Findings are presented from an evaluation of a pilot remand and assessment service - the Bentham Unit, The aims of the Bentham Unit are to provide rapid assessment, identify mentally disordered remand prisoners, and speed their transfer from prison to NHS care, where a need is indicated.

The number, rate and speed of referral, assessment and transfer to NHS care of offenders remanded to Wormwood Scrubs prison during periods before and after the Bentham Unit opened were compared.

The service attracted a large volume of referrals. Between the two periods, significant increases in the numbers of referrals and hospital disposals, and major reductions in the interval between reception on remand into the prison, NHS assessment and transfer to NHS care, were observed.

The aims of the unit were met. Implications for service configurations are discussed.

ECT is rarely used as a prophylactic treatment. A 74-year-old woman with unstable bipolar affective disorder receiving maintenance ECT presented a unique opportunity to measure the cognitive effects of continuing ECT.

A single case report with serial psychometric testing during over 400 ECT treatments as a single maintenance treatment.

Serial testing did not demonstrate progressive cognitive deterioration, but consistent cognitive deficits typical of acute treatment were evident. The degree of cognitive difficulty may be related to the frequency of treatment.

Maintenance ECT can be an effective prophylactic treatment for selected patients. Cognitive effects would appear to be no greater than with acute treatment and seem to be non-progressive.

This study aimed to determine the prevalence of psychiatric disorder in young adults with homzygous sickle cell (SS) disease and in controls with normal haemoglobin, and to examine factors associated with psychiatric disorder.

The study design was cross-sectional. Subjects were aged 18–20 years: 63 with SS disease and 89 controls. The Psychiatric Assessment Schedule was used to determine psychiatric disorder at index of Definition level 5.

Psychiatric disorder was identified in 18 (29%) SS disease patients and in 22 (25%) controls. In SS patients, psychiatric disorder was not related to illness severity but was associated with leaving school early, difficulties in social adjustment, impaired cognitive function and having previous psychiatric difficulties. Male SS patients with psychiatric disorder all had low body mass index (BMI < 17.60). In controls, psychiatric disorder was associated with female gender, unemployment and difficulties in social adjustment.

The prevalence of psychiatric disorder was similar in patients and controls, although associated factors tended to be different. The association with low BMI in SS men merits further study.

Dysfunctional parental styles, as measured by the Parental Bonding Instrument (PBI), have been associated with adult depression in Western cultures. This study sought to determine whether such parental styles are also associated with adult depression in a non-Western society.

PBI scores and parental styles assessed by PBI quadrants were explored in 51 Japanese depressive patients and controls in a matched, case-control design.

Low care and high protection scores were associated not with melancholic but with non-melancholic depression. Subjects exposed to dysfunctional parental styles demonstrated a high risk for non-melancholic depression.

These data suggest that the association between dysfunctional parental styles on PBI and non-melancholic depression may be independent of cultural differences.

The spontaneous diurnal variation of mood and other symptoms provides a substrate for the examination of the relationship between symptoms and regional brain activation in depression.

Twenty unipolar depressed patients with diurnal variation of mood were examined at 8 a.m. and 8 p.m. with neuropsychological measures, clinical ratings and single photon emission tomography (SPET). Brain perfusion maps were spatially transformed into standard stereotactic space and compared pixel-by-pixel. A parametric (correlational) analysis was used to examine the relationship between symptom severity and brain perfusion, both between and within subjects.

Global depression severity and an independent ‘vital’ depression factor were associated in subjects with increased perfusion in cingulate and other paralimbic areas. In addition there was a probable association between an increase in an anxious-depression factor and reduced frontal neocortical perfusion.

Depressive symptom changes are associated with metabolic changes in the cingulate gyrus and associated paralimbic structures.

Delirium or confusional state is a common mental disorder in the elderly. To follow changes in symptoms over time and to evaluate the efficacy of treatment of delirium, a reliable and valid instrument for measuring degrees of delirium is essential.

An observer's rating scale with 22 items, the Confusional State Evaluation (CSE), was developed. Scores on 12 of the items were summarised to a “confusion score”. Based on ratings of 7l demented and non-demented elderly patients with delirium, the interrater reliability and validity of the scale was studied.

