A previous study demonstrated a higher rate of first hospitalisation for schizophrenia in twins than in singletons.

To compare the schizophrenia rates in monozygotic twins, dizygotic twins and the general population.

Through record linkage between the Young Cohort of the Danish Twin Register and the Danish Psychiatric Case Register, the rate of schizophrenia in’ monozygotic and dizygotic twins and the rate in the general population were compared.

The rate of first admission to hospital for schizophrenia in dizygotic twins was 40% greater than that in the general population. The rate in monozygotic twins was not increased. The difference between the rates in mono- and dizygotic twins was statistically significant (P < 0.001)

This result is surprising and is in the direction opposite to that expected, suggesting new possibilities in the study of risk factors.

Schizophrenia occurring for the first time in late life may be a distinct entity or part of a continuum.

Can late-onset schizophrenia (LOS) and early-onset schizophrenia (EOS) be differentiated by their phenomenology and risk factors to their development?

Convenience samples of 27 DSM–III–R defined LOS subjects, 30 EOS subjects and 34 control subjects were systematically assessed.

Premorbidly, both groups of subjects with schizophrenia had personality traits that were different from controls but not from each other. The EOS subjects had more family members with a history of psychiatric illness or schizophrenia and less hearing impairment than the other two groups, which did not differ from each other. Clinically, LOS and EOS subjects were similar, except that EOS subjects had more negative symptom scores, tended to have more delusions of guilt/sin and of being controlled and more formal thought disorder, and had significantly poorer instrumental activities of daily living.

Phenomenology and risk factors do not distinguish discrete LOS.

Late-onset schizophrenia (LOS) may have a basis in age-related coarse brain disease, but empirical support for this is conflicting.

Is LOS characterised by more neurological disease than early-onset schizophrenia (EOS)?

DSM–III–R–defined LOS subjects (n=27) were compared with 30 EOS and 34 volunteer control subjects on neurological status, neuropsychological test performance and brain magnetic resonance imaging (MRI)

LOS and EOS groups had more ‘soft’ neurological signs and drug-induced movement abnormalities, and performed more poorly on tests assessing speed of information processing, memory and frontal executive functioning. On MRI, the LOS and EOS groups had greater lateral ventricular size than the control group. The LOS subjects also had more signal hyperintensities in periventricular white matter and subcortical nuclei than controls.

LOS and EOS subjects were very similar on neuropsychological, neurological and structural neuroimaging parameters, except that there were more MRI periventricular hyperintensities in LOS subjects.

Since 1991, English mental health policy guidelines have been explicit in recommending inter-professional working, involvement of patients and carers, harmonisation between health and social services and targeting at people with severe mental illness.

To explore the structure and operation of mental health services in practice and relate them to measurable data.

A survey of mental health trusts was conducted in 1997–1998. Responses were compared with a concurrent survey of social services departments. Some qualitative data were collected. Harmonisation and targeting scores were devised and tested for association.

The response rate was 79%. The frequency with which different professionals, patients and carers were involved in the care process is described. Reasons for this are discussed briefly. Levels of harmonisation and targeting were found to vary widely and to be positively associated.

This survey portrays mental health services' practice in relation to Government policy. However, adherence to guidelines cannot be taken as a guarantee of service quality or efficiency.

It is not clear which model of case management is most likely to improve quality of life in people with severe mental illness.

To use baseline data derived from the UK700 Case Management Trial to assess the relative importance of clinical, social and unmet needs variables as predictors of subjective quality of life in patients with severe mental illness.

Patients (n=708) were assessed on quality of life (Lancashire Quality of Life Profile), needs (Camber well Assessment of Need), psychopathology and social functioning. Variables that were amenable to change through case management were investigated as predictors of quality of life.

Social variables accounted for 7% of the variance for subjective quality of life, compared with 19% for clinical variables, and 20% for unmet needs. The strongest predictors of subjective quality of life were unmet basic, social and functioning needs, depression and positive psychotic symptoms.

Subjective quality of life in severely mentally ill patients is predicted by clinical variables and unmet needs. The results identify priority areas for the attention of case managers who seek to improve quality of life in these patients.

Does incidence of dementia follow the age pattern of prevalence? Is gender a risk factor? Do patterns of incidence differ between dementias?

