Childhood hallucinations of voices occur in a variety of contexts and have variable long-term outcomes.

To study the course of experience of voices sequentially over a 3-year period in those with and those without a need for mental health care (patient status).

In a group of 80 children of mean age 12.9 years (s.d.=3.1), of which around 50% were not receiving mental health care, baseline measurement of voice characteristics, voice attributions, psychopathology, stressful life events, coping mechanisms and receipt of professional care were used to predict 3-year course and patient status.

The rate of voice discontinuation over the 3-year period was 60%. Patient status was associated with more perceived influence on behaviour and feelings and more negative affective appraisals in relation to the voices. Predictors of persistence of voices were severity and frequency of the voices, associated anxiety/depression and lack of clear triggers in time and place.

Need for care in the context of experience of voices is associated with appraisal of the voices in terms of intrusiveness and ‘omnipotence’. Persistence of voices is related to voice appraisals, suggesting that experience of voices by children should be the target of specific interventions.

The risk for schizophrenia has been associated with a family history of this and other psychiatric disorders. The relationship between age at first contact and family history of psychiatric illness is not certain.

To estimate the risks for schizophrenia associated with a range of psychiatric diagnoses in family members and to investigate the relationship between these risks and age at first contact for schizophrenia.

A nested case–control study design was employed. Psychiatric admission data and socio-economic data were available for 7704 cases admitted between 1981 and 1998 in Denmark, 192 590 gender- and age-matched controls, and for the parents and siblings of all subjects.

Controlling for socio-economic factors, risk for schizophrenia was associated with a family history of all psychiatric disorders except substance misuse and independently with a family history of suicide. The risk for schizophrenia associated with a family history of psychiatric disorders decreased as age at first contact increased.

Risk for schizophrenia is associated with a range of psychiatric disorders in family members and these risks are not constant across the risk period.

High-risk’ studies of schizophrenia have the potential to clarify the pathogenesis of schizophrenia. Here, results of extreme outcome groups in the Edinburgh High-Risk Study are presented.

To compare groups of good and poor outcome from the Edinburgh High-Risk Study and clarify the nature of the change from the state of vulnerability to that of developing psychosis.

The recruitment procedure is described. Good and poor outcome are defined. These groups are compared in terms of genetic liability and of baseline and change in neuropsychology and neuroanatomy.

Demographic characteristics and genetic liability do not differ between the groups. The good outcome group perform better at baseline in some neuropsychological tests, but there is little neuroanatomical difference. The poor outcome group show consistently impaired memory function and a tendency to reduction in temporal lobe size.

In genetically predisposed subjects, the change from vulnerability to developing psychosis may be marked by a reduced size and impaired function of the temporal lobe.