A recent necropsy study has shown that 80% of patients with the Wernicke-Korsakoff syndrome were not diagnosed as such during life. Review of the clinical signs of these cases revealed that only 16% had the classical clinical triad and 19% had no documented clinical signs. The incidence of clinical signs in this and other retrospective pathological studies is very different from that of prospective clinical studies. This discrepancy may relate to "missed" clinical signs but the magnitude of the difference suggests that at least some cases of the Wernicke-Korsakoff syndrome may be the end result of repeated subclinical episodes of vitamin B 1 deficiency. In order to make the diagnosis, clinicians must maintain a high index of suspicion in the "at risk" group of patients, particularly alcoholics. Investigations of thiamine status may be helpful and if the diagnosis is suspected, parenteral thiamine should be given.

SynopsisThe notions of loss and danger are briefly described. Two groups of raters in London and Canberra were shown to be reliable in rating the degree of loss and the degree of danger associated with a sample of life events previously rated as ‘severe’ on a contextual measure of long-term threat. The life events were reported by 164 young women attending a general practitioner in London. The women were interviewed by a psychiatrist using the Present State Examination. Their psychiatric symptoms were rated by a team of raters who were ignorant of the life events reported by the young women. Three types of cases of psychiatric disorder of recent onset were diagnosed: depression, anxiety, and mixed depression/anxiety. The frequency of life events reported by these three types of cases as occurring in the year before the onset of their disorder was compared with the frequency of events in the same time period reported by a group of women without severe psychiatric disorder. The results were used to argue that severe loss was a causal agent in the onset of depressive disorder and severe danger was a causal agent in the onset of anxiety states in this sample. Cases of mixed depression/anxiety were more likely to report both a severe loss and a severe danger before onset. This supported the argument for recognizing a distinct group of mixed disorders in the classification of depressive illnesses.

SynopsisThe method is described of a point-prevalence survey of minor psychiatric morbidity among a sample of healthy community residents. The General Health Questionnaire was used as the sole means of case identification. The demographic characteristics of the sample were compared in detail with those of the total population. The factors mainly responsible for sample bias were difficulty with the English language, the varying degree of personal contact made with residents, and the difficulty in contacting the employed population during working hours. The overall response rate of the survey was 66·%. The demographic groups found to be at significantly higher risk for minor psychiatric morbidity included women, the young, non-British migrant women, and lower social class men.

No abstract

The 30-item General Health Questionnaire misclassified 26 per cent of respondents in two samples of women who were interviewed by a psychiatrist using the Present State Examination. False negatives were likely to be women with chronic disorders, particularly anxiety states. False positives were likely to be distressed by severe physical illness, a recent adverse life event, or loneliness. Applying a higher threshold score to their GHQ responses would help to separate those with a diagnosable psychiatric disorder from those in states of distress.