There is a lack of cross-national research on care for people with schizophrenia.

To produce standardised European versions of five instruments in key areas of mental health service research in five languages, and to compare data from five European countries regarding patients with schizophrenia and mental health care provision and costs.

Five centres, in Amsterdam, Copenhagen, London, Santander and Verona, participated. Instruments assessing needs, service use, informal carer involvement, quality of life, and service satisfaction were subjected to a conversion procedure including translation, back-translation, focus group discussion and reliability assessment. Patients of local mental health services with a Schedules for Clinical Assessment in Neuropsychiatry diagnosis of schizophrenia were interviewed.

Service provision varied between sites; 404 patients were studied. instrument reliability was found to be good.

The instruments developed were reliable across the range of countries, and will facilitate future comparative health service research.

Previous attempts to decide whether there is significant year-to-year variation in the birth rate of people who subsequently develop schizophrenia have given conflicting results, probably because of differences in the statistical methods employed.

To determine whether there is significant year-to-year variation in the birth rate.

Variation in the birth rate for the period 1921–1960 was studied in three separate national data sets – English, Danish and Scottish – using cubic splines to smooth the distribution curve before calculating residuals from a Poisson distribution.

Over-dispersion was found in all three data sets, particularly in the Danish and Scottish data. However, the correlation between the sets of standardised residuals derived from the three data sets was only statistically significant for Denmark v. England.

There was statistically significant year-to-year variation in the birth rate of people who subsequently developed schizophrenia in three countries in north-west Europe in the years 1921–1960. This is potentially a clue to the nature of the environmental determinants of schizophrenia, but better data will be needed before useful explanatory hypotheses can be generated and tested.

Treatment of patients with personality disorder remains controversial and severe mental illness is prioritised in secure forensic psychiatry services.

To compare patients with personality disorder and mental illness according to demography, referral, criminality, previous institutionalisation and diagnostic comorbidity.

A record survey of 511 patients with personality disorder and 2575 with mental illness admitted to secure forensic psychiatry services between 1 January 1988 and 31 December 1994 from half of England and Wales.

Personality disorder admissions declined over time; more were female, White, younger and extensively criminal (specifically, sexual and arson offences). Personality disorder was highly comorbid; antisocial, borderline, paranoid and dependent personality disorder were most prevalent.

Patients with personality disorder were highly selected and previously known to psychiatric services. Referrer, diagnostic comorbidity and behavioural presentation determined their pathways into care. Future research must determine whether their continuing admission represents effective use of scarce resources and whether new services are required.

The temporal stability of a diagnosis is one measure of its predictive validity.

To measure diagnostic stability in first-episode psychosis using ICD–10 and DSM–III–R.

Between 1992 and 1994 we ascertained a cohort of persons with first-episode psychosis (n=168), assigning to each a consensus diagnosis. At three-year follow-up, longitudinal consensus diagnoses, blind to onset diagnoses, were made. Stability was measured by the positive predictive values (PPVs) of onset diagnoses. For onset schizophrenia, we also calculated sensitivity, specificity and concordance (κ).

First-episode ICD–10 and DSM–III–R schizophrenia had a PPV of over 80% at three years. Over one-third of cases with ICD–10 F20 schizophrenia at three years had non-schizophrenia diagnoses at onset. Manic psychoses showed the highest PPV (91%). For onset schizophrenia, both systems had high specificity (ICD–10: 89; DSM–III–R: 93%), but low sensitivity (ICD–10: 64%; DSM–III–R: 51%) and moderate concordance (ICD–10: 0.54; DSM–III–R: 0.46).

Bipolar disorders and schizophrenia showed the highest stability. DSM–III–R schizophrenia did not have greater stability than ICD–10 schizophrenia.

The greater frequency of mental illness in deprived and inner-city populations is well recognised; allocation of funds in the UK health service makes some allowance for this. However, it is not clear whether the differences are similar for all levels of mental health care need.

To study the range in prevalence of mental health problems and care at primary care, general secondary care and forensic care levels.

We used mainly descriptive statistics to study evidence available from existing sources – some based on indicators of likely need, some on observed prevalance of treatment.

Among English health authority areas, the most morbid have about twice the prevalence of primary care level mental illness of the least morbid. For secondary care the ratio is between 2.5 and 4 to 1, while for services for mentally disordered offenders it is in excess of 20:1.

Where needs indices are used for resource allocation, responsible authorities should ensure that they produce ranges reflecting the full compass of services funded. For forensic services the range of morbidity levels may be so great that funding needs to rest at a larger population level than that of health authorities.

The Townsend index is a measure of social deprivation. It can be applied to postal districts and has been employed in studies examining the ecological associations of mental illness.

We examine the utility of the Townsend index in identifying older populations with a high prevalence and risk of developing depression.

The study was carried out in the context of a cohort study of an age- and gender-stratified sample of 5222 community residents aged 65 years and over. Subjects were interviewed at intervals of two years. The relationships between Townsend score and psychiatric diagnoses (in particular, depression) were examined.

