The significant reductions in hospital admission demonstrated in US assertive community treatment (ACT) studies have not been replicated in the UK. Explanations cite poor UK ‘model fidelity’ and/or better UK standard care. No international model-fidelity comparisons exist.

To compare high-fidelity US ACT teams with a UK team.

The UK700's ACT team (n=97) was compared with high-fidelity US ACT teams (n=73) by using two measures: a forerunner of the Dartmouth Assertive Community Treatment schedule (to assess adherence to ACT principles) and 2-year prospective activity data.

The UK and US teams had similar high-fidelity scores. Although significant differences were found in the amount and type of activity, practice differences in areas central to ACT were not great.

The failure of UK ACT studies to demonstrate the outcome differences of early US studies cannot be attributed entirely to the lack of ACT fidelity.

In 1999 the UK received 4346 refugees from Kosovo.

To determine the prevalence of mental health problems in this group.

A sample of 842 adults was surveyed. All were asked to complete self-report questionnaires (translated into Kosovan Albanian). A subset of 120 participants were later interviewed in Albanian using the Clinician Administered PTSD (post-traumatic stress disorder) Scale and a depression interview.

The study yielded estimates of prevalence of PTSD and depression. Self-report measures appear to overestimate the prevalence of these disorders. Just under half of the group surveyed had a diagnosis of PTSD and less than one-fifth had a major depressive disorder.

These results may be taken as a sign of the resilience of many who survived this conflict but they also imply that there is still a substantial need for good health and social care in a significant proportion. Psychosocial interventions are likely to be an important part of the treatment programme.

It has been argued that post-traumatic stress disorder (PTSD) is a timeless condition, which existed before it was codified in modern diagnostic classifications but was described by different names such as ‘railway spine’ and ‘shellshock’. Others have suggested that PTSD is a novel presentation that has resulted from a modern interaction between trauma and culture.

To test whether one core symptom of PTSD, the flashback, has altered in prevalence over time in soldiers subjected to the intense stress of combat.

Random selections were made of UK servicemen who had fought in wars from 1854 onwards and who had been awarded war pensions for post-combat disorders. These were studied to evaluate the incidence of flashbacks in defined, at-risk populations.

The incidence of flash backs was significantly greater in the most recent cohort, veterans of the 1991 Persian Gulf War; flashbacks were conspicuous by their absence in ex-servicemen from the Boer War and the First and Second World Wars.

Although this study raises questions about changing interpretations of post-traumatic illness, it supports the hypothesis that some of the characteristics of PTSD are culture-bound. Earlier conflicts showed a greater emphasis on somatic symptoms.

Experiencing life-threatening events often contributes to the onset of such psychiatric conditions as post-traumatic stress disorder (PTSD). Children can develop PTSD; however, there is controversy over whether PTSD symptoms decrease or persist over time.

To examine the long-term effects of surviving the 1966 Aberfan disaster in childhood.

Survivors (n=41) were compared with controls (n=72) matched for age and background. All were interviewed using the Composite International Diagnostic Interview, measures of current health and social satisfaction, and the General Health Questionnaire. The survivor group also completed the Impact of Event Scale to assess current levels of PTSD.

Nineteen (46%; 95%CI 31–61) survivors had had PTSD at some point since the disaster, compared with 12 (20%; 95% CI 10–30) controls (OR=3.38 (95% CI 1.40–8.47)). Of the survivors, 12 (29%; 95% CI 15–43) met diagnostic criteria for current PTSD. Survivors were not at a significantly increased risk of anxiety, depression or substance misuse.

Trauma in childhood can lead to PTSD, and PTSD symptoms can persist for as long as 33 years into adult life. Rates of other psychopathological disorders are not necessarily raised after life-threatening childhood trauma.

Deliberate self-harm (DSH) is the strongest risk factor for future suicide. Up-to-date information on the extent of risk is lacking.

To investigate the risk of suicide after DSH during a long follow-up period.

A mortality follow-up study to 2000 was conducted on 11583 patients who presented to hospital after DSH between 1978 and 1997. Data were obtained from a general hospital DSH register in Oxford and the Office for National Statistics, and from equivalent mortality registers in Scotland and Northern Ireland.

