Inequalities of service use across ethnic groups are important to policy makers, service providers and service users.

To identify ethnic variations in pathways to specialist mental health care, continuity of contact, voluntary and compulsory psychiatric in-patient admissions; to assess the methodological strength of the findings.

A systematic review of all quantitative studies comparing use of mental health services by more than one ethnic group in the UK. Narrative analysis supplemented by meta-analysis, where appropriate.

Most studies compared Black and White patients, finding higher rates of in-patient admission among Black patients. The pooled odds ratio for compulsory admission, Black patients compared with White patients, was 4.31 (95% CI 3.33–5.58). Black patients had more complex pathways to specialist care, with some evidence of ethnic variations in primary care assessments.

There is strong evidence of variation between ethnic groups for voluntary and compulsory admissions, and some evidence of variation in pathways to specialist care.

A growing body of evidence suggests that migration is a risk factor for the development of schizophrenia, although the putative mechanism remains obscure.

To examine immigrant background and history of foreign residence as risk factors for schizophrenia.

Using data from the Danish Civil Registration System, we established a population-based cohort of 2.14 million persons resident in Denmark by their fifteenth birthday. Schizophrenia in cohort members and parental psychiatric disorder were identified by cross-linkage with the Danish Psychiatric Case Register.

The relative risk of developing schizophrenia was 2.45 (95% CI 2.25–2.67) and 1.92 (95% CI 1.74–2.12) among first- and second-generation immigrants respectively, and 1.60 (95% CI 1.25–2.05) among Danes with a history of foreign residence.

Migration confers an increased risk for schizophrenia that is not solely attributable to selection factors and may also be independent of foreign birth.

Treatment non-adherence and service disengagement are commonly attributed to impaired insight. There is evidence that recovery style (i.e. psychological adjustment) may underlie service engagement.

We examined whether insight, psychotic symptoms or individuals' recovery style (‘integration’ v. ‘sealing-over’) predicts service engagement.

Fifty patients with schizophrenia were assessed during acute psychosis and at 3-month and 6-month follow-ups. Measures included recovery style, psychosis symptoms, insight and service engagement.

Sealing-over at 3 months following onset of an episode of psychosis predicted low service engagement at 6 months. Neither insight nor symptoms predicted engagement. The clear shift from integration to sealing-over within the first 3 months was independent of changes in symptoms or insight. Sealing-over between 3 and 6 months was associated with improvement in psychosis symptoms.

Recovery style contributed more to engagement than did insight, appears to be dynamic in the short term and is orthogonal to insight. Overall, this study demonstrated the importance of addressing psychological adjustment to psychosis as well as illness status when investigating treatment engagement in people with psychosis.

The impact of comorbid personality disorder on the occurrence of violence in psychosis has not been fully explored.

To examine the association between comorbid personality disorder and violence in community-dwelling patients with psychosis.

A total of 670 patients with established psychotic illness were screened for comorbid personality disorder. Physical assault was measured from multiple data sources over the subsequent 2 years. Logistic regression was used to assess whether the presence of comorbid personality disorder predicted violence in the sample.

A total of 186 patients (28%) were rated as having a comorbid personality disorder. Patients with comorbid personality disorder were significantly more likely to behave violently over the 2-year period of the trial (adjusted odds ratio = 1.71, 95% CI 1.05–2.79).

Comorbid personality disorder is independently associated with an increased risk of violent behaviour in psychosis.

Dialectical behaviour therapy (DBT) is widely considered to be a promising treatment for borderline personality disorder (BPD). However, the evidence for its efficacy published thus far should be regarded as preliminary.

To compare the effectiveness of DBT with treatment as usual for patients with BPD and to examine the impact of baseline severity on effectiveness.

Fifty-eight women with BPD were randomly assigned to either 12 months of DBT or usual treatment in a randomised controlled study. Participants were recruited through clinical referrals from both addiction treatment and psychiatric services. Outcome measures included treatment retention and the course of suicidal, self-mutilating and self-damaging impulsive behaviours.

Dialectical behaviour therapy resulted in better retention rates and greater reductions of self-mutilating and self-damaging impulsive behaviours compared with usual treatment, especially among those with a history of frequent self-mutilation.

Dialectical behaviour therapy is superior to usual treatment in reducing high-risk behaviours in patients with BPD.