High Townsend scores were associated with increased prevalence and incidence of depression and prevalence of organic psychiatric illness.

The Townsend index can be used to prioritise psychiatric and primary care resources so as to cater for older populations likely to suffer from depression and organic psychiatric conditions.

Post-partum depression in the developing world has received tittle research attention, and its association with disturbances in the mother–infant relationship is unknown.

To determine the prevalence of post-partum depression and associated disturbances in the mother–infant relationship in Khayelitsha, a South African peri-urban settlement.

The mental state of 147 women who had delivered two months previously was assessed, and the quality of their engagement with their infants was determined.

The point prevalence of DSM–IV major depression was found to be 34.7%. Maternal depression was associated with poor emotional and practical support from the partner. It was also associated with insensitive engagement with the infants.

The rate of post-partum depression in Khayelitsha was around three times that found in British post-partum samples, and these depressions were strongly associated with disturbances in the mother–infant relationship.

Social cognitive skills are those which enable understanding of social situations; they are relevant to a variety of psychiatric disorders including autism, schizophrenia and externalising behaviour problems in children.

To examine the heritability of social cognitive skills.

Using a population-based sample of twins aged 5–17, the genetic and environmental influences on social cognitive skills were examined.

Male scores were higher than female scores (P < 0.001), indicating poorer social cognition among males. A heritability of 0.68 (95% CI 0.43–0.78) was found, with shared environmental influences accounting for only 0.05 of the variance (95% CI 0.00–0.28). This could be removed from the model without worsening the fit. There were no significant differences in genetic effects between the genders, but age-related changes were found, with younger twins showing greater genetic influence on social cognition.

Social cognition appears to be under considerable genetic influence in the population and shows significant male–female differences. No gender differences in genetic influences on the variance of scores were found, but the effects of age were significant.

Family relationships in the transition from childhood to adult life may be important mediators of risk and resilience for adult psychopathology.

To develop a reliable and valid measure of the quality of relationships with each parent in young adults.

Interrater reliability of the Relationship with Family of Origin Scale (REFAMOS) was assessed from audio-taped interviews with 59 subjects. Age-related trends and associations with recalled childhood relationships were examined in survivors of childhood cancer and their controls (n=178).

Intraclass correlation coefficients were in the range 0.69–0.95, and κ values 0.80–0.82. Indices of current closeness to mothers were negatively correlated with age of subject and positively correlated with recalled maternal care in childhood. Negative qualities in current relationships were correlated with recalled overprotection.

The REFAMOS has good interrater reliability, and shows the predicted age-related trends in scores and associations with recalled childhood relationships.

Previously reported results have demonstrated the efficacy of exposure and cognitive therapy in the treatment of chronic post-traumatic stress disorder (PTSD), but have not shown one to be superior to the other.

To investigate whether treatment benefits and equivalence are maintained at 12-month follow-up in patients with chronic PTSD treated with either imaginai exposure or cognitive therapy.

Twelve-month follow-up of a randomised clinical trial.

Fifty-four subjects (87% of the sample) were available to follow-up. They did not significantly differ clinically from drop-outs. There was significant clinical improvement at 12 months compared with pre-treatment. However, 39% of those followed-up still met criteria for PTSD. There were no significant differences between the two treatments. Victims of crime displayed higher levels of symptoms at follow-up than victims of accidents.

Clinical benefits for exposure or cognitive therapy were maintained.

People prescribed clozapine for treatment-resistant schizophrenia have mandatory haematological monitoring through a case register for identifying reversible neutropenia.

To quantify risk factors for agranulocytosis in subjects receiving clozapine.

Data from 12 760 subjects registered to receive clozapine from January 1990 to April 1997 were analysed. Risk factors for agranulocytosis were quantified using a Cox proportional-hazards regression analysis.

The risk for agranulocytosis in Asian subjects was 2.4 times that in Caucasians (P=0.03). There was an age-related increase in risk of 53% per decade (P=0.0001).

The case register yielded valuable information for guiding research into the causes of the haematological reactions.

Several studies of papers published in non-psychiatric medical journals that report on randomised controlled trials (RCTs) indicate that there is inadequate reporting of the process by which randomisation is carried out.

To examine the adequacy of the reporting of the procedure of randomisation in clinical trials of parallel design published in the British Journal of Psychiatry (BJP) and the American Journal of Psychiatry (AJP).

All issues of the BJP and the AJP published between January 1990 and December 1998 were surveyed, and papers that reported on RCTs were examined to judge the adequacy of the reporting of the process of randomisation.

We found 183 papers which claimed to report on RCTs (73 in the BJP and 110 in the AJP). Nine (8.2%) of those in the AJP and six (8.2%) in the BJP described the technique of creating the randomisation sequence. Two (1.8%) of those in the AJP and 11 (15.1%) of those in the BJP described the mechanism of allocating treatment. One paper in the AJP and five papers in the BJP described both the generation of random numbers and allocation.

Adequate reporting of the method of randomisation was uncommon. The RCT status of some of the papers must therefore be in doubt.