Much of China lacks well-developed services for people with schizophrenia and their families, and most of the existing services focus on hospitals. There is a need for culturally sensitive family treatments offered by nurses.

To conduct a longitudinal experimental study examining the effect of patient and family education in a sample of Chinese people with schizophrenia.

A randomised controlled trial was conducted in a large hospital with a sample of 101 patients with schizophrenia and their families. Data were collected at admission and at discharge, and then at 3 and 9 months after discharge. The intervention group received family education, and data on their knowledge about schizophrenia, symptoms, functioning, psychosocial behaviour, relapse and medication adherence were collected and compared with the control group.

There was a significant improvement in knowledge about schizophrenia in the experimental group and a significant difference in symptom scores and functioning at 9 months after discharge. Patients who were non-adherent to medication regimens were more likely to relapse.

Family education on schizophrenia by nurses in China was effective in improving knowledge and promoting improvement in patients' symptoms.

Patient-rated unmet need is cross-sectionally associated with quality of life. Its longitudinal relationship has not been established.

To test the hypotheses that: (a) higher patient-rated unmet need is associated with lower individual quality of life assessments by apatientover time; and (b) reduction in patient-rated unmet need precedes improvement in quality of life.

One hundred and one individuals using adult mental health services were asked to complete 6-monthly questionnaires, comprising quality of life (Manchester Short Assessment of Quality of Life, MANSA) and unmet need (Camberwell Assessment of Need Short Appraisal Schedule, CANSAS) assessments.

Seventy-three participants provided 240 separate pairs of consecutive assessments. Random effects regression models indicated an impact on current quality of life for both average level of unmet need (B= −0.23, 95% CI −0.29 to −0.17) and change in unmet need over the past month (B= −0.04, 95% CI −0.02).

Changes in patient-rated unmet needs may cause changes in quality of life.

Longitudinal studies have been inconclusive in identifying alcohol as a risk factor for anxiety and depression.

To examine whether excessive alcohol consumption is a risk factor for anxiety and depression in the general population, and whether anxiety and depression are risk factors for excessive alcohol consumption.

Data were analysed from the 18-month follow-up of the Psychiatric Morbidity Among Adults Living in Private Households, 2000 survey.

Hazardous and dependent drinking were not associated with onset of anxiety and depression at follow-up. Binge-drinking was non-significantly associated with incident anxiety and depression (adjusted OR= 1.36, 95% CI 0.74–2.50). Abstainers were less likely to have new-onset anxiety and depression at follow-up. Anxiety and depression or sub-threshold symptoms at baseline were not associated with incident hazardous or binge-drinking at follow-up, but there was weak evidence linking sub-threshold symptoms with onset of alcohol dependence (adjusted OR=2.04, 95% CI 0.84–4.97).

Excessive alcohol consumption was not associated with the onset of anxiety and depression but abstinence was associated with a lower risk. Sub-threshold symptoms were weakly associated with new-onset alcohol dependence.

Caring for someone with anorexia nervosa is distressing.

To gain a detailed understanding of carers' illness models and caregiving experiences.

Qualitative analysis and computerised text analysis were conducted on narratives written by parents as part of a family intervention at a specialist in-patient unit (20 mothers, 20 fathers)

Themes concerned illness perceptions, impact on the family and carers' emotional, cognitive and behavioural responses towards the illness. Parents perceived anorexia nervosa to be chronic and disabling. Carers blamed themselves as contributing to the illness and perceived themselves as helpless in promoting recovery. Mothers illustrated an intense emotional response, whereas fathers produced a more cognitive and detached account.

Part of the distress in living with anorexia nervosa may be explained by unhelpful assumptions and maladaptive responses to the illness. Training parents in skills to manage the illness may improve outcome by reducing interpersonal maintaining factors.

Most studies of mortality in psychiatric patients have investigated inpatients rather than those attending outpatient clinics or primary care, where most receive treatment.

