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The objective of the study was to develop a culturally sensitive psychiatric screening instrument valid for Ethiopians in Ethiopia and Israel. The study sample was composed of 356 Amharic-speaking Ethiopians from Ethiopia and Israel, aged 18—55, divided into three groups: i) general population; ii) people in non-psychiatric treatment; iii) people in psychiatric treatment. They were interviewed with the Self-Reporting Questionnaire (SRQ), modified to include 10 culturally specific items, and the Brief Psychiatric Research Scale (BPRS) as a criterion of psychopathology. Physicians also completed an encounter form about the presence of mental health symptoms in participants. To make the questions more culturespecific, the translation of 12 items on the SRQ was changed. The content, construct, and criterion validity of each question were also examined, leading to the deletion of five items. The validity of the revised instrument (SRQ-F) was superior to that of the original instrument (SRQ). This study demonstrates the need for psychiatric screening instruments to be adapted to different cultures by incorporating meaningful translations and adding culturally specific items.

BackgroundPoorly defined cohorts and weak study designs have hampered cross-cultural comparisons of course and outcome in schizophrenia.AimsTo describe long-term outcome in 18 diverse treated incidence and prevalence cohorts. To compare mortality, 15- and 25-year illness trajectory and the predictive strength of selected baseline and short-term course variables.MethodHistoric prospective study. Standardised assessments of course and outcome.ResultsAbout 75% traced. About 50% of surviving cases had favourable outcomes, but there was marked heterogeneity across geographic centres. In regression models, early (2-year) course patterns were the strongest predictor of 15-year outcome, but recovery varied by location; 16% of early unremitting cases achieved late-phase recovery.ConclusionsA significant proportion of treated incident cases of schizophrenia achieve favourable long-term outcome. Sociocultural conditions appear to modify long-term course. Early intervention programmes focused on social as well as pharmacological treatments may realise longer-term gains.

Need for care was studied in a Dutch incidence cohort of patients with schizophrenic disorders 15 and 17 years from first onset of psychosis. Long-term course of the disorders varied from complete remission and full community participation to chronic psychosis and long-term hospital stay. Fifty patients were assessed twice with the Needs For Care Assessment Schedule (NFCAS, Brewin and Wing 1989); at the latter follow-up an assessment was also made using the Camberwell Assessment of Need (CAN, Phelan et al. 1995). The NFCAS is an investigator- or professional-based instrument which provides an 'objective' assessment of needs. Need for care was recorded in 22 areas of clinical and social functioning. Comparison of the two assessments over a 2-year period demonstrated a high stability on the individual items (mean 88%, mostly concerning the absence of a problem twice), but did not show the expected stability of need status among this group of patients with chronic disorders. One in five patients (22%) had no needs at all on both occasions and 56% of the patients showed a change in needs. There was more negative than positive change: 28% suffered from new unmet needs at the 17-year follow-up, while only 12% had improved their status to no needs. About one-third (36%) had at least one unmet need, mostly regarding psychotic symptoms, dyskinesia or underactivity. The CAN provides a 'subjective' assessment of needs according to the view of patients themselves. The problems patients reported most commonly were in the areas of day-time activities, social relationships and information on their condition and treatment, for all which they asked for more help than they received. This patient-based instrument produces slightly higher numbers of problems and unmet needs, and a lower ratio between met and unmet needs. There is an overall percentage of 21% of disagreement between patient and investigator view regarding the unmet need status. Agreement between the two instruments on the nature of the problems with unmet needs was lacking altogether.

Data are presented on the 15-year natural course of schizophrenia and other nonaffective functional psychoses in a cohort of 82 first-contact cases from a circumscribed area in the Netherlands. The subjects were suffering from functional psychosis with International Classification of Diseases-Ninth Revision (ICD-9) diagnoses 295, 297, or 298.3-9 (broad definition of schizophrenia) on entry. Standardized assessments of psychopathology, psychological impairments, negative symptomatology, social disability, and use of mental healthcare were used. The study reveals a pattern of chronicity and relapses with a high risk of suicide: Two-thirds of the subjects had at least one relapse and after each relapse 1 of 6 subjects did not remit from the episode; 1 of 10 committed suicide; and 1 of 7 had at least one episode with affective psychotic symptoms that started on average 6 years after the onset of the schizophrenic disorder. Diagnoses were reclassified in five patients, according to DSM-III-R criteria for a bipolar disorder. The predictive power--in terms of time in psychosis and in partial or full remission--of demographic, illness, and treatment variables at onset of the illness was very limited. Insidious onset and delays in mental health treatment are risk factors that predict a longer duration of first or subsequent episodes. The importance of mental health treatment in regard to outcome is probably subject to change because an early warning and intervention strategy could prevent further damage and deterioration. Our data support the need for an adequate relapse prevention program as a priority for our mental health services.

