The lack of prospective studies and data on male victims leaves major questions regarding associations between child sexual abuse and subsequent psychopathology.

To examine the association between child sexual abuse in both boys and girls and subsequent treatment for mental disorder using a prospective cohort design.

Children (n=16L2; 1327 female) ascertained as sexually abused at the time had their histories of mental health treatment established by data linkage and compared with the general population of the same age over a specified period.

Both male and female victims of abuse had significantly higher rates of psychiatric treatment during the study period than general population controls (12.4% v. 3.6%). Rates were higher for childhood mental disorders, personality disorders, anxiety disorders and major affective disorders, but not for schizophrenia. Male victims were significantly more likely to have had treatment than females (22.8% v. 10.2%).

This prospective study demonstrates an association between child sexual abuse validated at the time and a subsequent increase in rates of childhood and adult mental disorders.

Patients with schizophrenia have an increased risk of developing diabetes. However, no pragmatic pathway of care has ever been proposed in order to identify individuals at risk and manage that risk effectively.

To develop practical recommendations for the screening and management of diabetes in schizophrenia.

Staged review of evidence for the under recognition of diabetes in people with schizophrenia and of the applicability of current screening strategies to this population. Recommendations for pragmatic pathways of care were developed.

All patients with schizophrenia should be screened and managed as a high-risk group for the development of diabetes. Psychiatrists should be responsible for screening and diabetes risk management; primary care physicians and/or diabetologists should be responsible for managing diabetes. Choice of antipsychotics should be based on achieving good control of schizophrenia, which may improve compliance with diabetes risk reduction strategies.

Effective multi-disciplinary team working should reduce the burden of diabetes in schizophrenia.

Even at the first episode of psychosis, high expressed emotion (EE) characterises over half of patient–carer relationships. This study compared a carer appraisal model of EE with the ability of illness factors to predict EE at the first episode.

To investigate the utility of a carer appraisal model of EE in first-episode psychosis.

We compared high- and low-EE carers of people who had first-episode psychosis (n=46).

High EE in carers was associated with higher avoidant coping, higher subjective burden and lower perceived patient interpersonal functioning. Patient illness factors and carers ‘distress levels were not associated with EE.

Even at the first episode, carers' psychological appraisal, not patient illness factors, is influential in determining high EE. Carers ‘appraisal of their situation should be a primary target to lower or prevent high EE in early intervention for psychosis.

Although there have been many studies of the biological and psychosocial causations of postnatal depression, studies of sociocultural risk factors are rare.

To investigate the sociocultural risk factors of postnatal depression using ethnographically informed epidemiological methods.

Atotal of 959 women were assessed at their first ante-partum visit (baseline), in the third trimester, immediately after delivery, and 3 months post-partum. Six domains of risk factors were examined. The dependent variable was postnatal depression (as defined by the Edinburgh Postnatal Depression Scale) at 3 months post-partum.

Conflict with mother-in-law, marital dissatisfaction, past depression and antenatal depression independently predicted the occurrence of postnatal depression. The cultural practice of peiyue – a Chinese post-partum custom of mandated family support – was associated with better social support and a slightly lower risk of postnatal depression.

Sociocultural aspects of the immediate puerperium shape maternal emotional well-being. In-law conflict is an important source of household distress in many Asian societies. The findings have implications for clinical practice and future studies.

An earlier trial demonstrated good outcomes after 1 year for patients with chronic fatigue syndrome (CFS) who received an educational intervention designed to encourage graded activity.

To determine 2-year outcomes for the same treated patients and the response to treatment of patients formerly in the control condition.

Patients in the treatment groups (n=114) were followed up at 2 years; 32 patients from the control group were offered the intervention after 1 year and were assessed 1 year later. Assessments were the self-rated measures used in the original trial.

At 2 years 63 of the treated patients (55%) no longer fulfilled trial criteria for CFS compared with 64 patients (56%) at 1 year. Fourteen of 30 crossover patients (47%) achieved a good outcome at 1 year and seven (23%) no longer fulfilled criteria for CFS.