To evaluate the mortality risk in mental illness for patients in contact with psychiatric services or primary care (n=221 048) across Nova Scotia (population 936 025).

A population-based record-linkage analysis was made of the period 1995–2000, using an inception cohortto calculate mortality rate ratios.

The mortality rate was 1.74, with increased ratios for all major causes of death. Male mortality was almost double that of females after controlling for demographic factors, treatment setting and place of residence. Patients of lower income, in specialist psychiatric settings, and with dementia or psychoses were also at greater risk. However, in absolute numbers, 72% of deaths occurred in patients who had only seen their general practitioner.

Mortality risk is increased in all psychiatric patients, not just those who have received in-patient treatment.

There is substantial evidence that maternal smoking during pregnancy is associated with both antisocial behaviour and symptoms of attention-deficit hyperactivity disorder (ADHD) in offspring. However, it is not clear whether maternal smoking during pregnancy is independently associated with antisocial behaviour or whether the association arises because antisocial behaviour and ADHD covary.

To examine the relationship between maternal smoking during pregnancy, antisocial behaviour and ADHD in offspring.

Questionnaires concerning behaviour and environmental factors were sent to twins from the CaStANET study and data analysed using a number of bivariate structural equation models.

Maternal prenatal smoking contributed small but significant amounts to the variance of ADHD and of antisocial behaviour. The best fitting bivariate model was one in which maternal prenatal smoking had a specific influence on each phenotype, independent of the effect on the other phenotype.

Both antisocial behaviour and ADHD symptoms in offspring are independently influenced by maternal prenatal smoking during pregnancy.

People with schizophrenia make poor dietary choices.

To measure the impact of giving free fruit and vegetables for 6 months on eating habits in schizophrenia.

We randomly allocated 102 people with schizophrenia in two areas of Scotland to receive free fruit and vegetables for 6 months, supported by instruction in meal planning and food preparation; free fruit and vegetables alone; or to continue as before. Diet was assessed using the Scottish Health Survey questionnaire. Blood samples to measure micronutrients were taken and mental state, body mass index, level of physical activity and future risk of coronary heart disease (CHD) were assessed.

After the intervention, those who received free fruit and vegetables, or free fruit and vegetables and associated instruction, were consuming significantly more fruit and vegetables than those in the treatment as usual group. Consumption fell to pre-intervention levels 12 months after the intervention stopped. There was no between-group difference at any time in blood micronutrients, body mass index, physical activity or risk of CHD.

The diet of people with schizophrenia improved when they were given free fruit and vegetables but this was not sustained after withdrawal of the intervention. A support programme added no benefit.

Schizophrenia is associated with widespread cognitive deficits that have an impact on social function. Modafinil promotes wakefulness and is reported to enhance cognition.

To study the acute effects of modafinil administration upon brain activity and cognitive performance in people with chronic schizophrenia.

In a randomised double-blind placebo-controlled crossover design, 19 patients received either modafinil (100 mg) or placebo prior to undertaking a working memory task with functional magnetic resonance imaging.

Seventeen patients completed the study and another underwent acute relapse 4 days post-drug. Modafinil administration was associated with significantly greater activation in the anterior cingulate cortex during the working memory task. The anterior cingulate cortex signal correlated with cognitive performance, although only a subset of patients exhibited ‘enhancement’.

Modafinil modulates anterior cingulate cortex function in chronic schizophrenia but its beneficial cognitive effects may be restricted to a subset of patients requiring further characterisation.

Reliable, valid and easily administered screening instruments would greatly facilitate large-scale neuropsychiatric research.

To test a parent telephone interview focused on autism-tics, attention-deficit hyperactivity disorder (ADHD) and other comorbidities (A-TAC).

Parents of 84 children in contact with a child neuropsychiatric clinic and 27 control children were interviewed. Validity and interrater and test–retest reliability were assessed.

