The experience of having been sexually abused is associated with a wide range of psychiatric symptoms and difficulties, and these problems can persist over years. The psychological treatment of children who have experienced sexual abuse has only recently begun to be systematically investigated. An increasing number of robust studies have been conducted.

To review systematically the available evidence from randomised controlled trials of psychological treatments for children who have been sexually abused, and to consider the place of these treatments in a multi-disciplinary service.

A systematic search of the available research was undertaken. Included trials were critically appraised and the results considered.

Twelve studies were included in the review. The best evidence of efficacy for improving psychological symptoms in these children was found for cognitive–behavioural therapy, particularly for young children.

Efficacious treatments exist to improve psychological symptoms in children who have experienced sexual abuse. Consideration is given to the place of these treatments within the response of a multi-disciplinary service.

It is important not to foster unnecessary public anxiety with regard to the risk of a biochemical terrorist incident, but the authorities need to consider their response strategy, particularly with regard to mental health issues.

To describe the likely effects of a terrorist incident involving biochemical agents and to identify important response issues.

Literature survey.

Observations following conventional terrorist incidents and other major trauma, including biochemical and nuclear accidents, suggest that a biochemical terrorist incident would have widespread public effects. The mental health services should play a major role in designing an effective multi-disciplinary response, particularly with regard to the reduction of public anxiety, identifying at-risk individuals and collaborating with medical and emergency services, as well as providing care for those who develop post-traumatic psychopathology.

We should not feel helpless in the face of a biochemical threat; there is considerable knowledge and experience to be tapped. Awell-designed, well-coordinated and rehearsed strategy based on empirical evidence will do much to reduce public anxiety and increase professional confidence.

Worldwide, 340 million people are affected by depression, with high comorbid, social and economic costs.

To identify potential predictors of effect in prevention programmes.

A meta-analysis was made of 69 programmes to reduce depression or depressive symptoms.

The weighted mean effect size of 0.22 was effective for different age groups and different levels of risk, and in reducing risk factors and depressive or psychiatric symptoms. Programmes with larger effect sizes were multi-component, included competence techniques, had more than eight sessions, had sessions 60–90 min long, had a high quality of research design and were delivered by a health care provider in targeted programmes. Older people benefited from social support, whereas behavioural methods were detrimental.

An 11% improvement in depressive symptoms can be achieved through prevention programmes. Single trial evaluations should ensure high quality of the research design and detailed reporting of results and potential predictors.

The symptom of thought broadcast may have diagnostic significance but its definition varies.

To examine multiple definitions of thought broadcast in differenttexts, to synthesise their common features and to undertake local and national surveys of psychiatrists to determine which definitions they endorse.

A semi-structured literature review of electronic databases, supplemented by a manual search of psychiatric textbooks, conceptual analyses and postal surveys of clinicians in NorthTrent (58 trainees and 70 consultants) and throughout the UK (49 professors of general adult psychiatry).

Thought broadcast is susceptible to multiple definitions: three exemplars were identified in the literature, each endorsed by influential authors. Among those psychiatrists responding to the survey (approximately 59%), some endorsed each definition of thought broadcast.

Thought broadcast means different things to different people. Inconsistent terminology might impair communication in clinical and research contexts.

Analysis of the patterns of variation in health care costs and the determinants of these costs (including treatment differences) is an increasingly important aspect of research into the performance of mental health services.

To encourage both investigators of the variation in health care costs and the consumers of their investigations to think more critically about the precise aims of these investigations and the choice of statistical methods appropriate to achieve them.

We briefly describe examples of regression models that might be of use in the prediction of mental health costs and how one might choose which one to use for a particular research project.

If the investigators are primarily interested in explanatory mechanisms then they should seriously consider generalised linear models (but with careful attention being paid to the appropriate error distribution). Further insight is likely to be gained through the use of two-part models. For prediction we recommend regression on raw costs using ordinary least-square methods. Whatever method is used, investigators should consider how robust their methods might be to incorrect distributional assumptions (particularly in small samples) and they should not automatically assume that methods such as bootstrapping will allow them to ignore these problems.

Concern is widespread about potential sponsorship influence on research, especially in pharmacoeconomic studies. Quantitative analysis of possible bias in such studies is limited.

To determine whether there is an association between sponsorship and quantitative outcomes in pharmacoeconomic studies of antidepressants.

Using all identifiable articles with original comparative quantitative cost or cost-effectiveness outcomes for antidepressants, we performed contingency table analyses of study sponsorship and design v. study outcome.

Studies sponsored by selective serotonin reuptake inhibitor (SSR1) manufacturers favoured SSRIs over tricyclic antidepressants more than non-industry-sponsored studies. Studies sponsored by manufacturers of newer antidepressants favoured these drugs more than did non-industry-sponsored studies. Among industry-sponsored studies, modelling studies favoured the sponsor's drug more than did administrative studies. Industry-sponsored modelling studies were more favourable to industry than were non-industry-sponsored ones.