Severe and long term mental disorders, like schizophrenia, show in general a wide range of psychiatric signs and symptoms, psychological and physiological impairments and social disablement (Shepherd, 1994; Wing, 1982) reflecting a variety of mental health needs. Many studies provide only a cross-sectional view of the clinical and social problems of the patient population, for example at intake or admission to a mental hospital. Longitudinal studies following patients after discharge for some period of months or years show in general the expected improvement of functioning (e.g. Nienhuis et al., 1994), but as far as only chronic patients are concerned such a positive change is much less noted. The concept of chronicity of mental disorders would presume that after some time needs are fairly predictable and stable and do not change much over time. Our investigation on the long-term course of schizophrenia (Wiersma et al., 1996; 1997) enables us to study over a period of two years, from 15 to 17 years since first onset of psychosis, the stability or variability of needs in schizophrenic disorder. We are not aware of empirical studies on changes in needs among patients with long-term disorders.

BackgroundThe effectiveness of different assessment procedures for determining prevalence rates of psychiatric disorder in young adults was investigated.MethodIn a two-stage multi-method procedure, the Young Adult Self-Report, the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), the Structured Interview for Personality Disorders (Revised), and the Global Assessment of Functioning (GAF) Scale were used to assess prevalence rates in 706 19–24-year-olds from the general population. Furthermore, individuals' subjective perception of distress and referral to mental health services were assessed.ResultsThe prevalence of any SCAN/DSM–III–R disorder was 19.3% (95% confidence interval: 11.2–27.4%). Most subjects who received a SCAN/DSM–III–R diagnosis were only mildly impaired. The highest prevalence rates of dysfunctioning (GAF score below 61) without referral to mental health services were for dissociative disorder (2.3%), sleep disorder (2.1 %), alcohol dependence (1.3%) and affective disorder (1.8%).ConclusionInstruments that assess functional impairment in addition to DSM–III–R diagnoses are indispensable in prevalence studies.

Background. A randomised controlled trial of day treatment with community care for patients with schizophrenic and affective disorders, referred for in-patient psychiatric treatment, was conducted to evaluate patterns of treatment and the course of illness with its psychosocial consequences over a period of two years.Method. Seventy patients, of whom 34 had affective and 36 had schizophrenic disorder, were assigned to the experimental condition (day treatment with ambulatory and domiciliary care), and 33 patients, of whom 16 had affective and 17 had schizophrenic disorder, were assigned to the control condition of standard clinical care.Results. Day treatment with community care was feasible for 40.6% of the affective patients and 33.3% of the schizophrenic patients. The direct treatment costs of both disorders, based on numbers of in- and day-patient days and out-patient contacts over two years, appeared more or less the same. Patients benefited equally from day treatment as from in-patient treatment, although there were some gains in self-care and in functioning in the household among experimentals. Although schizophrenics were socioeconomically worse off, and also suffered from more (severe) symptoms and social disabilities than the affective patients at entry into the study, they were similar at two years. This finding is unexpected, compared with other follow-up studies. Extra cost for patients and families were not observed. Patients and their families in the experimental condition were significantly more satisfied with the treatment. Experimental patients spent much more time at home during admission, remained much less time in secluded wards, and were more compliant with treatment.Conclusions. Day treatment could be considered a cost-effective alternative to in-patient treatment.

BackgroundThe objective was to examine the relationship between positive life change (PLC) and recovery from depression and anxiety. Following Brown et al (1988, 1992), we hypothesised: (a) that an excess of PLC would be found in the 3-month period before recovery compared with base rates (‘excess hypothesis’) and (b) that fresh-start and anchoring subtypes of PLC would trigger recovery from depression and anxiety respectively (‘specificity hypothesis’).MethodOne hundred and seventy primary care patients with a depressive and/or anxiety disorder, selected from 1994 consecutive attenders, were assessed at baseline and at 1-year and 3.5-year follow-ups on life change (LEDS) and psychopathology (PSE and Course Interview).ResultsOur results appeared to confirm the excess hypothesis regarding depression and anxiety (twofold excess was found prior to recovery), but not regarding mixed anxiety/depression. They did not support the specificity hypothesis.ConclusionsPLC facilitates recovery but is neither a necessary nor sufficient condition for remission. Difficulty reduction is the most important recovery-enhancing factor.

