Stalking is causing pervasive and intense personal suffering and is an area of psychiatry that is currently overlooked.

To review demographic and clinical characteristics of stalkers as well as the psychological consequences for victims of stalking.

A Medline and PsycLit search was conducted on stalking, forensic psychiatry, personality disorders, de Clérambault syndrome and erotomania, with respect to the relevance of the articles selected for stalking.

Stalkers are best thought of as a heterogeneous group whose behaviour can be motivated by different forms of psychopathology, including psychosis and severe personality disorders.

There is a clear need to arrive at a consensus on a typology of stalkers and associated diagnostic criteria. The effectiveness of psychological and pharmacological treatments have not yet been investigated. Treatment may need to be supplemented with external incentives provided by the legal system.

Changes in service provision, secular trends in substance misuse and changing social structures might affect outcome in psychosis.

To assess the three-year outcome of an inception cohort of first-episode psychoses treated in a modern, community-oriented service; to compare outcomes with an earlier cohort treated in hospital-based care; and to examine the predictive validity of ICD–10 diagnostic criteria.

Three-year follow-up (1995–1997) of an inception cohort of first-episode psychoses and comparison with two-year follow-up (1980–1982) of the Determinants of Outcome of Severe Mental Disorders (DOSMED) Nottingham cohort.

On most outcome measures, non-affective psychoses had a worse outcome than affective psychoses. Affective psychoses had better outcome than previously reported. Substance-related psychoses had very poor occupational outcome. Similar proportions of the current and DOSMED cohort were in remission but the former were rated as having greater disability.

In a modern community service, 30–60% of patients with first-episode psychoses experience a good three-year outcome. The ICD–10 criteria have good predictive validity.

There have been no large-scale prospective studies evaluating the transfer of care from psychiatric hospitals to district-based services.

We aimed to compare the quality of life of patients in two north London hospitals scheduled for closure with that in the community homes to which they were discharged.

The total long-stay population of Friern Hospital and several hundred long-stay patients in Claybury Hospital were assessed with a batch of eight schedules while in hospital. They were followed up after one year in the community and then at five years.

Of the 670 discharged patients, 126 died before the five-year follow-up. Data were obtained on 523 (97%) of the survivors. There was no change in the patients' clinical state or in their problems of social behaviour. However, they gained domestic and community living skills. They also acquired friends and confidants. They were living in much freer conditions and the great majority wanted to remain in their current homes.

Community care has enhanced the quality of life of this group of patients, involved in a well-planned and adequately resourced reprovision programme.

Direct comparisons of the prognosis for treated depression in adult and elderly cohorts are few, but suggest higher morbidity and mortality in the elderly.

To examine outcome in two such groups after 4.5 years and compare results with those reported elsewhere.

Fifty-six adults (aged under 65) and 54 elderly people (over 65) with primary depression were assessed 4.5 years after receiving hospital treatment, and factors influencing the outcome were explored.

Recovery rates were higher in the adults than in the elderly (42.8% v. 24%), largely due to higher rates of death (33%) and dementia (14.8%) in the latter group, who also suffered more serious health problems (62.9% v. 28.5%). Survival analysis showed no difference in the recovery time between cohorts, with over 90% recovered after 25 weeks. After deducting the natural deaths, melancholic illness proved a poor outcome predictor in the adults.

The outlook for elderly depressed patients is poorer than for younger patients because of concurrent physical disease, a higher death rate and the development of dementia.

Most prior studies of panic-depression comorbidity have been limited methodologically by use of small clinical samples and incomplete analyses.

General population data were used to study the association of lifetime and recent (12 months) panic–depression comorbidity with symptom severity, impairment, course and help-seeking in the National Comorbidity Survey (NCS).

The NCS is a nationally representative survey of the prevalences and correlates of major DSM–III–R disorders in the US household population.

Strong lifetime and current comorbidity were found between panic and depression. Comorbidity was associated with greater symptom severity, persistence, role impairment, suicidality and help-seeking, with many findings persisting after controlling for additional comorbid diagnoses. Findings did not differ according to which disorder was chronologically primary.

Both lifetime and current panic–depression comorbidity are markers for more severe, persistent and disabling illness. Neither additional comorbid diagnoses nor the primary–secondary distinction were important moderators of these associations.

Decreased expression of proteins such as synaptophysin in the hippocampus and prefrontal cortex in schizophrenia is suggestive of synaptic pathology. However, the overall profile of changes is unclear.

To investigate synaptophysin gene expression in the cerebral cortex in schizophrenia.

