Tragic and high-profile killings by people with mental illness have been used to suggest that the community care model for mental health services has failed.

To consider whether such homicides have become more frequent as psychiatric services have changed.

Data were extracted from Home Office-generated criminal statistics for England and Wales between 1957 and 1995 and subjected to trends analysis.

There was little fluctuation in numbers of people with a mental illness committing criminal homicide over the 38 years studied, and a 3% annual decline in their contribution to the official statistics.

There are many reasons for improving the resources and quality of care for people with a mental disorder, but there is no evidence that it is anything but stigmatising to claim that their living in the community is a dangerous experiment that should be reversed. There appears to be some case for specially focused improvement of services for people with a personality disorder and/or substance misuse.

The effectiveness of antipsychotic monotherapy in schizoaffective disorder is limited, and further constrained by safety concerns.

We aimed to compare the efficacy, tolerability and safety profile of the new pharmaceutical, olanzapine, with haloperidol.

Data were assessed from 300 DSM – III – R schizoaffective subjects from a larger double-blind prospective international study. Subjects were randomly allocated to six weeks of olanzapine (5–20 mg) or haloperidol (5–20 mg) treatment; responders were followed for up to one year of double-blind, long-term maintenance therapy.

Olanzapine-treated patients achieved a statistically significant greater improvement than haloperidol-treated patients on overall measures of efficacy, including clinical response. Significantly fewer olanzapine patients left the study early, and fewer adverse events were observed among those receiving olanzapine. During maintenance, olanzapine-treated patients continued to experience additional improvement, with fewer EPS but more weight gain than those on haloperidol.

Olanzapine demonstrated substantial advantages over the conventional antipsychotic haloperidol in the management of schizoaffective disorder.

Tardive dyskinesia is important in the side-effect profile of antipsychotic medication.

The development of tardive dyskinesia was evaluated in patients treated with double-blind, randomly assigned olanzapine or haloperidol for up to 2.6 years.

Tardive dyskinesia was assessed by the Abnormal Involuntary Movement Scale (AIMS) and Research Diagnostic Criteria for Tardive Dyskinesia (RD-TD); it was defined as meeting RD-TD criteria at two consecutive assessments. The risk of tardive dyskinesia, the relative risk, incidence rate, and incidence rate ratio were estimated.

The relative risk of tardive dyskinesia for the overall follow-up period for haloperidol (n=522) v. olanzapine (n=1192) was 2.66 (95% CI=1.50–4.70). Based on data following the initial six weeks of observation (during which patients underwent medication change and AIMS assessments as frequently as every three days), the one-year risk was 0.52% with olanzapine (n=513) and 7.45% with haloperidol (n=114). The relative risk throughout this follow-up period was 11.37 (95% Cl=2.21–58.60).

Our results indicated a significantly lower risk of tardive dyskinesia with olanzapine than with haloperidol.

The burdens experienced by relatives of mentally ill persons are substantial.

To study the relationship between family burden and sociocultural context.

A comparative study of Euro-Americans and Latinos ascertained whether dimensions of family response are (a) non-specific to diagnostic groups; and/or (b) variable across cultural settings.

Regardless of diagnosis or ethnicity, patient misery was found most burdensome and distressing. However, considerable difference in shades of meaning and nuance across groups appears in relation to what is classed similarly as ‘misery’. Only gender was significantly associated with social performance (males reported to have greater deficits). A complex cultural – ecological effect was observed among the Latino–schizophrenia group.

Findings suggest similarities and differences in levels of family burden in relation to socio-cultural factors across cultural and diagnostic groups. The specificity of results by objective and subjective measures, types of burden, gender, ethnicity, diagnosis, and living situation confirm the importance of context and heterogeneity in understanding family burden and distress.

Alzheimer's disease and other types of dementia are characterised by numerous psychiatric and behavioural changes. Little is known of their natural history.

To investigate the sequence and pattern of these changes throughout the course of dementia.

One hundred people, initially living at home with carers, entered a prospective, longitudinal study. At four-monthly intervals, behavioural and psychiatric symptoms were assessed using the Present Behavioural Examination and Mini-Mental State Examination. Follow-up continued for up to nine years (mean 3.3 years; s.d. 2.4). Patterns of onset and disappearance of these symptoms, their sequence and association with time of death and cognitive decline were analysed. Autopsy confirmed a diagnosis of pure Alzheimer's disease in 48 subjects. Data for this subgroup are presented.

Some changes tend to occur earlier than others but changes can occur at almost any time in the course of dementia.

The natural history of behaviour changes in Alzheimer's disease shows great individual variation although some changes tend to follow a recognisable sequence.

Following the success of the NINCDS–ADRDA criteria for Alzheimer's disease, groups interested in vascular dementia and dementia with Lewy bodies have now adopted similar criteria.

To assess whether the validity of these criteria are influenced by the prevalence of mixed pathologies or by the prevalence rate.

A community based postmortem study.

