There is a significant gap between the demand for psychological therapy services and the available supply. One proposal to overcome this problem is to increase efficiency of provision through the adoption of briefer ‘minimal interventions' within stepped care models.

To examine the theoretical underpinnings of stepped care, together with the practicalities of the adoption of this system of care.

Narrative literature review.

The potential clinical and economic benefits of stepped care are dependent upon underlying assumptions of equivalence in terms of clinical outcomes, efficiency in terms of resource use and costs, and acceptability of ‘minimal interventions' to patients and therapists. Illustrative studies of these issues are considered.

Although psychological services might benefit from the adoption of the stepped care model, a substantial research agenda needs to be fulfilled before a judgement can be made as to whether stepped care might be an efficient method of delivering psychological services.

The hypothesis that schizophrenia is neurodevelopmental was investigated in a prospective study of young people with a postulated 10–15% risk for the development of schizophrenia.

To determine premorbid variables distinguishing high-risk people who will go on to develop schizophrenia from those who will not.

A high-risk sample of 163 young adults with two relatives with schizophrenia was recruited. They and 36 controls were serially examined. Baseline measures were compared between those who did develop schizophrenia, a well control group, a well high-risk group and high-risk participants with partial or isolated psychotic symptoms.

Of those at high risk, 20 developed schizophrenia within 2½ years. More experienced isolated or partial psychotic symptoms. Those who developed schizophrenia differed from those who did not on social anxiety, withdrawal and other schizotypal features. The whole high-risk sample differed from the control group on developmental and neuropsychological variables.

The genetic component of schizophrenia affects many more individuals than will develop the illness, and partial impairment can be found in them. Highly significant predictors of the development of schizophrenia are detectable years before onset.

Reduced hippocampal volume is a consistently described structural abnormality in schizophrenia but its cause and timing are not known.

To examine the relationship of duration of schizophrenic illness and treatment effects with hippocampal volumes.

Quantitative 1.5 T magnetic resonance imaging brain scans of young male patients in the early stage of schizophrenic illness were compared with those of chronically ill older patients. Scans were also acquired for controls matched to both patient groups for age and handedness. Duration of illness was recorded and severity of symptoms assessed with the Positive and Negative Syndrome Scale.

The patients with schizophrenia had smaller hippocampal volumes than the controls. The volume reduction was larger in older patients than in young, compared with age-matched controls. In the early illness group atypical antipsychotics rather than haloperidol were associated with larger hippocampal volumes even after controlling for differences in illness severity Conclusions The greater reduction of hippocampal volume in people with chronic v. early illness, after controlling for illness severity and age, supports the hypothesis of progressive hippocampal reduction in males with schizophrenia. Atypical antipsychotics early in illness may protect against this.

Persistent impairments in neurocognitive function have been described in patients with bipolar disorder whose disease is in remission. However, methodological issues such as the effect of residual mood symptoms and hypercortisolaemia may confound such studies.

To assess neurocognitive functioning in prospectively verified euthymic patients with bipolar disorder.

Sixty-three patients with bipolar disorder and a matched control group completed a comprehensive neurocognitive test battery. Euthymia was confirmed in the patient group by prospective clinical ratings over 1 month prior to testing. Saliva samples were collected to profile basal cortisol secretion.

Patients were significantly impaired across a broad range of cognitive domains. Across the domains tested, clinically significant impairment was observed in 3% to 42% of patients. Deficits were not causally associated with residual mood symptoms or hypercortisolaemia.

Neurocognitive impairment persists in patients whose bipolar disorder is in remission. This may represent a trait abnormality and be a marker of underlying neurobiological dysfunction.

Few published studies address depression outcomes in primary care from a cross-cultural perspective.

To define baseline factors associated with 9-month clinical outcome: across six countries.

Adults meeting criteria for current major depression were recruited from primary care clinics in Australia, Brazil, Israel, Spain, Russia and the USA; 968 patients were assessed at the 9-month follow-up. Predictors of complete remission were examined using logistic regression with a hierarchical model.

