Cingulate dysfunction has been reported in schizophrenia. Although the paracingulate sulcus (PCS) is known to be asymmetric in healthy people, little information is available about its morphology in schizophrenia.

To search for morphological anomalies of the PCS in men with early-onset schizophrenia.

The PCS was examined in magnetic resonance images of the brains of men with schizophrenia and 100 healthy men.

A significant asymmetry was found in the brains of healthy volunteers, whose sulci were more frequent and more marked in the left hemisphere. In contrast, the sulcus was as frequent in the right as in the left hemisphere in the patient group. Moreover, patients displayed significantly more rightward asymmetry, and overall less-asymmetrical patterns than the comparison group.

Since the PCS has developed at 36 weeks of gestation, these findings suggest an impaired maturation of the cingulate region during the third trimester.

That sexual dysfunction occurs in schizophrenia is not in doubt. Previous studies have had weaknesses such as the use of selected populations or the absence of a control group.

To measure rates of sexual dysfunction in people with schizophrenia compared with the general population.

Sexual dysfunction was assessed by a self-completed gender-specific questionnaire. Ninety-eight (73%) of 135 persons with schizophrenia and 81 (71%) of 114 persons recruited as controls returned the questionnaire.

At least one sexual dysfunction was reported by 82% of men and 96% of women with schizophrenia. Male patients reported less desire for sex, were less likely to achieve and maintain an erection, were more likely to ejaculate more quickly and were less satisfied with the intensity of their orgasms. Female patients reported less enjoyment than the control group. Sexual dysfunction in female patients was associated with negative schizophrenic symptoms and general psychopathology. There was no association between sexual dysfunction and type of antipsychotic medication.

People with schizophrenia report much higher rates of sexual dysfunction than do the general population. Men and women with schizophrenia have a different pattern of sexual dysfunction.

Polyuria is common in patients with bipolar disorder treated with lithium. However, the risk factors for polyuria in these patients have not been established.

To estimate the prevalence of polyuria associated with the use of lithium and to identify additional risk factors.

A 4-month prospective follow-up study in an out-patient lithium clinic. The 75 participants were asked to provide 24-h urine samples; polyuria was defined as a urine volume greater than 3 litres per 24 h. Risk factors examined included demographic variables, medications and medical comorbidities.

The prevalence of polyuria among lithium users was 37%. Concomitant use of serotonergic antidepressants was strongly associated with polyuria (odds ratio 4.25, 95% CI 1.15–15.68) compared with patients not using these agents.

Our data confirm the high prevalence of lithium-induced polyuria. Physicians should be aware that concurrent use of serotonergic antidepressants and lithium significantly enhances the risk of its occurrence. Although limited polyuria is not harmful, it may be troublesome for the patient. In many cases cessation of lithium therapy is not an option because of difficulty in controlling the manic or depressive symptoms.

Depersonalisation disorder is a poorly understood and underresearched syndrome.

To carry out a large and comprehensive clinical and psychopathological survey of a series of patients who made contact with a research clinic.

A total of 204 consecutive eligible referrals were included: 124 had a full psychiatric examination using items of the Present State Examination to define depersonalisation/derealisation and 80 had either a telephone interview (n=22) or filled out a number of self-report questionnaires. Cases assessed were diagnosed according to DSM–IV criteria.

The mean age of onset was 22.8 years; early onset was associated with greater severity There was a slight male preponderance. The disorder tended to be chronic and persistent. Seventy-one per cent met DSM–IV criteria for primary depersonalisation disorder. Depersonalisation symptom scores correlated with both anxiety and depression and a past history of these disorders was commonly reported. ‘Dissociative amnesia’ was not prominent.

Depersonalisation disorder is a recognisable clinical entity but appears to have significant comorbidity with anxiety and depression. Research into its aetiology and treatment is warranted.

Few double-blind trials have examined the efficacy of a combination of a mood stabiliser and an atypical antipsychotic in acute mania.

To determine the efficacy of risperidone in combination with a mood stabiliser in acute mania.

Patients taking a mood stabiliser were randomised to 3 weeks' treatment with risperidone (n=75) or placebo (n=76).

Young Mania Rating Scale (YMRS) scores improved rapidly with significantly greater reductions at week 1 in the risperidone group compared with the placebo group. At end-point YMRS scores decreased by 14.5 and 10.3 points in the risperidone and placebo groups, respectively. Significant improvements v. placebo (P < 0.05) were noted in the risperidone group on several other clinically meaningful measures. Additionally, a post hoc analysis excluding carbamazepine-treated patients (plasma concentrations of risperidone active moiety were 40% lower in this group) revealed significantly greater reductions (P=0.047) in YMRS scores in the risperidone group than in the placebo group. Incidence of adverse events was similar in both groups.

