This case-control study used data from Chandigarh, North India to investigate the association between antecedent fever and acute brief psychosis.

To assess whether antecedent fever may be a biological correlate of acute brief psychosis, and contribute to the nosology of acute brief psychosis.

The study was based in an incidence cohort from two catchment areas, an urban and a rural site, that were part of the World Hearth Organization Determinants of Outcome study. The cases (n=17) met criteria for acute brief psychosis; controls (n=40) were patients with other acute and subacute psychoses. The Life Events Schedule was used to determine the presence of antecedent fever.

The crude odds ratio for fever as a risk factor for acute brief psychosis was 6.2 (P=0.004). The odds ratio in a logistic regression analysis – adjusted for site, gender and CATEGO classification – was 11.2 (P=0.003).

Antecedent fever may be a biological correlate of acute brief psychosis. This finding supports the validity of this entity, and has implications for its aetiology and diagnosis.

Volunteer befriending promoted remission of chronic depression when clinical and other treatment variables were controlled.

To examine the role of other psychosocial factors relevant for outcome.

Factors measured at baseline interview were examined in multivariate analyses along with psychosocial factors occurring during follow-up, such as ‘fresh-start’ experiences and new severe events and difficulties.

Fresh-start experiences and a standard attachment style were found to enhance chances of remission, with new severe stressors and markedly poor coping strategies liable to prevent it, with volunteer befriending continuing to play a role.

The positive result reported in the preceding paper is unlikely to be an artefact. However, fresh-start experiences, absence of new severe stressors and standard attachment style were more important predictors of remission. This knowledge might profitably be incorporated into the evaluation of existing treatments.

Bulimia nervosa affects women at a peak age of reproductive functioning, but few studies have examined the impact of pregnancy on bulimia.

To examine the impact of pregnancy on symptoms of bulimia nervosa and associated psychopathology.

Women actively suffering from bulimia nervosa during pregnancy (n=94) were interviewed using the eating disorder examination (12th edn) and structured clinical interview for DSM–III–R, with additional structured questions. Behaviours were recorded at conception, each trimester and postnatally. Relative risks were calculated for prognostic factors.

Bulimic symptoms improved throughout pregnancy. After delivery, 57% had worse symptoms than pre-pregnancy, but 34% were no longer bulimic. Relapse was predicted by behavioural severity and persistence, previous anorexia nervosa (‘Type II’ bulimia), gestational diabetes and ‘unplanned’ pregnancy. Unplanned pregnancies were the norm, usually resulting from mistaken beliefs about fertility. ‘Postnatal depression’ was suggested in one-third of the sample, and in two-thirds of those with ‘Type II’ bulimia, and was predicted by alcohol misuse, symptom severity and persistence.

Postnatal treatment intervention should focus on women ‘at risk’ of relapse, but all women with bulimia should be assessed for postnatal depression.

The Health of the Nation Outcome Scales (HoNOS) have been developed for assessing the effectiveness of mental health services.

To investigate the validity and reliability of the HoNOS in patients in contact with mental health services.

Subjects (age range 19–64) came from day hospitals, acute in-patient units and out-patient clinics in general practice. We obtained the opinions of experienced professionals, advocacy groups and patient groups to evaluate consensual and content validity.

One hundred patients were assessed using the package of rating scales. Interrater and test–retest reliability were good for some items and poor for others. The HoNOS had good criterion validity: acute in-patients had higher scores than day patients and out-patients. HoNOS also had good concurrent validity, correlating well with other scales. Comments suggested that the HoNOS was a useful and suitable scale for this population but psychotic symptoms and certain social factors were not sufficiently covered.

The HoNOS had good validity but variable reliability. It may be better than existing scales because of the wide range of areas which it covers.

Stereotypes of older people suggest that they are depressed.

To examine depression symptoms among people aged ⩾65 in the general population and to ask the following questions. Are there high proportions of depressive symptoms among otherwise well people? Do these levels reflect the prevalence of depression? Do key symptoms vary with age and do they confirm stereotypes?