Three hundred patients had died by suicide or probable suicide. The risk in the first year of follow-up was 0.7% (95% CI 0.6–0.9%), which was 66 (95% CI 52–82) times the annual risk of suicide in the general population. The risk after 5 years was 1.7%, at 10 years 2.4% and at 15 years 3.0%. The risk was far higher in men than in women (hazard ratio 2.8, 95% CI 2.2–3.6). In both genders it increased markedly with age at initial presentation.

Following DSH there is a significant and persistent risk of suicide, which varies markedly between genders and age groups. Reduction in the risk of suicide following DSH must be a key element in national suicide prevention strategies.

In the UK and The Netherlands, people with high rates of psychosis are chronically exposed to discrimination.

To test whether perceived discrimination is associated longitudinally with onset of psychosis.

A 3-year prospective study of cohorts with no history of psychosis and differential rates of reported discrimination on the basis of age, gender, disability, appearance, skin colour or ethnicity and sexual orientation was conducted in the Dutch general population (n=4076). The main outcome was onset of psychotic symptoms (delusions and hallucinations).

The rate of delusional ideation was 0.5% (n=19) in those who did not report discrimination, 0.9% (n=4) in those who reported discrimination in one domain, and 2.7% (n=3) in those who reported discrimination in more than one domain (exact P=0.027). This association remained after adjustment for possible confounders. No association was found between baseline discrimination and onset of hallucinatory experiences.

Perceived discrimination may induce delusional ideation and thus contribute to the high observed rates of psychotic disorder in exposed minority populations.

Age- and gender-specific suicide rates in England and Wales have changed considerably since 1950.

To assess whether cohort effects underlie some of these changes.

Graphical displays to assess age–period–cohort effects on suicide for the period 1950–1999.

Successive male birth cohorts born after 1940 carried with them, as they aged, a greater risk of suicide than their predecessors although this effect diminished for the 1975 and 1980 birth cohorts. There was less clear evidence of any increased risk of suicide in post-war female birth cohorts.

Succeeding generations of males born in the post-war years have experienced increasing rates of suicide at all ages, an observation in keeping with patterns seen in other countries. If these trends continue into middle- and old-age they will lead to a great increase in overall male suicide rates.

Clinicians claim that partners in a couple can be understood to share a mode of relating, at an unconscious level. Assessment of this depends on inference from observable data. This study tests the viability and reliability of a modification of the Personal Relatedness Profile (PRP) for this purpose.

To test the interrater reliability and construct validity of a joint PRP score for couples.

Seven therapists independently rated couples' interactions using the 30-item PRP and segments of videotaped interviews with 19 couples.

Interrater reliability was good and correlations between items clearly supported the underlying Kleinian bipolar model used (paranoid–schizoid/depressive positions).

Psychoanalytic couple psychotherapists agree in independent judgements of the nature of couple functioning, these judgements being based on envisaging couples in terms of an unconsciously shared state of mind.

The persistent and disabling nature of psychiatric stigma has led to the establishment of global programmes to challenge the negative stereotypes and discriminatory responses that generate social disability but these initiatives are rarely evaluated.

To assess the effectiveness of an intervention with young people aimed at increasing mental health literacy and challenging negative stereotypes associated with severe mental illness.

A total of 472 secondary school students attended two mental health awareness workshops and completed pre- and post-questionnaires detailing knowledge, attitudes and behavioural intentions.

Young people use an extensive vocabulary of 270 different words and phrases to describe people with mental health problems: most were derogatory terms. Mean positive attitude scores rose significantly from 1.2 at baseline to 2.8 at 1-week follow-up and 2.3 at a 6-month follow-up. Changes were most marked for female students and those reporting personal contact with people with mental illness.

Short educational workshops can produce positive changes in participants' reported attitudes towards people with mental health problems.

Although mild cognitive impairment is associated with an increased risk of developing dementia, there has been little work on its incidence and prevalence.

To report age-specific prevalence, incidence and predictive validities for four diagnostic concepts of mild cognitive impairment.

