This paper describes and analyses the editor's decision-making process at the British Journal of Psychiatry (BJP), and investigates the association between reviewers' assessments and editorial decisions.

Four hundred consecutive manuscripts submitted over a six-month period to the BJP were examined prospectively for assessors' comments and editorial decisions on acceptance or rejection. Interrater reliability of assessments was calculated and a logistic regression analysis investigated the effect of the rank allocated by assessors and the comprehensiveness of the assessments on the editor's decision.

The editor sent 248/400 (62%) manuscripts to assessors for peer review. Kappa for reliability of assessors' rankings was 0.1 indicating poor interrater reliability. Assessors agreed best on whether to reject a paper. A ranking of five (indicating rejection) had the greatest association with editor's rejection (P < 0.001, odds ratio 0.079), and the mean ranking of assessments was also significantly associated with editorial acceptance or rejection (P=0.004, odds ratio 0.24)

Assessors and editors tend to agree on what is clearly not acceptable for publication but there is less agreement on what is suitable.

We tested the hypothesis that reduced levels of the GABA-benzodiazepine receptor occur in alcohol dependency using single photon emission tomography (SPET) and the specific GABA-benzodiazepine ligand, 123l-iomazenil.

Neurologically and cognitively unimpaired abstinent alcohol-dependent (n=12) and non-alcohol-dependent male subjects (n=14) underwent a 123l–iomazenil SPET scan. SPET and magnetic resonance images were co-registered and voxel-based statistical tests performed. Subjects' clinical and alcohol history were obtained with standard questionnaires. The relationships between clinical and alcohol variables and the regional level of GABA-benzodiazepine receptors were investigated using multiple regression analysis.

Abstinent alcohol-dependent subjects had decreased levels of GABA-benzodiazepine receptor compared with non-alcohol-dependent subjects within the frontal, parietal and temporal cortices, including regions in which grey matter atrophy was absent.

Alcohol dependency is associated with reduced GABA-benzodiazepine receptor levels in the absence of grey matter atrophy in some cortical regions, such as within the parietal lobe. Regional variability of reduction in GABA-benzodiazepine receptors demonstrates that alcohol does not have a global, toxic effect on the brain.

The Global Burden of Disease studies are important because they encompass morbidity as well as mortality. Burden due to morbidity is calculated from incidence, duration and disability. There is a dearth of epidemiological measurements of disability.

Data from a quasi-community sample (n=1364) were analysed. Diagnoses of mental and physical disorders, and reports of disability, were based on established methods.

The disabilities reported in mental and physical disorders were comparable. Disability was correlated with comorbidity. The disability in mental disorders was examined by three methods: pure disorders, main problem and regression. It appears that major depression and substance disorder weights were overestimated, and anxiety disorder weights were underestimated in the Global Burden of Disease studies.

A method for disentangling the effects of concurrent comorbidity is presented. The size of burden attributed to mental disorders is of potential benefit for funding mental health services. It is important that we get the estimates right.

Structural brain abnormalities have been reported in schizophrenia. We tested the hypothesis that these abnormalities represented a marker for the genetic liability to schizophrenia in a sample of people with schizophrenia and their relatives from families multiply affected with the disorder.

We compared 31 people with schizophrenia, 57 relatives and 39 unrelated control subjects. Volumetric measurement of brain structures was carried out using stereological principles from three-dimensional reconstructed magnetic resonance images.

Subjects with schizophrenia had larger lateral ventricles than their relatives and the normal control subjects. Relatives who were ‘presumed obligate carriers' had larger left lateral ventricles than other relatives and the control subjects. Subjects with schizophrenia showed smaller whole brain and cerebellar volumes and larger lateral ventricles than their age–and gender-matched unaffected siblings.

In families multiply affected with schizophrenia lateral ventricular enlargement distinguishes people with schizophrenia and presumed obligate carriers from other relatives and unrelated control subjects. These changes may be a marker for a genetic liability to schizophrenia.

This paper presents 15-year outcome data on place of residence, clinical and social morbidity and carer distress in a cohort of 179 people with schizophrenia who were living with their families in 1981–1982

Data on morbidity and carer distress were derived from replicated patient and informant interviews using standardised research instruments. Details of residence came from patient and informant interviews corroborated by case note information.

Thirty-nine (22%) of the original 179 patients were dead and six (3%) lost to follow-up. Of the remaining 134 patients, 74 (55%) still lived with their families, 31 (23%) lived in institutional accommodation, 26 (19%) lived alone and 3 (2%) were homeless. There was little change in the level of clinical or social morbidity or carer distress.

