Chinese herbal medicine has been used to treat millions of people with schizophrenia for thousands of years.

To evaluate Chinese herbal medicine as a treatment for schizophrenia.

A systematic review of randomised controlled trials (RCTs).

Seven trials were included. Most studies evaluated Chinese herbal medicine in combination with Western antipsychotic drugs; in these trials results tended to favour combination treatment compared with antipsychotic alone (Clinical Global Impression ‘not improved/worse’ n= 123, RR=0.19, 95% CI 0.1-0.6, NNT=6,95% CI 5–11; n=109, Brief Psychiatric Rating Scale ‘not improved/worse’ RR=0.78,95% CI 0.5-1.2; n=109, Scale for the Assessment of Negative Symptoms ‘not improved/worse’ RR=0.87,95% CI 0.7-1.2; n= 109, Scale for the Assessment of Positive Symptoms ‘not improved/worse’ RR=0.69,95% CI 0.5-1.0, NNT=6 95% CI 4-162). Medium-term study attrition was significantly less for people allocated the herbal/antipsychotic mix (n=897, four RCTs, RR=0.34,95% CI 0.2–0.7, NNT=23,95% CI 18-43).

Results suggest that combining Chinese herbal medicine with antipsychotics is beneficial.

Gulf War veterans reported multiple psychological symptoms immediately after the war; the temporal course of these symptoms remains unclear.

To assess the prevalence of war-era onset mental disorders in US veterans deployed to the Gulf War and in non-deployed veterans 10 years after the war.

Mental disorders were diagnosed using structured clinical interviews. Standard questionnaires assessed symptoms and quality of life.

Gulf War-era onset mental disorders were more prevalent in deployed veterans (18.1%, n=1061) compared with non-deployed veterans (8.9%, n=1128). The prevalence of depression and anxiety declined 10 years later in both groups, but remained higher in the deployed group, who also reported more symptoms and a lower quality of life than the non-deployed group. Remission of depression may be related to the presence of comorbid psychiatric disorders and level of education. Remission of anxiety was related to treatment with medication.

Gulf War deployment was associated with an increased prevalence of mental disorders, psychological symptoms and a lower quality of life beginning during the war and persisting at a lower rate 10 years later.

There is growing research interest in the influence of the built environment on mental disorders.

To estimate the variation in the prevalence of common mental disorders attributable to individuals and the built environment of geographical sectors where they live.

A sample of 3870 adults (response rate 90%) clustered in 248 geographical sectors participated in a household cross-sectional survey in Santiago, Chile. Independently rated contextual measures of the built environment were obtained. The Clinical Interview Schedule was used to estimate the prevalence of common mental disorders.

There was a significant association between the quality of the built environment of small geographical sectors and the presence of common mental disorders among its residents. The better the quality of the built environment, the lower the scores for psychiatric symptoms; however, only a small proportion of the variation in common mental disorder existed at sector level, after adjusting for individual factors.

Findings from our study, using a contextual assessment of the quality of the built environment and multilevel modelling in the analysis, suggest these associations may be more marked in non-Western settings with more homogeneous geographical sectors.

Little is known about the epidemiology of adult attention-deficit hyperactivity disorder (ADHD).

To estimate the prevalence and correlates of DSM-IV adult ADHD in the World Health Organization World Mental Health Survey Initiative.

An ADHD screen was administered to respondents aged 18–44 years in ten countries in the Americas, Europe and the Middle East (n=11422). Masked clinical reappraisal interviews were administered to 154 US respondents to calibrate the screen. Multiple imputation was used to estimate prevalence and correlates based on the assumption of cross-national calibration comparability.

Estimates of ADHD prevalence averaged 3.4% (range 1.2–7.3%), with lower prevalence in lower-income countries (1.9%) compared with higher-income countries (4.2%). Adult ADHD often co-occurs with other DSM-IV disorders and is associated with considerable role disability. Few cases are treated for ADHD, but in many cases treatment is given for comorbid disorders.

Adult ADHD should be considered more seriously in future epidemiological and clinical studies than is currently the case.

Impulsive aggression in adulthood is associated with disturbances in serotonergic function. In contrast, research examining this association in childhood has yielded inconsistent results.

The current study examined the prospective relationship between serotonergic function measured in childhood and the later emergence of antisocial personality disorder.

Hormonal response to fenfluramine, an index of serotonergic function, was assessed in 58 children with attention-deficit hyperactivity disorder between 1990 and 1997 when they were aged 7–11 years. Approximately 9 years later these individuals were evaluated for antisocial personality disorder.

Lower serotonergic responsivity assessed in childhood predicted the development of antisocial personality disorder (t (56)=2.25, P=0.028).