The dorsolateral prefrontal (Brodmann area [BA] 9/46), anterior cingulate (BA 24), superior temporal (BA 22) and occipital (BA 17) cortex were studied in two series of brains, totalling 19 cases and 19 controls. Synaptophysin was measured by immunoautoradiography and immunoblotting. Synaptophysin messenger RNA (m RNA) was measured using in situ hybridisation.

Synaptophysin was unchanged in schizophrenia, except for a reduction in BA 17 of one brain series. Synaptophysin mRNA was decreased in BA 17, and in BA 22 in the women with schizophrenia. No alterations were seen in BA 9/46.

Synaptophysin expression is decreased in some cortical areas in schizophrenia. The alterations affect the mRNA more than the protein, and have an unexpected regional distribution. The characteristics of the implied synaptic pathology remain to be determined.

Neighbourhood characteristics may influence the risk of psychosis, independently of their individual-level equivalents.

To examine these issues in a multi-level model of schizophrenia incidence.

Cases of schizophrenia, incident between 1986 and 1997, were identified from the Maastricht Mental Health Case Register. A multi-level analysis was conducted to examine the independent effects of individual-level and neighbourhood-level variables in 35 neighbourhoods.

Independent of individual-level single and divorced marital status, an effect of the proportion of single persons and proportion of divorced persons in a neighbourhood was apparent (per 1% increase respectively: RR=1.02; 95% CI 1.00–1.03; and RR=1.12, 95% CI 1.04–1.2.1). Single marital status interacted with the neighbourhood proportion of single persons, the effect being stronger in neighbourhoods with fewer single-person households.

The neighbourhood environment modifies the individual risk for schizophrenia. Premorbid vulnerability resulting in single marital status may be more likely to progress to overt disease in an environment with a higher perceived level of social isolation.

A recent review suggested an association between using unpublished scales in clinical trials and finding significant results.

To determine whether such an association existed in schizophrenia trials.

Three hundred trials were randomly selected from the Cochrane Schizophrenia Group's Register. All comparisons between treatment groups and control groups using rating scales were identified. The publication status of each scale was determined and claims of a significant treatment effect were recorded.

Trials were more likely to report that a treatment was superior to control when an unpublished scale was used to make the comparison (relative risk 1.37 (95% C11.12–1.68)). This effect increased when a ‘gold-standard’ definition of treatment superiority was applied (RR 1.94 (95% C11.35–2.79)). In non-pharmacological trials, one-third of ‘gold-standard’ claims of treatment superiority would not have been made if published scales had been used.

Unpublished scales are a source of bias in schizophrenia trials.

Special hospitals in England provide psychiatric care and treatment in high security. Their future is often questioned.

To test for variation in demand for high-security psychiatric services over one 10-year period.

This study was from the special hospitals' case registers and hospital records. The main measures were numbers and annual rates for referrals and beds offered; the Mental Health Act 1983 (MHA) classification of mental disorder; adjusted population rates by health region; admission episodes; legal category of detention; admission source and type of offence.

Referrals to special hospitals showed no decrease during the 10 years; an apparent increase may reflect under-recording before 1992. Admissions fell by about 16% over the 10 years, but with regional variation. Women, civil cases, admissions under the MHA classifications of psychopathic disorder or mental impairment and directly from a court on a hospital order were most affected. There was an increase in admissions of pre-trial and sentenced male prisoners, and of transferred hospital order patients from other hospitals.

There is continuing demand from all parts of the country for high-security hospital beds. The smaller numbers admitted appear to include more demanding cases.

It has been argued that many patients in special hospital beds do not need to be there. In the 1990s there were initiatives to discharge women and people with learning difficulties.

To test for trends in special hospital discharges and to examine annual resident cohorts.

This study was from case registers and hospital records. The main measures were numbers and annual rates for referrals and beds offered; the Mental Health Act 1983 (MHA) classification of mental disorder; adjusted population rates by region; admission episodes; legal category of detention; admission source and type of offence.

The median annual number of residents was 1859 (range 1697–1910), with an 8% fall for the period. This particularly affected people in mental impairment categories. Numbers were sustained in the male mental illness groups. Discharges, mainly to other institutions, increased. There was no overall change over the 10 years in length of stay for treatment, but successive admission cohorts from 1986 did show some reduction, even with solely remand order cases excluded.

Service planners need a longitudinal perspective on service use. Trends over 10 years to both fewer admissions and more discharges have reduced the special hospital population, but despite new treatments for schizophrenia, men under mental illness classification, as well as transfer from other secure settings, have gone against this trend.

Psychiatric hospital inpatients are known to be at high risk of suicide, yet there is little reliable knowledge of risk factors or their predictive power.

To identify risk factors for suicide in psychiatric hospital in-patients and to evaluate their predictive power in detecting people at risk of suicide.

