In the face of rapidly expanding empirical knowledge about this common childhood condition, there is a need for an up-to-date synthesis, especially for the use of practising clinicians.

The main epidemiological, experimental and clinical studies over the past decade are selectively reviewed.

Hyperkinetic/attention deficit hyperactivity disorder is common, with young school-age males most frequently affected. The prevalence figures vary depending on the criteria used. Overlap with conduct disorder is high. The causes are likely to stem from a combination of biological, often genetically determined neurochemical disturbances, and environmental disadvantages, with the biological risk tending to be highest in severely hyperactive girls. Good clinical management combines pharmacological, psychological and educational approaches in a sustained manner. Even then, the outcome is often equivocal and the long-term psychosocial adaptation unpredictable.

Clinically significant hyperactivity is rooted in biological, often genetically transmitted vulnerabilities, upon which environmental disadvantages transact. It may be viewed as a disorder of self-regulation with its roots partly in strained early caregiver–child interactions and disrupted primary attachments.

Psychiatrists are sometimes asked to express an opinion about the competence and motivation of a mentally ill mother to be a consistent, adequate and safe parent of her recently born infant, There are no reliable methods for assessing mother–infant interaction and relationship in a psychiatric context.

The Bethlem Mother–infant Interaction Scale (BMIS) was developed by the staff of a specialised psychiatric mother and baby unit. Of the seven subscales, four measured different aspects of the mother's contribution to the dialogue with her baby, one measured her capacity to organise and maintain routine care, one attempted to rate the perception by staff of risk to the child, and the remaining subscale rated the baby's contribution to their interaction. In normal clinical practice the ratings were made consensually by nurses and they encompassed observations that had been made by them during the previous week.

Despite the simple and global nature of the ratings of the BMIS, moderate to high coefficients of inter-rater reliability were obtained for weekly ratings by nurses as well as for intra-rater reliability of ratings of videotaped interactions between mothers and their infants. Ratings of mothers and babies in day-to-day activity in the unit that were based on one hour's observation only were much less reliable. The internal consistency of the BMIS was high and comparisons with other methods used in non-clinical settings showed good criterion-related validity.

Using the BMIS facilitated attempts to reliably assess disturbances of mother–infant interaction and the scale was acceptable and clinically useful. The nurses' ratings of their perceptions of ‘risk’ to the infant, which are in some ways the most important, were the least reliable. Repeated weekly ratings gave a valuable impression of change or lack of it over time. The predictive validity of the scale has yet to be determined.

The Bethlem Scale was designed as a validated measure of mother–infant adjustment in mother–baby units.

A multi-centre trial was conducted to investigate aspects of the reliability, validity and clinical usefulness of the Bethlem Mother–infant Interaction Scale within five in-patient psychiatric mother–baby units.

This revealed good inter-rater, test-retest and inter-item reliability. Correlations of the scale items with psychiatrist's ratings and changes in scoring over time suggest reasonable validity, despite some design problems with individual items.

Mother–infant interaction scales may have an important role in improving the quality of care for mothers and their babies in the psychiatric setting. The development of a more extensive scale, the Monash Mother–infant Interaction Scale, is discussed.

Comparing women's and men's emotional reactions to childbirth can clarify the impact on mental health of childbirth as a life event.

Fifty-four first-time mothers attending obstetric services in Oporto, Portugal, and 42 of their husbands or partners participated in a longitudinal study of their mental health. All subjects were given a semi-structured clinical interview (SADS) at 6 months antenatally and at 12 months postnatally and sub-samples were interviewed at 3 months postnatally. At all these times all the mothers and fathers also completed a translated version of a self-rating scale for depression, the Edinburgh Postnatal Depression Scale (EPDS).

More women than men had past histories of depression but their rates of depression did not differ significantly during pregnancy. In the first 3 months postnatally, nearly a quarter of the women ‘at risk’ were found to have become depressed (major, minor and intermittent) in contrast with less than 5% of the men. In the next nine months men were more prone to become depressed than previously and their conditions tended to follow an earlier onset of depression in their spouses.

