. For cases the mean level of chronic social difficulties (3.3) was four times that for non-cases (0.8). Six months after injury, 28% of the head injury group had three or more symptoms. These chronic cases were on average ten years older than those whose symptoms had remitted. Chronic cases had, on average, three social difficulties, twice as many as found among those whose symptoms had remitted. The emergence and persistence of the postconcussional syndrome are associated with social adversity before the accident. While young men are most at risk of minor head injury, older women are most at risk of chronic sequelae.

The psychobiology of minor head injury.

Twenty-six consecutive admissions to an accident and emergency unit with minor head injury were examined. This was defined as a head injury warranting brief in-patient overnight stay but with a post-traumatic amnesia of less than 12 hours. Each patient had a neurological examination, a post-traumatic symptom check list completed, EEG power spectra analysis and auditory brain stem-evoked potential recordings, and a four-choice reaction-time measurement. These assessments were repeated six weeks later. Six months after the head injury a symptom check list was completed and four-choice reaction time measured again. Post-traumatic symptoms are persistent in half of all patients at six weeks and six months follow-up. The EEG power spectra showed a significant change in theta power between the first recording and the second one at six weeks, with relative reduction being noted. Approximately half of all patients had significant delays in brain stem conduction time at day 0. There was a trend towards a decrease in brain stem conduction time at six weeks, though in almost half the brain stem conduction time still remained abnormal at six weeks. Head-injured patients had prolonged choice reaction times at day 0 with serial improvement between then and six months, though the values at six weeks were still significantly longer than healthy controls. It is suggested that these findings reflect both cortical and brain stem damage following minor head injury, the brain stem damage being more persistent. There appear to be three patterns of recovery, half recovering within six weeks, a minority persisting over six months with persisting brain stem dysfunction and less than a third showing an exacerbation of symptoms with no evidence of brain stem dysfunction, the exacerbation being possibly a consequence of psychological and social factors.

Psychiatric rehabilitation--does it work? A three year retrospective survey.

To evaluate the effectiveness of a rehabilitation unit in returning psychiatric patients to community settings, a survey was undertaken of all patients referred to the rehabilitation unit at Holywell Hospital (Bush House) from 1985 to 1987. The location of 96 patients at the end of 1987 was recorded; 38 were living in the community and 38 had either failed to make this transition or had attempted a community placement but were back in hospital. Comparison of these two sub-groups showed those living successfully in the community to be older and to have had fewer hospital admissions, although the total number of years in hospital was similar. A number of other clinical findings have been helpful in planning future services and in modifying rehabilitation programmes at this unit. The deficiencies of this quantitative evaluation process were identified and there is a need for further qualitative investigations.

Measurement of reaction time following minor head injury.

A four-choice reaction time test was carried out on 45 minor head injury cases, 24 hours after the injury and 6 weeks later. Twenty-eight subjects were re-tested after a six month interval. Reaction time measures were also obtained in a matched, general practice control group. The concussion cases displayed significantly poorer performances than the matched controls in four measures, at day 0 and at 6 weeks. The patients also showed serial improvement in these measures up to six months after the injury, when their scores excelled those of the matched controls.

Erroneous plasma "cortisol" values in Addison's disease : A problem of the fluorimetric assay of 11-OH corticosteroids.

A case is described in which a woman, being investigated for Addison's disease, had what appeared initially to be plasma cortisol levels within the normal range. Subsequent investigations including ACTH stimulation and an immunofluorescent test for adrenal cortical antibodies showed the diagnosis to be correct. Attention is drawn to the lack of specificity of the fluorimetric plasma 11-OH corticosteroid assay and, therefore, to the danger of using plasma "cortisol" as a screening test for adrenocortical hypofunction.