Psychological medicine. Monograph supplement最新文献

A simple two-allele Mendelian model of the genetics of handedness is described and fitted to data in the literature. The model proposes that there are two alleles, D (dextral) and C (chance), the homozygous DD genotype producing only right-handers (directional asymmetry), the homozygous CC genotype producing a racemic mixture of 50% right-handers and 50% left-handers (fluctuating asymmetry), and the heterozygote, DC, being intermediate between the homozygotes and producing 25% left-handers, and 75% right-handers. It is also suggested that the true population incidence of left-handedness is 7.75%, deviations from this figure being due to either criterion shifts or selection biases. The same model is then fitted, by means of a number of minor conceptual extensions, to data from the literature on the relationship of handedness to language dominance, acute and permanent aphasia, and visual processing dominance.

This monograph is concerned with some epidemiological observations of minor psychiatric morbidity. Differences in rates of specific disorders have historically formed a crucial part of epidemiological enquiry. Sex differences in the prevalence of minor affective disorders have been demonstrated in studies of populations in treatment and in community populations, and have been variously ascribed to constitutional or environmental factors. A review of the literature exposes the methodological problems of measurement and study design, and the conflicting nature of the findings. Efforts have recently concentrated on establishing the social factors important in the aetiology of minor affective disorder without adequate exclusion of constitutional factors. The importance of life events, chronic social stress and inadequate social supports in the aetiology of minor affective disorder has been demonstrated, but the variance explained by such factors is small, reinforcing the view that constitutional factors of some kind are likely to be of importance. The evidence for a genetic contribution to minor affective disorder is tenuous, but there is circumstantial evidence that changes in gonadal hormones are linked to mood changes in women. Until further evidence is available this must remain a powerful possibility in the genesis of sex differences in minor affective disorder. This investigation used epidemiological methods to assess whether there is a sex difference in the constitutional vulnerability of the male and female phenotype to minor psychiatric morbidity. In order to minimize the effects of environment and of sex roles and stereotypes as far as possible, a sample of relatively homogeneous employed men and women (drawn from a population of executive officers in the Home Office) was studied. The data obtained from this population of men and women of similar age, education, occupation and social environment were compatible with the null hypothesis that there is no sex difference in the prevalence of minor psychiatric morbidity, or its outcome in such a homogeneous group. However, women did report significantly more somatic symptoms than men. The second hypothesis, that there is a substantial sex difference in the self-perception of illness, illness behaviour and sickness absence in individuals with minor psychiatric morbidity among a homogeneous group of men and women of similar age, education and occupation, and subject to similar levels of social stress and support, received only partial support from the findings of the study.(ABSTRACT TRUNCATED AT 400 WORDS)

There is a pressing need to evaluate the different forms of treatment for depressive illness encountered in general practice. This study consists of a controlled, randomized, clinical trial designed to investigate the effectiveness of social work intervention with depressed women. Eighty women aged between 18 and 45 were included and assessed initially by means of a psychiatric and social interview. Those ascertained to be suffering from 'acute' or 'acute on chronic' depression were randomly allocated to an experimental group who were referred to a social worker attached to a general practice or to a control group for routine treatment by their doctor. They were re-assessed 6 months later. Over 60% of both groups were clinically improved at follow-up, with no statistically significant differences between the two groups in clinical, social or medical outcome. Further analyses suggested, however, that those women initially assessed as suffering from 'acute on chronic' depression with major marital difficulties were found to benefit from social work treatment. These patients could be distinguished from the others by their high degree of motivation, by the initial severity of their problems and by the amount of practical help provided by the social workers.