Rates of complete remission in the six sites ranged from 25% to 48%. Logistic regression using pooled data showed that education, key life events and the Quality of Life Depression Scale score at baseline were the final predictors of complete remission, adjusting for centres, socio-demographic data, severity of depression, comorbidity and general quality of life. Variation in predictors across sites was not statistically significant.

The two major findings of this study were the low proportion of people achieving complete remission at follow-up across the six sites, and that some baseline characteristics (education, Quality of Life Depression Scale score and key life events) are modest predictors of outcome in depression.

We have previously reported that the temporomesial area, including the amygdala, is activated in women when processing unpleasant words concerning body image.

To detect gender differences in brain activation during processing of these words.

Functional magnetic resonance imaging was used to investigate 13 men and 13 women during an emotional decision task consisting of unpleasant words concerning body image and neutral words.

The left medial prefrontal cortex and hippocampus were activated only among men, and the left amygdala was activated only among women during the task; activation in the apical prefrontal region was significantly greater in men than in women.

Our data suggest that the prefrontal region is responsible for the gender differences in the processing of words concerning body image, and may also be responsible for gender differences in susceptibility to eating disorders.

Electroconvulsive therapy (ECT) is a procedure that attracts special safeguards under common law for voluntary patients and under both current and proposed mental health legislation, for those receiving compulsory treatment.

To review patients' views on issues of information, consent and perceived coercion.

Seventeen papers and reports were identified that dealt with patients' views on information and consent in relation to ECT; 134 ‘testimonies' or first-hand accounts were identified. The papers and reports were subjected to a descriptive systematic review. The testimony data were analysed qualitatively.

Approximately half the patients reported that they had received sufficient information about ECT and side-effects. Approximately a third did not feel they had freely consented to ECTeven when they had signed a consent form. Clinician-led research evaluates these findings to mean that patients trust their doctors, whereas user-led work evaluates similar findings as showing inadequacies in informed consent.

Neither current nor proposed safeguards for patients are sufficient to ensure informed consent with respect to ECT, at least in England and Wales.

Self-harm is associated with a high risk of suicide. It is unclear whether suicidal intent at the time of self-harm is a risk factor for future suicidal behaviour.

To investigate the relationship between suicidal intent and patient characteristics, repetition of self-harm, and suicide.

Clinical and demographic data on 4415 patients presenting to hospital following self-harm between 1993 and 2000 were analysed. Suicidal intent was measured using the Beck Suicide Intent Scale (SIS). Follow-up information on repetition of self-harm and suicide was investigated for 2489 patients presenting between 1993 and 1997.

Suicidal intent at the time of self-harm was associated with risk of subsequent suicide, especially within the first year and among female patients. Suicide was more strongly associated with scores on the circumstances section of the SIS than the self-report section. The association between repetition of self-harm and SIS scores was different for male and female patients.

The measurement of suicidal intent in the assessment of self-harm patients is beneficial for the evaluation of future suicide risk. A shortened measuring scale might be useful in clinical practice.

Charcoal-burning, a new suicide method, emerged in Hong Kong during the latest economic recession. With-in 2 months charcoal-burning had become the third most common suicide method.

To examine the characteristics of suicides by charcoal-burning, and to delineate the pathways linking macro-level economic and social changes with the subjective experiences of those surviving a charcoal-burning suicide attempt.

Both quantitative and qualitative methods were used. In the coroner's records study, the first 160 cases of suicide by charcoal-burning were compared with a control group. In the ethnographic enquiry, we interviewed 25 consecutive informants who had survived serious suicide attempt using charcoal-burning.

People who completed suicide by the charcoal-burning method were more likely to have been economically active and physically healthy, and were less likely to have had pre-existing mental illness. Charcoal-burning suicide was associated with overindebtedness. Media reports were pivotal in linking overindebtedness and financial troubles with charcoal-burning.

The political economy of suicide by charcoal-burning illustrated how historical, socio-economic and cultural forces shaped the lived experience that preceded suicide.