La belle indifférence refers to an apparent lack of concern shown by some patients towards their symptoms. It is often regarded as typical of conversion symptoms/hysteria.

To determine the frequency of la belle indifférence in studies of patients with conversion symptoms/hysteria and to determine whether it discriminates between conversion symptoms and symptoms attributable to organic disease.

A systematic review of all studies published since 1965 that have reported rates of la belle indifférence in patients with conversion symptoms and/or patients with organic disease.

Atotal of 11 studies were eligible for inclusion. The median frequency of la belle indifférence was 21 % (range 0–54%) in 356 patients with conversion symptoms, and 29% (range 0–60%) in 157 patients with organic disease.

The available evidence does not support the use of la belle indifférence to discriminate between conversion symptoms and symptoms of organic disease. The quality of the published studies is poor, with a lack of operational definitions and masked ratings. La belle indifférence should be abandoned as a clinical sign until both its definition and its utility have been clarified.

A relationship between the serotonin transporter gene, adverse events and onset of major depression has been reported.

To replicate a gene × environment interaction in a cohort with longitudinal data for life events, experience of depression, parental bonding and neuroticism.

Atthe 25-year follow-up, genomic DNA was obtained from 127 cohort members (mean age 48 years) to determine the genotype of the serotonin transporter gene-linked promoter region (5-HTTLPR). Associations were investigated between the 5-HTTLPR genotype, positive and adverse life events and the gene × environment interaction, and also between the 5-HTTLPR genotype and risk factors for depression.

No relationship was found between 5-HTTLPR genotype and either risk factors for depression or positive life events. Adverse life events had a significantly greater impact on the onset of depression for individuals with the s/s genotype.

The 5-HTTLPR genotype is a significant predictor of onset of major depression following multiple adverse events. This is one of the more robust findings concerning specific biological risk factors for depression.

Major depression in childhood or adolescence increases the risk of affective disorder in adulthood. The precise nature and course of the subsequent disorder remain unclear.

To investigate long-term psychiatric outcome of school-age depression in community and clinic samples.

A group of 113 young adults were followed up after a mean of 7.8 years (s.e.=15).

Groups with persistent and recurrent depression were identified. Recurrence of affective disorder was similar in clinic and community groups. The clinic group had significantly longer index episodes; these were predicted by an early psychiatric history, longer episode duration before treatment and greater impairment. Being female, having higher self-report depression scores and comorbidity at index episode predicted earlier recurrence. Males were more likely to have persistent depression.

Prognosis is similar in young people with depression from community and clinical samples. Boys from a clinical sample are at higher risk than girls of becoming persistently and severely mentally ill.

Recent interest in suicide rates in schizophrenia has been considerable.

To establish the lifetime suicide rate from the pre-chlorpromazineera and to compare this with recent lifetime suicide rates for schizophrenia.

We have compared suicide and suicide attempt rates for 741 admissions for schizophrenia and 1303 admissions for psychoses to the North Wales Asylum between 1875 and 1924, with first admissions for psychosis in North West Wales between 1994 and 1998.

The suicide rate in schizophrenia between 1875 and 1924 was 20 per 100 000 hospital years, a lifetime rate of less than 0.5%. The suicide rate for all psychoses was 16 per 100 000 hospital years. Current rates of suicide for schizophrenia and other psychoses appear 20-fold higher.

These findings point to an increase in suicide rates for patients with schizophrenia.

Few studies have investigated large population-based cohorts for an association between alcohol consumption and suicide.

To investigate the possible association between alcohol intake and suicide.

We used nationwide population-based cohort data from the Japan Public Health Centre-Based Prospective Study cohort. Atotal of 43 383 men aged 40–69 years participated. Death from suicide was defined according to ICD–10 as codes X60-X84.

Duringthe367817person-years of follow-up, there were 168 suicides. Compared with occasional drinkers, the pooled multivariate relative risk (RR; with 95% CI) of suicide for non-drinkers and regular heavy drinkers was 2.3 (1.2–4.6) and 2.3 (1.2–4.7) respectively. The RR increased with the amount of alcohol consumed (P for trend =0.004).

There is a U-shaped association between alcohol consumption and subsequent suicide.

Substance use may be a risk factor for the onset of schizophrenia.

To examine the association between substance use and age at onset in a UK, inner-city sample of people with recent-onset schizophrenia.

The study sample consisted of 152 people recruited to the West London First-Episode Schizophrenia Study. Self-reported data on drug and alcohol use, as well as information on age at onset of psychosis, were collected. Mental state, cognition (IQ, memory and executive function) and social function were also assessed.

In total, 60% of the participants were smokers, 27% reported a history of problems with alcohol use, 35% reported current substance use (not including alcohol), and 68% reported lifetime substance use (cannabis and psychostimulants were most commonly used). Cannabis use and gender had independent effects on age at onset of psychosis, after adjusting for alcohol misuse and use of other drugs.

The strong association between self-reported cannabis use and earlier onset of psychosis provides further evidence that schizophrenia may be precipitated by cannabis use and/or that the early onset of symptoms is a risk factor for cannabis use.

Data on effectiveness of acute day hospital treatment for psychiatric illness are inconsistent.

To establish the effectiveness and costs of care in a day hospital providing acute treatment exclusively.

In a randomised controlled trial, 206 voluntarily admitted patients were allocated to either day hospital treatment or conventional wards. Psychopathology, treatment satisfaction and subjective quality of life at discharge, 3 months and 12 months after discharge, readmissions to acute psychiatric treatment within 3 and 12 months, and costs in the index treatment period were taken as outcome criteria.

