Most previous investigations of imitative suicide have reported suicide clustering in the general population, either temporal clustering following media reporting of suicide or case studies of geographically localised clusters.

To determine whether space–time and space–time–method clustering occur in a national case register of those who had recent contact with mental health services and had died by suicide and to estimate the suicide imitation rate in this population.

Knox tests were used for space–time and space–time–method clustering. Model simulations were used to estimate effect size.

Highly significant space–time and space–time–method clustering was found in a sample of 2741 people who died by suicide over 4 years who had had recent contact with one of 105 mental health trusts. Model simulations with an imitation rate of 10.1% (CI 4-17) reproduced the observed space–time–method clustering.

This study provides indirect evidence that imitative suicide occurs among people with mental illnesses and may account for about 10% of suicides by current and recent patients.

Informed consent in research is partly achieved through the use of information sheets. There is a perception however that these information sheets are long and complex. The recommended reading level for patient information is grade 6, or 11–12 years old.

To investigate whether the readability of participant information sheets has changed over time, whether particular study characteristics are related to poorer readability and whether readability and other study characteristics are related to successful study recruitment.

We obtained 522 information sheets from the UK National Institute for Health Research Clinical Research Network: Mental Health portfolio database and study principal investigators. Readability was assessed with the Flesch reading index and the Grade level test.

Information sheets increased in length over the study period. The mean grade level across all information sheets was 9.8, or 15–16 years old. A high level of patient involvement was associated with more recruitment success and studies involving pharmaceutical or device interventions were the least successful. The complexity of information sheets had little bearing on successful recruitment.

Information sheets are far more complex than the recommended reading level of grade 6 for patient information. The disparity may be exacerbated by an increasing focus on legal content. Researchers would benefit from clear guidance from ethics committees on writing succinctly and accessibly and how to balance the competing legal issues with the ability of participants to understand what a study entails.

The prevalence of schizophrenia is known to be greater in urban than in rural areas. Less studied are differences between the patients themselves and, more specifically, their use of psychiatric services.

The prevalence of schizophrenia was determined in rural Nithsdale in Scotland and urban Nunhead and Norwood in South London. Information about patients' psychiatric history, use of services during the study year and global assessment of functioning were obtained from case records and staff.

There were no significant differences in prevalence rates between Nithsdale patients, all White (2.78 per 1000 general population), Nunhead (3.46 per 1000) and Norwood (2.24 per 1000) Whites; rates were significantly higher among the non-Whites in Nunhead (7.36 per 1000) and Norwood (5.53 per 1000), who were mainly Black Caribbeans. Nithsdale patients were at a higher level of functioning and made substantially more use of psychiatric services. During the study year, 42% of Nithsdale patients used more than one of three principal community services, namely day, out-patient and community psychiatric nursing care.

The prevalence of schizophrenia is no different in rural Nithsdale and inner-city Nunhead and Norwood, when only White patients are considered. Nithsdale patients were at a higher level of functioning and made more use of available psychiatric services.

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.

The view that most military personnel evacuated from war zones are suffering from combat stress reactions, or are otherwise traumatised by the horrors of war, has an impact on all aspects of military psychiatry.

To delineate the reasons for psychiatric aeromedical evacuation from Iraq from the start of build-up of UK forces in January 2003 until the end of October that year, 6 months after the end of formal hostilities.

A retrospective study was conducted of field and in-patient psychiatric assessments of 116 military personnel evacuated to the UK military psychiatric in-patient facility in Catterick Garrison.

Evacuees were mainly non-combatants (69%). A significant proportion were in reserve service (21%) and had a history of contact with mental health services (37%). Only 3% had a combat stress reaction. In over 85% of cases evacuation was for low mood attributed to separation from friends or family, or difficulties adjusting to the environment.

These findings have implications especially for screening for suitability for deployment, and for understanding any longer-term mental health problems arising in veterans from Iraq.

Tardive dystonia is an uncommon complication of neuroleptic treatment which is frequently disabling and poorly responsive to treatment.

The case is reported of a 28-year-old patient with schizophrenia who developed severe, generalised tardive dystonia after five years of neuroleptic treatment. Stopping neuroleptic medication and treatment with tetrabenazine, an anticholinergic and a benzodiazepine were ineffective. Treatment with clozapine and then the novel combination of clozapine plus clonazepam was instituted.

Treatment with clozapine alone brought about limited improvement. Addition of clonazepam resulted in virtually complete disappearance of all abnormal movements. This remission has been sustained for nearly two years.

This report adds to two other cases suggesting that the combination of clozapine and clonazepam may be an effective treatment for tardive dystonia.

Providing specialised services to individuals experiencing first-episode psychosis (FEP) is a relatively new endeavour.

To overview developing services for newly diagnosed cases of FEP and the context in which they develop.

This paper describes five model multi-element FEP programmes, outlines recent evaluation studies of FEP services, discusses current evidence gaps relating to the evaluation of complex interventions and specific interventions for FEP and illustrates attempts to examine aspects of clinical work practised at the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne, Australia.

Considerable progress has been made in terms of influencing practice in the assessment and treatment of early psychosis.

There is need for quality clinical and research efforts to inform and accelerate progress in this burgeoning field.

Diabetes mellitus is a complex metabolic disorder characterised by persistent hyperglycaemia. The prevalence of diabetes is increased in people with schizophrenia.

To provide an update of current thinking in diabetes for practising psychiatrists.

Literature review.

Diabetes is a costly condition in individual, social and economic terms, and the global burden of diabetes is increasing in most populations. The insidious onset and asymptomatic nature of diabetes results in many people remaining undiagnosed and at great risk of developing life-threatening vascular complications. Lifestyle and pharmacological interventions can reduce incident diabetes and delay its progression.

Public health policies are urgently required to encourage people to follow a healthy lifestyle. Primary prevention strategies for diabetes should target individuals at especially high risk of developing type 2 diabetes, including those with severe mental illness.

K.B. is Editor of the British Journal of Psychiatry, but has not played any role in the decision-making for this paper. K.B. leads and J.N. is a partner and K.H. a researcher in the Synergi Collaborative Centre.

People with learning disability who exhibit challenging behaviour are frequently segregated from services and local teams are often reluctant to receive them back into their care. This situation is worse in those whose challenging behaviour includes a forensic history, but the difference between those labelled as challenging and those treated as offenders is not clear, and there is a lack of evidence about treatment effectiveness.

To test between-group differences in aggression and treatment outcome in people with learning disability and challenging behaviour, with and without a forensic history.

Clinical records of 86 former in-patients (45 offenders and 41 non-offenders) of a specialist unit were compared on measures of behavioural disturbance and placement outcome.

People in the offenders group were significantly less likely to be aggressive to others and to use weapons, but significantly more likely to harm themselves compared with the non-offenders group. Both groups had a significant reduction in their challenging behaviour during admission, and there was no significant difference in treatment outcome.

The negative reputation of people with learning disabilities who offend needs to be reconsidered.