Although there is a consensus that clozapine is more effective than conventional antipsychotic drugs for treatment-resistant schizophrenia, there is great heterogeneity among results of relevant trials.

To re-evaluate the evidence comparing clozapine with conventional antipsychotics and to investigate sources of heterogeneity.

Individual studies were inspected with assessment of clinical relevance of results. Meta-regression analysis was performed to investigate sources of heterogeneity.

Ten trials were examined. Recent large-scale studies have not found a substantial advantage for clozapine, especially in terms of a clinically relevant effect. Meta-regression showed that shorter study duration, financial support from a drug company and higher baseline symptom score consistently predicted greater advantage of clozapine.

It may be inappropriate to combine studies in meta-analysis, given the degree of heterogeneity between their findings. The benefits of clozapine compared with conventional treatment may not be substantial.

There is evidence that psychopathology in mothers may be associated with dysfunctional mother–infant interactions.

To investigate mother–infant relations when mothers have borderline personality disorder.

Eight mothers with borderline personality disorder and twelve mothers without psychiatric disorder were videotaped interacting with their 2-month-old infants in three successive phases of interaction: face-to-face play; an episode when the mother adopted a ‘still face’ and was unreactive; and a period when play interactions were resumed. The videotapes were rated by judges blind to the diagnostic group of the mother.

The mothers with borderline personality disorder were more intrusively insensitive towards their infants. During the still-face period, their infants showed increased looking away and dazed looks. Following this, mother–infant interactions were less satisfying and their infants showed dazed looks and lowering of affect.

The diagnosis of borderline personality disorder is associated with a particular pattern of mother–infant interaction. The infants' responses to the still-face challenge might suggest dysfunctional self-regulation, but the developmental significance remains to be assessed.

A recent Cochrane review of reality orientation therapy identified the need for large, well-designed, multi-centre trials.

To test the hypothesis that cognitive stimulation therapy (CST) for older people with dementia would benefit cognition and quality of life.

A single-blind, multi-centre, randomised controlled trial recruited 201 older people with dementia. The main outcome measures were change in cognitive function and quality of life. An intention-to-treat analysis used analysis of covariance to control for potential variability in baseline measures.

One hundred and fifteen people were randomised within centres to the intervention group and 86 to the control group. At follow-up the intervention group had significantly improved relative to the control group on the Mini-Mental State Examination (P=0.044), the Alzheimer's Disease Assessment Scale – Cognition (ADAS–Cog) (P=0.014) and Quality of Life – Alzheimer's Disease scales (P=0.028). Using criteria of 4 points or more improvement on the ADAS–Cog the number needed to treat was 6 for the intervention group.

The results compare favourably with trials of drugs for dementia. CST groups may have worthwhile benefits for many people with dementia.

Childhood sexual abuse is a non-specific risk factor for psychopathological disorders in childhood and later life. The response of non-abusing parents to disclosure of abuse may influence the child's outcome.

To assess the level of psychopathological symptoms in parents and children following disclosure of sexual abuse and the changes following a parental treatment intervention.

Parents completed standardised rating scales about their own and their child's symptoms. These were repeated following the intervention.

Thirty-nine parents of 31 children completed scales at the baseline assessment; 18 repeated these following interventions. Initially, parents reported high rates of psychopathological symptoms in themselves and their children, which were reduced following the intervention.

This study confirms the high rates of psychopathological symptoms found in parents of children following disclosure of sexual abuse. Children clinically identified for intervention had higher measured levels of psychopathological symptoms. Targeted treatment interventions are needed.

The association between sexual abuse, mental health and behavioural problems in people with learning disabilities has not previously been examined in a controlled study.

To identify symptoms of psychological disturbance in adults with and without a confirmed history of sexual abuse.

The study used a matched (1:1) case–control design comparing 54 adults who had experienced sexual abuse with 54 adults with no reported history of abuse. The two groups were selected from a community population of adults with learning disabilities living in residential care, and compared for selected psychiatric diagnoses and for scores on measures of disturbed behaviour.

Sexual abuse was associated with increased rates of mental illness and behavioural problems, and with symptoms of post-traumatic stress. Psychological reactions to abuse were similar to those observed in the general population, but with the addition of stereotypical behaviour. The more serious the abuse, the more severe the symptoms that were reported.

The study provides the first evidence from a controlled study that sexual abuse is associated with a higher incidence of psychiatric and behavioural disorder in people with learning disabilities.

Traditional healers provide a popular and accessible service across the African continent. Little is known of the characteristics or mental health status of those using these services.

To determine and compare the prevalence of common mental disorder among, and the characteristics of, those attending primary health care clinics (PHCs) and traditional healer centres (THCs) in Dar-es-Salaam.

The Clinical Interview Schedule – Revised was used to determine the prevalence of mental disorders in 178 patients from PHCs and 176 from THCs, aged 16–65 years.

The prevalence of common mental disorders among THC patients (48%) was double that of PHC patients (24%). Being older, Christian, better educated, and divorced, separated or widowed were independently associated with THC attendance. None of these factors explained the excess of mental disorder among THC attenders.

The high prevalence of mental disorders among THC attenders may reflect the failure of primary health care services adequately to detect and treat these common and disabling disorders. Traditional healers should be involved in planning comprehensive mental health care.

In a previous report a step-down psychosocial programme for severe personality disorders was found to be more effective at expected termination of treatment than a longer in-patient treatment with no planned after-care.

To evaluate the clinical effectiveness of these two psychosocial specialist programmes over a 3-year follow-up period.

Two samples allocated to the in-patienttreatment and to the step-down programme were compared prospectively on symptom severity, social adjustment, global assessment of mental health and other clinical indicators at 6, 12, 24 and 36 months after intake.

Improvements were significantly greater in the step-down programme for social adjustment and global assessment of mental health. Patientsin the programme were found to self-mutilate, attempt suicide and be readmitted significantly less at 24- and 36-month follow-up than patients in the in-patient group.

Improvements associated with specialist residential treatment continued 2 years after discharge. A step-down model has significant advantages over a purely in-patient model.

Above-average levels of psychopathology have been demonstrated convincingly in groups of outstanding individuals working in the arts. Currently, jazz musicians have not been studied in this regard.

To investigate any evidence of psychopathology in a group of eminent jazz musicians.

Biographical material relating to 40 eminent American modern jazz musicians was reviewed and an attempt was made to formulate diagnoses using DSM–IV.

Evidence was provided of levels of psychopathology in the sample of jazz musicians similar to those found in other previously investigated creative groups, with the exception of substance-related problems. An interesting connection between creativity and sensation-seeking was highlighted.

The link between psychopathology and creativity in the arts was given further weight. Future studies of jazz musicians using larger samples and making comparison with groups from different eras of music would give greater clarification to this area.