Few double-blind trials have examined the efficacy of a combination of a mood stabiliser and an atypical antipsychotic in acute mania.

To determine the efficacy of risperidone in combination with a mood stabiliser in acute mania.

Patients taking a mood stabiliser were randomised to 3 weeks' treatment with risperidone (n=75) or placebo (n=76).

Young Mania Rating Scale (YMRS) scores improved rapidly with significantly greater reductions at week 1 in the risperidone group compared with the placebo group. At end-point YMRS scores decreased by 14.5 and 10.3 points in the risperidone and placebo groups, respectively. Significant improvements v. placebo (P < 0.05) were noted in the risperidone group on several other clinically meaningful measures. Additionally, a post hoc analysis excluding carbamazepine-treated patients (plasma concentrations of risperidone active moiety were 40% lower in this group) revealed significantly greater reductions (P=0.047) in YMRS scores in the risperidone group than in the placebo group. Incidence of adverse events was similar in both groups.

Risperidone is superior to placebo when used in combination with lithium or divalproex in acute mania.

Bibliometric research has used publication or funding databases to compare the amount of research activity on different illnesses. Only one study has examined bipolar disorder and schizophrenia in this way, and it was restricted to one database.

The primary aim is to compare levels of research activity in bipolar disorder and schizophrenia. Secondary aims are to examine how research activity on the disorders varies over time and across scientific fields.

The numbers of publications, projects, journals and funding awards on bipolar disorder and schizophrenia were extracted from nine computer databases to compare research activity on the two conditions.

Ratios (bipolar disorder: schizophrenia) ranged from 1:1.3 for the number of research funding awards to 1:7.6 for the number of clinical trials.

There is a relative dearth of research activity on bipolar disorder compared with schizophrenia.

In 1986 the British Journal of Psychiatry published a study of physicians' and surgeons' management of psychological problems, later cited as evidence of barriers limiting liaison psychiatry.

To repeat the study after 16 years of liaison psychiatry.

Anonymous, confidential questionnaires were distributed to doctors at St George's Hospital, London, replicating the original study.

Most of the 225 respondents believed that psychological factors could influence physical prognosis and should be routinely assessed, with greater sense of responsibility for overdoses and dying patients. Most respondents found emotional assessment impractical. Although 78% wanted more psychiatric input, referrals were avoided because of ‘stigmatisation’. Men were more likely than women to hold pejorative views, but outcomes no longer varied with seniority or speciality.

Compared with 1986, hospital doctors appear more aware of the psychological needs of patients.

It has been argued that post-traumatic stress disorder (PTSD) is a timeless condition, which existed before it was codified in modern diagnostic classifications but was described by different names such as ‘railway spine’ and ‘shellshock’. Others have suggested that PTSD is a novel presentation that has resulted from a modern interaction between trauma and culture.

To test whether one core symptom of PTSD, the flashback, has altered in prevalence over time in soldiers subjected to the intense stress of combat.

Random selections were made of UK servicemen who had fought in wars from 1854 onwards and who had been awarded war pensions for post-combat disorders. These were studied to evaluate the incidence of flashbacks in defined, at-risk populations.

The incidence of flash backs was significantly greater in the most recent cohort, veterans of the 1991 Persian Gulf War; flashbacks were conspicuous by their absence in ex-servicemen from the Boer War and the First and Second World Wars.

Although this study raises questions about changing interpretations of post-traumatic illness, it supports the hypothesis that some of the characteristics of PTSD are culture-bound. Earlier conflicts showed a greater emphasis on somatic symptoms.

Age- and gender-specific suicide rates in England and Wales have changed considerably since 1950.

To assess whether cohort effects underlie some of these changes.

Graphical displays to assess age–period–cohort effects on suicide for the period 1950–1999.

Successive male birth cohorts born after 1940 carried with them, as they aged, a greater risk of suicide than their predecessors although this effect diminished for the 1975 and 1980 birth cohorts. There was less clear evidence of any increased risk of suicide in post-war female birth cohorts.

Succeeding generations of males born in the post-war years have experienced increasing rates of suicide at all ages, an observation in keeping with patterns seen in other countries. If these trends continue into middle- and old-age they will lead to a great increase in overall male suicide rates.