It is perceived that North American home treatment studies reveal greater success in reducing days in hospital than do European studies. There are difficulties in extrapolating findings internationally.

We aimed to determine whether North American studies find greater reductions in days in hospital and whether experimental service patients in North American studies spend less time in hospital.

The results of a systematic review were analysed with respect to study location. Service components ascertained through follow-up were utilised to interpret the meta-analyses conducted.

Most of the 91 studies found were from the USA and UK. North American studies found a difference of one hospital day (per patient per month) more than European studies but there was no difference in experimental data between the two locations.

North American studies demonstrate greater differences in days in hospital but patients in their experimental services seem to spend no fewer days in hospital, implying a disparity in control services.

Social adversities are accepted as critical factors in the development of psychopathology in young people, but the precise mechanisms of this relationship are unknown.

To explore sources of evidence and suggest future lines of research to clarify the relationship between exposure to negative circumstances and development of psychopathology in young people.

Selective survey of the literature to collect a series of hypotheses that might serve as a framework for future research.

Evidence to date suggests there is no simple relationship between adverse life events and the subsequent emergence of psychopathology. The interplay of acute and chronic stressors over the lifespan with affective temperament; the interrelationship of ‘sensitivity’ and ‘performance’ cognitions in response to life events; and limbic-cortical neural networks are all indicated as important avenues of future research.

Neurological soft signs preceding adult-onset schizophrenia suggest a neurodevelopmental origin and could reflect physical illness in childhood.

To investigate possible associations of adult-onset psychosis with neurological soft signs and common infectious illnesses in childhood.

Using data from the UK National Child Development Study, a longitudinal general population sample, odds ratios were calculated for clinical diagnoses of common childhood viral illnesses and later adult psychotic illness, childhood epilepsy and a range of neurological soft signs.

The number of illnesses per individual did not relate either to the number of soft signs, or to any particular adult outcome. Schizophrenia, affective psychosis and epilepsy were not associated with common childhood illness but were associated with neurological soft signs and an increased, but small, frequency of previous meningitis and tuberculosis.

Overall the data support the notion of neurological soft signs as markers of disordered neurodevelopment in schizophrenia (but the early neurological abnormalities are not caused by infectious illness) and an association between meningitis or tuberculosis in childhood and a small proportion of cases of epilepsy, affective psychosis and schizophrenia.

The links between drug use and psychosis are of major aetiological and prognostic significance. Psychosis and drug dependence frequently co-occur within the prison population, providing the opportunity to study this link more closely.

To explore the relationship between psychosis and drug dependence in a sample of prisoners.

A total of 3142 prisoners were surveyed nationally and structured clinical data were obtained from a subsample of 503 respondents. Psychiatric assessment was based on the Schedules for Clinical Assessment in Neuropsychiatry (version 1.0). Measures of amphetamine, cannabis, cocaine and heroin use and dependence were obtained through self-report.

Logistic regression analyses indicated that first use of amphetamines or cocaine before the age of 16 years and severe cannabis or cocaine dependence were related to an increased risk of psychosis. In contrast, severe dependence on heroin was associated with a reduced risk of this classification.

Severe dependence on cannabis and psychostimulants is associated with a higher risk of psychosis and is in contrast to severe dependence on heroin, which has a negative relationship with psychosis.

In the UK, people with mental disorder thought to pose a high risk of harm to others are usually put in a high-security (special) hospital. Little is known about what happens after that.

To test a hypothesis that, under current services and laws (from the mid-1980s), no one leaving high-security hospitals remains indefinitely institutionalised.

The special hospitals' case register was used for case ascertainment and admission data; post-discharge data were collected from multiple sources on patients discharged in 1984 (census date 31.12.1995).

In this discharge cohort (n=223), 36 (17%) did not return to the community: 17 died in special hospital and 19 continuously lived in other institutions until death or the census date. Over two-thirds of these had mental illness, were older on admission and had lived longer in special hospital than their better-rehabilitated peers. Offending history was irrelevant to this. Most post-discharge institution time was in open psychiatric hospital, or back in special hospital, not in medium secure units or prison.

The hypothesis was not sustained, but fewer people never reached the community than before the mid-1980s. Atypical antipsychotics might reduce this number. We found no justification for a new tier of long-term medium secure units.

Depressive symptoms are associated with cognitive decline in elderly people, but the nature of their temporal relationship remains equivocal.

To test whether depressive symptoms predict cognitive decline in elderly people with normal cognition.

The Center for Epidemiologic Study depression scale (CES – D) and the Mini-Mental State Examination (MMSE) were used to evaluate depressive symptomatology and cognitive functioning, respectively. A sample of 1003 persons aged 59–71 years and with a MMSE score of 26 or over was selected. Cognitive decline was defined as a drop of at least 3 points on the MMSE at 4-year follow-up.

