Numerous in vivo brain imaging studies suggest that cerebral Structure is abnormal in schizophrenia, but implicate different regions to varying extents.

We identified published MRI studies in schizophrenia with searches of the computerised literature and key Journals. Reports giving the volumes of cortical structures in people with schizophrenia and controls were included. The percentage differences in volumes were calculated and the median taken as a summary measure for each brain region.

Forty relevant studies were identified. The median percentage volume differences revealed overall reductions in the whole brain (3%), temporal lobe (6% left. 9.5% right), and the amygdala/hippocampal complex (6.5%, 5.5%); and increases in the lateral ventricles (44%, 36%), that were greatest in the body and occipital horns. Segmentation studies suggest that grey matter is reduced but that white matter volumes may actually be increased. In men, substantial reductions were also evident in the amygdala and hippocampus, as well as the largest reductions of all in the parahippocampus (14%, 9%). Few studies gave figures for women alone.

Several brain structures in schizophrenia are affected to a greater extent than expected from overall reductions in brain volume. Further studies are required in affected women, and to try to identify clinical and aetiological associations of these findings.

The Clinical Standards Advisory Group was asked by UK health ministers to advise on the standards of clinical care being achieved for people with schizophrenia. A subcommittee commissioned a review of standards, followed by research into how far these were reflected in contracts and met by providers.

No comprehensive but practical set of standards was found. A protocol of 143 items of good service practice was constructed, and applied by teams visiting services in 11 UK districts. The team appraisals were summarised in 20 key points, each scored 0 (absent) to 4 (excellent performance). Seven points were used to assess standards of commissioning and 13 for standards of service provision.

When placed into rank order, the mean key point scores for commissioners and providers in the same district tended to be very similar. Total district scores were then used to assign districts to one of three groups. Four performed reasonably well, five were moderate and two were poor.

One of the key elements associated with these differences was the local level of morale. After wide consultation, a revised protocol of 26 key points for direct rating was drawn up and has since been further tested.

Less syntactically complex speech in patients with schizophrenia has been thought to represent a premorbid dysfunction, of possible prognostic value and indicative of a neurodevelopmental origin for schizophrenia.

Narratives written at age 11 by children who then developed psychiatric disorders in adult life (using PSE CATEGO diagnoses), especially schizophrenia, were compared with matched controls on syntactic complexity syntactic maturity, grammatical deviance and spelling ability.

Children who later developed either schizophrenia, affective psychosis or a neurotic type of disorder in adulthood did not differ from normal controls on any of the measures of syntactic production, grammatical errors or spelling.

it is probable that previous reports of reduced syntactic complexity in schizophrenic speech are a consequence of being in a psychotic state and do not represent a premorbid deficit.

‘Cloze procedure assesses the predictability of text by deleting words at set intervals and having a panel of raters fill the blanks. Two refinements to the procedure are described: ‘modified Cloze and ’ ‘reverse Cloze’, the latter examining the subject's ability to interpret a partial transcript.

Samples of speech were obtained from patients with schizophrenia, manic-depression and orthopaedic disorders using a standard prompt, and the output analysed using modified Cloze. In addition, subjects completed a reverse Cloze passage.

Both modified Cloze and reverse Cloze discriminated the performance of patient groups, with patients with schizophrenia performing worst.

These techniques extend earlier findings suggesting reduced predictability in psychotic speech, particularly for patients with schizophrenia. The reverse Cloze procedure suggests a ‘mirror-image’ deficit and is a potential objective index of psychopathology that is much simpler to apply than traditional Cloze.

In schizophrenia, disturbances in the development of physiological hemisphere asymmetry are assumed to play a pathogenetic role. The most striking difference between hemispheres is in language processing. The left hemisphere is superior in the use of syntactic or semantic information, whereas the right hemisphere uses contextual information more effectively.

Using psycholinguistic experimental techniques, semantic associations were examined in 38 control subjects, 24 non-thought-disordered and 16 thought-disordered people with schizophrenia, for both hemispheres separately.

