The World Health Organization Short Disability Assessment Schedule (WHO DAS-S) is an instrument for clinicians' assessment and rating of difficulties in maintaining personal care, in performing occupational tasks and in functioning in relation to the family and the broader social context due to mental disorders. The WHO DAS-S was developed and underwent preliminarily testing in the context of two international field trials of the multiaxial presentation of ICD-10 for use in adult psychiatry. The instrument was found to be useful, user-friendly and reasonably reliable for use by clinicians belonging to different schools of psychiatry and psychiatric traditions. Further work on the WHO DAS-S should include development of national adaptations of the instrument, studies of concurrent validity of the instrument and modification of the instrument to accommodate changes in the next edition of the International Classification of Impairments, Disabilities and Handicaps (ICIDH).

Notwithstanding that (excluding the dementias) they form the core of serious psychiatric illness the 'functional psychoses' lack a satisfactory label. The adjective 'functional' implies that, by contrast with the 'organic' dementias, there are no identifable changes in the brain. Seventeen years of neuroradiological research, backed up by post-mortem studies, have established beyond reasonable doubt that in schizophrenia at least such changes (a modest mean increase in ventricular size, a possible reduction in brain size and loss of asymmetry) are present but their meaning and the relationship to symptomatology is obscure.This modest gain in understanding has done little to illuminate nosology. The failure of the research community to establish whether schizophrenic, affective, schizo-affective and delusional psychoses (the subject matter of this volume) are distinct or overlapping disease entities (and if, in part, the latter -what overlaps with what?) represents the major unresolved crisis in psychiatric research. As this book makes abundantly clear there are an embarrassingly large number of ways of defining schizophrenia (or affective or schizo-affective psychoses) and, although this book does not document the evidence, they define quite different populations of patients. The Diagnostic Q Statistical Manual (DSM 111-R) criteria for example are considerably more restrictive than the criteria of Bleuler. There has been a welcome trend, well illustrated in this volume, towards the application of operational criteria. This helps us to agree on what (for a given purpose) we are going to call schizophrenia. but it docs not tell us whether what we are calling schizophrenia has any meaning in terms of predicting outcome or response to treatment. There is also the problem of labelling whatever illnesses have been excluded from the definition.The authors have provided a useful compendium of the different diagnostic systems that are now in use together with a brief commentary on the origins and application of each. What they have not done is to provide a critique of the validity (or otherwise) of the different systems, or to address the problem of whether there really are separable disease entities. Their own solution (the 'polydiagnostic approach') is to use an array of different criteria. This sounds cumbersome and evades the categorical question. A quite different approach (which I favour) is to accept that the categories are arbitrary, and to deal with continua which are defined by the frequency of occurrence of different psychopathological features (e.g. Schneiderian first rank symptoms, affective flattening, elation). One can then ask questions such as how age of onset and sex relate to form of psychosis, and what are the predictors of early relapse and response to neuroleptic medication without being too concerned about whether this is a case of true schizophrenia (according to x's criteria) or schizo-affective disorder. But for an account of which criteria are actually being used to reach diagnoses and what they...

In order to find out whether the level of Expressed Emotion represents only the emotional engagement of the closest relative, or whether it corresponds to a special sort of relationship between relative and patient, 17 parents of schizophrenic patients were examined with the Camberwell Family Interview and rated as high or low EE. They were also questioned in a semi-structured interview about interactions between themselves and the patient. Transcripts of these reported interactions were analysed and described with an interpersonal instrument (SASB). The comparison of the data from CFI and SASB shows that EE-measures of the parents correlate strongly with certain features of the relationship. High EE relationships have a more negative emotional climate, a conflict-prone structure and especially rigid patterns of interaction. In addition, there were significant correlations between SASB-variables and two subscores of the CFI (criticism and emotional overinvolvement). These results add to the validity of the EE-concept and suggest that EE-measures of relatives correspond with certain qualities of the patient-relative relationship.

Together with a survey conducted among the population of Vienna on the prevalence of hypertension, the consumption of psychotropic substances was investigated. In cooperation with a polling institute a quota-sample of 1,470 Viennese over 15 were visited in their homes by 50 physicians trained in interview techniques. The quota-sample comprised 1,470 people (0.959(0/00) of the population of 1,531,346 inhabitants) and was representative in terms of age, sex, social status, and area of residence. The overall prevalence of psychoactive drug consumption among the inhibitants of Vienna investigated was found to be 6.8%. The female to male ratio was 3.5 to 1. Furthermore, psychoactive drug use increased with age and was influenced by social status, with the highest consumption rate found among divorced women and widows. Using the Goldberg "General Health Questionnaire", data were collected on the presence of psychopathologic symptoms and the responders' subjective feeling of being under stress was elicited. A significant correlation could be shown between these two factors and the use of psychoactive drugs. The type of drugs most frequently used were tranquilizers (4.96%), followed by antidepressants (0.95%) and hypnotics (0.88%).

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