Pharmacoeconomic studies of antidepressants reveal clear associations of study sponsorship with quantitative outcome.

Few studies have examined the relationship between antidepressant prescription and receipt of depression-related disability benefits.

To address two questions: first, is prescription of antidepressants in accordance with published clinical guides associated with better disability outcomes, and second, what is the relationship between guideline-concordant antidepressant prescription and length of disability?

An observational study was conducted using administrative data from three major Canadian financial and insurance sector companies. Short-term disability and prescription drug claims records for 1996–1998 were linked for workers receiving depression-related short-term disability benefits during that time.

Recommended first-line agents and recommended doses were significantly associated with return to work (χ2=6.64, P < 0.036). In addition, among those who returned to work, early intervention was significantly associated with a shortened disability episode (β=-24.1; 95% CI-34.4 to −13.8).

Depression-related workplace disability is a problem for which there is no simple solution. These results provide an additional piece to the puzzle of helping workers disabled by depression to return to work.

Arguments for and against evidence-based psychiatry have mostly centred on its value for clinical practice and teaching. Now, however, use of the same paradigm in evaluating health care has generated new problems.

To outline the development of evidence-based health care; to summarise the main critiques of this approach; to review the evidence now beingemployed to evaluate mental health care; and to consider how the evidence base might be improved.

The following sources were monitored: pub ications on evidence-based psychiatry and health care since 1990; reports of randomised trials and meta-analytic reviews to the end of 2002; and official British publications on mental health policy.

Although evidence-based health care is now being promulgated as a rational basis for mental health planning in Britain, its contributions to service evaluation have been distinctly modest. Only 10% of clinical trials and meta-analyses have been focused on effectiveness of services, and many reviews proved inconclusive.

The current evidence-based approach is overly reliant on meta-analytic reviews, and is more applicable to specific treatments than to the care agencies that control theirdelivery. A much broader evidence base is called for, extending to studies in primary health care and the evaluation of preventive techniques.

Previously reported associations between advancing paternal age and schizophrenia could be due to an increase in paternal germ cell mutations or be confounded by heritable personality traits associated with schizophrenia that result in delayed parenthood.

To investigate this association while adjusting for personality traits related to poor social integration in the subjects.

A cohort of 50 087 adolescent males was followed up by record linkage to determine hospital admissions for schizophrenia between 1970 and 1996.

Advancing paternal age was associated with an increased risk of developing schizophrenia in a ‘dose-dependent’ manner. The adjusted odds ratio for each 10-year increase in paternal age was 1.3 (95% Cl 1.0–1.5; P=0.015).

Advancing paternal age is an independent risk factor for schizophrenia. Adjusting for social integration in subjects made little difference to this association, consistent with the hypothesis that advancing paternal age may increase liability to schizophrenia owing to accumulating germ cell mutations.

The unavailability of psychotropic and analgesic drugs for medical purposes results in suffering that goes unrelieved. Their excessive availability results in overmedication and suffering of a different kind.

To highlight the discrepancies between the demand for and supply of controlled drugs for licit purposes by different communities, and to promote their rational utilisation.

Review of the United Nations, World Health Organization and other literature on the licit use of narcotic analgesics and psychotropic substances.

Thereare large differences in the use of psychotropics and analgesics by different countries. The differences between industrialised and non-industrialised countries are particularly striking. There is evidence of unmet need in some countries and overutilisation in others.

Governments, international organisations, health professionals and the pharmaceutical industry must work together to ensure an adequate supply of psychotropic and analgesic drugs for medical and scientific purposes, and to implement appropriate measures to minimise the development of misuse and dependence.

Studies investigating the efficacy of clinical interventions for reducing treatment non-adherence have generated contrasting findings, and treatment non-adherence remains common in clinical practice.

To systematically review whether there are effective clinical interventions that community psychiatric services can implement to reduce non-adherence.

Systematic review and metaregression analysis of randomised controlled trials (RCTs) and controlled clinical trials (CCTs) were used to assess the efficacy of interventions to enhance adherence.

We reviewed 24 studies, more than half of which were RCTs. In 14 studies the experimental intervention was an educational programme. Five studies evaluated pre-discharge educational sessions, three studies explored the benefit of psychotherapeutic interventions and two studies looked at the effect of telephone prompts. The overall estimate of the efficacy of these interventions produced an odds ratio of 2.59 (95% Cl 2.21–3.03) for dichotomous outcomes, and a standardised mean difference of 0.36 (95% Cl 0.06–0.66) for continuous outcomes.

Community psychiatric services can potentially use effective clinical interventions, backed by scientific evidence, for reducing patient non-adherence.