Studies of people with schizophrenia assessed using magnetic resonance imaging (MRI) usually include patients with first-episode and chronic disease, yet brain abnormalities may be limited to those with chronic schizophrenia.

To determine whether patients with a first episode of schizophrenia have characteristic brain abnormalities.

Systematic review and meta-analysis of 66 papers comparing brain volume in patients with a first psychotic episode with volume in healthy controls.

Atotal of 52 cross-sectional studies included 1424 patients with a first psychotic episode; 16 longitudinal studies included 465 such patients. Meta-analysis suggests that whole brain and hippocampal volume are reduced (both P < 0.0001) and that ventricular volume is increased (P < 0.0001) in these patients relative to healthy controls.

Average volumetric changes are close to the limit of detection by MRI methods. It remains to be determined whether schizophrenia is a neurodegenerative process that begins at about the time of symptom onset, or whether it is better characterised as a neurodevelopmental process that produces abnormal brain volumes at an early age.

Scarce longitudinal data exist on the occurrence of psychotic symptoms in the general population.

To estimate the incidence of, and risk factors for, self-reported psychotic symptoms in Great Britain.

Data from the 18-month follow-up of a national survey were used. Incident cases were those who endorsed one or more items on the Psychosis Screening Questionnaire at follow-up, but not at baseline. The association between factors recorded at baseline and incident self-reported symptoms was examined.

At follow-up, 4.4% of the general population reported incident psychotic symptoms. Six factors were independently associated with incident symptoms: living in a rural area; having a small primary support group; more adverse life events; smoking tobacco; neurotic symptoms; and engaging in a harmful pattern of drinking.

A small but not insignificant percentage of the population of Great Britain reported incident psychotic symptoms over 18 months. The risk factors for psychotic symptoms showed some similarities with risk factors for schizophrenia, but there were also some striking differences. The relationship between such risk factors and the factors that perpetuate psychotic symptoms remains to be ascertained.

The reported link between psychological trauma and onset of psychosis remains controversial.

To examine associations between self-reported psychological trauma and psychotic symptoms as a function of prior evidence of vulnerability to psychosis (psychosis proneness).

At baseline, 2524 adolescents aged 14–24 years provided self-reports on psychological trauma and psychosis proneness, and at follow-up (on average 42 months later) participants were interviewed for presence of psychotic symptoms.

Self-reported trauma was associated with psychotic symptoms, in particular at more severe levels (adjusted OR 1.89, 95% CI 1.16–3.08) and following trauma associated with intense fear, helplessness or horror. The risk difference between those with and without self-reported trauma at baseline was 7% in the group with baseline psychosis proneness, but only 1.8% in those without (adjusted test for difference between these two effect sizes: χ2=4.6, P=0.032).

Exposure to psychological trauma may increase the risk of psychotic symptoms in people vulnerable to psychosis.

Research has revealed high levels of mental health needs in young offenders but many studies have been small, focusing on specific populations.

To evaluate the mental health and psychosocial needs of a nationally representative sample of juvenile offenders in England and Wales, including female offenders and those from Black and minority ethnic groups.

A cross-sectional survey of 301 young offenders, 151 in custody and 150 in the community, was conducted in six geographically representative areas across England and Wales. Each young person was interviewed to obtain demographic information, mental health and social needs, and psychometric data.

Young offenders were found to have high levels of needs in a number of different areas including mental health (31%), education/work (36%) and social relationships (48%). Young offenders in the community had significantly more needs than those in secure care and needs were often unmet. One in five young offenders was also identified as having a learning disability (IQ < 70).

Needs for young offenders were high but often unmet. This emphasises the importance of structured needs assessment within custody and community settings in conjunction with a care programme approach that improves continuity of care.

The full costs of accommodating and supporting young people in the criminal justice system are unknown. There is also concern about the level of mental health needs among young offenders and the provision of appropriate mental health services.

To estimate the full cost of supporting young people in the criminal justice system in England and Wales and to examine the relationship between needs, service use and cost.

Cross-sectional survey of 301 young offenders, 151 in custody and 150 in the community, conducted in six geographically representative areas of England and Wales.

Mental health service use was low despite high levels of need, particularly in the community Monthly costs were significantly higher among young people interviewed in secure facilities than in the community ($4645 v. $ 1863; P < 0.001). Younger age and a depressed mood were associated with greater costs.

Young people in the criminal justice system are a significant financial burden not only on that system but also on social services, health and education. The relationship between cost and depressed mood indicates a role for mental health services in supporting young offenders, particularly those in the community.