Baseline high levels of depressive symptoms predicted a higher risk of cognitive decline at 4-year follow-up. The MMSE score of participants with depression was more likely to fall below 26 at 2-year follow-up and to remain below at 4-year follow-up than the MMSE score of those without depressive symptoms. Persistent but not episodic depressive episodes were associated with cognitive decline.

High levels of depressive symptoms, when persistent, are associated with cognitive decline in a sample of elderly people.

Subjects recovered from depression have a substantial risk for recurrence of depression, suggesting persistent abnormalities in brain activity.

To test whether women recovered from depression show abnormal brain activity in functional magnetic resonance imaging (fMRI) during a conditioning paradigm with a noxious pain stimulus.

Ten unmedicated women who had recovered from major depression and eight healthy control women each received either noxious hot or non-noxious warm stimuli, the onset of which was signalled by a specific coloured light during 3-tesla echo planar imaging-based fMRI.

Similar patterns of brain activation were found during painful stimulation for both patients and healthy controls. However, relative to healthy controls, subjects recovered from depression showed a reduced response in the cerebellum during anticipation of the noxious stimulus compared with anticipation of the non-noxious stimulus.

Our data suggest that abnormal cerebellar function could be a marker of vulnerability to recurrent depression. This could provide a new target for therapeutic interventions.

Attention-deficit hyperactivity disorder (ADHD) is a common childhood condition, and is more prevalent in boys. The adult outcome of girls with ADHD has never been studied.

To identify predictors for adult psychiatric outcome of children with ADHD, including gender and comorbidity.

Children aged 4–15 years, referred for hyperactivity/inattention and treated with stimulants were included (n=208). The Psychiatric Case Register provided follow-up data on psychiatric admissions in adulthood until a mean age of 31 years.

A total of 47 cases (22.6%) had a psychiatric admission in adulthood. Conduct problems in childhood were predictive (hazard ratio HR=2.3; 95% CI 1.22–4.33). Girls had a higher risk compared with boys (HR=2.4; 95% CI 1.1–5.6).

Girls with ADHD had a higher risk of adult psychiatric admission than boys. Conduct problems were also associated with a higher risk. Girls with ADHD with conduct problems had a very high risk of a psychiatric admission in adulthood.

In the past 10 years the new atypical antipsychotic drugs have stimulated further interest in the pharmacological management of schizophrenia. The risk of movement disorders has been reported to be less with these new agents.

To examine the current prevalence of movement disorders among all people with schizophrenia in a discrete geographical area, to compare the prevalence in patients receiving and not receiving atypical antipsychotic drugs; and to compare current prevalence with prevalence over the past 20 years.

In Nithsdale, south-west Scotland, in 1999/2000, we replicated previous studies by using the Abnormal Involuntary Movements Scale, Simpson-Angus scale and Barnes Akathisia Rating Scale to measure tardive dyskinesia, parkinsonism and akathisia, respectively. Mental state was assessed by the Positive and Negative Syndrome Scale.

In 136 patients the prevalence of probable tardive dyskinesia was 43%, of parkinsonism 35% and of akathisia 15%. Parkinsonism was present as often in those receiving atypicals as in those receiving standard oral antipsychotics. The prevalence of tardive dyskinesia has doubled over 20 years.

Movement disorders remain significant problems for patients despite the introduction of atypical antipsychotic drugs.

Whereas the majority of long-stay in-patients have been successfully resettled in the community there is a group of such patients who are too disturbed or disturbing to be managed in standard community homes.

To study the long-term outcome of a group of 72 long-stay psychiatric inpatients, regarded as unsuitable for community placement.

A prospective cohort study with follow-ups at 1 year and 5 years.

The patients' mental state remained unchanged after 1 year and 5 years. The level of functioning and social behaviour showed minimal change after 1 year, but then improved over the next 4 years. The profile of problematic behaviours changed significantly over 5 years, with a reduction of 50% in their frequency Physical aggression practically disappeared. The improvements in behaviour enabled 29 patients (40% of the study group) finally to be resettled in various care homes, gaining better access to community amenities and living more independently.

A high proportion of patients with severe disabilities, designated as difficult to place’ in the community, could benefit from slow-stream rehabilitation within specialised facilities, enabling them to move into ordinary community homes.

The long-term psychological effects of surviving a major disaster are poorly understood. We undertook a survey of survivors of the Piper Alpha oil platform disaster (1988).

To examine the role of factors relating to the trauma, the survivors and the survivors' circumstances.

Ten years after the disaster, 78% (46/59) of the survivors were located, of whom 72% (33/46) agreed to be interviewed. A further three individuals completed postal measures.

The most stringent diagnostic criteria for post-traumatic stress disorder (PTSD) were met by 21% (7/33) of the survivors over 10 years after the disaster. Features such as physical injury, personal experience and survivor guilt were associated with significantly higher levels of post-traumatic symptoms.

A narrow definition of factors affecting outcome will limit the potential for improving survivor well-being in the long-term after major disasters. Specific symptoms that are not included in the criteria for the diagnosis of PTSD, together with issues such as re-employment, need to be addressed.