Interrater and test–retest reliability were very good. Areas under receiver operating characteristics curves between interview scores and clinical diagnoses were around 0. 90 for ADHD and autistic spectrum disorders, and above 0. 70 for tics, learning disorders and developmental coordination disorder. Using optimal cut-off scores for autistic spectrum disorder and ADHD, good to excellent kappa levels for interviews and clinical diagnoses were noted.

The A–TAC appears to be a reliable and valid instrument for identifying autistic spectrum disorder, ADHD, tics, learning disorders and developmental coordination disorder.

An increased focus in research specific to first-episode schizophrenia has provided a rapidly growing body of evidence that can be directly translated to clinical practice.

To provide clinical recommendations specific to effective pharmacotherapy of first-episode schizophrenia.

Evidence from clinical trials focused on the first-episode population is combined with data from other areas of investigation.

In first-episode psychosis, when to initiate treatment is not always clear, being intimately linked to challenges regarding early detection and diagnosis. There may be differences in antipsychotic dosing, patterns of response and sensitivity to side-effects. Adherence appears to be even more problematic at this stage.

Clinicians currently treating early psychosis have considerably more information to guide their decision-making. However, the speed at which the field is growing is a reminder totreatthis knowledge as a work in progress.

Reality orientation therapy combined with cholinesterase inhibitors has not been evaluated in patients with Alzheimer's disease.

To perform such an evaluation.

We randomly assigned 79 of 156 patients treated with donepezil to receive a reality orientation programme. Caregivers of the treatment group were trained to offer the programme at home 3 days a week, 30 min/day for 25 consecutive weeks, and were invited to stimulate and involve patients in reality-based communication.

The treatment group showed a slight improvement in Mini-Mental State Examination (MMSE) scores (mean change + 0.2, s.e. = 0.4) compared with a decline in the control group (mean change −1.1, s.e. =0.4; P=0.02). Similarly for the Alzheimer's Disease Assessment Scale – Cognition (treatment group mean change +0.4, s.e.=0.8; control group –2.5, s.e.=0.8; P = 0.01). The intervention had an equal effect on cognition in those with mild (MMSE score ⩾20) and moderate (score < 20) dementia. No significant effect was observed for behavioural and functional outcomes.

Reality orientation enhances the effects of donepezil on cognition in Alzheimer's disease.

Venlafaxine extended-release (ER) has proven efficacy in the treatment of anxiety symptoms in major depression, generalised anxiety disorder and social anxiety disorder.

To evaluate the efficacy, safety and tolerability of venlafaxine ER in treating panic disorder.

Adult out-patients (n=361) with panic disorder were randomly assigned to receive venlafaxine ER (75–225 mg/day) or placebo for up to 10 weeks in a double-blind study.

Venlafaxine ER was not associated with a greater proportion of patients free from full-symptom panic attacks at the finalon-therapy evaluation, but was associated with lower mean panic attack frequency and a higher proportion free from limited-symptom panic attacks, higher response and remission rates, and improvements in anticipatory anxiety, fear and avoidance. Adverse events were comparable with those of the drug in depression and anxiety disorders.

Venlafaxine ER seems to be effective and well tolerated in the short-term treatment of panic disorder.

Bipolar disorder has been ranked seventh among the worldwide causes of non-fatal disease burden.

To estimate the cost-effectiveness of interventions for reducing the global burden of bipolar disorder.

Hospital-and community-based delivery of two generic mood stabilisers (lithium and valproic acid), alone and in combination with psychosocial treatment, were modelled for 14 global sub-regions. A population model was employed to estimate the impact of different strategies, relative to no intervention. Total costs (in international dollars (I$)) and effectiveness (disability-adjusted life years (DALYs) averted) were combined to form cost-effectiveness ratios.

Baseline results showed lithium to be no more costly yet more effective than valproic acid, assuming an anti-suicidal effect for lithium but not for valproic acid. Community-based treatment with lithium and psychosocial care was most cost-effective (cost per DALY averted: I$2165–6475 in developing sub-regions; I$5487–21123 in developed sub-regions).

