Autistic traits are widely distributed in the general population, but the boundaries of the autistic spectrum are unclear. Whole-population surveys of unselected samples of children are hampered by the lack of appropriate screening instruments.

To assess whether the Social and Communication Disorders Checklist (SCDC) fulfils the need for a sensitive measure of autistic traits, which can be completed in a few minutes and which measures heritable characteristics in both males and females.

A 12-item scale, the SCDC, was completed by three independent samples drawn from a twin register, a group with Turner syndrome and children with a diagnosis of autistic-spectrum disorder attending clinics. The data were used to establish the heritability reliability and validity of the checklist.

Traits measured by the SCDC were highly heritable in both genders (0.74). Internal consistency was excellent (0.93) and test–retest reliability high (0.81). Discriminant validity between pervasive developmental disorder and other clinical groups was good, discrimination from non-clinical samples was better; sensitivity (0.90), specificity (0.69).

The SCDC is a unique and efficient first-level screening questionnaire for autistic traits.

General practitioners (GPs) have an important role in the care of patients with chronic schizophrenia and of those in the early phases of this disorder.

To obtain information about the number of patients in the early and chronic stages of schizophrenia seen in general practice; the needs and attitudes of GPs, their diagnostic knowledge concerning early phases of schizophrenia and their knowledge and practice concerning treatment of patients with first-episode and multi-episode schizophrenia.

Apostal survey was conducted among randomly selected GPs in Switzerland.

Atotal of 1089 GPs responded to the survey. Early psychosis had a low prevalence in general practice, and GPs expressed a wish for specialised, low-threshold referral services. Diagnostic and treatment knowledge showed inconsistencies. Most GPs said they would treat first-episode schizophrenia with antipsychotics, but only a third recommended maintenance treatment after a first episode of schizophrenia that would conform with international recommendations.

Easily accessible, low-threshold referral services are pivotal in supporting GPs in the management and treatment of emerging schizophrenia in primary healthcare patients.

Crisis resolution teams (CRTs) are being introduced throughout England, but their evidence base is limited.

To compare outcomes of crises before and after introduction of a CRT.

A new methodology was developed for identification and operational definition of crises. A quasi-experimental design was used to compare cohorts presenting just before and just after a CRT was established.

Following introduction of the CRT, the admission rate in the 6 weeks after a crisis fell from 71% to 49% (OR 0.38, 95% CI 0.21–0.70). A difference of 5.6 points (95% CI 2.0–8.3) on mean Client Satisfaction Questionnaire (CSQ–8) score favoured the CRT. These findings remained significant after adjustment for baseline differences. No clear difference emerged in involuntary hospitalisations, symptoms, social functioning or quality of life.

CRTs may prevent some admissions and patients prefer them, although other outcomes appear unchanged in the short term.

The outcome for opiate-dependent patients seeking abstinence is unclear in this era of improved access to methadone maintenance.

To measure the outcome 2–3 years after in-patient treatment.

Opiate-dependent patients admitted with a goal of abstinence were followed-up. A structured interview examined drug use and treatment in the preceding month.

Five patients had died and 109 (76%) of the remaining 144 were interviewed. Fifty per cent (54 patients) reported recent opiate misuse and 57% (62) were on methadone maintenance. Twenty-three per cent (25 patients) were abstinent (i.e. neither using opiates nor on methadone maintenance). Abstinence was significantly associated with completion of the 6-week in-patient treatment programme and attendance at out-patient after-care, and negatively associated with a family history of substance misuse.

Abstinence remains an attainable goal. As the principal influence on outcome was treatment adherence, inpatient services should seek to enhance rates of programme completion. Aftercare should be provided to patients. We caution against use of pre-treatment patient characteristics as criteria for prioritising access to in-patient treatment.

The families of patients with first-episode psychosis often play a major role in care and often experience lack of support.

To determine the effect of integrated treatment v. standard treatment on subjective burden of illness, expressed emotion (EE), knowledge of illness and satisfaction with treatment in key relatives of patients with a first episode of schizophrenia-spectrum disorder.

Patients with ICD-10 schizophrenia-spectrum disorders (first episode) were randomly assigned to integrated treatment or to standard treatment. Integrated treatment consisted of assertive community treatment, psychoeducational multi-family groups and social skills training. Key relatives were assessed with the Social Behaviour Assessment Schedule (SBAS, burden of illness), the 5-min speech sample (EE), and a multiple choice questionnaire at entry and after 1 year.

