Several, although not all, of the previous small diffusion-weighted imaging (DWI) studies have shown cortical white-matter disruption in schizophrenia.

To investigate cortical white-matter microstructure with DWI in a large community-based sample of people with schizophrenia.

Sixty-eight people with schizophrenia and 64 healthy controls underwent a session of DWI to obtain the apparent diffusion coefficient (ADC) of white-matter water molecules. Regions of interest were placed in cortical lobes.

Compared with controls, the schizophrenia group had significantly greater ADCs in frontal, temporal and occipital white matter (analysis of covariance, P < 0.05).

Our findings confirm the presence of cortical white-matter microstructure disruption in frontal and temporo-occipital lobes in the largest sample of people with schizophrenia thus for studied with this technique. Future brain imaging studies, together with genetic investigations, should further explore white-matter integrity and genes encoding myelin-related protein expression in people with first-episode schizophrenia and those at high risk of developing the disorder.

Mentalising impairment (an impaired ability to think about people in terms of their mental states) has frequently been associated with schizophrenia.

To assess the magnitude of the deficit and analyse associated factors.

Twenty-nine studies of mentalising in schizophrenia (combined n = 1518), published between January 1993 and May 2006, were included to estimate overall effect size. Study descriptors predicted to influence effect size were analysed using weighted regression-analysis techniques. Separate analyses were performed for symptom subgroups and task types.

The estimated overall effect size was large and statistically significant (d= –1.255, P < 0.001) and was not significantly affected by sample characteristics. All symptom subgroups showed significant mentalising impairment, but participants with symptoms of disorganisation were significantly more impaired than the other subgroups (P<0.01).

This meta-analysis showed significant and stable mentalising impairment in schizophrenia. The finding that patients in remission are also impaired favours the notion that mentalising impairment represents a possible trait marker of schizophrenia.

Post-traumatic stress disorder (PTSD) has inconsistently been associated with lower levels of cortisol.

To compare basal cortisol levels in adults with current PTSD and in people without psychiatric disorder.

Systematic review and meta-analysis. Standardised mean differences (SMD) in basal cortisol levels were calculated and random-effects models using inverse variance weighting were applied.

Across 37 studies, 828 people with PTSD and 800 controls did not differ in cortisol levels (pooled SMD = −0.12, 95% C1= −0.32 to 0.080). Subgroup analyses revealed that studies assessing plasma or serum showed significantly lower levels in people with PTSD than in controls not exposed to trauma. Lower levels were also found in people with PTSD when females were included, in studies on physical or sexual abuse, and in afternoon samples.

Low cortisol levels in PTSD are only found under certain conditions. Future research should elucidate whether low cortisol is related to gender or abuse and depends on the measurement methods used.

Depression is a frequent condition in early psychosis. Therefore, early detection instruments should distinguish depression from beginning psychosis

To examine whether basic symptoms, i.e. subtle subjective deficits, differ between participants suffering from a potential prodrome (n = 146), first-episode schizophrenia (n= 153) and non-psychotic depression (n = 115)

Basic symptoms were assessed with the Schizophrenia Proneness Instrument

The prodrome and schizophrenia groups did not differ in level of basic symptoms but both had higher levels than the depression group. DSM – IV depression was frequent in those suffering from a potential prodrome (38%) and first-episode schizophrenia (21%). In both groups, participants with and without depression did not differ in basic symptoms. In multivariate analyses, consideration of current depression generally facilitated correct group classification, except for participants suffering from both a potential prodrome and depression

Cognitive basic symptoms distinguished well between all three groups. However, identification of persons suffering from a potential prodrome might be enhanced by considering current affective status

Mental capacity is central to legal and ethical debates on the use of compulsion in psychiatry.

To describe the clinical epidemiology of mental incapacity in patients with psychiatric disorders, including interrater reliability of assessments, frequency in the psychiatric population and associations of mental incapacity.

Cross-sectional studies of capacity to consent to treatment for psychiatric patients were systematically reviewed from Medline, EMBASE and PsycInfo databases. Information on the reliability of assessments, frequency and associations of mental incapacity was extracted.

Out of 37 papers reviewed, 29 different capacity assessment tools were identified. Studies were highly heterogeneous in their measurement and definitions of capacity. Interrater reliabilities between tools were high. Studies indicate incapacity is common (median 29%) but the majority of psychiatric in-patients are capable of making treatment decisions. Psychosis, severity of symptoms, involuntary admission and treatment refusal were the strongest risk factors for incapacity.