Comparisons of EPDS and SADS ratings showed that the translated EPDS was a valid instrument for women but it was less satisfactory when applied to men.

We compare and contrast some correlates of paternal and maternal depression after the live birth of a first child, as part of a longitudinal study.

Fifty-four first-time mothers attending obstetric services in Oporto, Portugal, and 42 of their husbands or partners participated in a longitudinal study of their mental health. All subjects were given a semi-structured clinical interview (SADS) at six months antenatally and at 12 months postnatally and sub-samples were interviewed at three months postnatally. At all these times all the mothers and fathers also completed a translated version of a self-rating scale for depression, the Edinburgh Postnatal Depression Scale (EPDS) and a series of other questionnaires and interviews to measure different psychosocial variables. Profiles of risk factors associated with depression in the first postnatal year were analysed by means of logistic regressions.

In the mothers, aside from a history of depression, the only other powerful predictor of postnatal depression was the mean objective negative impact score of life events. ‘Postnatal’ depression in fathers was associated with a history of depression in themselves and with the presence of depression in their wives or partners during pregnancy and soon after delivery.

Prevention and early treatment of depression in fathers may benefit not only themselves but also their spouses and their children.

In community mental health care, knowledge about costs of care is very limited. Only few studies have related costs to outcome measures.

This German study assesses the cost of psychiatric care of 66 schizophrenic patients during one year of living in the community. Predictors of high cost were identified.

The average cost of comprehensive community care of one patient of the cohort was US$ 353 per week. This was only 43% of the cost of constant long-term care in a psychiatric hospital. Significant predictors of total cost of community care were the number of rehabilitative problems at the beginning and at the end of the study period, the type of accommodation before index hospitalisation and the gender of patients.

Results must be understood in terms of the characteristics of the special patient group and the catchment area we studied and are of high relevance in planning future care.

Different approaches to estimating local catchment-area needs for psychiatric services are illustrated and compared.

Data from an epidemiological morbidity survey of a random sample of 496 adults were available, as were actual service utilisation rates. Four types of utilisation were modelled (i.e. overall out-patient, in-patient, emergency clinic) using social indicators available from Statistics Canada census-tract data. Finally, a case–control study compared out-patients from a deprived and an affluent catchment area, matched case by case for primary diagnosis, age, sex and residential status (n=52).

Modelling proved highly predictive of utilisation, the overall-use model accounting for 73% of the variance. The case–control study indicated a higher rate of Axis II traits, substance abuse and needs for social care in the deprived catchment area.

Resource allocation based on the social indicators modelling method was more consistent with sensible distribution of human resources. None of the methods, however, appear to reflect adequately the severity of caseloads evidenced in the case–control study.

OPCRIT (a suite of computer programs that allow data entry and generate diagnoses according to 12 operational diagnostic systems) is used in a wide range of psychiatric research including both European Science Foundation and NIMH research initiatives in the molecular genetics of mental disorders. We examined its concurrent validity in 100 subjects collected for linkage studies of Bipolar Disorder and Schizophrenia.

We compared diagnoses generated by OPCRIT from data rated by two trained clinicians with diagnoses made according to consensus, best-estimate, lifetime procedures by the same two raters according to DSM–III–R and RDC classifications.

Good to excellent agreement was achieved between OPCRIT diagnoses and those made by consensus best-estimate procedures.

OPCRIT provides a convenient, reliable, rapid and valid approach to polydiagnostic assessment that can be used as an adjunct to conventional (but time consuming) best-estimate consensus diagnostic procedures.

Artificial Neural Network (ANN), as a potential powerful classifier, was explored to assist psychiatric diagnosis of the Composite International Diagnostic Interview (CIDI).

Both Back-Propagation (BP) and Kohonen networks were developed to fit psychiatric diagnosis and programmed (using 60 cases) to classify neurosis, schizophrenia and normal people. The programmed networks were cross-tested using another 222 cases. All subjects were randomly selected from two mental hospitals in Beijing.