Nine centres contributed data from community-based random samples, using standardised methods (GMS–AGECAT package)

Proportions of depressive symptoms varied between centres. Some often associated with ageing were rare. Many were more common in women. Low-prevalence centres tended to have fewer symptoms among ‘well’ people, but there were inconsistencies. Low levels of symptoms among the well population of a centre did not necessarily predict lower levels in the depressed.

Variations in the prevalence of depressive symptoms occurred between centres, not always related to levels of illness. There was no consistent relationship between proportions of symptoms in well persons and cases for all centres. Few symptoms were present in > 60% of the older population – stereotypes of old age were not upheld.

Following the development of a child and adolescent version of the Health of the Nation Outcome Scales (HoNOSCA), field trials were conducted to assess their feasibility and acceptability in routine outcome measurement.

To evaluate the reliability, validity and acceptability of HoNOSCA in routine outcome measurement.

Following training, 36 field sites provided ratings on 1276 cases at one time point and outcome data on 906. Acceptability was assessed by way of written feedback and at a debriefing meeting.

HoNOSCA demonstrated satisfactory reliability and validity characteristics. It was sensitive to change and its ability to measure change accorded with the clinicians' independent rating. HoNOSCA was reasonably acceptable to clinicians' from a range of disciplines and services.

Provided that training needs can be met, HoNOSCA represents a satisfactory brief outcome measure which could be used routinely in child and adolescent mental health services.

Acute tryptophan depletion lowers brain serotonin synthesis and results in a transient, but striking, clinical relapse in recovered depressed patients.

To identify brain regions which change their activity as an acute depressive relapse evolves and to determine how pathological mood might modulate neural activity during a cognitive task.

We used H215O positron-emission tomography (PET) to study eight recovered depressed men after tryptophan depletion and after a control procedure. During both PET scan sessions, subjects performed a paced verbal fluency task which alternated with a control verbal repetition task.

Increasing levels of depression after tryptophan depletion were associated with diminished neural activity in the ventral anterior cingulate, orbitofrontal cortex and caudate nucleus regions. In addition, depressive relapse attenuated cognitive task-related activation in the anterior cingulate cortex.

Our data indicate that changes in neural activity in distinct brain regions mediate the clinical phenomena of depression and depression-related cognitive impairment following acute tryptophan depletion. These changes could be associated with the widespread distribution of serotonin neurons in brain pathways associated with the expression of affect and cognitive performance.

Following the success of the NINCDS–ADRDA criteria for Alzheimer's disease, groups interested in vascular dementia and dementia with Lewy bodies have now adopted similar criteria.

To assess whether the validity of these criteria are influenced by the prevalence of mixed pathologies or by the prevalence rate.

A community based postmortem study.

Mixed pathologies were common (33.8%). The high specificities obtained for the CDLB and NINDS–AIREN criteria (1.00 and 0.95, respectively) were associated with low sensitivities (0.22 and 0.43, respectively). Low prevalence and the presence of mixed pathologies had a deleterious effect on positive predictive values.

Current clinical diagnostic criteria are good at detecting pathology per se but not at detecting pure pathology. A large proportion of subjects from the general population fulfilling probable CDLB, probable NINCDS–ADRDA or probable NINDS–AIREN will have mixed pathologies.

Little is known about men who commit sex offences in the context of psychosis.

To examine the relationship of illness and psychotic symptoms to sex offending in men with schizophrenia.

A search of Home Office records was completed for all 84 male restricted hospital order in-patients with schizophrenia, resident in any hospital in England and Wales during May 1997, with an index conviction for a contact sex offence against a woman.

At the time of their index offences 80 men were psychotic and half of them had delusions or hallucinations related to the offences. Specific delusional or hallucinatory drive was pertinent in only 18 men but the majority of men committed their first sex offence after onset of schizophrenia. Exclusive sex offending was uncommon.

