Evidence exists for an association between aggression and schizophrenia. Although the aetiology of aggression is multifactorial, three studies have reported associations between polymorphisms of the catechol-O-methyltransferase (COMT) gene and aggression in schizophrenia.

To replicate these findings in a larger sample using the Overt Aggression Scale (OAS).

A sample of 180 people with DSM–IV schizophrenia were rated for aggression using the OAS. Kruskal–Wallis and contingency table analyses were applied to the OAS results.

The high-activity homozygotes showed significantly higher scores of aggression, whereas the heterozygotes showed significantly lower scores. The odds ratio for aggression for the high-activity homozygotes was 2.07 (95% Cl=1.03–4.15), whereas that for the heterozygotes was 0.54 (95% CI=0. 30–1.00).

The high-activity COMT homozygote confers a higher risk of recorded aggression in schizophrenia. Heterozygotes had a significantly lower risk, which may represent an example of heterosis/heterozygote advantage.

In an autopsy series, 10 out of 27 deaths in which ‘idiopathic’ pulmonary emboli were discerned as the sole cause of death had occurred in psychiatric patients.

To investigate whether antipsychotic medication is a risk factor for venous thrombosis.

A description of the 10 psychiatric patients was obtained from the pulmonary emboli autopsy reports. We carried out a brief historic overview of the literature. We re-analysed data from the Leiden Thrombophilia Study (LETS), a case–control study on patients with venous thrombosis.

In the autopsy reports, five out of 10 psychiatric patients with fatal pulmonary embolism had confirmed use of antipsychotic drugs. After the application of chlorpromazine and its analogues a higher incidence of venous thrombosis in psychiatric patients was described in the German literature between 1953 and 1977. In the re-analysis of the LETS case–control study, four patients used antipsychotic drugs versus none in the control group. Recent epidemiological studies of good methodological quality have confirmed these findings.

Venous thrombosis appears to be associated with the use of antipsychotic drugs in psychiatric patients.

No existing instrument measures all or even most of the issues considered important by users of mental health services.

To develop and test a self-assessment instrument to enable users of mental health services to rate their experience across the range of domains that they consider to be important.

Relevant domains were identified and a new instrument was drafted and field tested to examine its psychometric properties.

The 17-item, self-rated Carers' and Users' Expectations of Services – User version (CUES–U) appears acceptable to most service users. Its items have reasonable test–retest reliability and a ‘total CUES–U score’ correlates significantly with a total score of the Health of the Nations Outcome Scales (Spearman's ρ=0.42; P<0.01).

The development and testing of CUES–U suggest that it might be feasible to apply a self-rated measure of the expectations and experience of users of mental health services.

Childhood sexual abuse (CSA) is associated with an increased risk of subsequent psychiatric disorders.

To explore the risk associated with features of CSA and examine whether specific associations exist between particular profiles of CSA and the development of specific syndromes.

In a population-based sample of adult female twins, we used logistic regression to explore the association between features of CSA (reported by the twin and her co-twin) and lifetime major depression, generalised anxiety disorder, bulimia nervosa, panic disorder and alcohol and drug dependence.

In univariate and stepwise multiple regressions, patterns of predictors differed, although not significantly, across diagnoses. Greater risk was associated with attempted or completed intercourse, the use of force or threats, abuse by a relative, and a negative response by someone who was told about the abuse. Similar patterns were observed with co-twin reports.

Specific features of CSA differentially increase risk of later psychopathology; however, there do not appear to be unique predictive relationships between features of CSA and the emergence of specific psychiatric disorders.

The Hospital Anxiety and Depression (HAD) rating scale is a commonly used questionnaire. Former studies have given inconsistent results as to the psychometric properties of the HAD scale.

To examine the psychometric properties of the HAD scale in a large population.

All inhabitants aged 20–89 years (n=92 100) were invited to take part in The Nord-Tr⊘ndelag Health Study, Norway. A total of 65 648 subjects participated, and only completed HAD scale forms (n=51 930) formed the basis for the psychometric examinations.

Principal component analysis extracted two factors in the HAD scale that accounted for 57% of the variance. The anxiety and depression sub-scales shared 30% of the variance. Both sub-scales were found to be internally consistent, with values of Cronbach's coefficient (a) being 0.80 and 0.76, respectively.

Based on data from a large population, the basic psychometric properties of the HAD scale as a self-rating instrument should be considered as quite good in terms of factor structure, intercorrelation, homogeneity and internal consistency.