Objective: Because previous studies of day treatment as an alternative to inpatient treatment bad major disadvantages or methodological shortcomings, the authors conducted a randomized controlled trial to estimate and predict the extent to which day treatment is feasible for unselected patients referred for inpatient treatment. Method: Of 160 patients, 57 were randomly assigned to the control condition and 103 were assigned to the experimental condition. Control patients received standard clinical care. In the experimental condition, day treatment was attempted as soon as the patient's condition permitted. The average number of nights per week that experimental patients spent away from the hospital was compared to the average number of nights away for patients under standard care. Results: Day treatment was satisfactory for 40% of the experimental patients but was completely infeasible for another 40%. The level of surveillance needed in the first week, physical illness, number of previous admissions, depressive symptoms, and treatment by qualified psychiatrists versus registrars were variables predictive of these differences. Conclusions: In this unselected group of patients, no absolute contraindications against day treatment were found. This suggests that the selection criteria applied in nearly all other controlled studies on the subject were unwarranted. The approach used in this study facilitated treatment in the least restrictive environment possible.

SummaryWe have attempted to evaluate quantitative changes in the mental health delivery system in Greece, dictated by a fiveyear program to reform psychiatric care. By the end of the program, a number of psychiatric units in general hospitals, as well as community mental health centres, had been created, while the number of beds in psychiatric hospitals have been significantly reduced. Mental health services have become more accessible to the population, and served more patients. However, not all the objectives of the program have been met. Only about half of the initially proposed number of beds in the psychiatric units in general hospitals have been actually developed. The catchment area, a basic pre-requisite of the program, has not been put into effect. Finally, the noticeable trend towards a restriction of the role of psychiatric hospitals did not coincide with the development of adequate new services.

During various visits to the Soviet Union information was collected through free interviews and discussions on the psychosocial consequences of the Chernobyl nuclear incident and the earthquake in Armenia. Following a brief history of the disasters and a description of the present situation, it is illustrated in what ways the transformation from victim to survivor is different.

The feasibility of day treatment with community care for schizophrenic patients was tested by means of a longitudinal randomized experiment with 34 experimentals and 16 controls: 38 percent could be treated satisfactorily in a day program that included a very active ambulatory service. The new approach did not improve prognosis with respect to psychiatric symptomatology, social role disabilities, or number of readmissions during the first year of followup. Total cost of treatment was less for day-treatment patients than for ordinary clinical patients.

SynopsisThis article addresses the issues of recognition and labelling of psychological disorders (PDs) by general practitioners (GPs), and he association of recognition with management and outcome. Nearly 2000 attenders of 25 GPs were screened with the GHQ and a stratified sample of 296 patients was examined twice, using the Present State Examination (PSE) and Groningen Social Disability Schedule (GSDS).Prevalence rates of PDs according to the GHQ, GP and PSE were 46%, 26% and 15% respectively. For the 1450 ‘new’ patients, i.e. patients who had no PD diagnosed by their GP in the 12 months prior to the enrolment visit, these rates were 38%, 14%, and 10%. GPs missed half of the PSE cases and typically assigned non-specific diagnoses to recognized cases. Depressions were more readily recognized than anxiety disorders, and the detection rates for severe disorders were higher than those for less severe disorders.Recognition was strongly associated with management and outcome. Recognized as compared to non-recognized cases were more likely to receive mental health interventions from their GP and had better outcomes in terms of both psychopathology and social functioning. Initial severity, psychological reasons for encounter, recency of onset, diagnostic category, and psychiatric comorbidity were related to both better recognition and outcome. However, these variables could not account for the association of recognition with management and outcome, but some did modify the association. A causal model of the relationships is presented and possible reasons for non-recognition and for the beneficial effects of recognition are discussed.