Relatives in integrated treatment felt less burdened and were significantly more satisfied with treatment than relatives in standard treatment. There were no significant effects of intervention groups on knowledge of illness and EE.

The integrated treatment reduced family burden of illness and improved satisfaction with treatment.

Providing specialised services to individuals experiencing first-episode psychosis (FEP) is a relatively new endeavour.

To overview developing services for newly diagnosed cases of FEP and the context in which they develop.

This paper describes five model multi-element FEP programmes, outlines recent evaluation studies of FEP services, discusses current evidence gaps relating to the evaluation of complex interventions and specific interventions for FEP and illustrates attempts to examine aspects of clinical work practised at the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne, Australia.

Considerable progress has been made in terms of influencing practice in the assessment and treatment of early psychosis.

There is need for quality clinical and research efforts to inform and accelerate progress in this burgeoning field.

The stability of eating disorder diagnoses has received little research attention.

To examine the course of the full range of clinical eating disorders.

A sample of 192 women with a current DSM–IV eating disorder (55 with anorexia nervosa, 108 with bulimia nervosa and 29 with eating disorder not otherwise specified) were assessed three times over 30 months using a standardised interview.

Although the overarching category of ‘eating disorder’ was relatively stable, the stability of the three specific eating disorder diagnoses was low, with just a third of participants retaining their original diagnosis. This was due only in part to remission since the remission rate was low across all three diagnoses.

There is considerable diagnostic flux within the eating disorders but a low overall remission rate. This suggests that underpinning their psychopathology may be common biological and psychological causal and maintaining processes.

Adherence to treatment guidelines enhances treatment outcome. However, in clinical practice many patients with depression do not receive appropriate treatment.

To evaluate the treatment of depression in in-patients of German psychiatric hospitals with respect to treatment outcome and adherence to guidelines.

We recruited 1202 in-patients with depression from ten different hospitals. Quality data concerning treatment were collected at admission, during the treatment course and at discharge.

The level of depression was significantly decreased and most patients were satisfied with treatment. Many aspects of the treatment routine adhered to guideline recommendations. Adherence to guidelines could be improved with respect to adjustment of antidepressant dosage, reduction of benzodiazepine prescription, enhanced use of electroconvulsive therapy and wider use of interpersonal therapy.

The study reveals a high standard of psychiatric treatment of in-patients with depression. Nevertheless there is still room for improvement. Differences between hospitals in adherence to guidelines indicates the need for individual application of quality management tools.

Despite the widespread use of the Brief Psychiatric Rating Scale (BPRS), the clinical meaning of its total score and cut-off values used to define treatment response are unclear.

To link the BPRS to Clinical Global Impression (CGI) ratings.

Equipercentile linking of BPRS and CGI ratings from seven drug trials in acutely ill patients with schizophrenia (n=1979).

‘Mildly ill’ according to the CGI approximately corresponded to a BPRS total score of 31, ‘moderately ill’ to a BPRS score of 41 and ‘markedly ill’ to a BPRS score of 53. ‘Minimally improved’ according to the CGI score was associated with percentage BPRS reductions of 24, 27 and 30% at weeks 1, 2 and 4, respectively. The corresponding numbers for a CGI rating of ‘much improved’ were 44, 53 and 58%

The results provide a clearer understanding of how to interpret BPRS total and percentage reduction scores in clinical trials with patients acutely ill with schizophrenia who are experiencing positive symptoms.

Patients attending an accident and emergency department may exhibit psychological disturbances post-injury. Early interventions have been suggested to reduce the risk of post-injury disorder, including psychoeducation.

We assessed the efficacy of providing such self-help information.

Patients who had experienced trauma were randomised to two groups: those given (n=75) and not given (n=67) a self-help booklet. Psychological assessments were completed within 2, 10–12 and 24–26 weeks.

Post-traumatic stress disorder (PTSD), anxiety and depression decreased (P < 0.05) with time but there were no group differences in PTSD or anxiety. The controls were less depressed (P < 0.05) at follow-up. There was a reductionin PTSD caseness within the control (50%) compared with the intervention (20%) group which was almost significant (P < 0.06).

This trial failed to support the efficacy of providing self-help information as a preventive strategy to ameliorate PTSD.

Professional boundaries between psychiatrists and other mental health professionals are difficult to set. Empirical evidence for the distribution of diagnostic and treatment tasks among professionals is lacking.

This study examines the ‘collective sense of the profession’ about the relationship between patient characteristics and the contribution of tasks by disciplines.

