A large number of rating scales have been devised to assess the clinical construct of 'depression'. These scales have been universally used in research with little consideration of their content, or how they relate to accepted definitions of depressive disorder. The scales are often arbitrarily selected and used for the study on the assumption that all measure the same construct. The item analysis of a number of the most widely used depression scales reveals a variation in the areas of psychopathology they cover; some scales place greater emphasis upon the assessment of anxiety than upon depressed mood. Since disturbance in neurobiological systems is manifest by specific aspects of affective and behavioural malfunction, and since psychodynamic factors lead to particular cognitive sets, the advancement of research will depend upon the construction and validation of more refined measures than are provided by the present approach.

SynopsisIn the last century psychopathologists attached importance to the concept of anhedonia, the loss of ability to experience pleasure. Its role in the diagnosis of melancholia was considered to be crucial. In the present century attention to anhedonia has faded, possibly because of the focus upon depressed mood as the pathognomonic feature of depressive disorders. Research on the symptomatology of endogenous depression did not include the concept; anhedonia was also lacking from the major instruments of psychiatric research, the depression rating scales,Attention was drawn to anhedonia by two authors: by Meehl in the 1960s and by Klein in the 1970s. Meehl considered anhedonia from the point of view of a personality defect predisposing to mental illness; and Klein regarded anhedonia to be a symptom of depressive illness and probably the best clinical marker predicting response to antidepressant drugs.In 1980 the revised DSM presented the concept of ‘loss of interest or pleasure’ as one of the two cardinal symptoms of major depression. Since then there has been a gradual recovery of emphasis although many systems confuse the two concepts of‘loss of interest’ and anhedonia. It is possible that anhedonia may provide the key to a more exact delineation of depressive disorders in biological research and in clinical practice. Further research will depend upon a more precise, cross-nationally agreed definition of the concept and the means of its assessment.

The interaction between pain and anxiety in the setting of somatic illness is a widely recognised association. More accurate knowledge about the association and also about the means of assessing anxiety in a clinical setting are of use to the clinician. The present study used the Hospital Anxiety and Depression Scale for assessment of anxiety, and the set of linear analogue scales for detecting the presence and severity of anxiety and pain in an oncology clinic, where patients were undergoing active treatment for cancer. The relationship between pain and anxiety was found to be significant, even when the possible mediating effect of the variables of illness severity and age were removed. The need for detecting anxiety in order to plan treatment strategy is emphasised.

The concepts of disorders of body image are reviewed from three aspects: sociocultural, neurological and psychiatric disorders. Particular attention is paid to the construct of body dysmorphic disorder as defined in the DSMIII-R and the separation of this from somatic delusional disorder. The recognition of associated psychopathology will frequently lead to successful treatment before too much time is spent on fruitless attempts at treatment of the presenting complaint.

No abstract

No abstract

C6I jolrui E SEM i.iij.iri| .v.ïrir.iiir| .ii|i iri|i SJ3pjSUO3 '((sii'.!!! | in s.luminili', js3q .>i|i jo suo U3JJIJMSEI) oqM '(066l) uspur] •JsajajUfq3nui J3EJJJE JOU pip pò i|[.mi aqj .M-irjMDiu.i UMOs/jjpqac apisjpQ •XjjEiqsXsd ui pauiEjj jou asoqj Xq poqjaui aqj JO 3Sn aqj ajE3OApE OJ p.urd.ud SEM .M| in|i XqjjOMajou si ]] "(OJJUO3[Euosjad ui .un.ipi|iiDi dn p|ipq oj uiSaq p|PO3 iliisi.Hl E l|3|l)M qÃoePOjqj poqjaui |EUOIJEj;-paui E oj 33ij3Ejd 3ijpadEJ3qjoudXq |Euoij-U3AU03 U1OJJ passaj8ojd 7J|Pq3$-p[JOM II.I.11-..1 \\ .up u; sjsiuo3Ejojd sqj jo suo 3upq 3003 '3JEJ SEM uo|jS338ps-ojPE Xq JUaiUaSEUElU-JpS |i) ul.l.-illDi ,H|l UI)S3J3]U] •|E|ju3jodsji ssiiusip Xpjijua }ou p;p oqM suep|sXqd jo pueq ||6uis aqj oj paSuopq 'SJ3qjO M3J E pUE JODJE10 35(I| 'zj|Pq3$ q3noqj[E UEiUMoqs aqj pus UEjE|JEq3 aqj JO UjElUOp aqj Ul 3q OJ p3JE3ddE S[SOudXj-| •pajEaddsuaqj jou pEq 'sj3pjos|p qsns ui >\l l i.i||.i SaUIljaUIOS 'SJUaUIE3lpaUJ JO a3uBJ JU3JJP3 3qj 33UIS p3pppx3 U33q pEq 3SE3SIp 3IJEU10S 3AIJIUJPP 33UO J3JJO OJ Ill.llllir.lJI 3[JJ1| pEq SJ3UOIJIJ3Ejd |E3|p3ly\[ 'l|3EOjd-dB aiiuEuXpoqsXsd sqj Xq psjEuiuiop pUE 33U3I3S M3U E SEM M! r l.ii| K ii| >• •• 11 3UJJJ

Genital exhibitionism is a disorder without a satisfactory explanation; many views have been put forward as to its nature but although fragments of some of these theories appear to be relevant to the problems of some individuals, for others they are incongruent with the clinical data. At the present time we must conclude that the behavioural act does not signify a homogeneous population and that in every parameter so far studied, be it personality structure, attitude to women, erotic gratification from the act, other deviant behaviour or whatever, there is no single unifying characteristic which is always to be found. The intention in this paper is not to make a broad survey of the disorder for that has been undertaken within the last fifteen years by, inter alia, Evans (1970) and Rooth (1971, 1980); the purpose is to draw attention to some of the more recent studies in order to dispel stereotyped views and thereby to avoid the pitfalls in deriving the formulation of each individual case.