Risperidone is superior to placebo when used in combination with lithium or divalproex in acute mania.

Psychoactive substance use is strongly associated with psychiatric morbidity in both adults and adolescents.

To determine which of alcohol, nicotine and cannabis is most closely linked to psychiatric disorders in early adolescence.

Data from 2624 adolescents aged 13–15 years were drawn from a national mental health survey of children. The relationship between psychiatric morbidity and smoking, drinking and cannabis use was examined by logistic regression analyses.

Having a psychiatric disorder was associated with an increased risk of substance use. Greater involvement with any one substance increased the risk of other substance use. Analyses of the interactions between smoking, drinking and cannabis use indicated that the relationship between substance use and psychiatric morbidity was primarily explained by regular smoking and (to a lesser extent) regular cannabis use.

In this sample, links between substance use and psychiatric disorders were primarily accounted for by smoking. The strong relationship is likely to be due to a combination of underlying individual constitutional factors and drug-specific effects resulting from consumption over the period of adolescent development and growth.

The anterior cingulate cortex (ACC) is consistently implicated in the pathophysiology of schizophrenia, and our own work has identified morphological anomalies in the ACC of people with this disorder.

To examine whether ACC morphological anomalies are present in a group at ultra-high risk of psychosis and whether such anomalies can be used to predict the subsequent development of a psychotic illness.

Magnetic resonance imaging of 75 healthy volunteers and 63 people at ultra-high risk of developing a psychotic disorder (all right-handed males) was used to examine ACC sulcal and gyral features.

Compared with the controls, significantly fewer people in the ultra-high risk group had a well-developed left paracingulate sulcus and significantly more had an interrupted left cingulate sulcus. There was no difference between those who did (n=21) and did not (n=42) subsequently develop a psychotic illness.

Although ACC anomalies are present in young people considered to be at ultra-high risk of psychosis, they do not identify individuals who subsequently make the transition to psychosis.

Studies examining the effects of substance use in patients with schizophrenia have produced conflicting results.

To examine the effects of comorbid substance use on symptoms, social functioning and service use in patients with schizophrenia.

Patients (n=316) with and without substance use problems from three centres participating in the Scottish Comorbidity Study were compared, using research interviews and case note review, on measures of symptoms, social functioning and service use.

Patients with substance use problems were younger, more likely to be male and had shorter duration of illness. They had more police contact and increased self-reported needs, but otherwise showed few differences when compared with those without such problems.

The presence of problem substance use had only modest impact on service use, symptoms or social functioning for this group of patients with schizophrenia. This has important implications for service development to meet the perceived needs of this group.

Bibliometric research has used publication or funding databases to compare the amount of research activity on different illnesses. Only one study has examined bipolar disorder and schizophrenia in this way, and it was restricted to one database.

The primary aim is to compare levels of research activity in bipolar disorder and schizophrenia. Secondary aims are to examine how research activity on the disorders varies over time and across scientific fields.

The numbers of publications, projects, journals and funding awards on bipolar disorder and schizophrenia were extracted from nine computer databases to compare research activity on the two conditions.

Ratios (bipolar disorder: schizophrenia) ranged from 1:1.3 for the number of research funding awards to 1:7.6 for the number of clinical trials.

There is a relative dearth of research activity on bipolar disorder compared with schizophrenia.

There are no community services for the majority of the estimated 10 million persons with schizophrenia in India. Community-based rehabilitation (CBR) is a model of care which has been widely used for physical disabilities in resource-poor settings.

To compare CBR with out-patient care (OPC) for schizophrenia in a resource-poor setting in India.

A longitudinal study of outcome in patients with chronic schizophrenia contrasted CBR with OPC. Outcome measures were assessed using the Positive and Negative Symptom Scale and the modified WHO Disability Assessment Schedule at 12 months.

Altogether, 207 participants entered the study, 127 in the CBR group and 80 in the OPC group. Among the 117 fully compliant participants the CBR model was more effective in reducing disability, especially in men. Within the CBR group, compliant participants had significantly better outcomes compared with partially compliant or non-complaint participants (P<0.001). Although the subjects in the CBR group were more socially disadvantaged, they had significantly better retention in treatment.

The CBR model is a feasible model of care for chronic schizophrenia in resource-poor settings.

Seasonal affective disorder (SAD) is now a well-described form of depressive disorder. However, relatively little research has focused upon psychosocial factors and SAD.