J. van Baal, Gert Oostindie, Roosenburg en Mon Bijou: Twee Surinaamse plantages, 1720-1870. Caribbean series II, Koninklijk Instituut voor Taal-, Land- en Volkenkunde; Dordrecht: Foris, 1989. xii + 548 pp. - C. Baks, Marine Carrin-Bouez, La fleur et l’os; Symbolisme et rituel chez les Santal, Cahier de l’Homme, Nouvelle Serie XXVI, Paris: Éditions de l’École des Hautes Études en Sciences Sociales, 1986. 193 pp., figures et tableaux, photos, carte. - C. Baks, Serge Bouez, Réciprocité et hiérarchie; l’Alliance chez les Ho et les Santal de l’Inde, Recherches sur la Haute Asie 7, Paris: Société d’Ethnographie, 1985. 232 pp., annexes, figures et tableaux, photos, carte. - René van den Berg, Bambang Kaswanti Purwo, Towards a description of contemporary Indonesian: Preliminary studies, Part III. Jakarta: Badan Penyelenggara Seri NUSA/Universitas Katolik Indonesia Atma Jaya [=Nusa, Linguistic studies of Indonesian and other languages in Indonesia. Volume 30]. 1988. ix + 94 pp. - Martin van Bruinessen, Elly Touwen-Bouwsma, Staat, Islam en lokale leiders in West Madura, Indonesië. Een historisch-antropologische studie. Kampen: Uitgeverij Mondiss, 1988 [dissertatie Vrije Universiteit Amsterdam, 1988]. xx, 276 pp. - J.G. de Casparis, John Miksic, Small finds: Ancient Javanese gold, Singapore: National Museum, 1988. VIII + 88 pp. 20 Plates, 56 Figures. - B.F. Drewes, Asian women doing theology, vol. XVI-47 of Exchange, Bulletin of Third World Christian Literature and Ecumenical Research, September 1987, ii + 78 pp. - Ch. van Fraassen, Femme Gaastra, Bewind en beleid bij de VOC 1672-1702, De Walburg Pers, 1989. 343 pp., ill. - B.F. Galjart, James C. Scott, Weapons of the weak. Everyday forms of peasant resistance. New Haven and London: Yale University Press, 1985. - R. Giel, R. van Lier, Tropische Tribaden: Een verhandeling over homoseksualiteit en homoseksuele vrouwen in Suriname, Dordrecht: Foris, 1986. 84 pp. - Paul van der Grijp, Bernard Juillerat, Les enfants du sang: Société, reproduction et imaginaire en Nouvelle-Guinée, Paris: Editions de la Maison des Sciences de l’Homme, 1986, 569 pp. - M.A. Kagenaar, Aart G. Broek, Het Zilt van de Passaten; Caribische Letteren van Verzet; Essays. Haarlem: In de Knipscheer, 1988; 186 pp. - Peter Meel, Ben Scholtens, Louis Doedel, Surinaams vakbondsleider van het eerste uur; Een bronnenpublikatie. Paramaribo: Anton de Kom Universiteit van Suriname. 1987. 141 p. - Peter Meel, Nico Wijnen et al., A. de Kom, zijn strijd en ideeën, Amsterdam: Sranan Buku, 1989. 130 pp. - D.C. Mulder, A.A. Yewangoe, Theologia Crucis in Asia, Amsterdam, 1987. 352 pp. - Rien Ploeg, H.J.M. Claessen, Bronnen van macht; Over het gebruik van bronnen in het onderzoek naar de vroege staat, Leiden: ICA, 1987. 159 pp., J.G. Oosten (eds.) - Rien Ploeg, H.J.M. Claessen, Over de politiek denkende en handelende mens; Een inleiding in de politieke antropologie, Assen/Maastricht: Van Gorcum, 1988. 168 pp. - Harry A. Poeze, L.F. Jansen, In deze halve gevangenis; Dagboek van mr dr L.F. Jansen, Batavia/Djakarta 1942-1945; Bezorgd en geannoteerd door G.J. Knaap. Franeker: Van Wijnen, 1988, liv + 447 p. - Franois Raillon, William H. Frederick, Visions and heat; The making of the Indonesian revolution, Athens: Ohio University Press, 1989. 339 pp. - Reimar Schefold, Barbara Lüem, Wir sind wie der Berg, lächelnd aber stark: Eine studie zur ethnischen indentität der Tenggeresen in Ostjava, Basel: Ethnologisches Seminar der Universität und Museum für Völkerkunde. Distributed by Wepf & Co. AG Verlag, 1988, 243 pp.; ill. - J.W. Schoorl, J. van Baal, Ontglipt verleden; Verhaal van mijn jaren in een wereld die voorbijging, deel I, Tot 1947: Indisch bestuursambtenaar in vrede en oorlog; deel II, Leven in verandering: 1947-1958, Franeker: Wever. 1986, 510 pp., resp. 1989, 616 pp. - I. Serpenti, Miriam Kahn, Always hungry - Never greedy; Food and the expression of gender in a Melanesian society. Cambridge: Cambridge University Press, 1986. 187 pp., - A. Teeuw, M.M. Jocelyne Fernandez-Vest, Kalevala et traditions orales du monde. Édité par M.M. Jocelyne Fernandez-Vest. Colloques internationaux du CNRS. Paris 18-22 mars 1985. Éditions du Centre National de la Recherche Scientifique. Paris 1987. 593 pp. - A. Teeuw, Le conte, pourquoi? comment? Folktales, why and how? Actes des journées d’études en littérature orale. Analyse des contes - Problèmes de méthodes. Colloques internationaux du CNRS. Paris 23-26 mars 1982. Éditions du Centre National de la Recherche Scientifique. Paris 1984. 628 pp.