Compared to ICD-10 diagnosis by psychiatrists, the overall kappa of BP network was 0.94 and that of Kohonen was 0.88 (both P < 0.01). In classifying patients who were difficult to diagnose, the kappa of BP was 0.69 (P < 0.01). ANN-assisted CIDI was compared with expert system assisted CIDI (kappa=0.72–0.76); ANN was more powerful than a traditional expert system.

ANN might be used to improve psychiatric diagnosis.

The clinical validity of melancholia has been argued on the basis of its capacity to predict response to electroconvulsive therapy (ECT). We have argued that a sign-based (CORE) rating system of psychomotor disturbance can identify patients with melancholia. Therefore, the clinical validity of the CORE system was tested here in terms of its capacity to predict response to ECT.

The response of 81 patients with primary affective disorders to an individualised course of ECT was investigated. CORE scores and other clinical predictors were evaluated in terms of their capacity to predict effect size changes in symptoms and disability.

CORE scores predicted ECT response, as did the presence of psychotic features. The combination of marked psychomotor change (high CORE scores) and psychotic features predicted the best response to ECT.

This study supports the clinical validity of the CORE system for diagnosing melancholia.

Alcohol and drugs use were assessed in a nationwide one year suicide study in Finland.

Alcohol and drugs use were analysed in 1348 suicides, 96.5% of all suicides in the study year. Relative suicide risks for drugs were defined by relating the number of suicides committed by use of various drugs to drug availability.

Alcohol was detected twice as often in men as in women; the opposite was the case with drugs. The drugs most commonly used for suicide were neuroleptics and antidepressants, which were, in 74.3% and 77.4% of the cases, respectively, the victim's own prescribed drugs. Antidepressants were found in 19.0% of women and only 4.8% of men. Relative suicide risk for antidepressants varied substantially between different compounds.

Undertreatment of depression is a challenge for suicide prevention. Those who commit suicide by antidepressants use their own drugs. Relative suicide risk for a drug should be considered when choosing treatment for depressive patients.

Rates of self-poisoning fell during the 1980s, although recent reports suggest this trend may have reversed.

Data on all hospital discharges with a diagnosis of deliberate self-poisoning were obtained from the Information and Statistics Division of the NHS in Scotland. Rates of self-poisoning were investigated by overall trend, and for trends by age and by type of drug.

Deliberate self-poisoning rates for men and women began increasing in the late 1980s, and did so steadily during the early 1990s. Because the rates are increasing faster in men, the traditional excess of self-poisoning among women is being eroded. For men rates increased in all age groups up to the age of 60, but the greatest rise occurred between ages 15–29. For women the increase was largely restricted to 15–24-year-olds, and rates fell among women over the age of 50. Self-poisoning with paracetamol increased most rapidly; in contrast to aspirin which showed little change. Opiate analgesics, antirheumatics, antidepressants and antipsychotics have also shown some increase in their use in both genders. There has been a substantial fall in the use of benzodiazepines in women, but little change among men.

Rapid increases in self-poisoning particularly among young adults present a serious public health problem. Controlling this epidemic is made difficult because the principal drug involved, paracetamol, is readily available.

Recent studies suggest that larger brain size may offer some protection against the clinical manifestations of Alzheimer's disease. However, this association has not been investigated in population-based studies.

The relationship between head circumference, a measure of premorbid brain size, and score on the Cognitive Abilities Screening Instrument (CASI) was studied in a population of 1985 Japanese–Americans aged 65+ living in King County, Washington, USA.

After adjusting for age, sex and education, head circumference was positively associated with CASI score (b=3.8, 95% CI: 2.2, 5.4; P=0.0000), but not with diagnosis of probable AD (odds ratio=0.87, 95% CI: 0.33, 1.87). When the data were stratified by AD status, no association was seen among controls (b=1.6, 95% CI: – 1.7, 5.1; P=0.4), whereas a strong effect was present among cases (b=35.3, 95% CI: 12.2, 58.4: P=0.006).