Using a case–control design, 112 people who committed suicide while in-patients in psychiatric hospitals were compared with 112 randomly selected controls. Univariate analysis and multivariate analyses were used to estimate odds ratios and adjusted likelihood ratios.

The rate of suicide in psychiatric in-patients was 13.7 (95% CI 11.7–16.1) per 10 000 admissions. There were five predictive factors with likelihood ratios >2, following adjustment: planned suicide attempt, 4.1; actual suicide attempt, 4.9; recent bereavement, 4.0; presence of delusions, 2.3; chronic mental illness, 2.2; and family history of suicide, 4.6. On this basis, only two of the patients who committed suicide had a predicted risk of suicide above 5%.

Although several factors were identified that were strongly associated with suicide, their clinical utility is limited by low sensitivity and specificity, combined with the rarity of suicide, even in this high-risk group.

It has been suggested that adults with medically unexplained physical symptoms experienced greater ill-health then others (either in themselves or their families) during childhood.

To test these hypotheses.

We used data from the Medical Research Council (MRC) National Survey of Health and Development, a population-based cohort study established in 1946 (n=5362). Subjects were followed from birth in 1946 until 1989 (age 43 years). As outcome, we used operationally defined medically unexplained hospital admissions at age 15–43 years. Exposure variables included childhood illness, and illness in parents during the childhood of the subjects.

The risk set (n=4603) comprised individuals still in the Survey at age 15. Ninety-five unexplained hospital admissions were identified. Subjects whose mothers reported below-average health in the father were at increased risk of subsequent unexplained admissions. Below average reported health in the mother was not associated with this increased risk. Defined physical diseases in childhood were not associated, but persistent abdominal pain at age 7–15 years was.

Unexplained hospital admissions are associated with certain childhood experiences of illness, but defined physical illness in childhood is not a risk factor.

The concept of fixed, unshakeable (delusional) beliefs within the context of obsessive–compulsive disorder (OCD) is one that has received varying amounts of attention in the literature, and has not yet received universal acknowledgement. There are good grounds for including these cases within the diagnostic concepts of OCD, with significant implications for clinical management.

To present cases with unusual OCD, in order to re-evaluate the issue of delusions and OCD.

The cases of five subjects with delusions in the course of obsessive–compulsive disorder are presented to illustrate ‘delusional’ OCD. The management and outcome of these cases are discussed.

Fixity and bizarreness of beliefs in OCD occur on a continuum from ‘none’ to ‘delusional intensity’ and may fluctuate within subjects.

The idea that these cases may represent a form of OCD has implications for management, as, if this is correct, they should be able to respond to appropriate behavioural and/or pharmacological strategies used in OCD.

Many people with substance use disorders are vulnerable to other psychiatric disorders and present to addiction treatment services with comorbid psychiatric symptoms.

To describe the prevalence of recent psychiatric treatment and current psychiatric symptoms and explore links between substance misuse, personal/social functioning and symptom severity.

Subjects were 1075 adults recruited to the National Treatment Outcome Research Study (NTORS), of whom 90% were opiate-dependent. Psychiatric symptoms at intake were recorded using sub-scales from the Brief Symptom Inventory.

Recent psychiatric treatment was reported by one in five subjects. Psychiatric symptom levels were high and females had elevated scores on all scales. Symptoms were elevated among opiate users who were also frequent users of benzodiazepines, alcohol and, in particular, stimulants. Gender, physical health, drug dependence and personal relationship problems were more powerful predictors of psychiatric symptoms than substance use.

Addictions service providers should be vigilant to psychiatric problems among their clients at intake to treatment. Psychiatric symptoms are more closely linked to polydrug use than to opiate use in this population.

Lipid peroxidation may be increased in schizophrenia, due to the illness, lifestyle or medication.

To determine plasma lipid peroxide levels and serum vitamin E and A levels in first-episode never-treated people with schizophrenia and in controls.

Thirty in-patients with a first episode of schizophrenia or schizophreniform psychosis were recruited, as were controls matched for gender, age, smoking and dietary status. Blood samples were taken, smoking status was recorded and body mass index measured.

There were no significant differences between patients and controls in plasma lipid peroxide levels. Seventy-three per cent of the patients smoked. Patients who smoked had a higher mean lipid peroxide level than non-smokers. Seventy-seven per cent of patients and 70% of controls had a ratio of vitamin Eto cholesterol of less than 5. Body mass index was lower in patients than in controls.

As a result of the high prevalence of smoking this group shows increased lipid peroxidation. Low serum ratios of vitamin Eto cholesterol in both patients and controls suggest an unsatisfactory diet.