A community sample of 1045 dementia-free individuals aged 75 years and over was examined by neuropsychological testing in a three-wave longitudinal study.

Prevalence rates ranged from 3% to 20%, depending on the concept applied. The annual incidence rates applying different case definitions varied from 8 to 77 per 1000 person-years. Rates of conversion to dementia over 2.6 years ranged from 23% to 47%.

Mild cognitive impairment is frequent in older people. Prevalence, incidence and predictive validities are highly dependent on the diagnostic criteria applied.

Strong evidence exists for an association between childhood trauma, particularly childhood sexual abuse, and hallucinations in schizophrenia. Hallucinations are also well-documented symptoms in people with bipolar affective disorder.

To investigate the relationship between childhood sexual abuse and other childhood traumas and hallucinations in people with bipolar affective disorder.

A sample of 96 participants was drawn from the Medical Research Council multi-centre trial of cognitive–behavioural therapy for bipolar affective disorder. The trial therapists recorded spontaneous reports of childhood sexual abuse made during the course of therapy. Symptom data were collected by trained research assistants masked to the hypothesis.

A significant association was found between those reporting general trauma (n=38) and auditory hallucinations. A highly significant association was found between those reporting childhood sexual abuse (n=15) and auditory hallucinations.

The relationship between childhood sexual abuse and hallucinations in bipolar disorder warrants further investigation.

Suicide prevention strategies are usually formulated without seeking the views of people with psychiatric illnesses.

To establish what helped patients with severe psychiatric illness when they felt suicidal.

A semi-structured interview was constructed following transcribed interviews with 12 patients. This was administered to 59 out-patients with serious and enduring mental illness, focusing on factors they found helpful or unhelpful when at their most despairing.

Three-quarters of patients were in contact with psychiatric services when feeling at their lowest, and this contact was generally deemed to be helpful. Social networks were considered just as helpful as psychiatric services by the half of patients who discussed their feelings with friends or relatives. Religious beliefs and affiliations were helpful. Negative influences included the media and the stigma of psychiatric illness.

Efforts at suicide prevention might usefully focus on enhancing patients' social networks, increasing the likelihood of early contact with psychiatric services and decreasing the stigma attached to psychiatric illness. Larger studies of patients exposed to different service models would be informative.

There is no reliable and valid self-report measure of depressive symptoms for people with learning disabilities.

To develop a scale for individuals with learning disability, and a supplementary scale for carers.

Items were generated from a range of assessment scales and through focus groups. A draft scale was piloted and field tested using matched groups of people with or without depression, and their carers. The scale was also administered to a group without learning disabilities for criterion validation.

The Glasgow Depression Scale for people with a Learning Disability (GDS–LD) differentiated depression and non-depression groups, correlated with the Beck Depression Inventory – II (r=0.88), had good test – retest reliability (r=0.97) and internal consistency (Cronbach's α=0.90), and a cut-off score (13) yielded 96% sensitivity and 90% specificity. The Carer Supplement was also reliable (r=0.98; α=0.88), correlating with the GDS–LD (r=0.93).

Both scales appear useful for screening, monitoring progress and contributing to outcome appraisal.

Behavioural and anatomical studies in schizophrenia have pointed to cerebellar involvement.

To provide stereological estimations of volumes and cell number in the cerebella of people with schizophrenia and a control group using post-mortem material.

Stereological methods were applied to cerebella taken from eight male patients with a DSM–III diagnosis of chronic schizophrenia with no neurological disorder (mean age 57.5 years) and ten male controls (mean age 56.2 years). The Cavalieri principle was used to provide estimates of volumes, the optical disector method to obtain estimates of the numerical density of Purkinje and granule cells, and a combination of the two to obtain estimates of total cell numbers in the cerebellum. The rotator method was applied to obtain estimates of mean Purkinje cell volume.

No global structural difference in major volumes, cell numbers or Purkinje cell volume was found between the groups.

The most frequently reported pathological finding in the cerebellum in schizophrenia is vermal atrophy, which was not found in this small group of heavily affected patients.