Mixed pathologies were common (33.8%). The high specificities obtained for the CDLB and NINDS–AIREN criteria (1.00 and 0.95, respectively) were associated with low sensitivities (0.22 and 0.43, respectively). Low prevalence and the presence of mixed pathologies had a deleterious effect on positive predictive values.

Current clinical diagnostic criteria are good at detecting pathology per se but not at detecting pure pathology. A large proportion of subjects from the general population fulfilling probable CDLB, probable NINCDS–ADRDA or probable NINDS–AIREN will have mixed pathologies.

While the costs associated with Alzheimer's disease have been shown to be significant, there are few data relating cost of care to severity of the disease.

We aimed to compare the costs associated with different severities of Alzheimer's disease with those incurred by control subjects over a three-month period.

In this cross-sectional, multicentre, naturalistic analysis, non-institutionalised patients with Alzheimer's disease (128), their care-givers (128), and 56 matched controls were interviewed once to establish resource use over the previous three months. Patients were stratified into three severity groups according to their Mini Mental State Examination score. Costs were calculated from the perspective of society as a whole.

Over the three-month period, total mean cost per control subject (£387) was minor compared with mean cost incurred by patients with mild (£6616), moderate (£10 250) and severe (£13 593) Alzheimer's disease. Indirect cost, mainly time spent by care-givers, was the main cost component in all groups (68.6%), followed by direct medical costs (24.7%)

The cost of care for an Alzheimer's disease patient is directly related to the severity of the patient's illness.

Little evidence exists regarding the effectiveness or cost-effectiveness of alternative treatment services in the field of child and adolescent psychiatry.

To assess the cost-effectiveness of a home-based social work intervention for young people who have deliberately poisoned themselves.

Children aged ⩽16 years, referred to child mental health teams with a diagnosis of deliberate self-poisoning were randomly allocated to either routine care (n=77) or routine care plus the social work intervention (n=85). Clinical and resource-use data were assessed over six months from the date of trial entry.

No significant differences were found between the two groups in terms of the main outcome measures or costs. In a sub-group of children without major depression, suicidal ideation was significantly lower in the intervention group at the six-month follow-up (P=0.01), with no significant differences in cost.

A family-based social work intervention for children and adolescents who have deliberately poisoned themselves is as cost-effective as routine care alone.

Difficulties in family functioning are often evident when an adolescent has anorexia nervosa, and the possible causative or contributory role of such difficulties in the illness is unclear.

To elucidate the relationship between severity of anorexia nervosa and difficulties in family functioning and whether clinical improvement results in diminution of self-rated family difficulties.

Thirty-five adolescents with anorexia nervosa and their mothers completed the Family Assessment Device (FAD) while clinicians administered the McMaster's Structured Interview of Family Functioning (McSIFF). Severity of anorexia nervosa was rated at baseline and at one year follow-up using the Morgan–Russell Schedule.

Clinicians and patients were more critical of the families' functioning than parents. There was an inverse association between the extent of family difficulties and severity of anorexia nervosa. Over time subjects improved clinically but this was not matched by improvement in family functioning.

Difficulties in family functioning do not appear to be directly associated with severity of anorexia nervosa nor do these difficulties reduce with clinical improvement, in the short term.

Studies suggest that symptoms of traumatic grief constitute a distinct syndrome worthy of diagnosis.

A consensus conference aimed to develop and test a criteria set for traumatic grief.

The expert panel proposed consensus criteria for traumatic grief. Receiver operator characteristic (ROC) analyses tested the performance of the proposed criteria on 306 widowed respondents at seven months post-loss.

ROC analyses indicated that three of four separation distress symptoms (e.g. yearning, searching, loneliness) had to be endorsed as at least ‘sometimes true’ and four of the final eight traumatic distress symptoms (e.g. numbness, disbelief, distrust, anger, sense of futility about the future) had to be endorsed as at least ‘mostly true’ to yield a sensitivity of 0.93 and a specificity of 0.93 for a diagnosis of traumatic grief.

Preliminary analyses suggest the consensus criteria for traumatic grief have satisfactory operating characteristics, and point to directions for further refinement of the criteria set.

Case management, particularly in intensive form, has been widely introduced for the treatment of severe mental illness. However, the optimal intensity of case management has not been determined.

We aimed to assess whether intensive case management (small case load) reduces hospitalisation and costs compared with standard case management.

Development and rationale of a large randomised controlled trial comparing intensive case management (case load per worker? 15 patients) with standard case management (case load 30–35 patients)

Two-year outcome data will be obtained on patients representative of the seriously mentally ill in inner-city mental health services.

The study planned with 700 patients should be sufficient to detect small differences in the readmission of patients to hospital (10%), the number of days spent in hospital over a two-year period (10 days) and the average weekly cost of care per patient. The sample is large enough to compare the cost-effectiveness of intensive and standard case management in mild and severe disability and in people of African–Caribbean origin and White Caucasians.