Agreement between two independent raters was fair to excellent (weighted kappa 0.38–0.93). The correlation between the “consfucsoion score” of the scale and the global rating by a psychogeriatrician was good (r=0.79).

The CSE seems to be a reliable and valid measuring instrument which can be useful in following the course of confusion in elderly patients.

The literature regarding psychiatric illness among elderly people with learning disabilities is limited and conflicting because of methodological differences. There have been no recent studies comparing psychiatric epidemiology between younger and older adults with learning disabilities, using the same methodology and definitions.

Comprehensive psychiatric examination using a semi-structured rating scale was undertaken on everyone with learning disabilities, aged 65 years or over (n= 134), living in a defined geographical area. Comparison was made with a randomly selected control group of adults with learning disabilities aged 20–65 years (n=73) drawn from the same geographical area.

Elderly people with learning disabilities have a greater prevalence of psychiatric morbidity than younger controls (68.7v. 47.9%). Rates for depression and anxiety disorders are high, and dementia is common: there are equal rates for schizophrenia/delusional disorders, autism and behaviour disorders in the two groups.

The higher psychiatric morbidity among elderly (compared with younger) people with learning disabilities has not previously received adequate recognition. This warrants further investigation by service planners and clinicians.

This is a retrospective study describing sociodemographic and clinical characteristics of an almost complete sample of insanity acquittees in Ireland between 1850 and 1995.

Case records and legal files were examined for each of the 437 patients admitted to the Central Mental Hospital under guilty but insane criteria, and a profile of sociodemographic, forensic and clinical data completed on each.

The number of insanity acquittees has fallen five-fold since the 19th century. Acquittees were usually single males from rural areas, aged in their 30s, who had committed a violent crime while suffering from a major psychiatric illness. Female insanity acquittées were relatively few in number and were equally likely to have been charged with violent crime, especially against their own children. The mean length of detention was 14.5 years.

The insanity defence is rarely used in Ireland, is largely confined to serious offences (especially homicide), and generally results in prolonged detention.

We wished to determine whether prison inmates with severe mental disorders possess specific clinical characteristics compared with psychiatric in-patients suffering from similar problems.

Under a case-control design, 69 male prison inmates suffering from a schizophrenic or major affective disorder were matched for age and diagnostic spectrum to 60 male psychiatric in-patients. Standardised interviews were used to diagnose psychiatric disorders according to DSM-111-R and social functioning criteria. Case-notes were reviewed to cull data regarding social life, criminal record and service use.

Inmates were more likely to suffer from delusional/NOS psychotic disorders (72%) or major depression (70%), and psychiatric in-patients from schizophrenic or bipolar disorder (62% and 71%, respectively). Comorbidity was more prevalent among inmates than among in-patients, while in-patients presented less social autonomy than did inmates.

The clinical specificity of prison inmates with severe mental disor ders clearly differentiates them from psychiatric in-patients, and warrants recognition of their special needs for assessment and integrated treatment approaches.

The theory of cognitive analytic therapy is extended to offer an understanding of borderline personality disorder (BPD).

A structural model (the multiple self states model) and a classification of different levels of developmental damage are proposed.

The model offers an explanation of the phenomenology of BPD.

The multiple self states model provides insights that will be useful for clinicians involved in the psychotherapy and management of BPD patients.

In Italy a number of studies have been published on psychotropic drug use in general practice and community settings. However, the present study is the first Italian study to focus on hypnotic drug prescriptions in a large community sample.

Data were collected from 145 of the total of 404 pharmacies of five large cities in north-eastern Italy. All consecutive patients presenting a prescription for a hypnotic drug were interviewed by the pharmacists during a two-week period.

The pharmacists interviewed 7/44 consecutive patients. The highest prevalence of prescriptions for hypnotic drugs was found in the elderly and in women. The majority (96%) of prescriptions were for benzodiazepines, with lorazepam and triazolam accounting for 50%. Short-acting and ultra-short-acting benzodiazepines were more frequently prescribed for sleep induction by general practitioners (GPs) than by psychiatrists and other physicians. Frequently the benzodiazepine used as a hypnotic was also prescribed for day time sedation. Approximately 72% of subjects reported they had been taking the prescribed drug for one year or more.