These findings suggest that most people with schizophrenia who live with their families remain significantly disabled by their illness, while their carers suffer ongoing distress. Mental health services should seek to support families who want to care for relatives with schizophrenia. Appropriate alternative accommodation must be provided when family care is not possible.

It is reported that people with mild learning disability have a higher point prevalence of schizophrenia than the normal population, the reasons for which are unclear.

Thirty-nine subjects with mild learning disability and schizophrenia, 34 control subjects with schizophrenia and 28 control subjects with mild learning disability were seen. Interviews with relatives and carers were also conducted. Assessments were made of clinical variables, psychopathology, neurological ‘soft'signs, IQ, memory and family history. Blood was taken for karyotypic analysis from comorbid subjects.

The comorbid group had more negative symptoms, episodic memory deficits, soft neurological signs, epilepsy and receive more community supports than control subjects with schizophrenia. Comorbid subjects had a tendency to belong to multiply affected families and show high rates of chromosomal variants on routine karyotypic testing.

Future work on the generality of schizophrenia should include people with premorbid learning disability, as a discrete subtype from whom valuable genetic aetiological clues may be obtained.

Suicide rates have increased over the past three decades, especially in young men. Depression, conduct disorder, crime and substance misuse have also increased. This study tested hypotheses on the possible links between the secular increase in the rates of these behaviours.

A data set on 6091 subjects aged 8–18 years (58.4% boys) referred to psychiatric services over & 21-year period (1970–1990) was used. & detailed analysis of & random sample of 80 case notes was conducted.

Suicidal behaviours increased significantly among pubertal male adolescents only (n=1313). In this sub-sample, substance misuse accounted for the increase over time. The rates of both suicidal behaviours and of substance misuse almost doubled between 1979 and 1990 in this patient group. The case note analysis showed that solvent and alcohol misuse had also increased over the study period. Moreover, among the subjects misusing substances, alcohol was the only substance with & strong and positive association with suicidal behaviours. Substance misuse pre-dated suicidal behaviours in most patients.

A link has been found between the increase over time of suicidal behaviours in adolescent boys and & contemporaneous increase in substance misuse. The strength and direction of the association suggests that alcohol misuse is the causal factor.

The use of illegal drugs is seen as & major social problem. The social costs can be high.

Self-report data from interviews at intake to the National Treatment Outcome Research Study (NTORS) for 1075 drug users and cost data from various sources were used to estimate criminal behaviour and health and addiction service costs for & 12-month period. Multivariate statistical analysis was used to analyse cost variations.

Total costs for one year for the drug users amounted to over $12 million, the majority attributable to self-reported criminal behaviour. Social costs were positively related to & variety of factors including instability in living circumstances, amount of heroin used and whether or not drugs were taken intravenously.

The study clearly demonstrates the economic and social burden associated with heavy drug users and highlights the need for further investigations into the costs and benefits of policies that can reduce these social costs.

The National Treatment Outcome Research Study (NTORS) is the first large-scale, prospective, multi-site treatment outcome study of drug users in the UK.

Substance use, health and social problems of 1075 service users were assessed at intake to 54 agencies chosen to be representative of the main national drug treatment modalities.

Heroin dependence was the most frequently reported problem often with poly-drug and alcohol problems. Most service users injected drugs and & quarter of the injectors shared injecting equipment. Poly-drug use and heavy drinking were more common among service users admitted to residential treatments. High criminality rates were reported Psychological and physical health problems were common and many service users had prior contact with psychiatric and medical services.

The range and severity of problems adversely affect individual users, their families, and present & challenge to addiction treatment services. These problems create costs for the health care, social service and criminal justice system responses.

There is widespread scepticism concerning the reliability and validity of psychoanalytic judgements of patient–therapist transactions. We predicted that (a) in reviewing the initial part of 14 videotaped assessment interviews with borderline and dysthymic subjects, dynamic psychotherapists would agree in their ratings of psychoanalytically relevant characteristics of subjects' interpersonal relations; (b) inter-correlations among the ratings would conform with those expected from psychoanalytic descriptions of ‘paranoid-schizoid’ and ‘depressive position’ states of mind; and (c) these ratings would differentiate between borderline and dysthymic groups.

Six trained psychotherapists who were blind to the design of the study, independently rated qualities of interpersonal relatedness during the first 30 minutes of each interview, on & 30-item ‘personal relatedness profile’

There was satisfactory interrater reliability in judgements among the raters, and evidence that the items were interrelated. There was also & significant difference between the two subject groups.

It is possible to make reliable psychoanalytic judgements about qualities of interpersonal relatedness. Moreover, there is evidence that paranoid–schizoid and depressive positive aspects of psychological functioning do constitute & meaningful constellation of clinically grounded phenomena.