Most previous case–control studies of obstetric complications in schizophrenia have been small scale and many have relied on retrospective information.

To determine which obstetric complications are more common in probands with schizophrenia than matched controls.

Two hundred and ninety-six probands with an in-patient diagnosis of schizophrenia who had been born in Scotland in 1971–74, and a further 156 born in 1975–78, were closely matched with controls and the incidence of obstetric complications in the two compared using obstetric data recorded in a set format shortly after birth.

Not a single complication of pregnancy or delivery was significantly more common in the probands with schizophrenia than the controls in the 1971–74 birth cohort and only emergency Caesarean section and labour lasting over 12 hours were significantly more common in the schizophrenia probands in the 1975–78 cohort.

The evidence that schizophrenia is associated with a raised incidence of obstetric complications is weaker than has recently been assumed.

Unlike schizophrenia, little interest has been taken in the incidence of obstetric complications in affective psychoses.

To find out whether obstetric complications are more common in affective psychoses than matched controls.

Two hundred and seventeen probands with an in-patient diagnosis of affective psychosis who had been born in Scotland in 1971–74, and a further 84 born in 1975–78, were closely matched with controls and the incidence of obstetric complications in the two compared using obstetric data recorded in a set format shortly after birth.

Abnormal presentation of the foetus was the only complication significantly more common in the affective probands in the 1971–74 birth cohort and artificial rupture of the membranes was the only event more common in the probands in the 1975–78 cohort. Both are probably chance findings.

It is unlikely that the incidence of obstetric complications is raised in people with affective psychoses of early onset.

Controversy continues regarding an association between obstetric complications and risk of schizophrenia in early adult life.

To compare the rate of labour and delivery complications among persons who developed schizophrenia with controls; to establish whether any complication is associated with later schizophrenia.

We located the labour ward records of 431 individuals with schizophrenia and of same-gender controls from the same hospital birth series. Mothers were matched by age, socio-economic group and parity. Individual complications were evaluated blindly using two obstetric complication scales.

Overall, the rate of labour and delivery complications for those who developed schizophrenia did not differ from that of controls. Males who had presented to psychiatric services before the age of 30 had a greater frequency of and more severe labour/delivery complications than their matched controls.

Other than among young-onset males we found no increase in labour and delivery complications among cases.

Intensive case management is commonly advocated for the care of the severely mentally ill, but evidence of its cost-effectiveness is lacking.

To investigate the cost-effectiveness of intensive compared with standard case management for patients with severe psychosis.

708 patients with psychosis and a history of repeated hospital admissions were randomly allocated to standard (case-loads 30–35) or intensive (case-loads 10–15) case management. Clinical and resource use data were assessed over two years.

No statistically significant difference was found between intensive and standard case management in the total two-year costs of care per patient (means £24 550 and £22 700, respectively, difference £1850, 95% Cl – £1600 to £5300). There was no evidence of differential effects in African–Caribbean patients or in the most disabled. Psychiatric in-patient hospital stay accounted for 47% of the total costs, but neither such hospitalisation nor other clinical outcomes differed between the randomised groups.

Reduced case-loads have no clear beneficial effect on costs, clinical outcome or cost-effectiveness. The policy of advocating intensive case management for patients with severe psychosis is not supported by these results.

Cross-sectional data show that generalised anxiety disorder (GAD) is a chronic condition with episodes lasting much longer than the six-month minimum required by DSM–III–R and DSM–IV. Although GAD is chronic, little is known about factors influencing illness duration.

To investigate variables that influence the clinical course of GAD.

A total of 167 patients with GAD participated in the Harvard–Brown Anxiety Research Program. Patients were assessed at intake and re-examined at six- to twelve-month intervals for five years. Kaplan–Meier curves were constructed to assess the likelihood of remission. Regression analysis was used to investigate factors predicting full or partial remission.

The rate of remission was 0.38 after five years. Diminished likelihood of remission was associated with low overall life satisfaction, poor spousal or family relationships, a concurrent cluster B or C personality disorder and a low global assessment score.

Full or partial remissions were less likely to occur in patients with poor relationships and personality disorders. These patients should be given more intensive and possibly multi-modal therapy.

Patients with chronic fatigue syndrome (CFS) and depressive illness share many, but not all, features.

To test the hypothesis that patients with CFS have abnormal cerebral perfusion, that differs from that in patients with depressive illness.

We recruited 30 patients with CFS who were not depressed, 12 depressed patients and 15 healthy volunteers. Regional cerebral perfusion at rest was assessed using region of interest (ROI) and voxel-based statistical parametric mapping (SPM) techniques.

On SPM analysis there was increased perfusion in the right thalamus, pallidum and putamen in patients with CFS and in those with depressive illness. CFS patients also had increased perfusion in the left thalamus. Depressed patients differed from those with CFS in having relatively less perfusion of the left prefrontal cortex. The results were similar on ROI analysis.

Abnormal cerebral perfusion patterns in CFS subjects who are not depressed are similar but not identical to those in patients with depressive illness. Thalamic overactivity may be a correlate of increased attention to activity in CFS and depression; reduced prefrontal perfusion in depression may be associated with the greater neuropsychological deficits in that disorder.