Persistent antisocial behaviour is the most common mental health problem in childhood and has widespread effects, yet little is known about what it costs.

To identify the costs incurred by children with antisocial behaviour in the UK, and who pays these costs.

Eighty children aged 3–8 years referred to mental health services were studied using the Client Service Receipt Inventory for Childhood.

The mean annual total cost was $ 5960 (median 4597, range 48–19 940). The services used were mainly the National Health Service, education and voluntary agencies, but the greatest cost burden, $4637, was borne by the family Higher cost was predicted by more severe behaviour and being male.

The annual cost of severe antisocial behaviour in childhood in the UK is substantial and widespread, involving several agencies, but the burden falls most heavily on the family Wider uptake of evidence-based interventions is likely to lead to considerable economic benefits in the short term, and probably even more in the long term.

Substance use by people with severe psychiatric morbidity is associated with negative outcomes.

To assess in adults with less severe psychiatric morbidity the relationship between alcohol consumption and subsequent 7-year hospital admissions, and the development and recurrence of alcohol use disorders.

Follow-up data were assembled via a population-based hospital record-linkage system.

Baseline alcohol use groups were: dependent (n=31), harmful (n=114), moderate (n=621) and abstinent (n=249). The moderate but not the abstinent group had fewer mental health admissions and a longer time to first admission than the harmful and dependent groups. Both the moderate and the abstinent groups had longer times to ‘all-cause’ admissions than the dependent group. Many of those with alcohol use disorders at baseline relapsed (66%) but few (14%) developed a first-time alcohol use disorder.

Overall, moderate alcohol consumption among those with less severe psychiatric morbidity was not associated with more mental health admissions; those with alcohol dependence had poorer health outcomes than the remaining categories.

There is evidence that Irish migrants in Britain have higher rates of depression and suicide than other minority ethnic groups.

To examine the association between poorly planned migration and depression in Irish-born people living in London.

A sample of 360 Irish-born people was recruited from 11 general practices into a case-control study Participants were interviewed using standardised measures, including the Beck Depression Inventory (BDI). We calculated the odds ratio for any association between depression and eight questions on preparation for migration.

Poorly planned migration was associated with subsequent depression in Irish-born people living in London (OR=1.20, 95% CI 1.06-l.35). The odds of depression were increased by a factor of 20% for each additional negative answer to eight questions on preparation for migration. Positive post-migration influences such as adequate social support protected some against depression.

Depression in Irish-born people living in London is associated with poorly planned migration. However, this effect can be modified by experiences following migration.

A randomised controlled trial comparing group interpersonal psychotherapy with treatment as usual among rural Ugandans meeting symptom and functional impairment criteria for DSM–IV major depressive disorder or sub-threshold disorder showed evidence of effectiveness immediately following the intervention.

To assess the long-term effectiveness of this therapy over a subsequent 6-month period.

A follow-up study of trial participants was conducted in which the primary outcomes were depression diagnosis, depressive symptoms and functional impairment.

At 6 months, participants receiving the group interpersonal psychotherapy had mean depression symptom and functional impairment scores respectively 14.0 points (95% CI 12.2–15.8; P < 0.0001) and 5.0 points (95% CI 3.6–6.4; P < 0.0001) lower than the control group. Similarly, the rate of major depression among those in the treatment arm (11.7%) was significantly lower than that in the control arm (54.9%) (P < 0.0001).

Participation in a 16-week group interpersonal psychotherapy intervention continued to confer a substantial mental health benefit 6 months after conclusion of the formal intervention.

Psychological therapy groups for people with dementia are widely used, but their cost-effectiveness has not been explored.

To investigate the cost-effectiveness of an evidence-based cognitive stimulation therapy (CST) programme for people with dementia as part of a randomised controlled trial.

A total of 91 people with dementia, living in care homes or the community, received a CST group intervention twice weekly for 8 weeks; 70 participants with dementia received treatment as usual. Service use was recorded 8 weeks before and during the 8-week intervention and costs were calculated. A cost-effectiveness analysis was conducted with cognition as the primary outcome, and quality of life as the secondary outcome. Cost-effectiveness acceptability curves were plotted.

Cognitive stimulation therapy has benefits for cognition and quality of life in dementia, and costs were not different between the groups. Under reasonable assumptions, there is a high probability that CST is more cost-effective than treatment as usual, with regard to both outcome measures.

Cognitive stimulation therapy for people with dementia has effectiveness advantages over, and may be more cost-effective than, treatment as usual.