Many studies have found that people with schizophrenia exhibit abnormally high levels of semantic priming. Post-mortem and neuroimaging studies of schizophrenia suggest a reduction of neuritic processes (dendrites and synapses).

To demonstrate that reductions in neuritic processes can produce excessive priming in patients with schizophrenia.

Associative memory was simulated using a computer-based neural network system consisting of two interactive neural groups, one coding for individual memories and the other for the category to which each memory belonged.

Variation of a single parameter determining the density of local connections within the two neuronal groups gave a close approximation to levels of memory access and semantic priming previously reported in normal subjects and in patients with schizophrenia.

This study suggests that schizophrenia arises from excessive pruning of local connections in association cortex. Its findings shed light on the mechanisms underlying cognitive priming more generally, and how it might emerge developmentally.

Up to three-quarters of patients with fatigue syndromes have comorbid mood or anxiety disorders, suggesting that chronic fatigue is a forme fruste of anxiety or depressive states.

To establish whether the association of chronic fatigue with psychological distress is causal or due to a common genetic or environmental factor.

69 monozygotic (MZ) and 31 dizygotic (DZ) female twin pairs, with only one co-twin reporting at least 6 months of fatigue, completed questions on fatigue, the General Health Questionnaire (GHQ) and a structured psychiatric interview. We examined the effects of three progressively more stringent definitions of chronic fatigue on four GHQ sub-scales.

Fatigued MZ and DZ twins by all definitions were significantly more depressed, anxious, somatically preoccupied and socially dysfunctional than their non-fatigued co-twins. Intrapair differences were similar in DZ and MZ twins, but non-significant differences were observed for the somatic symptoms and anxiety/insomnia sub-scales.

In this sample, chronic fatigue and psychological distress are strongly associated without evidence for genetic covariation, implying that the association is environmental, or due to overlapping definitions. Any genetic covariation missed is likely to involve anxiety rather than depression.

Community surveys have reported a higher rate of mental health problems in combined groups of homosexual and bisexual participants, but have not separated these two groups.

To assess separately the mental health of homosexual and bisexual groups compared with heterosexuals.

A community survey of 4824 adults was carried out in Canberra, Australia. Measures covered anxiety depression, suicidality alcohol misuse, positive and negative affect and a range of risk factors for poorer mental health.

The bisexual group was highest on measures of anxiety depression and negative affect, with the homosexual group falling between the other two groups. Both the bisexual and homosexual groups were high on suicidality. Bisexuals also had more current adverse life events, greater childhood adversity, less positive support from family, more negative support from friends and a higher frequency of financial problems. Homosexuals reported greater childhood adversity and less positive support from family.

The bisexual group had the worst mental health, although homosexual participants also tended to report more distress.

Community-based care at the margin is a substitute for institutional care. Three factors are considered critical: definitions of eligibility, assessment procedures and balance of care.

To examine determinants of the margin between institutional and home-based care, review current practice, identify the implications and contribute to planning of integrated long-term care services.

A selective review was made of findings from research conducted after the community care reforms.

Marked variability and inconsistency in eligibility and assessment processes may contribute to misplacement of frail older people. There remains capacity to shift the balance of care from institutional to home-based care within reasonable cost parameters, particularly with more integrated services.

Greater standardisation of approaches to the determination of eligibility for social care and to assessment of need is required. Providing care at home for some of those currently entering care homes is feasible, but will require different service structures and staff roles, including specialist clinicians.

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.

Animal experiments suggest that maternal stress and anxiety during pregnancy have long-term effects on the behaviour of the off spring.

To test the hypothesis that antenatal maternal anxiety predicts behavioural problems at age 4 years.

Data were collected on multiple antenatal and postnatal assessments of maternal anxiety and depression, antenatal and obstetric risks, psychosocial risks and children's behavioural/emotional problems (n=7448).

Antenatal maternal anxiety predicted behavioural/emotional problems in boys (OR=2.14,95% CI 1.48−3.10) and girls (OR=1.88,95% CI 1.3–2.69) after accounting for covariates. When covarying maternal anxiety up to 33 months postnatally, antenatal anxiety continued to predict total problems in boys (OR=1.56,95% CI 1.02–2.41) and girls (OR=1.5l, 95% CI 1.22–2.81).

There could be a direct effect of maternal mood on foetal brain development, which affects the behavioural development of the child.

Patients with Alzheimer's disease show a wide variation in clinical phenotype. Genetic research has been largely concerned with the role of mutations or common variants as risk factors for the disease. Do genetic factors also influence clinical phenotype?

To examine the evidence that genetic factors influence the clinical expression of the disease in addition to influencing risk.

A selective review was made of the key literature.

Mutations in three genes, coding for amyloid precursor protein, presenilin-1 and presenilin-2, and a common variation (ε4) in another gene, APOE, have been shown to lead to an earlier development of the disease. More recently, genetic association and twin studies have suggested a role for genetic factors in the development of other aspects of clinical phenotype, notably the appearance of non-cognitive symptoms.