Background: The Schedules for Clinical Assessment in Neuropsychiatry (SCAN), the successor of the ninth version of the Present State Examination (PSE-9), is one of the latest instruments developed by the World Health Organisation for the assessment of psychiatric disorders. So far, the psychometric properties have only been established for certain sections of the instrument. The present study is the first to test the psychometric properties of SCAN-2.1 for most of the disorders covered by the SCAN, and was carried out prior to a survey conducted in the Nijmegen Health Area (the Netherlands). Methods: Interviewers were psychology graduates with little clinical experience. Two designs were used. In one design, pairs of independent live interviews with the same respondent were compared (test-retest situation). In the other, ten videotaped interviews by experts were rated by each of the interviewers (standardized situation), and the outcomes were compared with those of the other interviewers as well as with a reference score. Results: In the test-retest situation the κ coefficient for diagnostic caseness was qualified as substantial (0.62) and for diagnostic categories and diagnostic groups as moderate to good (0.24 to 0.64). In the standardized situation using videotaped interviews by experts, sensitivity as well as specificity proved to be substantial to almost perfect. The agreement per interviewer with regard to the reference diagnoses ranged from 87% (diagnostic group) to 94% (diagnostic caseness). Agreement on the syndrome level (without duration and interference criteria of DSM-IV) was excellent. Conclusions: Although the instrument is traditionally used by experienced clinicians, this study shows that less experienced (but well trained) interviewers can apply SCAN reliably. Special attention should be paid to the items without explicit interview questions, as they tend to be more sensitive to neglect than the items with interview questions.

Ethiopian psychiatry has changed considerably during the last few years with an increasing number of Ethiopian doctors and nurses trained in psychiatry. In the paper is given an outline of the history of psychiatry in Ethiopia from 1965 onwards. Important improvements in the Amanuel Mental Hospital in Addis Ababa which for long was the only psychiatric facility in the country, the establishment of the Department of Psychiatry at the Medical Faculty of the University of Addis Ababa and the introduction of psychiatry in the curriculum of the medical faculty are important steps. Recently training of nurses and doctors in psychiatry has led to the establishment of psychiatric clinics in 26 district hospitals throughout the country staffed with psychiatric nurses supervised by psychiatrists from Amanuel Hospital in Addis Ababa. The development of psychiatric research in Ethiopia is also outlined.

Assessment of needs for care is crucial in the evaluation of ongoing changes from institutional care to various forms of day- and outpatient treatment, Do patients really do better in the community and are they adequately cared for? The 15-year follow-up of a Dutch incidence cohort of patients with schizophrenia and other functional non-affective psychoses showed that 47 (out of 63) patients had positive ratings of symptoms and disabilities, They were assessed by means of the Needs for Care Assessment Schedule, which articulates the problems and corresponding interventions resulting in a judgement of met or unmet need for treatment or assessment, There was a mean of 2.1 clinical problems and 2.1 social problems per patient, Few problems were considered to generate unmet needs: 14% of the clinical problems and only 7% of the social problems. Nevertheless, 32% of the patients had one or more unmet needs, These results were compared with data from six research centres ill the United Kingdom (Camberwell, Oxford and South Glamorgan), Canada (Montreal): Italy (Verona) and Finland (Tampere). Despite differences in health care settings in the four countries, the ratio of met to unmet needs (about: 4-5 to 1) among chronic, mostly schizophrenic patients is more or less the same with the exception of an apparently underserved hostel population in Oxford and the Finnish patient population probably due to high expectations with respect to independent community living.