An adapted RAND appropriateness method was used. Eighty-six professionals judged 77 case descriptions of psychiatric patients on the contribution to diagnostic and treatment tasks of eight selected disciplines.

In two multi-level models the variance explained by the judges' characteristics was 3.7% for diagnostic tasks and 4.5% for treatment tasks. The variance explained by the patient characteristics was zero for diagnostic and 0.5% for treatment tasks. The variance explained by the indicated disciplines was 36.8% for diagnostic and 12.6% for treatment tasks.

The collective sense of the profession on the contribution of psychiatrists to mental healthcare is unambiguous but not related to patient characteristics. It seems to be based on an apriori ranking order of disciplines.

Previous work on the reliability of mental capacity assessments in patients with psychiatric illness has been limited.

To describe the interrater reliability of two independent assessments of capacity to consent to treatment, as well as assessments made by a panel of clinicians based on the same interview.

Fifty-five patients were interviewed by two interviewers 1–7 days apart and a binary (yes/no) capacity judgement was made, guided by the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). Four senior clinicians used transcripts of the interviews to judge capacity.

There was excellent agreement between the two interviewers for capacity judgements made at separate interviews (kappa=0.82). A high level of agreement was seen between senior clinicians for capacity judgements of the same interview (mean kappa=0.84)

In combination with a clinical interview, the MacCAT–T can be used to produce highly reliable judgements of capacity.

‘Autistic savants' are individuals with autism who have extraordinary skills. Brain mechanisms underlying such capacities are still unknown.

To map the exceptional calendar capacity of a man with primary autism.

Positron emission tomography was used to map brain activity in a man who is able to associate a day of the week with the corresponding calendar date.

During the calendar task, the left hippocampus, the left frontal cortex and the left middle temporal lobe were activated.

The cerebral circuit involved in this man's prodigious calendar skill is similar to that normally involved in memory retrieval tasks. These results suggest that the prodigious capacities may be sustained by memory processing.

The development of single-sex medium secure units for women has been driven by concern about the vulnerability of women to sexual abuse and exploitation in mixed-sex secure settings. Less is known about how women patients and staff perceive gender segregation and their experiences in single-sex units.

To examine the impact of gender segregation on the safety of women patients detained in medium secure psychiatric facilities.

A qualitative study was conducted involving individual interviews with 58 male and female staff and 31 women patients in single-sex and mixed-sex medium secure units throughout England and Wales.

Women patients in both types of units reported high levels of actual and threatened physical and sexual violence. Women in single-sex units reported intimidation, threats and abuse by other women patients, although they were less vulnerable to sexual abuse and exploitation and serious physical assault.

Further development of single-sex secure units for women may not be justified on the grounds of safety issues alone. Risk assessment of forensic psychiatric patients must include a full assessment of their safety within the psychiatric setting.

Suicide reduction is government strategy in many countries. We need to quantify the connection between non-fatal self-poisoning and eventual suicide.

To determine mortality after an episode of self-poisoning and to identify predictors of death by any cause or by suicide.

A retrospective single-group cohort study was undertaken with 976 consecutive patients attending a large accident and emergency unit in 1985–1986 after non-fatal self-poisoning. Information about deaths was determined from the Office for National Statistics.

Of the original patients, 94% were traced 16 years later; 17% had died, 3.5% by probable suicide. Subsequent suicide was related to numerous factors evident at the time of the episode of self-poisoning but, when examined for their independent effects, only the severity of the self-poisoning episode and relevant previous history seemed important.

Patients attending a general hospital after self-poisoning all require good basic assessment and care responsive to their needs. Attempts to reduce the huge excess of suicide subsequent to self-harm are not likely to achieve much if they are based on the identification of subgroups through ‘risk assessment’

Because early illness course and outcome may affect the long-term outcome of schizophrenia-spectrum disorders, it is especially important to address poor outcome in this early critical period.

To evaluate whether integrated treatment compared with standard treatment reduced the proportion of patients with poor clinical and social outcome after 1 year.

A total of 547 patients with first-episode psychosis were included in the study, 275 randomly assigned to integrated treatment and 272 to standard treatment. Measures assessed psychotic symptoms and social functioning.

There was a significant beneficial effect of integrated treatment v. standard treatment on ‘any poor outcome’. Integrated treatment had a significantly better effect on ‘any poor outcome’ in patients with schizophrenia compared with patients in standard treatment.

The integrated treatment significantly reduced the proportion of patients with poor clinical and social outcome compared with standard treatment.