Direct semantic priming did not differ between the hemispheres in any of the groups. Only thought-disordered people showed significant indirect semantic priming in the left hemisphere.

The results support: (a) a prominent role of the right hemisphere for remote associations; (b) enhanced spreading of semantic associations in thought-disordered subjects; and (c) disorganisation of the functional asymmetry of semantic processing in thought-disordered subjects.

There have been few prospective studies of the long-term outcome of psychosis in people of Afro-Caribbean origin in the UK.

We followed-up a population-based, consecutive series of 34 Afro-Caribbean and 54 White people with psychosis who had been extensively investigated during their first admission in 1973/74. Diagnoses were made by direct interview using the Present State Examination at both first admission and follow-up.

Ninety-seven per cent of the original sample were traced. A slightly greater proportion of the Afro-Caribbean people were assigned to the S+ Catego class (schizophrenia), both on first assessment and at follow-up. No difference was found between the two groups in the consistency of diagnosis over the 18 years or in the proportion of patients considered psychotic but Afro-Caribbean people tended to have fewer negative symptoms at follow-up. There were striking differences between the two groups in their experience of psychiatric care; Afro-Caribbean people were more likely to have been readmitted, to have experienced longer hospitalisations, and to have undergone more involuntary admissions than their White counterparts.

Afro-Caribbean people who met clinical and research criteria for schizophrenia had a less satisfactory experience of, and response to, psychiatric care over 18 years than their White counterparts.

Interpersonal dependence is thought to be important in a number of physical and psychological disorders. There are several developmental theories that suggest environmental influences in childhood are important.

A twin study methodology was used to look at the genetic and environmental influences on interpersonal dependence as measured by a sub-scale of the Interpersonal Dependency Inventory with a population-based sample of 2230 twins.

Psychometric analysis revealed that this was a stable measure and that there was a substantial degree of construct validity Both univariate and longitudinal twin analysis suggested that there was a modest genetic influence and a large, specific environment influence on interpersonal dependency as measured by this scale. The longitudinal analysis revealed that the genetic influence was stable over the time-scale sampled and the environmental influence was moderately stable.

This finding is at odds with theories that suggest shared environment is important in the aetiology of interpersonal dependency.

Knowledge of working capacity from adolescence until adulthood among severely disturbed in-patients is scarce.

In a follow-up study of 61 adolescent in-patients, we studied associations between being on a disability pension 20 years after hospitalisation, and the patients' psychopathology and treatment-related factors during the hospitalisation and seven-year follow-up.

Of the former in-patients. 27% had not been on a disability pension, 20% had short-term pension periods, and 53% were pensioned. Subjects whose overall psychosocial functioning had improved and who had not utilised in-patient services until the seven-year follow-up, had a better prognosis in terms of working capacity Half of the subjects who had not been on pension during the follow-up had received a diagnosis of conduct disorder at discharge, and half of those pensioned had a psychotic disorder.

The patients' level of psychosocial functioning and capability to work in young adulthood were associated with long-term prognosis in terms of working capacity Adolescence seems to be the critical time for intensive psychiatric care combined with vocational rehabilitation programmes.

Previous estimates of the prevalence of seasonal affective disorder (SAD) in community samples have been in the range 2–10%, using methods not derived from DSM algorithms. We report the first community-based study to estimate major and minor depression with a seasonal pattern in a community-based sample using a diagnostic instrument derived from DSM–III–R.

A modified version of the Composite International Diagnostic Interview was administered to 8098 subjects in the 48 coterminous states of the USA (the National Comorbidity Survey) to assess the prevalence of major and minor depression with a seasonal pattern.

The lifetime prevalence of major depression with a seasonal pattern was 0.4%, and the prevalence of major or minor depression with a seasonal pattern was 1.0%. Among respondents with major depression, male gender and older age were associated with a higher prevalence with a seasonal pattern.

