Little is known about the medium-term durability of cognitive–behavioural therapy (CBT) in a community sample of people with schizophrenia.

To investigate whether brief CBT produces clinically important outcomes in relation to recovery, symptom burden and readmission to hospital in people with schizophrenia at 1-year follow-up.

Participants (336 of 422 randomised at baseline) were followed up at a mean of 388 days (s.d. =53) by raters masked to treatment allocation (CBT or usual care).

At 1-year follow-up, participants who received CBT had significantly more insight (P=0.021) and significantly fewer negative symptoms (P=0.002). Brief therapy protected against depression with improving insight and against relapse; significantly reduced time spent in hospital for those who did relapse and delayed time to admission. It did not improve psychotic symptoms or occupational recovery, nor have a lasting effect on overall symptoms or depression at follow-up.

Mental health nurses should be trained in brief CBT for schizophrenia to supplement case management, family interventions and expert therapy for treatment resistance.

Religious participation or belief may predict better mental health but most research is American and measures of spirituality are often conflated with well-being.

To examine associations between a spiritual or religious understanding of life and psychiatric symptoms and diagnoses.

We analysed data collected from interviews with 7403 people who participated in the third National Psychiatric Morbidity Study in England.

Of the participants 35% had a religious understanding of life, 19% were spiritual but not religious and 46% were neither religious nor spiritual. Religious people were similar to those who were neither religious nor spiritual with regard to the prevalence of mental disorders, except that the former wereless likely to have ever used drugs (odds ratio (OR)=0.73, 95% CI 0.60-0.88) or be a hazardous drinker (OR=0.81, 95% CI 0.69-0.96). Spiritual people were more likely than those who were neither religious nor spiritual to have ever used (OR = 1.24, 95% CI 1.02-1.49) or be dependent on drugs (OR = 1.77, 95% CI 1.20-2.61), and to have abnormal eating attitudes (OR = 1.46, 95% Cl 1.10-1.94), generalised anxiety disorder (OR =1.50, 95% Cl 1.09-2.06), any phobia (OR = 1.72, 95% CI 1.07-2.77) or any neurotic disorder (OR = 1.37, 95% CI 1.12-1.68). They were also more likely to be taking psychotropic medication (OR = 1.40, 95% CI 1.05-1.86).

People who have a spiritual understanding of life in the absence of a religious framework are vulnerable to mental disorder.

The impact of comorbid personality disorder on the occurrence of violence in psychosis has not been fully explored.

To examine the association between comorbid personality disorder and violence in community-dwelling patients with psychosis.

A total of 670 patients with established psychotic illness were screened for comorbid personality disorder. Physical assault was measured from multiple data sources over the subsequent 2 years. Logistic regression was used to assess whether the presence of comorbid personality disorder predicted violence in the sample.

A total of 186 patients (28%) were rated as having a comorbid personality disorder. Patients with comorbid personality disorder were significantly more likely to behave violently over the 2-year period of the trial (adjusted odds ratio = 1.71, 95% CI 1.05–2.79).

Comorbid personality disorder is independently associated with an increased risk of violent behaviour in psychosis.

To date, no study has used standardised diagnostic assessment procedures to determine whether rates of perinatal depression vary across cultures.

To adapt the Structured Clinical Interview for DSM–IV Disorders (SCID) for assessing depression and other non-psychotic psychiatric illness perinatally and to pilot the instrument in different centres and cultures.

Assessments using the adapted SCID and the Edinburgh Postnatal Depression Scale were conducted during the third trimester of pregnancy and at 6 months postpartum with 296 women from ten sites in eight countries. Point prevalence rates during pregnancy and the postnatal period and adjusted 6-month period prevalence rates were computed for caseness, depression and major depression.

The third trimester and 6-month point prevalence rates for perinatal depression were 6.9% and 8.0%, respectively. Postnatal 6-month period prevalence rates for perinatal depression ranged from 2.1% to 31.6% across centres and there were significant differences in these rates between centres.

Study findings suggest that the SCID was successfully adapted for this context. Further research on determinants of differences inprevalence of depression across cultures isneeded.

Little is known about the proportion of psychiatric in-patients who lack capacity to make treatment decisions, or the associations of lack of capacity.

To determine the prevalence of psychiatric in-patients who lack capacity to make decisions about current treatment and to identify demographic and clinical associations with lack of mental capacity.

Patients (n=112) were interviewed soon after admission to hospital and a binary judgement of capacity was made, guided by the MacArthur Competence Tool for Treatment. Demographic and clinical information was collected from an interview and case notes.