BackgroundSeveral studies have suggested a declining first-admission rate for schizophrenia. This study examines the care-based incidence of schizophrenia in a Dutch register area.MethodData from Groningen psychiatric case register were used to compare first-admission rates for schizophrenia over 1976–90 with those of other functional psychoses, and to consider various potential biases.ResultsDiagnostic habits probably affected time trends in incidence rates. Using a broader definition of schizophrenia, no evidence was found for a decrease in the incidence of schizophrenia. Although first admissions to intramural services showed a (non-significant) decrease, this effect seemed to be neutralised when all mental health services were taken into account.ConclusionsCare-based studies of time trends in psychiatric disorders should embrace all mental health services. Furthermore, unless a diagnostic classification system with univocal criteria is used, bias caused by changing diagnostic habits cannot be ruled out.

A randomised controlled trial of day treatment with community care for patients with schizophrenic and affective disorders, referred for in-patient psychiatric treatment, was conducted to evaluate patterns of treatment and the course of illness with its psychosocial consequences over a period of two years.Seventy patients, of whom 34 had affective and 36 had schizophrenic disorder, were assigned to the experimental condition (day treatment with ambulatory and domiciliary care), and 33 patients, of whom 16 had affective and 17 had schizophrenic disorder, were assigned to the control condition of standard clinical care.Day treatment with community care was feasible for 40.6% of the affective patients and 33.3% of the schizophrenic patients. The direct treatment costs of both disorders, based on numbers of in- and day-patient days and out-patient contacts over two years, appeared more or less the same. Patients benefited equally from day treatment as from in-patient treatment, although there were some gains in self-care and in functioning in the household among experimentals. Although schizophrenics were socioeconomically worse off, and also suffered from more (severe) symptoms and social disabilities than the affective patients at entry into the study, they were similar at two years. This finding is unexpected, compared with other follow-up studies. Extra cost for patients and families were not observed. Patients and their families in the experimental condition were significantly more satisfied with the treatment. Experimental patients spent much more time at home during admission, remained much less time in secluded wards, and were more compliant with treatment.Day treatment could be considered a cost-effective alternative to in-patient treatment.

The course of the psychopathology and social functioning- in an experimental day-treatment group referred for inpatient psychiatric treatment is compared with that of a control group receiving standard inpatient care. During a follow-up period of 2 years subjects were interviewed three times. The interview comprised information about psychiatric symptoms, psychological functions, psychiatric diagnosis and social-role functioning. Apart from these discrete assessments an effort was made to map episodes of illness throughout the follow-up period. Upon entry the groups did not differ in terms of psychopathology or social functioning. At follow-up both groups had improved significantly with respect to symptomatology. psychological and social functioning. The extent to which the groups improved did not differ significantly regarding pathology, but self-care improved more in the experimental group. The average duration of episodes of illness was similar for the experimental and control group. During the 2-year follow-up patients suffered from a well-defined disorder during an average of 11 months. The fact that approximately 40% of them were still a psychiatric case after 2 years further underscores the severity of their pathology.

Inpatient point-prevalence and admission rates in both mental hospitals and psychiatric wards in general hospitals in East Bohemia and in Drenthe (the Netherlands) were compared. A higher point-prevalence rate was found in Drenthe as there was a higher rate of long-stay patients. However, in East Bohemia the admission rates were higher for all diagnostic categories, except for neuroses, the admission rates for neuroses were twice as high in Drenthe. The differences were explained by the availability of complementary in-patient services and more developed out- and day-patient facilities in Drenthe.

This study compares the screening capacity of an age-adjusted child-oriented questionnaire, the Young Adult Self Report (YASR) with two adult-oriented questionnaires, the General Health Questionnaire-28 (GHQ-28) and Symptom Checklist-90 (SCL-90) in a sample of young adults (18-25 years). The YASR performed just as well as the SCL-90 and both performed better than the GHQ-28. The relatively poor performance of the GHQ-28 compared with the YASR and SCL-90 could not be attributed to instrument characteristics or to the use of referral status as indicator of psychopathology. In assessing psychopathology in young adults an age-adjusted child-oriented instrument might be a good alternative to the existing adult-oriented instruments, especially when one takes into account the problem of data comparability over time in longitudinal studies in which children are followed into adulthood.

After more than 12 years of development, the ninth edition of the Present State Examination (PSE-9) was published, together with associated instruments and computer algorithm, in 1974. The system has now been expanded, in the framework of the World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration Joint Project on Standardization of Diagnosis and Classification, and is being tested with the aim of developing a comprehensive procedure for clinical examination that is also capable of generating many of the categories of the International Classification of Diseases, 10th edition, and the Diagnostic and Statistical Manual of Mental Disorders, revised third edition. The new system is known as SCAN (Schedules for Clinical Assessment in Neuropsychiatry). It includes the 10th edition of the PSE as one of its core schedules, preliminary tests of which have suggested that reliability is similar to that of PSE-9. SCAN is being field tested in 20 centers in 11 countries. A final version is expected to be available in January 1990.

