Search

Psychiatric epidemiologic surveys since 1980 have relied heavily on a small number of survey diagnostic instruments for case ascertainment, which encode reports of respondents to highly structured interview questions delivered by interviewers without clinical training. Many validations of these survey diagnostic instruments have been carried out.This paper reviews the success of the survey diagnostic instruments, for eight diagnostic categories, in validations with a psychiatrist examination as the gold standard.Public databases were searched for potentially relevant publications, of which more than 1000 were located. Tables show sensitivity, specificity, Kappa, sample source and size, survey instrument and validation method.The number of validation studies relevant to the eight disorders ranged from 8 for schizophrenia to 29 for major depressive disorder. Reported sensitivities ranged from zero to 100%, and specificities from 22% to 100%.Results for common mental disorders such as major depressive disorder, alcohol disorder, drug disorder, and agoraphobic disorder are better than for panic disorder, obsessive compulsive disorder, bipolar disorder, and schizophrenia. The validity of case ascertainment in psychiatric epidemiology is still in question.

This chapter explains how mental illness affects parenting and influences the development of children. It talks about abuse and neglect, the effects of separation and the risk of mental health problems in children. Large numbers of children grow up with a mentally ill parent. A study of parental psychiatric histories of 850 twin pairs in Virginia found that only 26% of families had no lifetime history of psychiatric disorder in either parent. The chapter outlines a developmental framework to help understand the interrelationship of risk variables in the development of the child, the emergence of disturbance and its modification. Clinically, this framework may assist with the developmental assessment of children. The effects of social disadvantage are discussed. The catalogue of risks for children of mentally ill parents described in the chapter emphasizes the need for skilful coordination of professionals involved with both the parents and the children.

As child mental health clinics round the country develop longer and longer waiting lists it is tempting to suggest ways of helping children in other settings so that overextended specialist staff can concentrate on specific complex disorders. If additional resources were made available to local authorities so that children with conduct disorder could receive input to improve their behaviour early in childhood, professionals, parents of affected children, and society as a whole would be delighted. Specialist education staff could help teachers in managing children more effectively using behavioural programmes in mainstream classes or in small groups. Social workers might be able to provide family therapy and behaviour therapy to help parents manage behaviour effectively rather than concentrating on child protection work, accommodating children, or programmes for delinquents. This preventive rather than palliative approach is advocated by the Department of Health.1 …

Ed Rosemary Chesson, Douglas Chisholm Jessica Kingsley, pounds sterling16.95, pp 278 ISBN 1 85302 329 9 Inpatient psychiatric units for children are under threat. Despite a 50% increase in psychiatric admissions of 10-14 year olds recorded by the Department of Health recently, the number of beds in the United Kingdom is falling and many units are offering only five day or day patient care. Although the absolute numbers of highly disturbed children remains relatively small, such children have a grossly disproportionate impact on outpatient mental health services and social services. Vast amounts of precious professional time can …

Thirty out-patients with severe anorexia nervosa were randomly allocated to either 12 sessions of dietary advice or 12 sessions of combined individual and family psychotherapy. At one-year follow-up both groups showed significant overall improvement, and the dietary advice group showed significant weight gain. A similar mean weight gain for the psychotherapy patients did not reach statistical significance, but this group made significant improvements in sexual and social adjustment.

The literature concerning medical marriages is reviewed and, where relevant to potential stress in marriage, the differences between British and North American medical careers are discussed. After a general review of psychiatric morbidity, suicide rates and substance abuse amongst doctors, the major difficulties for married doctors during training are contrasted with the increased stability of mature medical marriages, which nevertheless are relatively unsatisfying for both partners. Little is known about recent medical marriages, particularly in Britain. The likely difficulties for the woman doctor with a non-medical spouse and for dual doctor marriages are discussed, together with the implications for childcare. Problems in marriage are not necessarily associated with the actual number of hours spent working, but satisfaction seems to be associated with communuication and intimacy between the partners.

The need for prospective treatment studies has been emphasized repeatedly in attempts to evaluate long-term outcome in anorexia nervosa (Hsu, 1980). Vigersky (1977), concluding the proceedings of the 1976 International Conference of Anorexia Nervosa Research, stated that only random allocation of patients to different treatment modalities within one center is a valid test of any treatment’s efficacy because of the problems of pre-selection of subjects at different centers.