Mental capacity can be reliably assessed. The majority of psychiatric in-patients have capacity, and socio-demographic variables do not have a major impact but clinical ones do.

There is evidence to suggest that among young people with mild intellectual disability there are those whose cognitive difficulties may predict the subsequent manifestation of a schizophrenic phenotype. It is suggested that they may be detectable by simple means.

To gain adequate cooperation from educational services, parents and students so as to recruit a sufficiently large sample to test the above hypothesis, and to examine the hypothesis in the light of the findings.

The sample was screened with appropriate instruments, and groups hypothesised as being likely or not likely to have the phenotype were compared in terms of psychopathology and neuropsychology.

Simple screening methods detect a sample whose psychopathological and neuropsychological profile is consistent with an extended phenotype of schizophrenia.

Difficulties experienced by some young people with mild and borderline intellectual disability are associated with enhanced liability to schizophrenia. Clinical methods can both identify those with this extended phenotype and predict those in whom psychosis will occur.

People with schizophrenia comprise the majority of patients with severe mental illness recruited to recent mental health service studies of new teams (e.g. assertive outreach, crisis resolution). Reduction in hospitalisation has been the most consistent outcome measure in these studies, but results are inconsistent

To understand inconsistency of results from studies using hospitalisation as an outcome measure

The advantages and disadvantages of hospitalisation are explored, including the ways in which it is recorded. Regional variation in outcomes and the impact of control services are reviewed

Hospitalisation has face validity as an outcome but translates poorly between differing healthcare contexts. These variations can be exploited positively to distinguish potentially effective ingredients in community care (outreach, combined health and social care, team structure) from redundant components

Hospitalisation is a good proxy outcome measure in schizophrenia care in randomised controlled trials, but the dangers of extrapolating to new contexts require care

Little is known about the treatment of delusional parasitosis with typical and atypical antipsychotics.

To evaluate the effectiveness of typical and atypical antipsychotics in primary delusional parasitosis (delusional disorder, somatic type).

A systematic review was conducted.

No randomised trials were found and hence we collected the best evidence from 16 other trials and case reports, separating primary from other forms of delusional parasitosis. Studies using typical antipsychotics showed partial or full remission in between 60 and 100% of patients. Analysis of selected patients with primary delusional parasitosis showed that typical and atypical antipsychotics were effective in the majority, but that remission rates did not differ significantly between typical and atypical antipsychotics.

In the absence of controlled trials there is limited evidence that antipsychotics are effective in primary delusional parasitosis. Rigorous studies are needed to evaluate their effectiveness and to compare typical and atypical antipsychotics directly.

There is a gap between the supply of trained cognitive – behavioural therapists to treat depression and demand for care in the community. There is interest in the potential of self-help interventions, which require less input from a therapist. However, the design of effective self-help interventions is complex. Qualitative research can help to explore some of this complexity Aims The study aimed to identify qualitative studies of patient experience of depression management in primary care, synthesise these studies to develop an explanatory framework, and then apply this framework to the development of a guided self-help intervention for depression.

A meta-synthesis was conducted of published qualitative research.

The synthesis revealed a number of themes, including the nature of personal experience in depression; help-seeking in primary care; control and helplessness in engagement with treatment; stigma associated with treatment; and patients' understandings of self-help interventions.

This meta-synthesis of qualitative studies provided a useful explanatory framework for the development of effective and acceptable guided self-help interventions for depression.

It is essential in economic evaluations of schizophrenia interventions that all relevant costs are identified and measured appropriately Also of importance is the way in which cost data are combined with information on outcomes

To examine the use of health economicsin evaluations of interventions for schizophrenia

Areview of the key methods used to estimate costs and to link costs and outcomes was conducted

Costs fall on a number of different agencies and can be short term or long term. Cost-effectiveness analysis and cost-utility analysis are the most appropriate methods for combing cost and outcome data

Schizophrenia poses a number of challenges for economic evaluation

The EURO–D, a 12-item self-report questionnaire for depression, was developed with the aim of facilitating cross-cultural research into late-life depression in Europe.

To describe the national variation in depression symptoms and syndrome prevalence across ten European countries.