To determine the association between demographic/psychosocial factors and increased reported seasonal patterns of mood disorder (seasonality) and SAD in a community sample in the UK.

A total of 1250 people, aged between 18 and 64 years, randomly selected from a primary care database were screened for SAD. Those above cut-off underwent diagnostic interview and completed several self-report questionnaires. Multivariate analysis was conducted to determine which variables were significantly associated with increased seasonality.

Four factors (having experienced more numerous negative life events, having low levels of social support, being a woman and being non-native) were predictive of higher seasonality Being a woman was predictive of being diagnosed as a case of SAD.

A new association has been identified between increased seasonality, negative life events and social support. Future research should assess the psychosocial causes or consequences of SAD while continuing to examine the biology of the condition.

The 20th century ended without a resolution of the debate about the supremacy of Schneider's psychopathological conceptualisation of schizophrenia (the first-rank symptoms) over Bleuler's ‘four As' (disorders of association and affect, ambivalence and autism).

To examine the relationships between linguistic deviations and symptoms in patients with acute psychosis.

We assessed language disturbances and first-rank symptoms with the Clinical Language Disorder Rating Scale (CLANG) in 30 consecutive patients with acute psychosis, selected for the presence of at least one active first-rank symptom, and 15 control participants with depression but no psychotic symptoms.

Strong positive correlations were found between the CLANG factor ‘poverty’ (of speech) and first-rank delusions of control and (‘delusional perceptions’) between semantic/phonemic paraphasias and verbal auditory hallucinations. Language disturbances were superior to nuclear symptoms in discriminating ICD–10 schizophrenia from other psychoses.

Evaluating the features of psychosis as deviations in the cerebral organisation of language paves the way to a concept of psychosis that supersedes these traditional but competing categorical concepts.

Dependence increases the likelihood of adverse consequences of cannabis use, but its aetiology is poorly understood.

To examine adolescent precursors of young-adult cannabis dependence.

Putative risk factors were measured in a representative sample (n=2032) of secondary students in the State of Victoria, Australia, six times between 1992 and 1995. Cannabis dependence was assessed in 1998, at age 20–21 years.

Of 1601 young adults, 115 met criteria for cannabis dependence. Male gender (OR=2.6, P < 0.01), regular cannabis use (weekly: OR=4.9; daily: OR=4.6, P=0.02), persistent antisocial behaviour (linear effect P=0.03) and persistent cigarette smoking (linear effect P=0.02) independently predicted cannabis dependence. Neither smoking severity (P=0.83) nor persistent psychiatric morbidity (linear effect P=0.26) independently predicted dependence. Regular cannabis use increased risk only in the absence of persistent problematic alcohol use.

Weekly cannabis use marks a threshold for increased risk of later dependence, with selection of cannabis in preference to alcohol possibly indicating an early addiction process.

In 1986 the British Journal of Psychiatry published a study of physicians' and surgeons' management of psychological problems, later cited as evidence of barriers limiting liaison psychiatry.

To repeat the study after 16 years of liaison psychiatry.

Anonymous, confidential questionnaires were distributed to doctors at St George's Hospital, London, replicating the original study.

Most of the 225 respondents believed that psychological factors could influence physical prognosis and should be routinely assessed, with greater sense of responsibility for overdoses and dying patients. Most respondents found emotional assessment impractical. Although 78% wanted more psychiatric input, referrals were avoided because of ‘stigmatisation’. Men were more likely than women to hold pejorative views, but outcomes no longer varied with seniority or speciality.

Compared with 1986, hospital doctors appear more aware of the psychological needs of patients.

Little is known of the needs of elderly patients with psychotic illnesses.

To measure the care needs of an epidemiologically based group of patients over the age of 65 years suffering from psychotic illness, using a standardised assessment.

All patients aged 65 years and over with a diagnosis of schizophrenia and related disorders from a defined catchment area were identified. Their health and social care needs were investigated using the Cardinal Needs Schedule.

The 1-year prevalence of schizophrenia and related disorders was 4.44 per 1000 of the population at risk. There were high levels of unmet need for many patients, including those in National Health Service (NHS) continuing-care beds.

Many needs were identified, all of which could be addressed using the existing skills of local health and social care professionals. The investigation raises serious concerns about standards of hospital and community care for elderly patients with schizophrenia. The findings may be unique, reflecting long-standing problems within a particularly hard-pressed part of the NHS. However, it is not known whether a similar situation exists in other parts of the UK.

There has been little research into the health of infants of women with psychotic disorders.

To investigate the antenatal care of mothers with a history of psychotic disorders, obstetric outcomes and the subsequent health of their babies.