Of the 112 participants, 49 (43.8%) lacked treatment-related decisional capacity Mania and psychosis, poor insight, delusions and Black and minority ethnic group were associated with mental incapacity. Of the 49 patients lacking capacity, 30 (61%) were detained under the Mental Health Act 1983. Of the 63 with capacity, 6 (9.5%) were detained.

Lack of treatment-related decisional capacity is a common but by no means inevitable correlate of admission to a psychiatric in-patient unit.

Research of military personnel who deployed to the conflicts in Iraq or Afghanistan has suggested that there are differences in mental health outcomes between UK and US military personnel.

To compare the prevalence of post-traumatic stress disorder (PTSD), hazardous alcohol consumption, aggressive behaviour and multiple physical symptoms in US and UK military personnel deployed to Iraq.

Data were from one US (n = 1560) and one UK (n = 313) study of post-deployment military health of army personnel who had deployed to Iraq during 2007–2008. Analyses were stratified by high- and low-combat exposure.

Significant differences in combat exposure and sociodemographics were observed between US and UK personnel; controlling for these variables accounted for the difference in prevalence of PTSD, but not in the total symptom level scores. Levels of hazardous alcohol consumption (low-combat exposure: odds ratio (OR) = 0.13, 95% CI 0.07–0.21; high-combat exposure: OR = 0.23, 95% CI 0.14–0.39) and aggression (low-combat exposure: OR = 0.36, 95% CI 0.19–0.68) were significantly lower in US compared with UK personnel. There was no difference in multiple physical symptoms.

Differences in self-reported combat exposures explain most of the differences in reported prevalence of PTSD. Adjusting for self-reported combat exposures and sociodemographics did not explain differences in hazardous alcohol consumption or aggression.

Literature and clinical experience suggest that some people experience atypical, complicated or pathological bereavement reactions in response to a major loss.

Three groups of community-based bereaved subjects – spouses (n=44), adult children (n=40), and parents (n=36) – were followed up four times in the 13 months after a loss. A 17-item scale of core bereavement times was developed and used to investigate the intensity of the bereavement response over time.

Cluster analysis revealed a pattern of bereavement-related symptoms approximating a syndrome of chronic grief in 11 (9.2%) of the 120 subjects. None of the respondents displayed a pattern consistent with delayed or absent grief.

In a non-clinical community sample of bereaved people, delayed or absent grief is infrequently seen, unlike chronic grief, which is demonstrated in a minority.

Many adults with Down's syndrome develop Alzheimer's dementia relatively early in their lives, but accurate clinical diagnosis remains difficult.

To develop a user-friendly observer-rated dementia screening questionnaire with strong psychometric properties for adults with intellectual disabilities.

We used qualitative methods to gather information from carers of people with Down's syndrome about the symptoms of dementia. This provided the items for the Dementia Screening Questionnaire for Individuals with Intellectual Disabilities (DSQIID), which we then tested for its psychometric properties.

The DSQIID was administered to carers of 193 adults with Down's syndrome, 117 of whom were examined by clinicians who confirmed a diagnosis of dementia for 49 according to modified ICD–10 criteria. We established that a total score of 20 provides maximum sensitivity (0.92) and optimum specificity (0.97) for screening. The DSQIID has sound internal consistency (α = 0.91) for all its 53 items, and good test–retest and interrater reliability. We established a good construct validity by dividing the items into four factors.

The DSQIID is a valid, reliable and user-friendly observer-rated questionnaire for screening for dementia among adults with Down's syndrome.

Studies of the impact of mental disorders on educational attainment are rare in both high-income and low- and middle-income (LAMI) countries.

To examine the association between early-onset mental disorder and subsequent termination of education.

Sixteen countries taking part in the World Health Organization World Mental Health Survey Initiative were surveyed with the Composite International Diagnostic Interview (n=41 688). Survival models were used to estimate associations between DSM–IV mental disorders and subsequent non-attainment of educational milestones.

In high-income countries, prior substance use disorders were associated with non-completion at all stages of education (OR 1.4–15.2). Anxiety disorders (OR=1.3), mood disorders (OR=1.4) and impulse control disorders (OR=2.2) were associated with early termination of secondary education. In LAMI countries, impulse control disorders (OR=1.3) and substance use disorders (OR=1.5) were associated with early termination of secondary education.

Onset of mental disorder and subsequent non-completion of education are consistently associated in both high-income and LAMI countries.

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.