In rats, amino acid mixtures lacking tyrosine and its precursor phenylalanine decrease the release of dopamine produced by the psychostimulant drug amphetamine. Amphetamine has been proposed as a model for clinical mania.

To assess whether dietary tyrosine depletion attenuates the psychostimulant effects of methamphetamine in healthy volunteers and diminishes the severity of mania in acutely ill patients.

Sixteen healthy volunteers received a tyrosine-free amino acid mixture and a control mixture in a double-blind crossover design 4 h before methamphetamine (0.15 mg/kg). Twenty in-patients meeting DSM–IV criteria for mania were allocated blindly and randomly to receive either the tyrosine-free mixture or the control mixture.

The tyrosine-free mixture lowered both subjective and objective measures of the psychostimulant effects of methamphetamine. Ratings of mania were lower in the patients who received the tyrosine-free mixture.

Decreased tyrosine availability to the brain attenuates pathological increases in dopamine neurotransmission following methamphetamine administration and putatively in mania.

An important factor determining future health care expenditure is the relationship between ageing, health status and development of age-related disorders such as dementia.

To estimate the formal care costs associated with dementia in England and Wales between 1994 and 2031.

Epidemiological cost model, applied to individuals aged 65 years or over with dementia, using estimates of life expectancy with dementia and dementia-free life expectancy.

Total costs per year were £0.95 billion (men) and £5.35 billion (women) using 1994 population estimates. For 2031, costs were £2.34 billion and £11.20 billion, respectively. Reduced dementia prevalence rates and improvements in mental and physical functioning resulted in lower estimates: £1.01 billon (men) and £5.77 billion (women), and £1.65 billion (men) and £7.87 billion (women), respectively.

Future increases in the population aged 65 years or over lead to rising formal care costs. However, the magnitude of cost changes depends on assumptions over dementia prevalence and levels of mental and physical functioning.

Antipsychotic medications cause a wide range of adverse effects and have been associated with sudden death in psychiatric patients.

To supply power spectral analysis of heart rate variability as a tool to examine the arrythmogenic effects of neuroleptics.

Heart rate analysis was carried out in patients with schizophrenia on standard doses of neuroleptic monotherapy − 21 were on clozapine, 18 on haloperidol and 17 on olanzapine – and in 53 healthy subjects.

Patients with schizophrenia on clozapine had significantly higher heart rate, lower heart rate variability and lower high-frequency and higher low-frequency components compared with patients on haloperidol or olanzapine and matched control subjects. Prolonged QTc intervals were more common in patients than controls.

Patients treated with neuroleptic medications, especially clozapine, showed autonomic dysregulation and cardiac repolarisation changes. Physicians should be aware of this adverse reaction.

Low birth weight is a risk factor for coronary heart disease, diabetes, stroke and hypertension. Depression is highly associated with these conditions.

To examine the association between birth weight and depression in late life.

A total of 882 singleton term births in the 1920s had contemporary records of birth weight and weight at 1 year. At 68 years all completed the Geriatric Depression Scale and 867 completed the Geriatric Mental State Examination. A logistic regression was used to analyse the associations between depression, birth weight and weight at 1 year while adjusting for known risk factors.

Current social class, social class at birth, recent bereavement, social isolation and physical illness increased the risk of depression. After adjusting for these and weight at 1 year, the odds ratios for depression among men, but not women, rose incrementally with decreasing birth weight (1.0, 12.8; for continuous variable, P < 0.007).

Foetal undernutrition predisposes men to depression in late adult life. If replicated, these results would suggest a neurodevelopmental aetiology of depression, possibly mediated by programming of the hypothalamic–pituitary–adrenal axis.

In the UK, 6% of those aged 65 years and over were born abroad, most of whom now live in inner-city areas. It has been suggested that ethnic elders are particularly vulnerable to mental illness.

To compare the prevalence of dementia and depression in older migrants with those born in the UK.

A cross-sectional community study of 1085 people aged 65 years or older in an inner-London borough.

Compared with those born in the UK, the prevalence of dementia was raised in African–Caribbeans (17.3%, relative risk=1.72, Cl=1.06–2.81) and lower for the Irish-born (3.6%, relative risk=0.36, Cl=0.17–0.87). All those of African–Caribbean country of birth were significantly younger (P=0.000) but no more likely to be taking antihypertensive drugs. They were no more likely to report having cardiovascular problems but had increased rates of diabetes (P < 0.0000). The overall prevalence of depression was 18.3% (95% Cl=16.1–20.7). The highest prevalence rate was found among those born in Greece and Turkey (27.2%, Cl=179–39.6). Migration per se does not appear to be a risk for depression and dementia in this population.