To assess age-specific incidence rates of undifferentiated dementias, Alzheimer's disease and vascular dementia.

5222 individuals aged $65 years, were interviewed using the Geriatric Mental State/History and Aetiology Schedule. The AGECAT package was used to identify cases at three interviewing waves at two-year intervals. Diagnoses were made using ICD −10 Research Criteria and validated against neurological and psychological examination, with imaging and neuropathology on unselected subsamples.

Incidence rates of the dementias increase with age. Age patterns are similar between Alzheimer's disease and vascular dementia. Gender appears influential in Alzheimer's disease. In England and Wales, 39 437 new cases of Alzheimer's disease (4.9/1000 person-years at risk); 20 513 of vascular dementia (2.6/1000 person-years) and 155 169 of undifferentiated dementia (19/1000 person-years) can be expected each year.

Incidence rates for Alzheimer's disease and vascular dementia appear to behave differently with an increased risk of Alzheimer's disease for women compared to vascular dementia.

Depression in older people is common and has a high mortality, but effective treatments exist.

To describe drug prescribing in older community residents in relation to depression status.

The MRC–ALPHA community cohort aged 65 and over were interviewed using the Geriatric Mental State examination drug data collected at index interview and at two and four years.

Antidepressants were used by 10.9% of the depressed population. Benzodiazepines were used frequently. Of the antidepressant users, 59.6% took low-dose antidepressants for two years, had a poor outcome and few drug changes.

Trends of increasing antidepressant use have cost implications for primary care groups. Benzodiazepines may be mis-prescribed for treatment of depressive symptoms. Antidepressant users have poor outcome and follow-up.

Good interview and diagnostic measures for autism and other pervasive developmental disorders (PDDs) are available but there is a lack of a good screening questionnaire.

To develop and test a screening questionnaire based on items in the best available diagnostic interview – the Autism Diagnostic Interview – Revised (ADI–R)

A 40 -item scale, the Autism Screening Questionnaire (ASQ), was developed and tested on a sample of 160 individuals with PDD and 40 with non-PDD diagnoses.

The ASQ has good discriminative validity with respect to the separation of PDD from non-PDD diagnoses at all IQ levels, with a cut-off of 15 proving most effective. The differentiation between autism and other varieties of PDD was weaker.

The ASQ is an effective screening questionnaire for PDD.

The Hospital Anxiety and Depression Scale (HADS), developed for use with adults, has potential with adolescents.

To test the HADS's validity with adolescents.

The HADS was given to 248 schoolchildren and to 48 psychiatric outpatients and 38 deliberate self-harm inpatients aged 12–17, and validated against ICD–10 diagnoses for the out-patients.

The HADS has adequate test-retest reliability and factor structure, and discriminates between adolescents diagnosed with depressive or anxiety disorders and those without these diagnoses.

The psychometric properties of the HADS and its shortness make it useful for screening and in clinical settings with adolescents.

In a recent study, 20% of the variance in the weight of infants of mothers with eating disorders was accounted for by mealtime conflict.

To investigate the antecedents and interactive processes involved in the development of such conflict.

Mothers with eating disorders and their 12-month-old infants (n=34) and a comparison group (n=24) were videotaped during infant mealtimes. Specific classes of antecedents to conflict episodes were identified. An examination was then made of all such antecedents not leading to conflict and the mother–infant responses to each antecedent.

Within the index group, conflict was less likely when mothers acknowledged infants' cues and were able to put aside their own concerns. The relationship between maternal responses and the evolution of conflictual interaction was confirmed in multiple regression analyses including both index and comparison groups.

Mothers' and infants' responses to potential antecedents to conflict had an impact on whether mealtime conflict ensued. Conflict arose because maternal eating disorder psychopathology interfered with aspects of responsive parenting.

The clinical assessment and management of the risk of violence and suicide by people with mental illness may have to focus on environmental as well as individual factors.

To investigate possible associations between violence, homicide and suicide rates, population density and indices of deprivation, with particular reference to inner-city boroughs.

Coroners' statistics in London for homicide and suicide were obtained, with police-reported homicide and violence rates as a validity check. Correlations were made between these data and population density, the Jarman under-privileged areas score, and the Mental Illness Needs Index for each of the 32 London boroughs.