When a man with schizophrenia commits a serious sex offence the illness is, more commonly than not, relevant to that offence even though a direct symptom relationship may be relatively unusual.

We present the findings from the three-year follow-up of all first episodes of schizophrenia occurring during a two-year period in Cantabria (in Spain).

(a) To describe the clinical characteristics of the illness from the early stages of the disease, and (b) to study the long-term psychosocial adjustment and psychopathological evolution of these patients, identifying predictors for the course of the illness.

Of the original cohort of 86 patients, 76 (88.3%) were fully evaluated at three-year follow-up. Psychiatric assessment was performed (PSE–9 and SANS/SAPS). Social adjustment was evaluated using the Disability Assessment Schedule (DAS). Information regarding the clinical evolution and use of health resources was also gathered.

The majority of patients with a first-contact diagnosis of schizophrenia failed to meet the criteria for a CATEGO diagnosis at follow-up. The SANS/SAPS assessments revealed a doubling in the proportion of patients with ‘negative schizophrenia’. The pattern of clinical course was also evaluated, with 24 (31.5%) of the patients having a good outcome. Being male and having low social class tended to be associated with poor clinical outcome.

The outcome of schizophrenia is less pessimistic than was originally thought.

Reports suggest a high prevalence of substance misuse in psychotic disorders but few studies examine comorbidity at onset of psychosis.

To identify the prevalence and pattern of substance use and misuse in first-episode psychosis, and relationships with diagnosis, mode of presentation and demographic variables.

Consensus diagnoses for 168 subjects presenting with first-episode psychosis were made using ICD–10 diagnostic criteria. Information on substance use and misuse was obtained from multiple sources. We examined associations between substance misuse, diagnosis and demographic factors.

Criteria for drug use, drug misuse or alcohol misuse were met by 37% of the sample. One-year prevalence rates were 19.5% (drug misuse) and 11.7% (alcohol misuse). Thirteen subjects (8.4%) received a primary diagnosis of substance-related psychotic disorder; a significant increase compared with an earlier cohort from the same catchment area. Drug misuse was associated with younger age of onset of psychosis, male gender and non–African–Caribbean ethnicity.

This study confirms high rates of substance misuse at onset of psychosis. There is evidence for an increase in diagnosis of substance-related psychotic disorders over time. Those most at risk of substance misuse are young males.

While the costs associated with Alzheimer's disease have been shown to be significant, there are few data relating cost of care to severity of the disease.

We aimed to compare the costs associated with different severities of Alzheimer's disease with those incurred by control subjects over a three-month period.

In this cross-sectional, multicentre, naturalistic analysis, non-institutionalised patients with Alzheimer's disease (128), their care-givers (128), and 56 matched controls were interviewed once to establish resource use over the previous three months. Patients were stratified into three severity groups according to their Mini Mental State Examination score. Costs were calculated from the perspective of society as a whole.

Over the three-month period, total mean cost per control subject (£387) was minor compared with mean cost incurred by patients with mild (£6616), moderate (£10 250) and severe (£13 593) Alzheimer's disease. Indirect cost, mainly time spent by care-givers, was the main cost component in all groups (68.6%), followed by direct medical costs (24.7%)

The cost of care for an Alzheimer's disease patient is directly related to the severity of the patient's illness.

Serotonin (5-HT): dopamine imbalance may underlie neuroleptic-induced akathisia.

To evaluate the efficacy of the 5-HT2 antagonist, mianserin in neuroleptic-induced akathisia.

Thirty neuroleptic-treated patients with schizophrenia were randomly allocated in a double-blind design to receive either mianserin (15 mg/day) or placebo for five days. Patients were assessed at baseline and on Days 3 and 5 by the Barnes Akathisia Scale (BARS), as well as by other relevant clinical rating scales.