In Alzheimer's disease genetic variation influences a number of aspects of clinical phenotype.

There are no published studies evaluating the impact of introduction of television on disordered eating in media-naïve populations.

To assess the impact of novel, prolonged exposure to television on disordered eating attitudes and behaviours among ethnic Fijian adolescent girls.

A prospective, multi-wave cross-sectional design was used to compare two samples of Fijian schoolgirls before and after prolonged regional television exposure with a modified 26-item eating attitudes test, supplemented with a semi-structured interview to confirm self-reported symptoms. Narrative data from a subset of respondents from the exposed sample were analysed for content relating television exposure to body image concerns.

Key indicators of disordered eating were significantly more prevalent following exposure. Narrative data revealed subjects' interest in weight loss as a means of modelling themselves after television characters.

This naturalistic experiment suggests a negative impact of television upon disordered eating attitudes and behaviours in a media-naïve population.

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.

Little is known about the effects of the physical environment on individual health.

The present study tested the hypothesis that the prevalence of depression is associated with independently rated measures of the built environment, after adjusting for individuals' socio-economic status and the internal characteristics of their dwellings.

Cross-sectional survey of 1887 individuals aged 16 years and over in two electoral wards in north London. Depression was ascertained using the Center for Epidemiologic Studies Depression scale (CES–D). The built environment was rated independently, using a validated measure.

After adjusting for socio-economic status, floor of residence and structural housing problems, statistically significant associations were found between the prevalence of depression and living in housing areas characterised by properties with predominantly deck access (odds ratio=1.28, 95% Cl 1.03–1.58; P=0.02) and of recent (post-1969) construction (odds ratio=l.43, 95% Cl 1.06–1.91; P=0.02).

The prevalence of depression was associated with independently rated features of the built environment, independent of individuals' socio-economic status and internal characteristics of dwellings.

Schneider's first-rank symptoms are given particular weight when making a diagnosis of schizophrenia, but the nuclear syndrome, characterised by one or more first-rank symptoms, has been found previously to have no heritability.

To estimate the heritability of the nuclear syndrome.

A total of 224 twin pairs (106 monozygotic, 118 same-gender dizygotic) were ascertained from the Maudsley Twin Register in London via probands with any psychosis. Lifetime-ever first-rank symptoms were rated using the OPCRIT checklist. Probandwise concordance rates were calculated for the nuclear syndrome and a heritability estimate was derived from biometric model fitting.

Probandwise concordance rates were 13/49 (26.5%) for monozygotic and 0/45 to 2/46 (0.0–4.3%) for dizygotic pairs. The heritability estimate for the best-fitting model was 71% (95% CI 57–82).

These results indicate that the nuclear syndrome shows substantial heritability, although this is slightly lower than that for schizophrenia as defined by the DSM and ICD systems.

Serious violence is an unusual but significant correlate of psychosis, and leads to the need for specialist secure psychiatric services. Most such service users have previously used general psychiatric services.

To examine diagnostic and socio-demographic differences between high-security psychiatric service users from their peers in community services.

Two groups of patients with psychosis were compared: a national sample of high-security hospital residents, and a sample of patients in contact with general psychiatric services.

Schizophrenia was the almost invariable diagnosis for all special hospital patients. White patients in the community sample were significantly more likely to have affective components to their illness compared with African–Caribbean patients; unlike those in special hospitals. There was a small excess in the proportion of African–Caribbean patients in the special hospital group, controlling for diagnosis, gender and locality. Men were overrepresented in this group.

Among patients with psychosis, having a diagnosis of schizophrenia and being male increase the likelihood of special hospital admission. Suggestions that ethnic minority patients are much more likely to have engaged in serious violence and need high-security placement were not borne out.

Alzheimer's disease management involves symptomatic drug treatments passed by the National Institute for Clinical Excellence. Disease modification is now the goal.

To review current and developmental drugs for Alzheimer's disease, their usage, and the clinical context of known facts and proposed specific models.

A brief evidence-based review was made, using literature where available, or evidence from consensus groups where it was absent.

There is good evidence to support the use of cholinesterase inhibitors, and perhaps vitamin E. Oestrogen and anti-inflammatory agents show possibility, but there is not enough evidence to support routine use.

Symptomatic treatments exist for Alzheimer's disease. Observational studies and increasing knowledge of brain biology are leading towards further treatment options. Old age psychiatrists have valuable treatments they now have to learn to use.

Membrane phospholipid abnormalities in people with schizophrenia, measured with 31P magnetic resonance spectroscopy (31P-MRS), have been previously reported in brain regions involved in this disorder.

In this 4.0 Tesla 31P-MRS study of people with schizophrenia, membrane phospholipid metabolism was examined in brain regions previously inaccessible due to their small volumes.

Three-dimensional chemical-shift imaging (3D–CSI) examined 15 cc volumes in 12 brain regions in 11 people with chronic schizophrenia and 11 healthy control volunteers.