These results suggest that persons with AD with smaller head circumference either had the disease longer or progressed more rapidly than those with larger head circumference. Improvement in environmental factors in prenatal and early life that partially determine completed brain/head size may have consequences for the late-life expression of Alzheimer's disease in vulnerable individuals.

In previously published papers from the Nottingham Study of Neurotic Disorder a short treatment package of cognitive–behaviour therapy was no more effective than placebo drug treatment after 10 weeks' assessment in a cohort of 210 patients with neurotic disorders. This paper examines the outcome over two years of the patients treated by cognitive–behaviour therapy separated into two therapist groups, those who were competent in administering treatment and those of uncertain competence.

The therapists (mainly community psychiatric nurses) of 70 patients with an original DSM–III diagnosis of either dysthymic, panic or generalised anxiety disorder were separated into two groups on the basis of their perceived competence by their supervisor (DK). Ratings of psychopathology were made at regular intervals over two years by assessors blind to knowledge of treatment or therapist.

The patients treated by competent therapists (n=30) generally showed greater improvement than those allocated to therapists of uncertain competence (n=40), mainly with respect to depressive symptoms, and the difference persisted over two years, long after the cognitive–behaviour therapy had been completed.

Cognitive–behaviour therapy given by competent therapists over a 10 week period is of lasting benefit in neurotic disorder.

A long-term outcome study of DSM–III–R panic disorder included the Present State Examination (PSE) at baseline and follow up five to six years later.

PSE test–retest and individual within-patient change scores on various PSE syndromes were assessed for consistency with either a categorical view of panic disorder as a stable clinical entity or panic disorder as one facet only of a ‘general neurotic syndrome’.

PSE profile at baseline was virtually identical with that at follow up. Few patients had ‘changed’ in PSE syndrome diagnosis after five to six years.

These data, although not conclusive, are supportive of the concept of DSM–III–R panic disorder as a stable clinical entity and are correspondingly difficult to reconcile with the view that panic disorder is but one facet only of a general neurotic syndrome.

Demographic data, family history, psychopathological features, comorbidity and course of obsessive–compulsive disorder (OCD) are investigated and data generated to support the possible existence of two subgroups with gender-related differences of a broader nature.

Two hundred and sixty-three OCD patients, consecutive admissions to the Institute of Psychiatry, University of Pisa over a period of 5 years, not excluding those with comorbid Axis I and Axis II conditions, were studied. Patients were evaluated with a specifically designed semi-structured OCD interview.

We found a significantly greater history of perinatal trauma in men who also had an earlier onset, greater likelihood of never having been married and a higher frequency of such symptoms as sexual, exactness and symmetry obsessions and odd rituals; by contrast, women suffered a later onset of the disorder, were more likely to be married, had higher rates of associated panic attacks after the onset of OCD and a higher frequency of aggressive obsessions at the onset of their illness, and were less frequently associated with bipolar disorders.

Pathophysiological mechanisms in OCD seem to differ by gender. Perinatal trauma might predispose to earlier onset in men, whereas in women there is a close association between OCD and panic disorder.

The Yale–Brown Obsessive–Compulsive Scale (YBOCS) and Compulsion Checklist (CC) were compared with one another and with five other measures to assess their place in measuring the outcome of obsessive–compulsive disorder (OCD).

Data came from a randomised trial of 46 patients with OCD who completed eight weeks of treatment by exposure and response prevention. Using a structured modelling analysis, the YBOCS and the CC were compared with a latent factor derived from five other variables (Target Rituals, Target Obsession, Clinical Global Impression, Avoidance, Disability) of baseline severity and change after treatment, and also directly with those variables.

Both the YBOCS and the CC were accurate and sensitive measures of OCD. The YBOCS related slightly more than did the CC to the latent factor and to Disability directly. The YBOCS related slightly more to Disability than it did to other measures. Inter-assessor and self v. assessor reliability was high.

The 10-item YBOCS plus the 4-item Disability scale are a simple and efficient way to measure important aspects of OCD in clinical practice.