Community-based interventions for bipolar disorder were estimated to be more efficient than hospital-based services, each DALY averted costing between one and three times average gross national income.

Domestic spousal violence against women has far-reaching mental health implications.

To determine the association of domestic spousal violence with poor mental health.

In a household survey of rural, urban non-slum and urban slum areas from seven sites in India, the population of women aged 15–49 years was sampled using probability proportionate to size. The Self Report Questionnaire was used to assess mental health status and a structured questionnaire elicited spousal experiences of violence.

Of 9938 women surveyed, 40% reported poor mental health. Logistic regression showed that women reporting ‘any violence’ – ‘slap’, ‘hit’, ‘kick’ or ‘beat’ (OR 2.2, 95% CI 2.0–2.5) – or ‘all violence’ – all of the four types of physically violent behaviour (OR 3.5, 95% CI 2.94–3.51) – were at increased risk of poor mental health.

Findings indicate a strong association between domestic spousal violence and poor mental health, and underscore the need for appropriate interventions.

There are few studies of mental ill health among young people in developing countries.

To measure the prevalence of common mental disorders among low-income young people in the city of Cali, Colombia and to examine associations with violence and social capital.

The Self-Reporting Questionnaire was administered to 1057 young people aged 15–25 years. Social capital, violence, alcoholism and socio-demographic variables were also measured.

We found 255 young people (24%) with common mental disorders. Being a woman, having limited education and experiencing high levels of violence were the main risk factors for common mental disorders. Social capital did not emerge as a risk factor.

A large burden of mental ill health among young people was found; this requires urgent interventions and more research on the mechanisms which link mental health and violence.

There is some evidence that early sexual abuse is an aetiological factor for eating disorder. However, there is sparse information from large-scale, non-clinical studies.

This study was designed to explore which early experiences, recalled during pregnancy, were associated with both lifetime and antenatal eating disorder symptoms in a community sample.

Univariate and multivariate analyses were conducted of data from questionnaires administered during pregnancy to a community sample of pregnant women.

Recall of parental mental health problems and of early unwanted sexual experiences were independently associated with both lifetime eating problems, laxative use and vomiting during pregnancy, and marked concern during pregnancy over shape and weight.

There are public health implications for these results. Eating disorders in mothers represent a risk for child development. It may be important to enquire during pregnancy about a history of eating problems and to provide the opportunity for early experiences to be discussed.

There is a lack of community-based studies on prevalence rates of stalking and the impact of stalking on victims in European countries.

To examine lifetime and point prevalence rates of stalking, behavioural and psychological consequences for victims, and the impact of stalking on current psychological well-being in a German community sample.

A postal survey was conducted with a sample randomly selected from the population of a middle-sized German city; 679 people (400 women, 279 men) responded. The survey included a stalking questionnaire and the WHO–5 well-being scale.

Almost 12% of the respondents (n=78, 68 women, 10 men) reported having been stalked. A multiple regression analysis revealed a significant effect of victimisation on psychological well-being.

This study identified a high lifetime prevalence of stalking in the community. Effects on victims' psychological health are significant, suggesting that the phenomenon deserves more attention in future community mental health research.

Major depression can be treated by means of cognitive–behavioural therapy but as skilled therapists are in short supply there is a need for self-help approaches. Many individuals with depression use the internet for discussion of symptoms and to share their experience.

To investigate the effects of an internet-administered self-help programme including participation in a monitored, web-based discussion group, compared with participation in web-based discussion group only.

A randomised controlled trial was conducted to compare the effects of internet-based cognitive–behavioural therapy with minimal therapist contact (plus participation in a discussion group) with the effects of participation in a discussion group only.

Internet-based therapy with minimal therapist contact, combined with activity in a discussion group, resulted in greater reductions of depressive symptoms compared with activity in a discussion group only (waiting-list control group). At 6 months' follow-up, improvement was maintained to a large extent.

Internet-delivered cognitive–behavioural therapy should be pursued further as a complement or treatment alternative for mild-to-moderate depression.