Benefits of the intervention were maintained at 2 years. Delaying treatment is associated with reduced efficacy and required more intensive therapy.

High rates of osteoporosis in schizophrenia may result from the prolactin-raising effects of some antipsychotic medication.

To examine bone mineral density in relation to relevant endocrine variables in patients with schizophrenia taking prolactin-raising antipsychotics.

Fifty-five patients who had been receiving prolactin-raising antipsychotic medication for > 10 years underwent dual-energy X-ray absorptiometry of their lumbar and hip bones. Among the endocrine variables assessed were plasma prolactin and sex hormones.

Age-related reduced bone mineral density measures were found in 17 (57%) of the male and 8 (32%) of the female patients. Higher doses of medication were associated with increased rates of both hyperprolactinaemia and bone mineral density loss. Bone loss for the whole group was correlated with medication dose, and for men was inversely correlated with testosterone values.

These results suggestthat patients with schizophrenia on long-term prolactin-raising antipsychotic medication are at high risk of developing reduced bone mineral density as a consequence of hyperprolactinaemia-induced hypogonadism.

Deaths from antidepressants continue to account for a substantial proportion of drug-related deaths.

To investigate the relative toxicity of the major classes of antidepressant drugs, with the specific objective of assessing this in relation to the cause of death; and to analyse the deaths where there were multiple mentions of antidepressant drugs or other psychoactive drugs with antidepressants.

Mortality data were collected from the National Programme of Substance Abuse Deaths, and antidepressant prescription data were collected.

Most deaths from antidepressant drugs were suicides (80%). Tricyclic antidepressants (TCAs) accounted for more drug mentions than did other antidepressant drugs (12 per million prescriptions). Selective serotonin reuptake inhibitors (SSRIs) were associated with a significantly lower risk of toxicity, but 93% of deaths from SSRIs occurred in combination with other drugs, especially TCAs (24.5%). In ‘combination’ deaths patients were significantly more likely to have had a history of drug misuse.

The efficacy and safety of augmentation therapy with TCAs in SSRI-resistant patients should be monitored carefully, and patients prescribed antidepressants should be screened for drug use/misuse.

Somatic symptoms are extremely common features of depression and other mental disorders in African countries such as Nigeria, buttheir weight in the diagnosis of depression is not certain.

To determine what weight should be assigned to these symptoms in comparison with other well-known symptoms in the diagnosis of depression.

A sample of 829 persons completed the Patient Health Questionnaire which was earlier modified by the inclusion of the somatic symptoms being studied. Using principal component analysis and a logistic regression model, the contributions of these symptoms in comparison with others were determined.

Core depressive symptoms accounted for most of the total variance for depression. The somatic symptoms studied loaded separately from the core depressive symptoms and were not as good predictors of depression. A cognitive factor emerged as well as some somatic factors.

Although somatic symptoms may be florid among patients with depression, they have considerably less weight than core depressive symptoms in the diagnosis of depression. The emerging cognitive factor could be similar to that described by previous authors.

It has been suggested that psychosis genes might be associated with beneficial effects, explaining their high frequency in all human populations.

To test the relationship between academic success and the incidence of psychotic disorders.

The unusually complete demographic and scholastic records available in Iceland were used to locate academically accomplished individuals and assess the probability of previously identified patients with mental disorders and their relatives being among such groups.

Close relatives of successful students showed increased risks of psychosis. Individuals who subsequently developed psychosis and relatives of people with psychosis excelled in school performance, particularly in mathematics.

The study supports the hypothesis that stimulation associated with psychotic tendencies enhances performance in academic settings.

France has high rates of psychotropic drug consumption and suicide in the elderly population, but it has not yet been possible to determine whether this is due to exceptionally high morbidity rates.

To describe the first longitudinal population study of psychiatric disorder undertaken in France, and to estimate current and lifetime prevalences and age of onset of psychiatric disorder.