Day hospital patients showed significantly more favourable changes in psychopathology at discharge but not at follow-up. They also reported higher treatment satisfaction at discharge and after 3 months, but not after 12 months. There were no significant differences in subjective quality of life or in readmissions during follow-up. Mean total support costs were higher for the day hospital group.

Day hospital treatment for voluntary psychiatric patients in an inner-city area appears more effective in terms of reducing psychopathology in the short term and generates greater patient satisfaction than conventional in-patient care, but may be more costly.

Psychological treatments have been shown to be effective in patients with psychosis. However, the studies published to date have included participants across wide age ranges, so few conclusions can be reached about the effectiveness of such treatments in relation to age.

To evaluate outcomes by age in a randomised controlled trial designed to evaluate the effectiveness of cognitive-behavioural therapy (CBT), supportive counselling and treatment as usual.

Outcomes were evaluated in terms of symptoms, social functioning, insight and therapeutic alliance according to age at 3- and 18-month follow-up.

Younger participants responded better to supportive counselling than to treatment as usual and CBTover 3 months. Older participants responded better to CBT than to supportive counselling over 18 months. Younger participants showed a greater increase in insight after CBT compared with treatment as usual and supportive counselling, and were more difficult to engage in therapy.

Young people may have different needs with regard to engagement in psychological treatments. Treatment providers need to take age-specific factors into account.

Further treatment with clozapine is contraindicated in any patient who has previously experienced leucopenia or neutropenia during clozapine therapy.

To investigate the results of such a rechallenge in 53 patients.

An analysis was made of the demographic, haematological and outcome data of patients in the UK and Ireland who were rechallenged with clozapine following leucopenia or neutropenia during previous clozapine therapy.

Of 53 patients who were rechallenged, 20 (38%) experienced a further blood dyscrasia. In 17 of these 20 patients (85%) the second blood dyscrasia was more severe(P<0.001), in 12(60%) it lasted longer (P=0.0368) and in 17 (85%) it occurred more quickly on rechallenge (P<0.001). Of the original 53 patients, 55% (29 patients) are still receiving clozapine.

No clear risk factor for repeat blood dyscrasias was identified. Despite this, after risks and benefits have been considered, rechallenge may well be justified in some patients.

Little is known about the determinants of violence in women with psychosis.

To identify predictors of violence in a community sample of women with chronic psychosis.

The 2-year prevalence of physical assault was estimated for a sample of 304 women with psychosis. Baseline socio-demographic and clinical factors were used to identify predictors of assault.

The 2-year prevalence of assault in the sample was 17%. Assaultive behaviour was associated with previous violence (OR=5.87, 95% CI 2.42–14.25), non-violent convictions (OR=2.63, 95% CI 1.17–5.93), victimisation (OR=2.46, 95% CI 1.02–5.93), African–Caribbean ethnicity (OR=2.24, 95% CI 1.02–4.77), cluster B personality disorder (OR=2.66, 95% CI 1.11–6.38) and high levels of unmet need (OR=1.17, 95%C11.01–1.35). An interaction between African–Caribbean ethnicity and cluster B personality disorder was identified in relation to violent outcome. Violent women were found to be more costly to services.

Nearly a fifth of community-dwelling women with chronic psychosis committed assault over a period of 2 years. Six independent risk factors were found to predict violence.

Despite concern about the incidence of coronary heart disease (CHD) in people with severe mental illness (SMI), there is little systematic research on CHD risk factors in this population.

To compare the main risk factors for CHD in people with and without SMI in primary care, to investigate the role of socio-economic variables, and to examine any association between antipsychotic medication and CHD risk.

Cross-sectional screening.

In total, 75 of 182 general practice patients with SMI and 150 of 313 such patients without SMI attended the interview. SMI was associated with: raised 10-year CHD risk scores (OR= 1.8, 95% CI 1.0–3.1); high-density-lipoprotein (HDL)-cholesterol levels <l.0 mmol/l (OR=4.0, 95% CI 1.5–10.7); raised cholesterol/HDL-cholesterol ratios (OR=1.8, 95% CI 1.0–3.2); diabetes mellitus (OR=3.8, 95% CI 1.1–13.3) and smoking (OR=3.0, 95% CI 1.7–3.4). These associations varied significantly with age. Adjustment for unemployment did not fully explain the associations.

Excess risk factors for CHD are not wholly accounted for by medication or socio-economic deprivation. There is an urgent need for CHD screening and for relevant interventions for smoking cessation and diabetes, as well as advice on diet and exercise, in patients with SMI.

Research on posttraumatic stress disorder (PTSD) relies mainly on self-reports of exposure to trauma and its consequences.

To analyse the consistency of the reporting of potentially traumatic events (PTEs) over time.

A community-based cohort, representative of the canton of Zurich, Switzerland, was interviewed at the ages of 34–35 years (in 1993) and 40–41 years (in 1999). A semi-structured diagnostic interview, including a section on PTSD, was administered.

Of the 342 participants who attended both interviews, 169 reported some PTE (1993, n=110; 1999, n=120). In 1999, 56 participants (33.1%) reported for the first time PTEs that actually occurred before 1993, but which had not been reported in the 1993 interview. In total, 68 participants (40.2%) who had reported a PTE in 1993 did not report it in 1999. The overall frequency of inconsistent reporting was 63.9%.

The high level of inconsistency in the reporting of PTEs has implications for therapy as well as for research.