Somatoform disorders have few peers in terms of personal morbidity and cost to the health service, yet many psychiatrists train without any experience of them.

To review the prevalence, disability and economic burden of somatoform disorders, and to explore the reasons why they are neglected by psychiatrists.

A selective review of the key literature.

Psychiatrists' current preoccupation with so-called ‘serious mental illness’ gives somatoform disorders low priority. Some health planners have erroneously equated severity with diagnosis rather than level of need and disability. As a consequence the development of psychiatric services has been neglected.

Greater recognition of the importance of somatoform disorders will only occur if high quality research and teaching receive priority, and if the Royal Colleges continue to press for increasing public awareness of their importance. Services should be driven by clinical need rather than diagnosis.

Generalised anxiety disorder (GAD) has received less study than other anxiety disorders, particularly its long-term treatment.

To assess the efficacy and safety of venlafaxine extended release (ER) in patients with GAD.

A total of 541 out-patients, 18–86 years old, were recruited to this 24-week, placebo-controlled, double-blind study of three fixed doses (37.5, 75 and 150 mg/day) of venlafaxine ER.

All doses of venlafaxine ER showed efficacy superior to placebo, apparent from week 2, that was sustained throughout the 24-week study for the two higher doses. The discontinuation rate did not differ significantly among the treatment groups.

Venlafaxine ER is an effective and safe treatment for GAD for up to 6 months.

No controlled trial of treatment of generalised social phobia has been conducted in general practice.

To examine the efficacy of sertraline or exposure therapy, administered alone or in combination in this setting.

Study was of a randomised, double-blind design. Patients (n=387) received sertraline 50–150 mg or placebo for 24 weeks. Patients were additionally randomised to exposure therapy or general medical care.

Sertraline-treated patients were significantly more improved than non-sertraline-treated patients (χ2=12.53, P<0.001; odds ratio=0.534; 95% CI 0.347–0.835). No significant difference was observed between exposure— and non-exposure-treated patients (χ2=2.18, P=0.140; odds ratio=0.732; 95% CI 0.475–1.134). In the pairwise comparisons, combined sertraline and exposure (χ2=12.32; P<0.001) and sertraline (χ2=10.13; P=0.002) were significantly superior to placebo.

Sertraline is an effective treatment for generalised social phobia. Combined treatment with sertraline and exposure therapy, conducted by the general practitioner, may enhance the treatment efficacy in primary care.

There is a paucity of information concerning the prevalence and detection of seasonal affective disorder (SAD) in UK populations.

To determine the prevalence, detection and current treatment of SAD within a general population sample.

The study was conducted in conjunction with the Outcomes of Depression International Network (ODIN) project, a large European study of depression. At the North Wales arm of the project, 1999 adults were randomly selected from a health authority database and screened by post for SAD with the Seasonal Patterns Assessment Questionnaire (SPAQ). Those scoring above cut-off were offered diagnostic interview, after which diagnosis of SAD according to DSM–IV criteria could be made.

The prevalence rate of SAD was calculated to be 2.4% (95% CI 1.4–1.3). The majority of identified cases had not previously received a diagnosis of SAD from their general practitioner, although over half had been diagnosed with other forms of depression and had been prescribed antidepressant medication.

Although SAD was found to be common in this general population sample it appeared to be largely underdiagnosed and/or misdiagnosed.

An association exists between smoking and schizophrenia, independent of other factors and related to psychotic symptomatology.

To determine whether smoking is associated with psychosis in bipolar affective disorder.

Smoking data were collected from 92 unrelated patients with bipolar affective disorder. An ordinal logistic regression analysis tested the relationship between smoking severity and psychotic symptomatology, allowing for potential confounders.

A significant relationship was detected between smoking/heavy smoking and history of psychosis (68.7%, n=44). Smoking was less prevalent in patients who were less symptomatic (56.5%, n=13) than in patients with a more severe psychosis (75.7%, n=31). Prevalence and severity of smoking predicted severity of psychotic symptoms (P=0.001), a relationship independent of other variables (P=0.0272).

A link between smoking and psychosis exists in bipolar affective disorder and may be independent of categorical diagnosis.

Symptomatology in psychoses can be summarised as quantitative symptom dimensions, but their genetic basis is unknown.

To investigate whether genes make an important contribution to symptom dimensions.

A total of 224 probandwise twin pairs (106 monozygotic, 118 same-gender dizygotic) where probands had psychosis were ascertained from the Maudsley Twin Register in London. Factor analysis was performed on lifetime symptoms rated on the Operational Checklist for Psychotic Disorders (OPCRIT). Correlations of dimension scores within monozygotic and dizygotic pairs concordant for Research Diagnostic Criteria psychoses were performed. Relationships between dimension scores and genetic loading for psychoses were assessed using logistic regression.

Patterns of familial aggregation consistent with a genetic effect were found for the disorganised dimension and for some measures of the negative, manic and general psychotic dimensions. Disorganised dimension scores were related significantly to genetic loading for psychoses.

The disorganised dimension, and possibly other symptom dimensions, may be useful phenotypes for molecular genetic studies of psychoses.

Although a family history of schizophrenia is the strongest individual risk factor for schizophrenia, environmental factors related to urbanicity may contribute to a substantial proportion of the population occurrence of the disease.

This study replicates previous findings in four mutually exclusive Danish study populations, including out-patient information, ICD–10 diagnoses of schizophrenia, and a broader adjustment for mental illness in family members.

We established a population-based cohort of 2.66 million Danish people using data from the Civil Registration System linked with the Psychiatric Case Register.

Overall, 10 264 persons developed schizophrenia during the 50.7 million person-years of follow-up. The risk of schizophrenia was increased by urbanicity of place of birth and by family history of schizophrenia or other mental disorders.

Urban–rural differences of schizophrenia risk were replicated and could not be associated with the potential sources of bias we assessed. Environmental factors underlying the effect of place of birth are major determinants of schizophrenia occurrence at the population level, although the effect of family history is the strongest at the individual level.

Schizophrenia implies severe social impairments. Since the treatment of patients with schizophrenia shifted from long-term hospital admissions to community services, research on social functioning has become increasingly important.

Follow-up assessment of social functioning in young patients with schizophrenia during a 5-year period after intervention.

During intervention, families were randomised into two conditions: standard intervention and standard plus family intervention.

Although no differential treatment effect with regard to the course of the illness was found, patients from the standard plus family intervention condition stayed for fewer months in institutions for psychiatric patients than patients from the standard intervention condition.

Family intervention has helped parents to support their children, thereby diminishing institutional care.

Abnormal regulation of the adipocyte-derived hormone leptin could play a role in body weight gain induced by antipsychotics.

To study the effects of long-term antipsychotic treatment on leptin levels in patients with schizophrenia.

Serum leptin levels were determined in 59 out-patients with chronic schizophrenia and in the same number of healthy subjects controlled by gender, age and body mass index.

Leptin levels did not differ between patients and controls. Leptin levels in patients with schizophrenia correlated with weight gain, even after controlling for current weight, but did not show any association with clinical variables. Antipsychotic class tended to exert different effects over leptin levels (among atypicals, olanzapine induced a greater increase).

Elevation of leptin levels induced by chronic antipsychotic treatment can be attributed to weight gain, but other mechanisms could be involved.

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.