Glycerophosphoethanolamine was decreased in the anterior cingulate, right prefrontal cortex and left thalamus, but increased in the left hippocampus and cerebellum in those with schizophrenia. Phosphoethanolamine and glycerophosphocholine were decreased in the right prefrontal region and phosphocholine was decreased in the anterior cingulate. No significant difference in membrane phospholipid levels existed between groups in the parieto-occipital and posterior cingulate regions.

Altered membrane phospholipid metabolism was demonstrated in all regions implicated in schizophrenia.

Treatment-resistant depression (TRD) is relatively common but its neurobiological basis is poorly understood. Fronto-striatal structural brain changes have been reported in patients with depression but their association with treatment resistance and chronicity has not been established.

Magnetic resonance images of 20 patients with TRD were compared with images of 20recovered patients and 20 healthy controls. Images were compared using a voxel-based analysis (VBA) method; the results were validated by conventional volumetric analysis. The clinical associations of magnetic resonance imaging (MRI) changes with illness duration and severity were examined by VBA.

Only the TRD group exhibited right fronto-striatal atrophy, and subtle MRI changes in the left hippocampus on VBA. Atrophy was confirmed on volumetric analysis, the degree correlating with the cumulative number of electroconvulsive therapy (ECT) treatments received, suggesting an acquired deficit.

This is the first study to demonstrate fronto-striatal atrophy in patients with depression with poor outcome; the atrophy is more marked in those with more severe illness.

Sudden death has been linked to antipsychotic therapy but the relative risk associated with specific drugs is unknown.

To assess the risk of sudden unexplained death associated with antipsychotic drug therapy and its relation to drug dose and individual agents.

A case-control study of psychiatric in-patients dying suddenly in five hospitals in the north-east of England and surviving controls matched for age, gender and mental disorder. Logistic regression analysis was used to identify significant risk factors, and odds ratios were calculated.

Sixty-nine case-control clusters were identified. Probable sudden unexplained death was significantly associated with hypertension, ischaemic heart disease and current treatment with thioridazine (adjusted odds ratio=5.3, 95% CI 1.7–16.2, P=0.004). There was no significant association with other individual antipsychotic drugs.

Thioridazine alone was associated with sudden unexplained death, the likely mechanism being drug— induced arrythmia.

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.

Obsessive–compulsive disorder has been reported in association with Prader–Willi syndrome.

To report the nature and prevalence of compulsive and similar symptoms associated with Prader–Willi syndrome in a population ascertained as completely as possible.

Attempted complete ascertainment of people with Prader– Willi syndrome in eight English counties. Administration of standardised rating scales and a structured interview. Comparison with people with learning disability and high body mass indices.

Prader–Willi syndrome was associated with high rates of ritualistic behaviours, such as the need to ask or to tell something, insistence on routines, hoarding and ordering objects and repetitive actions and speech, compared with the control group, and was negatively correlated with IQ and socialisation age. Typical obsessive–compulsive symptoms, such as checking, counting and cleaning compulsions or obsessional thoughts, were not found.

Ritualistic and compulsive behaviours occur more frequently in association with Prader–Willi syndrome than among people with intellectual disability and significant obesity.

In the rating scales commonly used for assessing response to antipsychotic treatment, individual items embrace symptoms that apparently arise from distinguishable pathophysiological processes and might be expected to respond differently to treatment.

To test the reliability sensitivity to change and factor structure of a new scale for the assessment of the Signs and Symptoms of Psychotic Illness (the SSPI).

Interrater reliability was evaluated by determining the intraclass correlation for the ratings of 63 patients. Sensitivity to change was assessed in a longitudinal study of 33 patients. Factor structure was determined from scores for 155 patients.

The intraclass correlation was satisfactory for all individual items and excellent for the total score. Scores were sensitive to change. A change in Clinical Global Impression of one unit corresponded to an SSPI total score change of 31%. Factor analysis revealed five clusters of symptoms.

The SSPI provides a sensitive and reliable measure of the five major clusters of symptoms that occur commonly in psychotic illness.

Little evidence exists to indicate whether community psychiatric nurses can achieve the results reported by expert cognitive–behavioural therapists in patients with schizophrenia.

To assess the effectiveness and safety of a brief cognitive— behavioural therapy (CBT) intervention in a representative community sample of patients with schizophrenia in secondary care settings.

A pragmatic randomised trial was performed involving 422 patients and carers to compare a brief CBT intervention against treatment as usual.

Patients who received CBT (n=257) improved in overall symptomatology (P=0.015; number needed to treat [NNT]= 13), insight (P<0.001; NNT=10) and depression (P=0.003;NNT=9) compared with the control group (n=165). Insight was clinically significantly improved (risk ratio =1.15,95% C1 1.01-1.31). There was no increase in suicidal ideation.

Community psychiatric nurses can safely and effectively deliver a brief CBT intervention to patients with schizophrenia and their carers.