A study group of 1873 non-institutionalised persons aged 65 years and over was randomly recruited from the Montpellier district electoral rolls. The Mini International Neuropsychiatric Interview was used to assess current and lifetime symptoms. Cases identified by the application of DSM–IV criteria were reexamined by a clinical panel.

Forty-six percent of the study population had experienced a mental disorder in their lifetime, and 3.7% had made a suicide attempt. Lifetime prevalence of major depression was 26.5% and 30% for anxiety disorders. Current prevalence rates were 14.2% for anxiety disorders, 10.7% for phobia, 3% for major depression and 1.7% for psychosis.

Results show very high rates of lifetime but not current major depression. Rates of current phobia and suicidal ideation in the very elderly are also high compared with other studies. The rates reported are likely to be underestimates.

Several factors are thought to influence resource use and costs in treating schizophrenia.

To assess the relative impact of non-adherence and other factors associated with resource use and costs incurred by people with schizophrenia.

Secondary analyses were made of data from a 1994 national survey of psychiatric morbidity among adults living in institutions in the UK. Factors potentially relating to resource use and costs were examined using two-part models.

Patients who failed to adhere to their medication regimen were over one-and-a-halftimes as likely as patients who did adhere to it to report use of in-patient services. Non-adherence is one of the most significant factors in increasing external service costs, by a factor of almost 3. Non-adherence predicted an excess annual cost per patient of approximately $2500 for in-patient services and over $5000 for total service use.

Resource use and costs are influenced by various factors. Medication non-adherence consistently exhibits an association with higher costs. Further important factors are patient needs and the ability of the system to address them.

Fatigue is a common complaint that may lead to long-term sick leave and work disability.

To assess the efficacy of cognitive–behavioural therapy by general practitioners for unexplained, persistent fatigue among employees.

A randomised controlled trial, using a pre-randomisation design in primary care, investigated 151 employees on sick leave with fatigue. Participants in the experimental group were offered five to seven 30 min sessions of cognitive–behavioural therapy by a general practitioner; those in the control group were offered no treatment. Main outcome measures (fatigue severity self-reported absenteeism, registered absenteeism and clinical recovery) were assessed at 4 months, 8 months and 12 months.

At baseline, 44% of the patients already met research criteria for chronic fatigue syndrome. There was no significant difference between the experimental group and the control group on primary or secondary outcomes at any point.

Cognitive–behavioural therapy by general practitioners for unexplained, persistent fatigue did not prove to be an effective intervention. Since these doctors were unable to deliver this therapy effectively under ideal circumstances, it is unlikely that doctors in routine practice would be more successful in doing so.

Post-traumatic stress is thought to account for significant disability. It is also known to be highly comorbid with other psychiatric conditions such as depression and alcohol dependence.

To determine the relationship between post-traumatic stress, depression, alcohol dependence and disability.

Seventy armed services personnel were assessed for DSM–IV diagnoses of post-traumatic stress disorder, major depressive disorder and alcohol dependence, and with continuous measures of symptoms of post-traumatic stress, depression and alcohol dependence following a traumatic event. These variables, as predictors of disability (using the Sheehan Disability Scale), were analysed using multivariate analysis of variance, analysis of covariance and multiple regression backward elimination models.

No significant interaction was found for the diagnostic variables even after controlling for the continuous symptom measures. In the regression models, symptoms of depression were a significant predictor of total disability (R2=0.39). Symptoms of alcohol dependence and post-traumatic stress did not significantly predict disability.

Since post-traumatic stress was not found to be associated with disability, its clinical importance may be questionable.

Few follow-up studies of depression have evaluated depressive symptomatology over time at both threshold and sub-threshold levels.

To evaluate long-term longitudinal symptomatic course after an episode of severe depression.

A total of 61 participants from a previous study cohort underwent a detailed interview covering the longitudinal course of depression and pharmacological treatment over 8–11 years of follow-up.

Of the follow-up months, 52% were spent at an asymptomatic level, 15% at minor symptom level, 20% at residual symptom level and 13% at full depression level. Also, 30% of follow-up months were spent in an episode of depression, and 18% of patients never achieved asymptomatic status during follow-up. The percentage of patients at each symptom level remained relatively stable after the first 2 years, but levels in individuals fluctuated, with a mean of two changes in symptom levels per follow-up year.

