Many people with dementia live in residential homes, but little is known about their quality of life.

To compare the views of residents with dementia with the views of staff as to their quality of life, and to look at factors associated with these ratings.

The Quality of Life in Alzheimer's Disease (QoL-AD) scale was used to rate residents' and staff's perceptions of the quality of life of 238 residents of 24 residential homes in the UK.

There were 119 QoL-AD scales completed by both residents and staff. For the residents, high QoL-AD scores strongly correlated with lower scores for depression (ρ=–0.53, P < 0.0001) and anxiety (ρ= –0.50, P < 0.001). In contrast, better quality of life as rated by staff correlated most strongly with increased dependency (ρ=–0.53, P < 0.001) and behaviour problems (ρ=–0.40, P < 0.001).

The QoL-AD could be used as an effective measure of the quality of life of people with dementia in residential homes. Whereas mood was the main predictor of residents' own assessment of their quality of life, staff ratings were strongly linked with dependency. Staff should be aware that mood rather than level of dependency has agreater impacton residents' quality of life.

Over the past decade, developed Western countries have supplied increasingly stringent measures to discourage those seeking asylum.

To investigate the longer-term mental health effects of mandatory detention and subsequent temporary protection on refugees.

Lists of names provided by community leaders were supplemented by snowball sampling to recruit 241 Arabic-speaking Mandaean refugees in Sydney (60% of the total adult Mandaean population). Interviews assessed posttraumatic stress disorder (PTSD), major depressive episodes, and indices of stress related to pasttrauma, detention and temporary protection.

A multilevel model which included age, gender, family clustering, pre-migration trauma and length of residency revealed that past immigration detention and ongoing temporary protection each contributed independently to risk of ongoing PTSD, depression and mental health-related disability. Longer detention was associated with more severe mental disturbance, an effect that persisted for an average of 3 years after release.

Policies of detention and temporary protection appear to be detrimental to the longer-term mental health of refugees.

Information on psychiatric morbidity of prisoners has almost entirely been based on research in Western countries and it is uncertain whether these research findings are applicable to other settings.

The primary objective was to investigate the prevalence of psychiatric disorders in Iranian prisoners.

Through stratified random sampling, 351 prisoners were interviewed using the clinical version of the Structured Clinical Interview for DSM-IVAxis I Disorders and the Psychopathy Checklist: Screening Version.

The majority (88%) of prisoners met DSM – IV criteria for lifetime diagnosis of at least one Axis I disorder and 57% were diagnosed with current Axis I disorders. Opioid dependence (73%) had the highest prevalence among lifetime diagnoses, whereas major depressive disorder (29%) was the most common current diagnosis. Psychopathy was recorded in 23%. Prevalence rates of psychiatric disorders were significantly different among offence categories.

The results suggest that a substantial burden of psychiatric morbidity exists in the prison population of Iran, with treatment challenges that appear to be different from those observed in inmates in Western countries.

Relatively little is known about depression in countries that were formerly part of the Soviet Union, especially Russia.

To investigate the rates and distribution of depressive symptoms in urban population samples in Russia, Poland and the Czech Republic.

A cross-sectional study was conducted in randomly selected men and women aged 45–64 years (n=2151 intotal, response rate 69%) in Novosibirsk (Russia), Krakow (Poland) and Karvina (Czech Republic). The point prevalence of depressive symptoms in the past week was defined as a score of at least 16 on the Center for Epidemiological Studies Depression scale.

In men the prevalence of depressive symptoms was 23% in Russia, 21% in Poland and 19% in the Czech Republic; in women the rates were 44%, 40% and 34% respectively. Depressive symptoms were positively associated with material deprivation, being unmarried and binge drinking. The association between education and depression was inverse in Poland and the Czech Republic but positive in Russia.

The prevalence of depressive symptoms in these eastern European urban populations was relatively high; as in other countries, it was associated with alcohol and several sociodemographic factors.

Neurocognitive deficits exist in euthymic patients with bipolar disorder, but relationships between symptoms, psychosocial and neurological factors remain uncertain.

To measure neurocognitive function in bipolar disorder and explore links to sub-syndromal mood symptoms, soft neurological signs and psychosocial impairment.

Attention, memory and executive function were tested in 37 euthymic patients with bipolar disorder and 37 controls. Psychosocial functioning, soft neurological signs and residual mood symptoms were assessed.

Performances on tests reflecting executive function and verbal memory (but not attention) were significantly poorer in the bipolar disorder group. Sub-syndromal mood symptoms produced small cognitive effects, predominantly on verbal memory. Soft neurological signs, especially frontal signs, were marked; some patients showed marked social disability which correlated strongly with soft neurological signs but weakly with executive dysfunction, which was linked to illness episodes.