The widespread acceptance of evidence that even mildly raised blood pressure is associated with an increased risk of cardiovascular morbidity has led to the setting up of screening programmes and treatment trials for hypertension in several countries. In order to allay anxieties about adverse psychological consequences of their own treatment trial of mild to moderate hypertension in a population of 35-64 year old adults of both sexes, the Medical Research Council supported a special psychiatric study in the pilot phase of the trial. This case-controlled study demonstrated that there was no increase in psychiatric morbidity after diagnosis (labelling) of hypertension nor during one year on the trial. There was, in fact, a fall in such morbidity for trial entrants, related to a greater rate of improvement for those subjects who displayed morbidity and not to any alteration in the incidence of new morbidity. The improvement in psychological state was not associated with any of the antihypertensive drug regimes, nor was it an artefact of selection; rather it appeared to be a beneficial effect of regular clinic attendance. The results of this study are presented and discussed in the context of current research into the psychological aspects of hypertension.

One hundred male alcoholics without overt clinical signs of brain damage were interviewed, psychologically tested and scanned by means of a CT 1010 EMI scanner. Fifty age-matched controls, lifelong abstainers or light drinkers, were used for comparison. Fifty-six alcoholics from the initial sample were followed up after periods varying from 30 to 152 weeks, and radiological changes during the follow-up were assessed. The main results of the study can be summarized as follows: (1) All CT scan indices were significantly different in alcoholics and controls. Alcoholics had larger ventricles, wider cerebral sulci and wider Sylvian and interhemispheric fissures. Cerebellar sulci were visible only in alcoholics. These differences were greater for older alcoholics and controls, but were also present in the younger subjects. (2) In the alcoholic group the size of the ventricular system, and the width of the sulci, Sylvian and interhemispheric fissures were positively and significantly correlated with age. The duration of the drinking history and the age of onset were not significantly correlated with CT scan indices. (3) In those alcoholics whose age was greater than the mean for the whole group, the size of the ventricular system and width of the Sylvian fissure were significantly and negatively correlated with the duration of abstinence prior to scanning. (4) Other features such as decreased tolerance, a positive family history of alcoholism and 'social decline' were not significantly related to the severity of CT scan abnormalities. (5) When the effects of age and premorbid intelligence were controlled, alcoholics showed significant cognitive impairment when compared with controls. The differences in the scores of psychological tests and CT scan indices were greater between alcoholics and controls of high IQ than between those of low IQ. This discrepancy is likely to be due to a selection bias. (6) No significant correlations were found between the degree of cognitive impairment and clinical features. The size of the ventricular system was positively and significantly correlated with the discrepancy between immediate and delayed recall of verbal material. There were no other significant correlations between cognitive impairment and CT scan indices. (7) Those subjects who had remained abstinent during the follow-up period, when considered as a group, showed a significant reduction in the size of the ventricular system. When cortical indices and V/B ratio were combined, patients whose scans had improved at follow-up differed from the rest with regard to the length of abstinence prior to re-scanning.

A number of fundamental methodological problems exist in the area of premenstrual symptomatology and psychiatric ill-health. In the study described these have all been taken into account. The study has been so designed as to make expressly clear the definition of premenstrual complaint being employed and material gathered by means of a retrospective questionnaire is checked by means of an interview administered to a sub-sample and the use of a menstrual diary (Sampson & Jenner, 1977; Dalton, 1978). The use of an interview also permits a careful check to be made of the accuracy displayed by women asked to estimate their particular position in the menstrual cycle at the time of completion of the questionnaire. The use of the premenstrual interview, together with a standardized, semi-structured psychiatric interview specifically designed for the population under study, and a standardized, semi-structured social maladjustment schedule, permits a detailed assessment of the inter-relationship between premenstrual, psychiatric and social variables. Finally, the use of a general practice sample of women attending their general practitioners for many and varied reasons, together with a sample of women drawn from attenders at a specialized premenstrual tension treatment clinic, permits a comparison to be made between the symptom profiles of women in a general practice population who have not overtly identified themselves to the treatment agencies as premenstrual sufferers with a group of women who have so identified themselves. In this way, a more accurate estimate of the numbers of women in general practice samples who manifest a degree of premenstrual complaint equivalent to that shown by special treatment clinic attenders can be achieved.