Improving the efficiency of the drawover anaesthetic breathing system.

We investigated modifications to the reservoir tube usually used in drawover anaesthetic breathing systems as a method of improving its efficiency and performance. The resulting oxygen concentration was recorded at different oxygen flow rates whilst an artificial lung was being ventilated over a range of minute volumes. Addition of a reservoir bag and valves significantly increased the measured percentage of oxygen at the common gas outlet when compared to a 300-ml reservoir tube. There was no difference in the percentage of oxygen when comparing a reservoir bag and a 600-ml reservoir tube.

Social factors and comorbidity of depressive and anxiety disorders.

Differences in rates of depression across and between populations can be considerable and are largely determined by psychosocial factors. Such findings have important implications for comorbidity. On the basis of multiplying independent probabilities, the proportion of comorbid conditions increases as base rates of the disorders increase in a population. If such a chance combination has clinical implications, it would appear to be a "fact" of significance irrespective of biological underpinnings. In a recent survey of 404 women living with at least one child in an inner-city area, the rate of both anxiety and depression was highly related to the childhood experiences of neglect and abuse. However, adversity in adult life (e.g. widowhood or divorce), which might be expected to relate to current stressors, was only related to the rate of depression. The two risk factors had a considerable impact on comorbidity by increasing the rate of each disorder and thus the probability of their occurring together. They had a lesser impact as "common antecedents". If both influences are considered, such adversity explains around half of the comorbidity. This is a conservative estimate of the impact of psychosocial factors.

Pragmatic impairments in adults with childhood diagnoses of autism or developmental receptive language disorder.

Audiotaped conversational samples from adults diagnosed as having autistic disorders (n = 15) or developmental receptive language disorders (n = 17) in childhood were transcribed and analyzed using methods based on those of Bishop and Adams (1989). Subjects with autism showed substantially greater pragmatic impairment not explicable by generalized impairment of verbal skills. This was mainly due to autistic subjects' greater difficulty in forming context-relevant communicative intentions; in contrast, pragmatic impairments arising from failures in translating intentions into spoken utterances (i.e., impairments at the level of execution) did not distinguish between the groups. In both diagnostic groups, impairment in forming appropriate communicative intentions was closely related to more generalized impairment of reciprocal social behavior.

Aetiology of anxiety and depressive disorders in an inner-city population. 2. Comorbidity and adversity.

An earlier paper documented that adverse experiences in childhood and adolescence considerably raise risk of both depressive and anxiety conditions (with the exception of mild agoraphobia and simple phobia) in adult life. This paper deals with the same inner-city women with children at home. Consideration of adverse experiences throughout adulthood as a whole (excluding the period just before onset) particularly involving major prior losses suggests that rather different aetiological processes may be involved. Depression appears to be often linked to experiences of major loss in adulthood as a whole and to be particularly susceptible to shortcomings in the quality of ongoing social support. For anxiety only early adverse experiences appeared to be critical. (However, the onset of both conditions is often provoked by a severely threatening event in the most recent period--particularly 'loss' in depression, and 'danger' in anxiety.) Finally the critical role of early experience for both anxiety and depression explains to a considerable extent why they so often occur together; and social factors not studied in the present enquiry may account for some of the remaining unexplained comorbidity.

Shame among unemployed men.

Explicit criteria for rating feelings of shame were applied in a group of 80 unemployed men. Shame was prominent in 15% of the sample and milder features were present in a further 10%. It was strongly associated with the presence of minor affective disorder and with some, but not all, of the vulnerability factors associated with the latter. Possible explanations for these associations are discussed.

Depression and anxiety in unemployed men.

Psychiatric status and psychosocial variables were assessed in a group of 80 unemployed men. Symptoms of depression and anxiety were assessed using the Present State Examination and 'caseness' rated according to the Bedford College criteria. Among men who were normal at the time of job loss, 14% developed a 'case' disorder and a further 17% a 'borderline case' disorder over the first 6 months of unemployment. These rates are similar to those found in studies concerned with a wider range of severe life events. An increased risk of onset was associated with three factors: lack of an intimate relationship with a wife or girlfriend, trait shyness, and pre-existing economic difficulties.

Delusional depression following benzodiazepine withdrawal.

Withdrawal from long-term treatment with benzodiazepines was followed in three patients by a severe delusional depression. The delusional depression may be related to the neurotransmitter changes accompanying benzodiazepine withdrawal. Caution should be exercised in long-term use of benzodiazepines in susceptible individuals.

Influence of alpha thalassaemia on haematological parameters in Polynesian patients.

DNA mapping of the alpha globin gene cluster in cord blood from Polynesians has shown an increased frequency of alpha thalassaemia and triplicated alpha genes. Reduced levels of haemoglobin, mean corpuscular haemoglobin or mean corpuscular volume in these neonates may indicate alpha thalassaemia. Recognition of this will avoid unnecessary haematological investigations and iron supplementation.