A study of 1,506 deaths reported over a period of 2 years to the National Psychiatric Case Register of the Netherlands, on the total cohort of 17,211 long-stay patients counted on prevalence day (31 December 1969), showed very much higher death-rates than in the general population. Malignancy and cardiac disease were not so common, while respiratory disease was still common in inpatients.

Within the context of a World Health Organization coordinated collaborative study health workers in six developing countries were assessed 18 months after their training for improvement in their knowledge and attitude towards mental health problems and their management. The approaches to training varied between study areas, but the degree of improvement following the training, was of equal magnitude in all countries. The training process has formalized the recognition by the health workers that treatment of mental health problems is an integral part of their work.

In the churchyards of the Coptic churches of Ethiopia religious communities consisting of monks, nuns, students, disabled people and others who flee from society, are a common phenomenon. They are symbolic of the Ticket to Heaven to which many Ethiopians aspire. Because of its tolerance for marginal people the expectation was that psychotics, who are generally expelled from society, might find a place in such a community. A sample survey of 48 members of a religious community in Addis Abeba revealed the presence of 29 disabled people of whom six had a psychiatric illness. Two of these were psychotics. It is suggested that life in the community to some extent prevents the development of the secondary handicap of a chronic psychotic which is generally termed institutionalism.

We put forward the hypothesis that general practitioners (GPs) with a family medicine orientation are more sensitive to the presence of mental health problems than GPs with a clinical orientation. To test it, GPs were divided into three subgroups on the basis of an attitude questionnaire. The General Health Questionnaire (GHQ) and the Present State Examination (PSE) were used as criteria. No differences in sensitivity to psychiatric illness were observed using either scale. Results of factor analysis with the subscales of the GP attitude questionnaire and the indices ‘bias’ and ‘accuracy’ were similar to those reported by G OLDBERG and associates. ‘New’ patients were defined as patients in whom the GP had not identified a mental health problem (MHP) in the past year. ‘Old’ patients were defined as ‘not new’. GPs tended to under-identify MHPs in ‘new’ and over-identify them in ‘old’ patients. Recognition of psychiatric illness was better in ‘old’ than in ‘new’ patients. In ‘new’ patients, recognition depended on psychiatric diagnosis. Among ‘old’ patients, older people and people (especially women) with low education predominated. In their assessments GPs used information not contained in the GHQ.

A random sample of the Dutch population was interviewed at home regarding life situation and health. The present analysis concerns only married respondents below 25 years, and all others in the sample, aged 25 years or more. Crowding (the number of people on a dwelling-unit divided by the number of rooms) appeared to be negligible as a factor associated with ill-health. Only respondents from larger households in more crowded quarters more often visited their general practitioner or resorted to psychotropic drugs more frequently.

Approximately 15 per 1000 of the Dutch population are under the care of the combined mental health services on an average day. Only 4.5 per 1000 are intra-mural patients; about 40% of the latter reside in mental hospitals. Of these about one fifth are short-stay patients who are discharged within two years, but of whom many are readmitted soon. Rapid turn-over of patients does not depend on buildings but is related to a high staff-ratio. Long-stay patients function often quite reasonably in mental hospital, but their conditions of life frequently are much poorer than those of short-stay patients. They are in need of a sheltered place with some privacy. Their limited contacts with medical staff probably have little influence on the quality of their life as an inpatient.

To ascertain the frequency of mental disorders in Sudan, Philippines, India, and Colombia, 925 children attending primary health care facilities were studied. Rates of between 12% and 29% were found in the four study areas. The range of mental disorders diagnosed was similar to that encountered in industrialized countries. The research procedure involved a two-stage screening in which a ten-item "reporting questionnaire" constituted the first stage. The study has shown that mental disorders are common among children attending primary health care facilities in four developing countries and that accompanying adults (usually the mothers) readily recognize and report common psychologic and behavioral symptoms when these are solicited by means of a simple set of questions. Despite this, the primary health workers themselves recognized only between 10% and 22% of the cases of mental disorder. The results have been used to design appropriate brief training courses in childhood mental disorders for primary health workers in the countries participating in the study.

(1987). The Jigsaw Puzzle of Dutch Mental Health Care. International Journal of Mental Health: Vol. 16, Trends in Mental Health Care in Western Europe in the Past 25 Years, pp. 152-163.