Cognitive dysfunction, social dysfunction and soft signs occur in euthymic patients with bipolar disorder and may represent trait deficits.

Large-scale community studies of the prevalence of mental disorders using standardised assessment tools are rare in sub-Saharan Africa.

To conduct such a study.

Multistage stratified clustered sampling of households in the Yoruba-speaking parts of Nigeria. Face-to-face interviews used the World Mental Health version of the Composite International Diagnostic Interview (WMH-CIDI).

Of the 4984 people interviewed (response rate 79.9%), 12.1% had a lifetime rate of at least one DSM–IV disorder and 5.8% had 12-month disorders. Anxiety disorders were the most common (5.7% lifetime, 4.1% 12-month rates) but virtually no generalised anxiety or post-traumatic stress disorder were identified. Of the 23% who had seriously disabling disorders, only about 8% had received treatment in the preceding 12 months. Treatment was mostly provided by general medical practitioners; only a few were treated by alternative practitioners such as traditional healers.

The observed low rates seem to reflect demographic and ascertainment factors. There was a large burden of unmet need for care among people with serious disorders.

Approximately 1 in 200 UK pregnancies ends in stillbirth. Although serious psychological effects of stillbirth on mothers are well established, much less is known about the impact of such loss on fathers.

To assess the psychological morbidity of fathers in the pregnancy and post-partum year subsequentto a stillbirth, to test within-couple effects and to identify risk factors.

This was a community-based cohort study of 38 pregnant couples whose previous pregnancy had ended in stillbirth, and 38 pair-matched controls. Psychological assessments took place antenatally and at 6 weeks, 6 months and 1 year postnatally.

Fathers in the index group experienced significant levels of anxiety and post-traumatic stress disorder antenatally, but all of their symptoms remitted postnatally (after the birth of a live baby). Fathers' symptom levels were lower than those of mothers at all time points. In contrast to mothers, fathers experienced greater anxiety when a subsequent pregnancy (following stillbirth) was delayed.

The vulnerability of fathers to psychological distress during the pregnancy after a stillbirth needs to be recognised.

Despite its negative consequences, little is known about the natural history of depression in the oldest old.

To study the incidence, course and predictors of depression in the general population of the oldest old.

The Leiden 85-plus Study is a prospective population-based study of 500 people from their 85th to their 89th birthdays. Depressive symptoms were annually assessed with the 15-item Geriatric Depression Scale, using a cut-off of 4 points.

During a mean follow-up of 3.9 years, the annual risk for the emergence of depression was 6.8%. Poor daily functioning and institutionalisation predicted depression. Among the 77 participants with depression at baseline (prevalence 15%) the annual remission rate was ony 14%. In more than half of the participants with a remission of depression, we observed a relapse of depression during follow-up. No predictors of remission could be identified.

Among the oldest old, depression is frequent and highly persistent. More active case-finding and treatment would be potentially rewarding.

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.

High expressed emotion in carers predicts relapse in psychosis, but it is not known why this is so. In our cognitive model of psychosis, we postulated that the effect is mediated through affective changes.

To investigate the relationships between carer expressed emotion, patients' symptoms and carer characteristics during a recent relapse of psychosis.

A total of 86 patients and carers were investigated in a cross-sectional design.

Patients whose carers showed high expressed emotion had significantly higher levels of anxiety and depression, but not more psychotic symptoms or lower self-esteem. Linear regression showed that carers' critical comments predicted anxiety in patients. Critical comments were related to low carer self-esteem and avoidant coping strategies. Low carer self-esteem was also related to carer depression, stress and carer ‘burden’, and to low patient self-esteem.

Our hypothesis was partially supported. Carer criticism was associated with patient anxiety, low carer self-esteem and poor carer coping strategies. Family interventions should focus on improving these after a relapse of symptoms of psychosis.

Community-based health and social care professionals have little knowledge of the past experiences of people with severe learning disabilities and challenging behaviour who are living in institutions.

To gain a greater understanding of the experiences and needs of men who are living in a locked ward.

The study sample consisted of 20 men who were living in a locked ward of a long-stay institution. Qualitative (ethnographic) methods were used, involving participant observation (for around 250 hours) on the ward. All traceable families were interviewed. The analysis used grounded theory, and material was fed back into the resettlement process throughout.

The men's lives were emotionally, socially and physically deprived. Their individual, gender and social identities were not recognised, and their general health and mental healthcare needs were inadequately addressed.

