When parenteral treatments are indicated for acutely disturbed behaviour, previous guidelines have recommended droperidol or haloperidol in combination with benzodiazepines. However, there has been recent concern over cardiotoxicity and sudden death associated with some antipsychotic medication and droperidol has now been withdrawn.

To ascertain what alternatives can be recommended to replace intramuscular droperidol.

Selective review of current guidelines and the literature pertaining to rapid parenteral tranquillisation.

Current guidelines recommend haloperidol as an alternative to droperidol. There is evidence of cardiotoxicity with haloperidol and it has a propensity to cause extrapyramidal side effects that may exacerbate disturbed behaviour and reduce longer-term compliance. The rapid-acting intramuscular formulations of atypical antipsychotic agents show promise.

It is recommended that the mainstay of pharmacological rapid tranquillisation should be parenteral benzodiazepines used with due care.

It is now accepted that people with schizophrenia are significantly more likely to be violent than other members of the general population. A less acknowledged fact is that the proportion of societal violence attributable to schizophrenia is small.

To critically examine the epidemiological evidence for the association between violence and schizophrenia and estimate the impact of this association on society.

A selective review of the key literature on the epidemiology of violence and schizophrenia. Population-attributable risks for violence in schizophrenia are calculated from population-based studies.

Most studies confirm the association between violence and schizophrenia. Recent good evidence supports a small but independent association. Comorbid substance abuse considerably increases this risk. The proportion of violent crime in society attributable to schizophrenia consistently falls below 10%.

Less focus on the relative risk and more on the absolute risk of violence posed to society by people with schizophrenia would serve to reduce the associated stigma. Strategies aimed at reducing this small risk require further attention, in particular treatment for substance misuse.

Individuals with schizophrenia appear to be at increased risk for violent and criminal behaviour. Obstetric complications, neuromotor problems and intellectual deficits have variously been reported as increasing the risk for criminality in the general population.

To investigate whether such risk factors are associated with criminal behaviour in an epidemiological cohort of patients with schizophrenia.

We identified from health care registers all individuals with schizophrenia born in Helsinki between 1951 and 1960, and used the national criminal register to identify those with a criminal record by 1995. Childhood information was obtained from archived birth and school records.

Poor educational attainment, poor grades for attention at school, higher birth weight and larger head circumference were significantly associated with the risk of criminal offending in adulthood in this sample of patients with schizophrenia. An association between labour/delivery complications and later violent offending among male patients was of borderline significance.

Our hypotheses that birth complications and childhood neuromotor problems would increase the risk of criminal offending in schizophrenia were not upheld.

Animal experiments suggest that maternal stress and anxiety during pregnancy have long-term effects on the behaviour of the off spring.

To test the hypothesis that antenatal maternal anxiety predicts behavioural problems at age 4 years.

Data were collected on multiple antenatal and postnatal assessments of maternal anxiety and depression, antenatal and obstetric risks, psychosocial risks and children's behavioural/emotional problems (n=7448).

Antenatal maternal anxiety predicted behavioural/emotional problems in boys (OR=2.14,95% CI 1.48−3.10) and girls (OR=1.88,95% CI 1.3–2.69) after accounting for covariates. When covarying maternal anxiety up to 33 months postnatally, antenatal anxiety continued to predict total problems in boys (OR=1.56,95% CI 1.02–2.41) and girls (OR=1.5l, 95% CI 1.22–2.81).

There could be a direct effect of maternal mood on foetal brain development, which affects the behavioural development of the child.

There are no published studies evaluating the impact of introduction of television on disordered eating in media-naïve populations.

To assess the impact of novel, prolonged exposure to television on disordered eating attitudes and behaviours among ethnic Fijian adolescent girls.

A prospective, multi-wave cross-sectional design was used to compare two samples of Fijian schoolgirls before and after prolonged regional television exposure with a modified 26-item eating attitudes test, supplemented with a semi-structured interview to confirm self-reported symptoms. Narrative data from a subset of respondents from the exposed sample were analysed for content relating television exposure to body image concerns.

Key indicators of disordered eating were significantly more prevalent following exposure. Narrative data revealed subjects' interest in weight loss as a means of modelling themselves after television characters.

This naturalistic experiment suggests a negative impact of television upon disordered eating attitudes and behaviours in a media-naïve population.

