Health visitor-run adult sleep clinics.

Two sleep clinics run by health visitors were set up in Dundee to provide a brief, time-limited programme of advice and treatment for adults with insomnia and referred by their GPs. This article describes the clinics and reports the clinical features and outcome of the first 100 patients referred.

Clinical psychology training in Europe.

Clinical psychology training in the United Kingdom (UK) and in the remainder of Europe differs in several respects; in particular, the latter allows for greater variability and clinical specialization with much more training taking place postqualification than in the UK; differences in content and in the balance between the supply of, and demand for, clinical psychologists also exist. These differences reflect employment arrangements and, to a lesser extent, the structure of higher education and legal regulation. Various current and predicted changes in health-care systems and in the legal and educational context will probably lead to training in the UK and elsewhere in Europe becoming more similar in the years after 1992.

Prediction of survival by the Clifton Assessment Procedures for the Elderly (CAPE).

A sample of 261 elderly patients, most with a diagnosis of dementia, consecutively admitted to a geriatric psychiatry assessment ward, was assessed using the cognitive assessment scale (CAS) and behaviour rating scale (BRS) of CAPE. Scores of patients alive at four follow-up intervals were compared with those of non-survivors. On CAS, survivors scored significantly better at 18- and 48-month follow-up; and better, but not significantly so, at nine- and 36-month follow-up. On BRS, survivors scored significantly better at all four follow-up intervals. Only at 36-month follow-up did the scales predict survival of individual patients more efficiently than did base rates.

Prediction of survival in dementia by cognitive tests: a six-year follow-up.

One hundred and sixteen elderly female in-patients with confirmed diagnoses of senile or arteriosclerotic dementia were tested on the Paired-Associate Learning Test (PALT) and Cognitive Assessment Scale (CAS) of CAPE and were followed up annually for six years. Comparison of those patients who had died by each follow-up date with those who had survived showed that in general the latter had had better PALT and CAS scores.

A note on the female norms of the HDHQ.

Two samples--of 200 women tested in their homes and of 85 women attending a general practice--completed the Hostility and Direction of Hostility Questionnaire (HDHQ). The scores of the two samples on General Hostility and on the five subscales--AH, CO, PH, G and SC--were similar to one another but were significantly higher, indicating greater hostility, than those of the normative samples reported in the HDHQ Manual. These and previous findings cast doubt on the value of the Manual norms.

Prediction of survival by three psychological measures.

One hundred and seven elderly female in-patients with confirmed or suspected diagnoses of dementia were assessed by the Paired-Associate Learning Test (PALT), and the Cognitive Assessment Scale (CAS) and Behaviour Rating Scale (BRS) of CAPE. Eighteen months later, 62 patients were still alive. These had significantly better scores on the 'easy' set of PALT and on BRS than the non-survivors; the differences on the 'mediate' and 'hard' sets, and on CAS, while in the predicted direction, were not significant.

Use of the CAPE Pm test with disabled patients.

The problem of estimating a patient's CAS total score on CAPE when the Pm (maze) test cannot be administered because of sensory or physical--rather than cognitive--disability is considered. Analysis of the scores of 250 elderly subjects who attempted all three CAS tests suggests that 'proration' of total CAS scores from I/O and MA scores, while preferable to alternative methods, results in error in a significant proportion of cases and should be used only with caution.

The performance of depressed and manic patients on some repertory grid measures: a longitudinal study.

Sixteen of the depressed patients and nine of the manic patients, who were studied by Ashworth et al. (1982), were retested after clinical recovery. As on the previous occasion, each patient completed a repertory grid whose 10 elements were role titles and which employed 12 elicited constructs and one provided construct. After principal component analysis of each grid, various measures of cognitive structure and perception of self were derived. Whereas in the previous study the clinically depressed and manic patients had differed from one another, and usually also from normals, on 'cognitive simplicity', 'integration of self and others' and 'self-esteem', after recovery these differences had disappeared although there was a tendency for the previously depressed patients to view themselves as different from other people, and for the previously manic patients to have abnormally high self-esteem. However, for the most part, the cognitive abnormalities and features identified in the earlier study appear to have reflected the patients' clinical status rather than more permanent aspects of their thinking.

The short-term stability of the survey version of CAPE.

One hundred elderly women were assessed on two occasions, one week apart, on the survey version of CAPE. Although test-retest correlations were high, the dependency grades of 35 per cent of the sample changed on retesting by one grade, and 2 per cent by two grades, suggesting that the test may be too unstable for clinical purposes.