In Italy benzodiazepines are the most frequently prescribed drugs for sleep induction; as they are widely prescribed for elderly people by GPs often for long periods of time, educational programmes and guidelines on the rational use of benzodiazepines in general practice are needed.

The study sought to investigate the form of the delusion in schizophrenia and the overvalued idea in anorexia, employing a range of belief characteristics to discover whether differences could be detected between them, and how they stood in general relationship to the religious beliefs of normals.

A belief rating scale was devised with 12 characteristics, and completed by 20 schizophrenics, 20 anorectics, and 20 normal controls. Comparisons were drawn between populations using the Mann-Whitney test, and different types of belief were contrasted within diagnostic groups using each subject as their own control by repeated-measures MANOVA.

The schizophrenic delusion was differentiated from the overvalued idea in anorexia by a number of variables, which also served to distinguish both phenomena from religious beliefs held by normals. The schizophrenic delusion exhibited many of the qualities of an initial (or observational) belief, when its content suggested that it should manifest those of a derived belief. The anorectic overvalued idea, although occasionally an initial belief in terms of its content, was typically held in the form of a derived belief.

A wider range of characteristics is required to define all the differences between delusion and the overvalued idea, and these have implications for belief modification programmes.

The prevalence of psychiatric disorders in rural Punjab is unknown. Previous studies in rural areas elsewhere in the Indian subcontinent have yielded widely differing estimates.

First-stage screening of a village near Gujar Khan used the Bradford Somatic Inventory and Self Reporting Questionnaire. Psychiatric interviews were conducted with stratified samples using the ICD-10 Diagnostic Criteria for Research.

It is estimated that 66% of women and 25% of men suffered from anxiety and depressive disorders. Levels of emotional distress increased with age in both genders. Women living in unitary households reported more distress than those living in extended or joint families. With younger men and women, lower levels of education were associated with greater risk of psychiatric disorders. Social disadvantage was associated with more emotional distress.

This study in rural Punjab confirms the findings of a previous study in Chitral, northern Pakistan, of high levels of emotional distress and psychiatric morbidity among women in rural areas of Pakistan.

Recent surveys suggest that psychiatric patients are at increased risk of being infected with HIV, although very little information is available concerning the seroprevalence of HIV infection among this population outside the US. The aim of this study is to determine the seroprevalence of HIV-I among patients admitted to a psychiatric in-patient unit and to gather linked anonymous risk-factor information.

An unlinked serosurvey was made, using HIV-1 antibody testing of remnant blood specimens collected for routine medical purposes, of patients consecutively admitted to an acute psychiatric unit in Madrid.

Blood was obtained from 390 of the 477 eligible patients (81.8%). The prevalence of HIV was 5.1% (20/390). Patients aged between 18 and 39 accounted for 63.4% of the admissions and 75% of the positive results. Of the 29 patients who presented with injecting drug use, 14 were HIV-infected (48.3%; 95% CI 29.4 67.5). Of the 51 patients for whom any risk behaviour was noted on the admission chart, 18 were HIV-infected (35.3%; 95% CI 22.4 49.9).

This study demonstrates that there is a substantial prevalence of HIV infection in psychiatric patients admitted to an acute in-patient unit. History of injecting drug use was strongly associated with seropositivity. Clinicians recognised risk factors for HIV infection in the majority of the HIV-infected cases.

We examined psychiatric morbidity following war-related psychic trauma, with a special focus on the depressive comorbidity of post-traumatic stress disorder (PTSD).

Subjects consisted of 60 Israeli veterans who sought psychiatric treatment 4–6 years after having been exposed to war trauma. PTSD and psychiatric comorbidity were diagnosed using the Structured Interview for PTSD and the Schedule for Affective Disorders and Schizophrenia.

Both lifetime (100%) and current (87%) PTSD were the most prevalent disorders. Comorbidity was extensive, with major depressive disorder (MDD) most prevalent (95% lifetime, 50% current), followed by anxiety disorders, minor affective disorders, and alcoholism or drug misuse.

Within post-traumatic psychiatric morbidity of combat origin, PTSD and MDD are the most prevalent disorders. In addition it appears that PTSD, although related to post-traumatic MDD beyond a mere sharing of common symptoms, is of the same time differentiated from it as an independent diagnostic category.