The majority of patients with Alzheimer's disease live outside institutions and there is considerable serious psychological morbidity among their carers.

To evaluate whether family intervention reduces the subjective burden of care in carers of patients with Alzheimer's disease and produces clinical benefits in the patients.

A prospective single-blind randomised controlled trial with three-month follow-up in which the experimental group received family intervention and was compared with two control groups.

There were significant reductions in distress and depression in the intervention group compared with control groups at post-treatment and follow-up. There were significant reductions in behavioural disturbance at post-treatment and an increase in activities at three months in patients in the intervention group. Based on an improvement on the General Health Questionnaire resulting in a carer converting from a case to a non-case, the number to treat was three immediately post-treatment and two at follow-up.

Family intervention can have significant benefits in carers of patients with Alzheimer's disease and has a positive impact on patient behaviour.

Older people in nursing and residential homes often have complex disabilities and behavioural disturbances. Recent publicity has highlighted the dangers of medication in this group, and controls over prescribing have been suggested.

To investigate the effect of a review of medication by a pharmacist.

An 8-month prospective trial of an active medication review by a pharmacist was carried out on 330 residents in nursing homes in Manchester.

The intervention group experienced greater deterioration in cognitive function and behavioural disturbance than the control group, but the changes in depression and quality of life were similar for both groups. The number of drugs prescribed fell in the intervention group, but not in the control group, with a corresponding saving in drug costs. The number of deaths was significantly smaller in the intervention homes during the intervention period (4 v. 14) but not overall during the study period as a whole (26 v. 28).

This clinical intervention reduced the number of medicines prescribed to elderly people in nursing homes, with minimal impact on their morbidity and mortality.

Depression may be associated with cognitive decline in elderly people with impaired cognition.

To investigate whether depressed elderly people with normal cognition are at increased risk of cognitive decline and Alzheimer's disease.

Two independent samples of older people with normal cognition were selected from the community-based Amsterdam Study of the Elderly (AMSTEL) and the Longitudinal Aging Study Amsterdam (LASA). In AMSTEL, depression was assessed by means of the Geriatric Mental State Schedule. Clinical diagnoses of incident Alzheimer's disease were made using a two-step procedure. In LASA, depression was assessed with the Center for Epidemiologic Studies Depression Scale. Cognitive decline was defined as a drop of ⩾ 3 on the Mini-Mental State Examination at follow-up.

Both in the AMSTEL and the LASA sample, depression was associated with an increased risk of Alzheimer's disease and cognitive decline, respectively, but only in subjects with higher levels of education.

In a subgroup of more highly educated elderly people, depression may be an early manifestation of Alzheimer's disease before cognitive symptoms become apparent.

The acute and transient psychotic disorders (ATPD) in ICD–10 advanced the nosology of remitting psychoses with acute onset. But the proposed criteria for ATPD – especially in regard to duration – are tentative and need to be validated.

To evaluate: (a) the duration of remitting psychoses with acute onset; (b) the applicability of the ATPD criteria for these cases; and (c) differences in duration and ATPD diagnoses across sociocultural settings.

Data from the World Health Organization Determinants of Outcome study were used.

The 98 cases of remitting psychoses with acute onset had a modal duration of 2–4 months, with 43% falling in this range. Mainly because of this, few met the ATPD criteria. Duration and diagnostic findings were similar across settings.

ATPD criteria need refinement, especially in regard to duration. Further studies aimed at early detection and assessment of onset and duration of these disorders are needed.

Targeting resources on cost-effective care strategies is important for the global mental health burden.

To demonstrate cost–outcome methods in the evaluation of mental health care programmes in low-income countries.

Four rural populations were screened for psychiatric morbidity. Individuals with a diagnosed common mental disorder were invited to seek treatment, and assessed prospectively on symptoms, disability, quality of life and resource use.

Between 12% and 39% of the four screened populations had a diagnosable common mental disorder. In three of the four localities there were improvements over time in symptoms, disability and quality of life, while total economic costs were reduced.

Economic analysis of mental health care in low-income countries is feasible and practicable. Our assessment of the cost-effectiveness of integrating mental health into primary care was confounded by the naturalistic study design and the low proportion of subjects using government primary health care services.

Psychological debriefing is widely used for trauma victims but there is uncertainty about its efficacy. We have previously reported a randomised controlled trial which concluded that at 4 months it was ineffective.

To evaluate the 3-year outcome in a randomised controlled trial of debriefing for consecutive subjects admitted to hospital following a road traffic accident.

Patients were assessed in hospital by the Impact of Event Scale (IES), Brief Symptom Inventory (BSI) and questionnaire and re-assessed at 3 months and 3 years. The intervention was psychological debriefing as recommended and described in the literature.

The intervention group had a significantly worse outcome at 3 years in terms of general psychiatric symptoms (BSI), travel anxiety when being a passenger, pain, physical problems, overall level of functioning, and financial problems. Patients who initially had high intrusion and avoidance symptoms (IES) remained symptomatic if they had received the intervention, but recovered if they did not receive the intervention.

Psychological debriefing is ineffective and has adverse long-term effects. It is not an appropriate treatment for trauma victims.