Psychiatric therapy needs assessment regarding its maturation as a therapeutic science.

Judgement of whether such a science is emerging.

Four criteria are used: efficacy; identification of responsible treatment components; knowledge of their mechanisms of action; and elucidation of why they act only in some sufferers.

Brief behavioural, interpersonal, cognitive, problem-solving and other psychotherapies have a mature ability to improve anxiety and depressive disorders reliably and enduringly, often only with instruction from a manual or a computer. Therapy's cost-effectiveness and acceptability deserve more attention. We know little about which treatment components produce improvement, how they do so and why they do not help all sufferers.

Therapy is coming of age regarding efficacy for anxiety and depression, but is only a toddler regarding the scientific principles to explain its effects.

For more than 20 years, the Impact of Event Scale (IES) has been widely used as a measure of stress reactions after traumatic events.

To review studies that evaluated the IES's psychometric properties.

Literature review.

The results indicated that the IES's two-factor structure is stable over different types of events, that it can discriminate between stress reactions at different times after the event, and that it has convergent validity with observer-diagnosed post-traumatic stress disorder. The use of IES in many psychopharmacological trials and outcome studies is supportive of the measure's clinical relevance.

The IES is a useful measure of stress reactions after a range of traumatic events, and it is valuable for detecting individuals who require treatment.

Australia commenced a 5-year reform of mental health services in 1993.

To report on the changes to mental health services achieved by 1998.

Analysis of data from the Australian National Mental Health Report 2000 and an independent evaluation of the National Mental Health Strategy.

Mental health expenditure increased 30% in real terms, with an 87% growth in community expenditures, a 38% increase in general hospitals and a 29% decrease in psychiatric hospitals. The growth in private psychiatry, averaging 6% annually prior to 1992, was reversed. Consumer and carer involvement in services increased.

Major structural reform was achieved but there was limited evidence that these changes had been accompanied by improved service quality. The National Mental Health Strategy was renewed for another 5 years.

There is concern in the community about increasing cannabis use and its potential effect on health.

To ascertain the prevalence of cannabis use among Australian adolescents, associations with mental health problems, risk behaviours and service use.

Examination of data from a national representative sample of households comprising 1261 adolescents aged 13–17 years. Parents completed a psychiatric interview and questionnaires while adolescents completed questionnaires.

One-quarter of the adolescents in the sample had used cannabis. There were no gender differences. Use increased rapidly with age, was more common in adolescents living with a sole parent and was associated with increased depression, conduct problems and health risk behaviours (smoking, drinking) but not with higher use of services.

Cannabis use is very prevalent. The association with depression, conduct problems, excessive drinking and use of other drugs shows a malignant pattern of comorbidity that may lead to negative outcomes.

Aggregate returns give limited information about those detained under the Mental Health Act 1983.

To use existing data-sets to examine detentions under Part II of the Act.

Data from 26 areas, with a combined population of 9.2 million, were combined. Population census data were used to standardise rates of detention by age, gender and ethnicity.

The 31 702 detentions are distributed bimodally with peaks at age 25–34 years and at over age 80 years. In the younger age group rates of detention are higher for men. The excess of women in the older group is no longer apparent when rates are standardised for age and gender. Detentions are over six times more likely to be of Black people than of White (450 v. 68 per standardised 100 000 population).

The difference in rates of detention between Black and White people is greater than previously thought. The excess of older women detained under Part II of the Act is largely due to the lower life expectancy of men.

The socio-economic impact of bipolar disorder in the UK is unknown.

To estimate the annual socioeconomic burden imposed by bipolar disorder on UK society.

The annual cost of resource use attributable to managing bipolar disorder was calculated. Indirect societal costs were also calculated.

The annual National Health Service (NHS) cost of managing bipolar disorder was estimated to be $199 million, of which hospital admissions accounted for 35%. The annual direct non-health-care cost was estimated to be $86 million annually and the indirect societal cost was estimated to be $1770 million annually.

The annual cost to UK society attributable to bipolar disorder was estimated to be $2 billion at 1999/2000 prices (estimated 297 000 people with the disorder). Ten per cent of this cost is attributable to NHS resource use, 4% to non-health-care resource use and 86% to indirect costs.

Controversy exists about the efficacy of psychotherapy for the mental health problems of sexually abused children.

To compare the relative efficacy of focused individual or group therapy in symptomatic sexually abused girls, and to monitor psychiatric symptoms for persistence or change.

A multi-centre psychotherapy outcome study recruited 71 sexually abused girls aged 6–14 years who were randomly assigned to focused individual psychotherapy (up to 30 sessions) or psychoeducational group therapy (up to 18 sessions). Changes over the course of the study were monitored.