These results provide a critical link between the child and adult literature on the covariation of impulsive aggression and serotonergic function and suggest a potential explanation for inconsistencies in the childhood literature.

Little is currently known about functioning and impairment during adulthood associated with the course of personality disorders.

To investigate the association of personality disorder stability from adolescence through middle adulthood with measures of global functioning and impairment, using prospective epidemiological data.

A community-based sample of 658 individuals was interviewed at mean ages 14, 16, 22 and 33 years.

Individuals with persistent personality disorder had markedly poorer functioning and greater impairment at mean age 33 years than did those who had never been identified as having such disorder or who had a personality disorder that was in remission, after co-occurring Axis I disorders at age 33 years were taken into account. Remitted disorder was associated with mild long-term impairment. Adult-onset personality disorders, however, were also associated with significant impairment.

Persistent and adult-onset personality disorders are associated with functional impairment among adults in the community. These effects are independent of co-occurring Axis 1 disorders.

Cognitive difficulties are prevalent in people with a diagnosis of schizophrenia and are associated with poor long-term functioning.

To evaluate the effectiveness of cognitive remediation therapy on cognitive difficulties experienced by people with schizophrenia.

Participants with a diagnosis of schizophrenia, a social behaviour problem and a cognitive difficulty (n=85) were randomised to 40 sessions of cognitive remediation or treatment as usual in a single-blind randomised controlled trial. Working memory, cognitive flexibility and planning, were measured at weeks 0, 14 and 40.

There were durable improvements in working memory (advantage 1.33 points, 95% CI 0.43–2.16, standardised effect size 0.34) as well as an indication of improvement in cognitive flexibility. Memory improvement predicted improvement in social functioning. Costs were lower in the cognitive remediation group following therapy but rose at follow-up. However, cost-effectiveness analyses showed that improvements in memory were achieved at little additional cost.

Cognitive remediation therapy is associated with durable improvements in memory, which in turn are associated with social functioning improvements in people with severe mental illness.

Anxiety disorders in older people are highly prevalent, yet there is little evidence to guide targeted prevention strategies.

To identify subgroups at increased risk of developing anxiety in later life.

Anxiety was measured with the Hospital Anxiety and Depression anxiety sub-scale in 1931 people aged 55–85 years followed over 3 years. Risk factors were identified that had a high combined attributable fraction, indicative of substantial health gains when the adverse effect of the risk factors can be contained.

Factors significantly associated with increased risk of developing anxiety included sub-threshold anxiety depression, two or more chronic illnesses, poor sense of mastery, poor self-rated health and low educational level.

The identified risk groups are small, thus providing prevention with a narrow focus, and health gains are likely to be more substantial than in groups not exposed to these risk factors. Nevertheless, more research is needed to produce evidence on target groups where prevention has optimal impacts.

Studies investigating mortality secondary to electroconvulsive therapy (ECT) are few.

To assess the risk of mortality from natural and unnatural causes among ECT recipients compared with other psychiatric in-patients over a 25-year period.

Register-based cohort study of all in-patients admitted to a psychiatric hospital from 1976 to 2000. Cause-specific mortality was analysed using log–linear Poisson regression.

There were 783 deceased in-patients who had received ECT compared with 5781 who had not. Patients who had received ECT had a lower overall mortality rate from natural causes (RR=0.82,95% CI 0.74–0.90) but a slightly higher suicide rate (RR=1.20,95% CI 0.99–1.47), especially within the first 7 days after the last ECT treatment (RR=4.82,95% CI 2.12–10.95).

Further investigation of the effect of ECT on physical health and the observed increased suicide rate immediately following treatment are needed, although the last finding is likely to result from selection bias.

Many adults with Down's syndrome develop Alzheimer's dementia relatively early in their lives, but accurate clinical diagnosis remains difficult.

To develop a user-friendly observer-rated dementia screening questionnaire with strong psychometric properties for adults with intellectual disabilities.

We used qualitative methods to gather information from carers of people with Down's syndrome about the symptoms of dementia. This provided the items for the Dementia Screening Questionnaire for Individuals with Intellectual Disabilities (DSQIID), which we then tested for its psychometric properties.

The DSQIID was administered to carers of 193 adults with Down's syndrome, 117 of whom were examined by clinicians who confirmed a diagnosis of dementia for 49 according to modified ICD–10 criteria. We established that a total score of 20 provides maximum sensitivity (0.92) and optimum specificity (0.97) for screening. The DSQIID has sound internal consistency (α = 0.91) for all its 53 items, and good test–retest and interrater reliability. We established a good construct validity by dividing the items into four factors.

The DSQIID is a valid, reliable and user-friendly observer-rated questionnaire for screening for dementia among adults with Down's syndrome.