People who live in long-stay institutions, segregated from society, lose their individual and social identity, which complicates the presentation of mental health and behavioural problems, and raises important adult protection issues.

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.

Quantifying the contributions that different types of information make to the accurate prediction of offending offers the prospects of improved practice and better use of resources.

To quantify the contributions made by three types of information – demographic data alone, demographic and criminal record and demographic, criminal record and legal class of disorder – to the prediction of criminal conviction in patients.

All 425 patients discharged from the three special (high secure) hospitals in England and Wales over 2 years were followed for 10.5 years. The contribution of each type of information was described in terms of the area under the receiver operating characteristic curve (AUC) and the number needed to detain (NND).

The AUC values using the three types of information were 0.66, 0.72 and 0.73 respectively. Prediction based on the full model using an optimal probability cut-off implies an NND of 2. The AUCs for serious offences were 0.67, 0.69 and 0.75 respectively.

For long-term prediction of conviction on any charge, information on legal class adds little to the accuracy of predictions made using only a patient's age, gender and criminal record. In the prediction of serious offences alone the contribution of legal class is significant.

There have been no studies of the co-occurrence of personality and substance use disorders in young community-dwelling adults.

To examine the association between DSM–IV personality disorders and substance use disorders in a large representative sample of young community-dwelling participants.

Young Australian adults (n=1520, mean age=24.1 years) were interviewed to determine the prevalence of substance use disorders; 1145 also had an assessment for personality disorder.

The prevalence of personality disorder was 18.6% (95% CI 16.5–20.7). Personality disorder was associated with indices of social disadvantage and the likely presence of common mental disorders. Independent associations were found between cluster B personality disorders and substance use disorders. There was little evidence for strong confounding or mediating effects of these associations.

In young adults, there are independent associations between cluster B personality disorders and substance use disorders.

Black (Black Caribbean and Black African) patients are over-represented in admissions to general adult and medium-security psychiatric services in England.

To describe the socio-demographic, clinical and offence characteristics of patients in high-security psychiatric hospitals (HSPHs) in England, and to compare admission rates and unmet needs by ethnic group.

A total of 1255 in-patients were interviewed, and their legal status, socio-demographic characteristics and individual treatment needs were assessed.

Black patients in HSPHs are over-represented by 8.2 times (range 3.2–24.4, 95% CI 7.1–9.3), are more often male (P=0.037), and are more often diagnosed with a mental illness and less often diagnosed with a personality disorder or learning disability (P < 0.001) than White patients. Unmet needs were significantly less common among White than among Black patients (mean values of 2.22 v. 2.62, difference=0.40, 95% CI 0.06–0.73).

Compared with the proportion of Black patients in the general population in their region of origin, a much higher proportion of Black patients were admitted to HSPHs, and fewer of their needs were met.

An increased incidence of brain white-matter hyperintensities has been described in major depressive disorder, but the impact of such hyperintensities on treatment outcome is still controversial.

To investigate the relationship of brain white-matter hyperintensities with cardiovascular risk factors and with treatment outcome in younger people with major depressive disorder.

We assessed brain white-matter hyperintensities and cardiovascular risk factors in 84 people with major depressive disorder prior to initiating antidepressanttreatment. We also assessed hyperintensities in 35 matched controls.

We found no significant difference in the prevalence of white-matter hyperintensities between the depression and the control groups. Left-hemisphere subcortical hyperintensities correlated with lower rates of treatment response. We found no correlation between global hyperintensity measures and clinical outcome. Brain white-matter hyperintensities correlated with hypertension and age and with total cardiovascular risk score.

Subcortical white-matter hyperintensities in the left hemisphere (but not in other brain areas) may be associated with poor response to antidepressant treatment in major depression.

Previous research suggests that social workers experience high levels of stress and burnout but most remain committed to their work.

To examine the prevalence of stress and burnout, and job satisfaction among mental health social workers (MHSWs) and the factors responsible for this.

A postal survey incorporating the General Health Questionnaire, Maslach Burnout Inventory, Karasek Job Content Questionnaire and a job satisfaction measure was sent to 610 MHSWs in England and Wales.

Eligible respondents (n=237) reported high levels of stress and emotional exhaustion and low levels of job satisfaction; 111 (47%) showed significant symptomatology and distress, which is twice the level reported by similar surveys of psychiatrists. Feeling undervalued at work, excessive job demands, limited latitude in decision-making, and unhappiness about the place of MHSWs in modern services contributed to the poor job satisfaction and most aspects of burnout. Those who had approved social worker status had greater dissatisfaction.

Stress may exacerbate recruitment and retention problems. Employers must recognise the demands placed upon MHSWs and value their contribution to mental health services.