Both treatment groups showed a substantial reduction in psychopathological symptoms and an improvement in functioning, but with no evident difference between individual and group therapy. However, individual therapy led to a greater improvement in manifestations of post-traumatic stress disorder (PTSD).

The beneficial effects on PTSD support the use of individual therapy. However, the small sample size and lack of a control group limit conclusions about changes attributable to treatment.

Frequent attenders in medical settings account for a disproportionate amount of health-care resources. Little is known about service use and costs of secondary care in those frequent attenders presenting with medically unexplained symptoms.

To compare health-care use and costs of patients with medically unexplained symptoms with other frequent attenders in secondary care.

In a sample of 400 frequent attenders of secondary care services, those presenting with medically unexplained symptoms were identified by a review of medical records. Their use of health-care resources was compared with that of other frequent attenders.

Of the frequent attenders 17% had at least two medically unexplained consultation episodes. These patients had a greater number of referrals to secondary care and were more likely to undergo particular investigations.

Frequent attenders with medically unexplained symptoms account for levels of service use and expenditure that are comparable with other frequent attenders, but the use and cost of medical investigations in this group are significantly greater.

Continuity of care has been monitored rarely in Italian community mental health centres.

To estimate the long-term probability of leaving care in first-contact patients attending an out-patient service, and to identify patients most likely to drop out.

All patients who had a first contact with the community mental health centre of Magenta during a 1-year recruitment period were followed up for 24 months. Patients who failed to return after the last out-patient visit were regarded as ‘drop-outs'.

During the 1-year recruitment period 330 subjects were at their first contact. The 1-year incidence of first-contact patients was nearly 33 per 10 000 inhabitants. At follow-up, 46% of patients had dropped out. In comparison with patients with psychoses, subjects suffering from neurotic (P=0.004) and personality disorders (P=0.029) were more likely to drop out.

In the Italian system of community psychiatric care nearly half of the patients are no longer in contact after 2 years. Those who stay in treatment are more likely to suffer from psychosis, suggesting a commitment of Italian outpatient facilities to tackling the needs of patients with more severe disorders.

Twin studies have found that childhood attention-deficit hyperactivity disorder (ADHD) has a strong genetic component. Estimates of heritability the extent of non-additive genetic effects and of ‘sibling contrast’ effects vary between different studies.

To use multiple informants to assess the extent to which observer effects influence such estimates in an epidemiological sample of twins.

Questionnaire packs were sent to the families and teachers of twins aged 5–16 years in the Bro Taf region of South Wales. The twins were ascertained from community paediatric registers.

Both parent— and teacher-rated data showed a high degree of heritability for ADHD measured as a symptom dimension, but the correlation between the two types of rater was modest. Bivariate analyses suggested that parent and teacher ratings reflect the effects of different genes. Self-report data from twins aged 11–16 years showed no evidence of genetic effects.

Although ADHD is shown to be highly heritable by both parent— and teacher-rated data, the underlying genotypes may be substantially different. This has implications for study designs aiming to find genes that contribute to the disorder.

The Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA) is an established outcome measure for child and adolescent mental health. Little is known of adolescent views on outcome.

To develop and test the properties of an adolescent, self-rated version of the scale (HoNOSCA–SR) against the established clinician-rated version.

A comparison was made of 6-weekly clinician-rated and self-rated assessments of adolescents attending two services, using HoNOSCA and other mental health measures.

Adolescents found HoNOSCA–SR acceptable and easy to rate. They rated fewer difficulties than the clinicians and these difficulties were felt to improve less during treatment, although this varied with diagnosis and length of treatment. Although HoNOSCA–SR showed satisfactory reliability and validity, agreement between clinicians and users in individual cases was poor.

Routine outcome measurement can include adolescent self-rating with modest additional resources. The discrepancy between staff and adolescent views requires further evaluation.

Epidemiological studies of dementia subtypes have revealed widely varying distribution rates. There are almost no published community prevalence data for dementia with Lewy bodies (DLB) or the frontal lobe dementias (FLD).

To identify the distribution of dementia subtypes in a representative community population of older people.

People aged ⩾65 years in randomised enumeration districts in Islington, north London, were screened using a reliable and valid questionnaire. People screened as having dementia were assessed in detail and diagnoses were made according to standard diagnostic criteria.

Of 1085 people interviewed, 107 (9.86%) met screening criteria for dementia. Diagnoses were made for 72 people (67.3%). Distribution of subtypes varied according to the criteria used; the best-validated criteria yielding: Alzheimer's disease 31.3%; vascular dementia 21.9%; DLB 10.9%; and FLD 7.8%.

Alzheimer's disease is confirmed as the most common cause of dementia in older people, followed by vascular dementia. However, DLB and FLD occur sufficiently often to be seen frequently in clinical practice and should be incorporated into future editions of standard diagnostic criteria.