The EURO–D was administered to cross-sectional nationally representative samples of non-institutionalised persons aged ≥50 years (n = 22 777). The effects of age, gender, education and cognitive functioning on individual symptoms and EURO–D factor scores were estimated. Country-specific depression prevalence rates and mean factor scores were re-estimated, adjusted for these compositional effects.

The prevalence of all symptoms was higher in the Latin ethno-lingual group of countries, especially symptoms related to motivation. Women scored higher on affective suffering; older people and those with impaired verbal fluency scored higher on motivation.

The prevalence of individual EURO–D symptoms and of probable depression (cut-off score ≥4) varied consistently between countries. Standardising for effects of age, gender, education and cognitive function suggested that these compositional factors did not account for the observed variation.

Frontal release signs, a subset of neurological soft signs, are common in schizophrenia.

To explore the relationship between frontal release signs and neuropsychological tests of frontal lobe function in people with schizophrenia, their siblings and healthy controls.

Neuropsychological tests and frontal release signs were measured in a cohort of index cases (n=302), their siblings (n=240) and healthy controls (n=346).

The mean total score of frontal release signs was 1.5 (s.d. = 1.58) in the schizophrenia group, 0.54 (s.d.=0.92) for siblings and 0.42 (s.d.=0.77) for controls. Schizophrenia group scores were greater than healthy control or sibling cohort scores (P < 0.0001), which did not differ. In all three cohorts, right grasp reflex scores positively correlated with number of perseverative errors on the Wisconsin Card Sort Task (P<0.05). In the schizophrenia group, frontal release signs scores showed an inverse correlation with IQ (R = −0.199, P<0.0005).

Our findings of relationships between frontal release signs and cognitive assays of cortical dysfunction and the increased frequency of these signs in people with schizophrenia implicate a cortical origin for these clinical signs and evidence of frontal lobe dysfunction in this disorder.

The authors of a recent systematic review concluded that the use of non-pharmacological containment methods, excluding restraint and seclusion, was not supported by evidence. Their focus on randomised, controlled trials, however, does not reflect the research that has been, or could be, conducted.

To find empirically supported interventions that allow reduction in the use of seclusion in psychiatric facilities.

We reviewed English-language, peer-reviewed literature on interventions that allow reduction in the use of seclusion.

Staff typically used multiple interventions, including state-level support, state policy and regulation changes, leadership, examinations of the practice contexts, staff integration, treatment plan improvement, increased staff to patient ratios, monitoring seclusion episodes, psychiatric emergency response teams, staff education, monitoring of patients, pharmacological interventions, treating patients as active participants in seclusion reduction interventions, changing the therapeutic environment, changing the facility environment, adopting a facility focus, and improving staff safety and welfare.

Reducing seclusion rates is challenging and generally requires staff to implement several interventions.

Few studies have employed formal diagnostic criteria to determine the prevalence of psychiatric disorders in contemporaneous samples of children with and without intellectual disabilities.

To establish the prevalence of psychiatric disorders against ICD—10 criteria among children with and without intellectual disabilities, the association with social/environmental risk factors, and risk attributable to intellectual disability.

Secondary analysis of the 1999 and 2004 Office for National Statistics surveys of the mental health of British children and adolescents with (n=641) and without (n = 17774) intellectual disability.

Prevalence of psychiatric disorders was 36% among children with intellectual disability and 8% among children without (OR=6.5). Children with intellectual disabilities accounted for 14% of all British children with a diagnosable psychiatric disorder Increased prevalence was particularly marked for autistic-spectrum disorder (OR=33.4), hyperkinesis (OR=8.4) and conduct disorders (OR=5.7). Cumulative risk of exposure to social disadvantage was associated with increased prevalence.

A significant proportion of the elevated risk for psychopathology among children with intellectual disability may be due to their increased rate of exposure to psychosocial disadvantage.

Cognitive models propose that faulty appraisal of anomalous experiences is critical in developing psychosis, particularly delusions. A data gathering bias may be fundamental to abnormal appraisal

To examine whether there is a data gathering bias in people at high risk of developing psychosis

Individuals with an at-risk mental state (n=35) were compared with a matched group of healthy volunteers (n=23). Participants were tested using a modified version of the ‘beads’ reasoning task with different levels of task difficulty

When task demands were high, the at-risk group made judgements on the basis of less information than the control group (P < 0.05). Within both groups, jumping to conclusions was directly correlated with the severity of abnormal beliefs and intolerance of uncertainty (P<0.05). In the at-risk group it was also associated with impaired working memory (P<0.05), whereas in the control group poor working memory was associated with a more conservative response style (P<0.05)

People with an at-risk mental state display a jumping to conclusions reasoning style, associated with impaired working memory and intolerance of uncertainty. This may underlie a tendency to develop abnormal beliefs and a vulnerability to psychosis

There are claims that the extra costs of atypical (second-generation) antipsychotic drugs over conventional (first-generation) drugs are offset by improved health-related quality of life.