A matched, controlled cohort study was carried out using the General Practice Research Database. Women with a history of a psychotic disorder, who gave birth in 1996–1998, were compared with women matched for age and general practice (199 cases and 787 controls) and their infants.

Cases had a higher proportion of stillbirths (OR=4.03, 95% CI 1.14–4.25, P=0.03) and neonatal deaths (P<0.001). There was no difference in gestational age at antenatal booking. Mothers with psychotic disorders were less likely than controls to attend for infant immunisations 90–270 days after birth (RR=0.94, 95% CI 0.88–0.99, P=0.03). There was no significant difference in the rates of accidents and hospital contacts for infants.

There is an increased risk of stillbirth and neonatal death in women with a history of psychotic disorder, and it is therefore important for health care professionals to focus on optimal obstetric care. The physical health of babies who live with mothers with psychotic disorders is not significantly different from that of matched baby controls.

There is growing evidence that schizophrenia is a disorder of cortical connectivity Specifically, frontotemporal and frontoparietal connections are thought to be functionally impaired. Diffusion tensor magnetic resonance imaging (DT–MRI) is a technique that has the potential to demonstrate structural disconnectivity in schizophrenia.

To investigate the structural integrity of frontotemporal and frontoparietal white matter tracts in schizophrenia.

Thirty patients with DSM–IV schizophrenia and thirty matched control subjects underwent DT–MRI and structural MRI. Fractional anisotropy – an index of the integrity of white matter tracts – was determined in the uncinate fasciculus, the anterior cingulum and the arcuate fasciculus and analysed using voxel-based morphometry.

There was reduced fractional anisotropy in the left uncinate fasciculus and left arcuate fasciculus in patients with schizophrenia compared with controls.

The findings of reduced white matter tract integrity in the left uncinate fasciculus and left arcuate fasciculus suggest that there is frontotemporal and frontoparietal structural disconnectivity in schizophrenia.

The neurocognitive basis of auditory hallucinations is unclear, but there is increasing evidence implicating abnormalities in processing inner speech. Previous studies have shown that people with schizophrenia who were prone to auditory hallucinations demonstrated attenuated activation of brain areas during the monitoring of inner speech.

To investigate whether the same pattern of functional abnormalities would be evident as the rate of inner speech production was varied.

Eight people with schizophrenia who had a history of prominent auditory hallucinations and eight control participants were studied using functional magnetic resonance imaging while the rate of inner speech generation was varied experimentally.

When the rate of inner speech generation was increased, the participants with schizophrenia showed a relatively attenuated response in the right temporal, parietal, parahippocampal and cerebellar cortex.

In people with schizophrenia who are prone to auditory hallucinations, increasing the demands on the processing of inner speech is associated with attenuated engagement of the brain areas implicated in verbal self-monitoring.

The Ministry of Defence has its own hospital for soldiers requiring admission for mental health problems.

To assess the efficiency of the army psychiatric hospital at restoring patients to full active duty. To assess whether a new military training and rehabilitation unit (MTRU) that emphasises military-skills training, improves outcome.

A 2-year, inception-cohort outcome study of hospital in-patients. A 12-month, case-matched, ‘before and after’ outcome study compared MTRU patients with hospital in-patients.

I (hospital in-patients, n=309): at 2-year follow-up 67 (22%) were fully fit for active duty Military psychiatrists' success rate at predicting recovery to active duty was 27%. 2: the odds of a soldier in the MTRU cohort (n=35) returning to active duty were 14 times greater than for the hospital cohort (n=35). The odds of remaining in the army while unfit for active duty were 20 times less for the MTRU than for the hospital cohort.

The army hospital is inefficient at rehabilitation to active duty. The MTRU significantly increased the odds of returning to active duty and reduced the odds of remaining in the army while still unfit. These findings may be applicable to the emergency services.

Data collected by the Department of Health show a continuing increase in the rate of formal detention in hospital under Part II of the Mental Health Act 1983.

To establish whether the increase in formal detentions is uniform across subgroups of the population.

Data related to use of Part II of the Act between 1991 and 1997 collected by seven English local authorities were examined. Rates of compulsory admission were standardised to age, gender and ethnicity-specific populations.

Over the 8-year period the overall rate of detention under Part II increased by 32%. It increased in all three major ethnic groupings; the rate of increase was greater for men than for women (38% v. 26%) and, in particular, for younger men compared with younger women (43% v. 28%).

A combination of factors probably accounts for these findings, including service factors (particularly reduction in bed numbers), a culture of risk aversion, and changes in the effect of substance misuse on the presentation of mental illness.