After severe episodes, sub-syndromal levels of depression are common and persistent, with considerable fluctuation suggesting a continuum between sub-syndromal subtypes and full depression.

Care for people with schizophrenia should address a wide range of outcomes, including professional and consumer perspectives.

To measure changes in psychopathology functioning, needs for care and quality of life; to develop predictive models for each outcome domain; and to assess the frequency of ‘good'and ‘poor’ outcomes, as defined in a series of different definitions that use combinations of the four domains measured.

Three-year follow-up of a 1-year-treated prevalence cohort of 107 patients with an ICD–10 diagnosis of schizophrenia attending the South Verona community-based mental health service.

Mean symptom severity and some types of needs for care worsen, but quality of life shows no change. Functioning shows a non-significant trend to deteriorate. Between 32% and 42% of the variance in the four key outcomes was explained by our model. Different definitions of good'and ‘poor’ outcome included 0–31% of patients, depending on the definition used.

The 3-year outcome for schizophrenia depends on the domain of outcome used, whether staff or patient ratings are used and the stringency of the definitions used for good and poor outcome.

There is strong evidence that the rates of psychiatric admission for psychosis in the UK are elevated for the Black adult population compared with the White population. Black adults also have a higher rate of involuntary psychiatric admissions. There have been no studies in this country investigating links between ethnic background and psychiatric admission in the adolescent population.

To investigate whether Black compared with White adolescents from London are over represented in psychiatric in-patient settings and whether they are more likely to be detained under the Mental Health Act 1983.

Cross-sectional survey of London adolescents aged 13–17 years, who were in-patients in psychiatric units.

Adolescents from the Black group (Black African, Black Caribbean, Black British) were over represented among those admitted with a diagnosis of a psychotic disorder when compared with adolescents from the White group (White British/White Irish, White Other): odds ratio=3.7,95% C12.0–6.7. They were also more likely to be detained on admission and more likely to be born outside the UK and have refugee background.

The possible impact of various background factors influencing admission is discussed.

Predictors of the costs of psychosis have received insufficient research attention, particularly factors associated with indirect costs.

To identify the predictors of direct mental health care costs and indirect or time-loss costs in psychotic disorders and to discuss their implications for future interventions.

Structured interview data from the Low Prevalence Disorders Study (n=980) were used to examine predictors of the costs of psychosis in Australia. Estimates of annual costs per patient were derived from the perspectives of government and society. Hierarchical regressions were used to assess the contributions to costs of premorbid, psychosocial and clinical factors.

Schizophrenia involved greater costs than other psychotic disorders. Non-completion of high-school education and chronicity of illness course were predictive of higher costs across all categories, and some factors were linked primarily with mental health care costs (e.g. age at onset, current symptomatology) or indirect costs (e.g. male gender, overall disability).

Several concurrent strategies were recommended, including early intervention programmes and assertive evidence-based rehabilitation and supported employment programmes aimed at reducing disability The cost-effectiveness of these approaches needs to be evaluated from the perspectives of both government and society.

The ICD–10 categorisation of severity of depression into mild, moderate and severe depressive episodes has not been validated.

To validate the ICD–10 categorisation of severity of depression by estimating its predictive ability on the course of illness and suicidal outcome.

All psychiatric in-patients in Denmark who had received a diagnosis of a single depressive episode at their first discharge between 1994 and 1999 were identified. The risk of relapse and the risk of suicide were compared for patients discharged with an ICD–10 diagnosis of a single mild, moderate or severe depressive episode.

At their first discharge, 1103 patients had an ICD–10 diagnosis of mild depressive episode, 3182 had a diagnosis of moderate depressive episode and 2914 had a diagnosis of severe depressive episode. The risk of relapse and the risk of suicide were significantly different for the three types of depression – increasing from mild to moderate to severe depressive episode.

The ICD–10 way of grading severity is clinically useful and should be preserved in future versions.