To determine the relative costs and value of treatment with conventional or atypical antipsychotics in people with schizophrenia.

Cost-effectiveness acceptability analysis integrated clinical and economic randomised controlled trial data of conventional and atypical antipsychotics in routine practice.

Conventional antipsychotics had lower costs and higher quality-adjusted life-years (QALYs) than atypical antipsychotics and were more than 50% likely to be cost-effective.

The primary and sensitivity analyses indicated that conventional antipsychotics may be cost-saving and associated with a gain in QALYs compared with atypical antipsychotics.

Cognitive deficits are a core feature of schizophrenia. These deficits are not caused by medication or symptoms, and have a dramatic negative effecton real-world functioning

To critically examine a selection of the most common batteries used to assess cognition in schizophrenia

Literature review of cognitive assessment batteries for use in schizophrenia

A wide variety of neuro-cognitive test batteries have been developed or adapted to assess cognition in schizophrenia. These differ in time requirements, repeatability, ease of administration, degree of face validity, availability of co-normative data and degree to which results can be parsed into separate domains of cognitive functioning. The most appropriate depends on the setting and the question being addressed

Cognitive outcome measures have reshaped our understanding of schizophrenia and will be essential tools for unravelling the aetiology of the disease and designing more effective interventions

There is increasing interest in the proposition that residential environment can affect mental health.

To study the degree to which common mental disorder clusters according to postcode units and households. To investigate whether contextual measures of residential environment quality and geographical accessibility are associated with symptoms of common mental disorder.

A total of 1058 individuals aged 16–75 years (response rate 66%) participated in a cross-sectional survey The 12-item General Health Questionnaire measured symptoms of common mental disorder.

Only 2% (95% CI 0–6) of the unexplained variation in symptoms existed at postcode unit level, whereas 37% (95% CI 27–49) existed at household-level, but the postcode unit variation was reduced to zero after adjustments. There was little evidence to suggest that residential quality or accessibility were associated with symptoms.

There was substantial unexplained variation at the household level but we could find no evidence of postcode unit variation and no association with residential environmental quality or geographical accessibility. It is likely that the psychosocial environment is more important than the physical environment in relation to common mental disorder.

Epidemiological studies of schizophrenia suggest that this disorder has a substantial genetic component. Cognitive and social abilities, as well as the volumes of brain regions involved in emotion processing, have been found to be distributed along a continuum when comparing patients, siblings and controls, with siblings showing intermediate scores.

To establish whether facial expression recognition is impaired in unaffected siblings of patients.

Emotion and gender recognition were evaluated in a three-group pre–post study design in drugnaive patients with first-episode schizophrenia (n=40) and their unaffected siblings (n=30) compared with controls (n=26).

Patients and their healthy siblings showed impaired emotion recognition but normal gender recognition compared with controls. Patients' performance did not improve despite effective clinical stabilisation.

Impaired performance in healthy siblings and time stability in patients provides evidence of impairment of facial emotion recognition as an actual phenotype of schizophrenia.

Cognitive disturbances have been demonstrated in individuals with potentially prodromal symptoms in objective–neuropsychological as well as subjective-symptomatic studies. Yet, the relation between subjective and objective deficits and to different prodromal states is unclear

To explore interactions between subjective and objective cognitive measures in different prodromal states

In participants with an early (n=33) or late (n=69) initial prodromal state, cognitive subjective and objective deficits were assessed with the Schizophrenia Proneness Instrument and a comprehensive neuropsychological test battery

Participants with an early initial prodromal state were less impaired than those with a late initial state. Subjective and objective cognitive deficits were unrelated, excepttime-limited neurocognitive speed measures and subjectively reduced stress tolerance, especially in participants with an early initial prodromal state

Subjective and objective cognitive deficits are generally unrelated in the psychosis prodrome and as such they can add complementary information valuable for prediction. However, possible associations between the two levels might be better detectable in the less impaired early initial prodromal state