The concurrent validity of the survey version of the Clifton Assessment Procedures for the Elderly (CAPE).

The concurrent validity of the survey version of the Clifton Assessment Procedures for the Elderly (CAPE) was assessed by comparing the performance of four groups of elderly women selected to represent different levels of impairment and dependency. It was found to discriminate significantly among patients with severe (n = 100), moderate (n = 40), mild (n = 50) and no (n = 20) dementia; it also significantly distinguished between patients with severe and moderate dementia and patients with physical disability (n = 100) and with signs of 'institutionalization' (n = 25). Patients in the severe, moderate, mild and no dementia groups had all been judged clinically to have been placed appropriately as, respectively, geriatric psychiatry in-patients, geriatric psychiatry day-patients or local authority home residents, or as being able to live independently in the community. However, although the survey version dependency grade is intended for use in allocating patients to health and social services facilities, overall agreement between grades and clinically determined placement was only 63 per cent. Thus while the survey version may be useful in discriminating among groups of elderly people of different levels of impairment for research or screening purposes, its clinical value with individual patients remains uncertain.

Psychological features of women with idiopathic detrusor instability.

Psychological tests were completed by 57 incontinent women with idiopathic detrusor instability, and compared with those of 22 women with genuine stress incontinence (an anatomical disorder) and published norms. The previously reported findings of hysterical personality traits, situational stresses and sexual dysfunction in patients with detrusor instability were not confirmed. Higher scores for anxiety, neuroticism, hostility, and depression were found in patients with detrusor instability than in controls. These findings, known associations of psychosomatic disorders, lend further support to the view that idiopathic detrusor instability is a psychosomatic disorder.

The performance of depressed and manic patients on some repertory grid measures: a cross-sectional study.

Six groups were tested: 20 depressed, 10 manic, 10 schizophrenic, 10 alcoholic and 10 physically ill patients, and 10 recovered depressed patients. They were administered repertory grids whose 10 elements were role titles and which employed 12 elicited constructs and one provided construct. After principal component analysis of each grid, measures were derived of 'cognitive simplicity' (Chetwynd, 1977), 'monolithic' and 'articulated' structure (Makhlouf-Norris et al., 1970), 'integration of self and others', and 'self-esteem'. Although neither the depressed nor the manic group differed from all the other groups on any measure, there was a tendency for the depressed patients to be characterized by grids which showed relative 'cognitive simplicity', and 'monolithic' but 'unarticulated' structure, a large perceived distance between self and others, and low 'self-esteem' and for the manic patients to have relatively 'complex' (or confused) grids, with 'unarticulated' structure, a small 'self-other' distance and high 'self-esteem'.

The comparative effectiveness of three versions of 'classroom' reality orientation.

The effectiveness was compared of 'Classroom' Reality Orientation presented (1) once daily, in groups; (2) twice daily, in groups; and (3) once daily, individually. On a questionnaire measure of orientation all three versions produced significantly greater improvement than that found in an untreated control group, but did not differ in their relative effectiveness. Similarly, the three versions did not differ in their effectiveness when used with patients of varying degrees of deterioration.

Psychological construing and thought disorder: another test of the 'difficulty' hypothesis.

Two versions of the grid test of thought disorder were derived which used similar elements, and were of equal difficulty, but one of which employed psychological, and the other non-psychological, constructs. They were administered to thought-disordered schizophrenic patients and to psychiatric and normal controls. On one measure (consistency), although not on the other (intensity), the results strongly supported the hypothesis that thought-disordered patients are maximally disordered in the area of psychological construing. The results support those of an earlier study (McPherson et al. 1975) and are compatible with those theories which postulate a role for social factors in the aetiology of thought disorder.

The analysis of interactions in experiments on the specificity of schizophrenic thought disorder: a reply to Phillips.

Phillips (1977) has criticized the investigation of statistical interactions in a series of related papers concerned with the specificity hypothesis of schizophrenic thought disorder. In a discussion of these criticisms, some are accepted and some rejected. However, when the relevant data are reanalysed by a correct method for the investigation of nominated interactions, the specificity hypothesis is broadly supported. A new finding to emerge from the reanalysis is that, in two experiments where level of 'difficulty' of constructs was controlled, the specificity effect appears much reduced or non-existent when intensity scores are employed while remaining intact for consistency scores.