All consecutive cases entering the mental health services cooperating with the cumulative psychiatric case register of Mannheim between 1-31 July 1976 were followed up until the end of June 1978 and compared with the consecutive cases entering the mental health services cooperating with the psychiatric case register of Groningen between 1 January and 1 May 1979. Patterns of in-, day- and outpatient care delivered to these 2 cohorts of patients, who were greater than or equal to 15 years of age, and who had not been in contact with one of the services for at least 6 months prior to entry, were compared by diagnostic category. The most common episode of care was the relatively brief outpatient one. Mixed types of care and chronic cases were more common among patients with a psychosis or an addiction than in other diagnostic categories. Between 6 and 24 months after first contact 76% of the patients in Mannheim and 43% of the patients in Groningen had no more contacts. Between 18 and 24 months after the first contact the percentages had increased to 90 and 72% (respectively). In Groningen a higher percentage of patients received outpatient care only. Although a larger percentage of patients in Mannheim received inpatient care, the accumulation of "new chronic" patients was larger in Groningen, as a result of a greater length of stay in Groningen.

SYNOPSISIn total, 103 cases were randomly selected from the Groningen, Nottingham and South Verona registers. Six raters (two in each of the register areas) were involved in coding these cases according to the ICD–9. In general, interrater agreement was satisfactory when codes were grouped into a limited number of categories. Nevertheless, considerable variation in agreement rates was found. We distinguished three steps in the diagnostic process. The selected logistic model showed that reliability is significantly affected in each step, but only substantial in the first where clinicians formulate a diagnosis.

Over a period of 3 years since the first in a lifetime onset of an episode of non-affective functional psychosis a cohort of 82 Dutch patients was studied at set intervals with regard to prognosis and outcome. Prognostic statements on remission, relapse, duration of episode, length of stay in hospital, and occupational, family and overall social adjustment were checked against actual outcome after 1 year. In general, the research team of three psychiatrists, a psychologist and a sociologist began quite optimistically, but became slightly more pessimistic with time. However, their predictions proved hardly better than chance statements. The team appeared to be more pessimistic about the diagnosis of schizophrenia than about that of reactive psychosis, although they were not correct with one diagnostic category more often than with the other.

While the Dutch Government is actively planning to reduce the number of mental hospital beds, particularly those for long-stay patients, it takes little notice of the reality of mental health care in The Netherlands, cherishing various misconceptions regarding institutionalism and community care. On the basis of a case-register study the population of chronic mental patients is estimated, including their current discharge rate from mental hospital without any aftercare. The burden of the mentally disabled on the community is discussed.

Paradoxically, due to recent mental health legislation, the mentally handicapped of the developed world find themselves in the same situation as the majority of those in the developing world who never had contact with a mental health service. A survey of the literature and of the situation in Egypt and Lesotho suggests marked coincidence of vagrancy and chronic mental illness. In both the developed and developing world, adequate services to support these people are lacking.

Psychiatric rehabilitation of the chronically mentally ill requires conceptual distinction among psychological abnormalities of the nervous system, representing active pathology or a disease state; impairment of functions by means of which those abnormalities can be inferred; disabilities, i.e., losses of functional ability consequent upon an impairment; and handicaps, which are the social disadvantages resulting from disability [1-3]. These various levels of functioning cannot be separated from the environment. Socioenvironmental stressors, defined by Mechanic [4] as a discrepancy between demands presented to a person and his or her capacity to deal with them, influence the appearance of impairments, disabilities, and handicaps. Wing [5] lists three factors that can cause and exacerbate social disablement in cases of frequent relapse or chronic impairment: environmental overstimulation or understimulation, social disadvantage, and adverse personal reactions ("secondary disablement") caused by acceptance by the handicapped person of limitations that are not actually necessary. It is clear that assessment and evaluation of impairments are important in avoiding understimulation and overstimulation and preventing or correcting adverse personal reactions. Although premorbid and environmental factors play an important role, we can expect the more severely impaired also to be the more severely disabled. Patients with schizophrenia are especially subject to

Teams in seven developing countries have adopted a common research design to evaluate new community mental health care services. The nature of the intervention programs varied considerably according to the characteristics of each area. Observations made before the intervention and 18 to 24 months after showed significant changes in the attitudes, knowledge, and diagnostic accuracy of health staff and in community attitudes and reactions. A considerable number of individuals with serious mental disorders received effective care for the first time.