Homicide rates had a 14.3-fold range, suicide a 4.4-fold range and interpersonal violence a 6.6-fold range. The variables under study were strongly correlated with each other. Rates were highest in boroughs with high population density and deprivation scores. The associations persisted when covarying for deprivation, age structure or population density.

Because violence, homicide and suicide are so closely correlated, they are likely to be valid indices of the differences between adjacent boroughs; this has implications for the delivery of preventive and mental health services and for clinical management of risk.

Axis I comorbidities are prevalent among patients with severe bipolar disorder but the clinical and psychopathological implications are not clear.

To investigate characteristics of four groups of patients categorised as follows: substance abuse only (group I), substance abuse associated with other Axis I disorders (group 2), non-substance-abuse Axis I comorbidity (group 3), no psychiatric comorbidity (group 4)

Consecutive patients with bipolar disorder with psychotic features (n=125) were assessed using the Structured Clinical Interview for DSM–III–R – patient version, and several psychopathological scales.

By comparison with group 4, group I had a higher risk of having mood-incongruent delusions, group 2 had an earlier age at onset of mood disorder, a more frequent onset with a mixed state and a higher risk of suicide, and group 3 had more severe anxiety and a better awareness of illness.

Substance abuse, non-substance-abuse Axis I comorbidity and their reciprocal association are associated with different characteristics of bipolar disorder.

There are no large published studies of the prevalence of seasonal affective disorder (SAD) among UK populations.

To determine the prevalence of SAD among patients attending a general practitioner (GP).

Patients aged 16–64 consulting their GPs in Aberdeen during January were screened with the Seasonal Pattern Assessment Questionnaire (SPAQ). SPAQs were also mailed to 600 matched patients, who had not consulted their GP during January. Surgery attenders who fulfilled SPAQ criteria for SAD were invited for interview to determine whether they met criteria for SAD in DSM–IVand the Structured Interview Guide for the Hamilton Rating Scale for Depression– Seasonal Affective Disorder Version (SIGH–SAD).

Of 6161 surgery attenders, 4557 (74%) completed a SPAQ; 442 (9.7%) were SPAQ cases of SAD. Rate of caseness on the SPAQ did not differ between surgery attenders and non-attenders. Of 223 interviewed SPAQ cases of SAD, 91 (41%) also fulfilled DSM–IVand SIGH–SAD criteria.

There is a high prevalence of SAD among patients attending their GPs in January in Aberdeen; this is likely to reflect a similar rate in the community.

The prevalence of mental disorders in the community is high, yet many remain unrecognised, misdiagnosed or poorly managed within primary care. Hence, guidelines for diagnosing and managing mental disorders in primary care, ICD–10 PHC, have been developed.

To introduce the guidelines into primary care and to assess whether they improve recognition, accuracy of diagnosis and treatment standards.

GPs recorded information on all patients presenting with mental disorders before and after guidelines were introduced. A10% sample of patients underwent interviews to establish a formal diagnosis. Recognition of mental disorders was assessed by screening of patients attending their GP.

The guidelines had no impact on the overall detection of mental disorders, the accuracy of diagnosis or the prescription of antidepressants. There was a significant increase in the number of patients diagnosed with depression or unexplained somatic symptoms. The GPs also made increased use of psychological interventions.

The success of the guidelines in bringing about change is by no means certain. Some areas appeared more susceptible to change than others.

We report a survey of the content of obsessions in children with autism spectrum conditions. We use the term obsessions' narrowly, to indicate strong, repetitive interests. We predicted that obsessions would not cluster randomly, but rather would occur significantly more often in the domain of ‘folk physics' (an interest in how things work), and significantly less often in the domain of ‘folk psychology’ (an interest in how people work). These predictions were tested relative to a control group of 33 children with Tourette syndrome.

To examine the content of autistic obsessions, and to test the theory that these reflect an evolved cognitive style of good folk physics alongside impaired folk psychology.

Ninety-two parents returned a questionnaire designed to determine the subject of their child's obsessional interests. The results were analysed in terms of core domains of cognition.

Both predictions were confirmed.

These results suggest that impaired folk psychology and superior folk physics are part of the cognitive phenotype of autism. A content-free theory of obsessions is inadequate.