The excess of dementia may be of vascular aetiology. There is the potential for primary or secondary prevention.

Early psychodynamic writing on same-gender sexual preference contributed to its pathologisation and an interest in treatment directed at changing sexual orientation.

To establish the therapeutic approaches taken by contemporary psychotherapists and psychoanalysts to gay and lesbian clients/patients.

A random sample of individuals listed as working with adults in the British Confederation of Psychotherapists' register were sent postal questionnaires.

Data are available from 274 (69%) of 395 questionnaires. Only one of 218 respondents said that he/she was homosexual. One-third said that gay and lesbian patients did have a right to a gay or lesbian therapist. A total of 179 (82% of 218) respondents described work with gay and lesbian clients/patients, and in the majority of cases sexual orientation was an important aspect of the work.

Gays and lesbians seeking psychoanalysis or psychotherapy in the National Health Service or outside it for personal and/or training purposes will be unlikely to find a gay or lesbian therapist if they want one. The British Confederation of Psychotherapists' practitioners take on gay and lesbian clients/patients, although many do not see these social identities as relevant to the therapeutic process. Evidence from this study indicates that such clients/patients may encounter overt or covert bias, including the pathologisation of homosexuality per se.

Studies have consistently shown a higher incidence of schizophrenia with onset in early adult life in African and Caribbean migrants to the UK.

To establish the incidence (first-contact rates) of very-late-onset (>60 years) schizophrenia-like psychosis (SLP) in south London and to test the hypothesis that this is higher among African— and Caribbean-born than indigenous elders.

We identified all new referrals of SLP to the Maudsley Hospital between 1995 and 2000. Demographic details, including age, ethnicity and electoral ward (address), were obtained from case notes. Incidence was estimated using 1997 census data to determine the denominator population for each ethnic group.

The incidence of SLP was significantly higher in African— and Caribbean-born than indigenous elders: 172.4 per 100 000 population (95% Cl=579–286.8) in African— and Caribbean-born males and 323.5 per 100 000 population (95% Cl 167.8–479.1) in African— and Caribbean-born females. Rates also were increased in elders from other immigrant groups, but the numbers involved were too small to reach accepted levels of significance.

Large-scale epidemiological studies are needed to determine both the incidence of and the coexistent risk factors for SLP among all elderly migrants, who may constitute a group with high service needs.

Many patients with phobia/panic find it hard to access effective treatment.

To test the feasibility of computer-guided exposure therapy for phobia/panic.

Self-referrals were screened for 20 min and, if suitable, had six sessions of computer-guided self-help (from a system called Fear Fighter). Pre— and post-treatment ratings of 54 patients were compared with those of 31 similar out-patients with phobia/panic who received the same treatment guided by a clinician.

At pre-treatment, computer-guided cases were slightly less severe than clinician-guided patients. In a post-treatment intent-to-treat analysis, both groups improved comparably but computer-guided patients spent 86% less time with a clinician than did purely clinician-guided patients, who had no access to the computer system.

Computer-guided self-exposure therapy appeared feasible and effective for self-referrals and saved much clinician time. A controlled study is now needed.

The diagnosis of neurasthenia appeared in 1869 and rapidly became fashionable and highly prevalent. It disappeared almost completely, producing ongoing debates about what happened to the disease, which have not so far been informed by empirical data.

To use empirical historical hospital data from one specific hospital to explore several controversies about neurasthenia, including what happened to the disorder.

The annual reports of Queen Square Hospital were examined from 1870 to 1947. The prevalence of neurasthenia diagnoses as a proportion of total discharges was recorded. The possible diagnostic categories into which neurasthenia could have been reclassified were identified. Textbooks and writing by neurologists working at the hospital during this period were examined.

Neurasthenia accounted for 6–11% of total discharges from the late 1890s to 1930, when it virtually disappeared. Men accounted for 33–50% of cases.

Neurasthenia affected both the upper and working classes and both men and women. Neurologists, not psychiatrists, continued to see the disorder well into the 20th century. Neurasthenia did not disappear, but was reclassified into psychological diagnoses.