Sudden death has been linked to antipsychotic therapy but the relative risk associated with specific drugs is unknown.

To assess the risk of sudden unexplained death associated with antipsychotic drug therapy and its relation to drug dose and individual agents.

A case-control study of psychiatric in-patients dying suddenly in five hospitals in the north-east of England and surviving controls matched for age, gender and mental disorder. Logistic regression analysis was used to identify significant risk factors, and odds ratios were calculated.

Sixty-nine case-control clusters were identified. Probable sudden unexplained death was significantly associated with hypertension, ischaemic heart disease and current treatment with thioridazine (adjusted odds ratio=5.3, 95% CI 1.7–16.2, P=0.004). There was no significant association with other individual antipsychotic drugs.

Thioridazine alone was associated with sudden unexplained death, the likely mechanism being drug— induced arrythmia.

Little evidence exists to indicate whether community psychiatric nurses can achieve the results reported by expert cognitive–behavioural therapists in patients with schizophrenia.

To assess the effectiveness and safety of a brief cognitive— behavioural therapy (CBT) intervention in a representative community sample of patients with schizophrenia in secondary care settings.

A pragmatic randomised trial was performed involving 422 patients and carers to compare a brief CBT intervention against treatment as usual.

Patients who received CBT (n=257) improved in overall symptomatology (P=0.015; number needed to treat [NNT]= 13), insight (P<0.001; NNT=10) and depression (P=0.003;NNT=9) compared with the control group (n=165). Insight was clinically significantly improved (risk ratio =1.15,95% C1 1.01-1.31). There was no increase in suicidal ideation.

Community psychiatric nurses can safely and effectively deliver a brief CBT intervention to patients with schizophrenia and their carers.

Sleep effects of antidepressants are important clinically and for elucidating mechanism of action: selective serotonin reuptake inhibitors disturb sleep and 5-HT2 receptor-blocking compounds may enhance sleep quality.

To compare the objective and subjective effects on sleep of paroxetine and nefazodone in patients with moderate to severe depression.

Forty patients with depression were randomised to take paroxetine 20-40 mg/day or nefazodone 400–600 mg/day for 8 weeks. Objective and subjective quality of sleep and depression measures were assessed throughout.

Nefazodone significantly increased objective sleep efficiency and total sleep time, and improved subjective sleep on days 3 and 10. Paroxetine decreased sleep efficiency early in treatment and some sleep disruption remained at week 8. Paroxetine but not nefazodone produced marked suppression of rapid eye movement (REM) sleep.

Nefazodone improves sleep in early treatment compared with paroxetine in patients with moderate to severe depression. These effects are seen within the first 2 weeks of treatment and diminish thereafter.

Knowledge of the prevalence and correlates of personality disorders in the community is important for identifying treatment needs and for provision of psychiatric services.

To estimate the prevalence of personality disorders in a community sample and to identify demographic subgroups with especially high prevalence.

Clinical psychologists used the International Personality Disorder Examination to assess DSM-IV and ICD-10 personality disorders in a sample of 742 subjects, ages 34–94 years, residing in Baltimore, Maryland. Logistic regression was used to evaluate the association between demographic characteristics and DSM — IV personality disorder clusters.

The estimated overall prevalence of DSM — IV personality disorders was 9%. Cluster A disorders were most prevalent in men who had never married. Cluster B disorders were most prevalent in young men without a high school degree, and cluster C disorders in high school graduates who had never married.

Approximately 9% of this community sample has a DSM-IV personality disorder. Personality disorders are over-represented in certain demographic subgroups of the community

Personality disorder in people with learning disability has received little research attention, with only a handful of cross-sectional surveys of prevalence available. As yet, there have been no studies to include an examination of validity.

To investigate the prevalence of personality disorder in adults with learning disability who are in specialist challenging behaviour in-patient services and to examine the validity of the diagnosis of personality disorder in this group in terms of its association with abusive experience in early life.

The Standardised Assessment of Personality (SAP) was used to diagnose personality disorder in 36 individuals with mild/moderate learning disability Case notes were reviewed for details of clinical diagnosis and early psychosocial history.

Thirty-nine per cent of the sample met the criteria for severe personality disorder. This diagnosis showed a significant association with early traumatic experience.

Severe personality disorder is a common diagnosis in this group. There is preliminary evidence that the diagnosis is associated with abuse in childhood.