Compared with the placebo group, the mianserin-treated patients showed a significant reduction in all four BARS subscales by Day 5, with mean reductions in the BARS global score of 9.9% and 52.2%, respectively (P=0.006). Response to treatment (a reduction of at least two points on the BARS global subscale), was noted in six patients (40%) in the mianserin group and only one patient (9.1%) in the placebo group (P=0.04, log odds ratio 2.23).

Mianserin at a low dose may be a promising therapeutic option for patients with acute neuroleptic-induced akathisia.

There is an increasing interest in measuring health care outcomes in mental health services for children as well as adults.

We examined the sensitivity of the Paddington Complexity Scale (PCS) and the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) in describing the intakes of child and adolescent mental health clinics.

We carried out a prospective study of two out-patient units and one day patient unit, by means of questionnaires administered to clinicians, parents and children.

Clinician-rated PCS and HoNOSCAs were obtained for 248 new attenders. Both proved sensitive to intake differences between clinics. There were correlations of moderate intensity (r=0.6) between total PCS and HoNOSCA. There were weaker associations between these and parent/child rated measures of behaviour (r=0.4 and 0.3), quality of life and self-esteem (r=0.3 or less).

Both PCS and HoNOSCA are useful for describing clinical profiles of children and adolescents receiving mental health services.

Elucidation of aetiological processes leading to development of Axis II disorders is important in category validation and could lead to new treatments.

To establish aetiological associations between Axis II disorders and specific risk factors.

Male and female subjects (n=260) in maximum security hospitals and prisons were interviewed to determine DSM-III Axis II and lifetime Axis I diagnoses. Aetiological risk factors were obtained at interview and from case files. Independent statistical associations were established by logistic regression.

Axis II categories were divided into four groups: (a) disorders of character development, secondary to an adverse early environment: antisocial, self-defeating and paranoid; (b) disorders of temperament, secondary to constitutional aetiology: avoidant, dependent, schizoid and schizotypal; (c) a ‘mixed’ disorder of constitutional and environmental aetiology: borderline; and (d) aetiological associations not established: narcissistic, histrionic, compulsive and passive-aggressive.

The study validates several Axis II categories but challenges the inclusion of others within Axis II of DSM-IV, in particular schizoid, schizotypal, avoidant and borderline personality disorders. The findings have implications for future treatment interventions.

In an 11-country European collaboration, 14 population-based surveys included 21 724 subjects aged ⩾65 years. Most participating centres used the Geriatric Mental State (GMS), but other measures were also used.

To derive from these instruments a common depression symptoms scale, the EURO–D, to allow comparison of risk factor profiles between centres.

Common items were identified from the instruments. Algorithms for fitting items to GMS were derived by observation of item correspondence or expert opinion. The resulting 12-item scale was checked for internal consistency, criterion validity and uniformity of factor-analytic profile.

The EURO–D is internally consistent, capturing the essence of its parent instrument. A two-factor solution seemed appropriate: depression, tearfulness and wishing to die loaded on the first factor (affective suffering), and loss of interest, poor concentration and lack of enjoyment on the second (motivation)

The EURO–D scale should permit valid comparison of risk-factor associations between centres, even if between-centre variation remains difficult to attribute.

Little evidence exists regarding the effectiveness or cost-effectiveness of alternative treatment services in the field of child and adolescent psychiatry.

To assess the cost-effectiveness of a home-based social work intervention for young people who have deliberately poisoned themselves.

Children aged ⩽16 years, referred to child mental health teams with a diagnosis of deliberate self-poisoning were randomly allocated to either routine care (n=77) or routine care plus the social work intervention (n=85). Clinical and resource-use data were assessed over six months from the date of trial entry.

No significant differences were found between the two groups in terms of the main outcome measures or costs. In a sub-group of children without major depression, suicidal ideation was significantly lower in the intervention group at the six-month follow-up (P=0.01), with no significant differences in cost.

A family-based social work intervention for children and adolescents who have deliberately poisoned themselves is as cost-effective as routine care alone.