Prevalence estimates of major and minor depression with a seasonal pattern are much lower than those found in previous studies of SAD in the community probably due to the approach to diagnosis used in the present study which more accurately represents DSM–III–R criteria for major depression with a seasonal pattern. The distribution of the disorder is similar to that found in previous studies except for the higher prevalence among males.

Alcohol use disorders (AUDs) among the Yami aborigines in Taiwan were investigated and compared with four other Taiwanese aboriginal groups.

A sample survey was conducted using a semi-structured clinical interview for AUDs among 252 subjects, aged 15 and above, from two Yami villages on Orchid Island.

The prevalences of DSM–III–R and DSM–IV alcohol use disorders were 13.1% and 10.3% by one year, and 17.5% and 15.2% by lifetime, respectively with a male excess. The risk for AUDs in Yami men was significantly associated with a lower educational level, a non-married status, and the length of stay in mainland Taiwan. A protective effect of Christian belief was evident for lifetime risk for AUDs.

The lower prevalences of AUDs in Yami than in other aboriginal groups in Taiwan might be explained by social isolation of the former, and differences in drinking tradition, availability of alcohol, biological vulnerability, and the extent of acculturation between these groups.

Selective serotonin reuptake inhibitors are currently the most widely prescribed antidepressant drugs. There are only four published studies of breast-feeding mothers and their infants in which the mothers were taking fluoxetine.

Four mothers who took fluoxetine and their breast-fed infants were studied. Samples of plasma, breast-milk and urine were taken from the mothers and of plasma and urine from infants for assays of drug and metabolite concentrations. Bayley Scales of Infant Development were repeatedly used to assess cognitive and psychomotor development of the infants.

Fluoxetine and norfluoxetine were detected in all samples of maternal plasma (range of total concentration 138–427 ng/ml) and in breast-milk (range 39–177 ng/ml). Amounts of both fluoxetine and norfluoxetine in infants' plasma and urine were below the lower limit of detection. All infants were observed to be developing normally and showed no abnormal findings on neurological examination.

Much larger databases are needed but these four cases do not provide any evidence to suggest that women who are maintained on therapeutic doses of fluoxetine should discontinue breast-feeding their infants if they wish to breast-feed.

Velo-cardio-facial syndrome (VCFS), a syndrome of multiple congenital abnormalities including characteristic dysmorphology, congenital heart defects and learning disability is associated with small interstitial deletions of chromosome 22qll. We tested the hypothesis that VCFS may be significantly under-diagnosed by screening a learning-disabled population for chromosome 22qll deletions.

Two hundred and sixty-five people with learning disability residing in two learning disability hospitals in South Wales were reviewed. They were selected for inclusion in the study if they fulfilled any of the following criteria: psychotic disorder (schizophrenia or affective disorder), family history of psychotic disorder, cleft palate and/or lip, congenital heart disease, broadly defined facial dysmorphism or a history of hypocalcaemia. Fluorescence in situ hybridisation studies were performed on 74 selected individuals.

Cytogenetic analysis revealed that two people demonstrated a previously undetected chromosome 22qll deletion. A third person demonstrated a previously undetected cytogenetically visible deletion on chromosome 15.

VCFS appears to be aetiologically significant in a proportion of individuals with idiopathic learning disability especially in those where psychosis is associated with mild learning disability. We suggest that clinicians should consider a chromosome 22qll deletion in people who meet selection criteria.

Abnormalities presumed to occur during foetal life have been associated with schizophrenia. Polydactyly is a developmental abnormality but no previous association has been reported between Polydactyly and functional psychotic illness.

Individuals with both Polydactyly and a functional psychosis were ascertained during a study of familial schizophrenia.

Five such individuals were ascertained in the course of assessing 234 individuals with familial psychosis, giving a rate of Polydactyly in the sample of around 10 times the general population rate.

This study provides preliminary evidence that Polydactyly is over-represented in individuals with familial schizophrenia and related psychotic illnesses.