Social disorganisation, fragmentation and isolation have long been posited as influencing the rate of psychoses at area level. Measuring such societal constructs is difficult. A census-based index measuring social fragmentation has been proposed.

To investigate the association between first-admission rates for psychosis and area-based measures of social fragmentation, deprivation and urban/rural index.

We used indirect standardisation methods and logistic regression models to examine associations of social fragmentation, deprivation and urban/rural categories with first admissions for psychoses in Scotland for the 5-year period 1989–1993

Areas characterised by high social fragmentation had higher first-ever admission rates for psychosis independent of deprivation and urban/rural status. There was a dose–response relationship between social fragmentation category and first-ever admission rates for psychosis. There was no statistically significant interaction between social fragmentation, deprivation and urban/ rural index.

First-admission rates are strongly associated with measures of social fragmentation, independent of material deprivation and urban/rural category.

Most research investigating the relationship between IQ and risk of mental disorder has focused on schizophrenia.

To illuminate the relationship between IQ test scores in early adulthood and various mental disorders.

For 3289 men from the Copenhagen Perinatal Cohort, military IQ test scores and information on psychiatric hospitalisation were available. We identified 350 men in the Danish Psychiatric Central Register, and compared the mean IQ test scores of nine diagnostic categories with the mean scores of 2939 unregistered cohort controls.

Schizophrenia and related disorders, other psychotic disorders, adjustment, personality, alcohol and substance-use-related disorders were significantly associated with low IQ scores, but this association remained significant for the four non-psychotic disorders only when adjusting for comorbid diagnoses. For most diagnostic categories, test scores were positively associated with the length of the interval between testing and first admission. ICD mood disorders as well as neuroses and related disorders were not significantly associated with low IQ scores.

Low IQ may be a consequence of mental disease or a causal factor in psychotic and non-psychotic disorders.

No studies have assessed psychopathology among victims of stalking who have not sought specialist help.

To examine the associations between stalking victimisation and psychiatric morbidity in a representative community sample.

A random community sample (n = 1844) completed surveys examining the experience of harassment and current mental health. The 28-item General Health Questionnaire (GHQ–28) and the Impact of Event Scale were used to assess symptomatology in those reporting brief harassment (n = 196) or protracted stalking (n = 236) and a matched control group reporting no harassment (n = 432)

Rates of caseness on the GHQ–28 were higher among stalking victims (36.4%) than among controls (19.3%) and victims of brief harassment (21.9%). Psychiatric morbidity did not differ according to the recency of victimisation, with 34.1% of victims meeting caseness criteria 1 year after stalking had ended.

In a significant minority of victims, stalking victimisation is associated with psychiatric morbidity that may persist long after it has ceased. Recognition of the immediate and long-term impacts of stalking is necessary to assist victims and help alleviate distress and long-term disability.

There has been no long-term study of people addicted to injected heroin who have been treated without the prescribing of substitute opioids.

To investigate the outcome for patients treated for injected heroin addiction 33 years after they were first seen, and 26 years after they were first followed up, in terms of sustained abstinence, continuing maintenance on methadone and deaths.

Eighty-six people with heroin addiction first seen in 1966–1967 in a small town in the south-east of England were located and their clinical state assessed using multiple sources, including personal interviews with a proportion of the cohort.

Forty-two per cent of the cohort had been abstinent for at least 10 years; 10% were taking methadone and were classified as addicted; and 22% had died. Eight per cent of the cohort could not be located.

Results proved favourable in the above three parameters compared with other long-term studies.

A number of studies have reported increased violence in patients with schizophrenia.

To determine the prevalence of violence among those with schizophrenia in samples from 1949, 1969, 1989 and 2000 in Prague (Czech Republic) and to examine trends in this behaviour.

Records from 404 patients meeting DSM–IV criteria for schizophrenia were screened for violence (defined as 3 points on the Modified Overt Aggression Scale) from the first observed psychotic symptoms until the time of latest available information.

Logistic regression revealed a marginally significant increase in violence only inthe 2000 cohort. Overall, violence was associated with schizophrenia in 41.8% of men and 32.7% of women, with no association between substance misuse and violence.

The violence rate found in our sample is expected to remain stable over time under stable conditions. Substance misuse is not the leading cause of violence among those with schizophrenia.

Abnormalities of cognitive style in bipolar disorder are of both clinical and theoretical importance.

To compare cognitive style in people with affective disorders and in healthy controls.

Self-rated questionnaires were administered to 118 individuals with bipolar I disorder, 265 with unipolar major recurrent depression and 268 healthy controls. Those with affective disorder were also interviewed using the Schedules for Clinical Assessment in Neuropsychiatry and case notes were reviewed.

Those with bipolar disorder and those with unipolar depression demonstrated different patterns of cognitive style from controls; negative self-esteem best discriminated between those with affective disorders and controls; measures of cognitive style were substantially affected by current levels of depressive symptomatology; patterns of cognitive style were similar in bipolar and unipolar disorder when current mental state was taken into account.

Those with affective disorder significantly differed from controls on measures of cognitive style but there were no differences between unipolar and bipolar disorders when current mental state was taken into account.

Assertive outreach has been established to care for ‘difficult to engage’ patients, yet little is known about how patients experience their disengagement with mainstream services and later engagement with outreach teams.

To explore the views of disengagement and engagement held by patients of assertive outreach teams.

In-depth interviews were conducted with 40 purposefully selected patients and analysed using components of both thematic analysis and grounded theory.

Patients reported a desire to be independent, a poor therapeutic relationship and a loss of control due to medication effects as most important for disengagement. Time and commitment of staff, social support and engagement without a focus on medication, and a partnership model of the therapeutic relationship were most relevant for engagement.

The findings underline the importance of a comprehensive care model, committed staff with sufficient time, and a focus on relationship issues in dealing with ‘ifficultto engage'patients.

Caring for someone with anorexia nervosa is distressing.

To gain a detailed understanding of carers' illness models and caregiving experiences.

Qualitative analysis and computerised text analysis were conducted on narratives written by parents as part of a family intervention at a specialist in-patient unit (20 mothers, 20 fathers)

Themes concerned illness perceptions, impact on the family and carers' emotional, cognitive and behavioural responses towards the illness. Parents perceived anorexia nervosa to be chronic and disabling. Carers blamed themselves as contributing to the illness and perceived themselves as helpless in promoting recovery. Mothers illustrated an intense emotional response, whereas fathers produced a more cognitive and detached account.

Part of the distress in living with anorexia nervosa may be explained by unhelpful assumptions and maladaptive responses to the illness. Training parents in skills to manage the illness may improve outcome by reducing interpersonal maintaining factors.

Reality orientation therapy combined with cholinesterase inhibitors has not been evaluated in patients with Alzheimer's disease.

To perform such an evaluation.

We randomly assigned 79 of 156 patients treated with donepezil to receive a reality orientation programme. Caregivers of the treatment group were trained to offer the programme at home 3 days a week, 30 min/day for 25 consecutive weeks, and were invited to stimulate and involve patients in reality-based communication.

The treatment group showed a slight improvement in Mini-Mental State Examination (MMSE) scores (mean change + 0.2, s.e. = 0.4) compared with a decline in the control group (mean change −1.1, s.e. =0.4; P=0.02). Similarly for the Alzheimer's Disease Assessment Scale – Cognition (treatment group mean change +0.4, s.e.=0.8; control group –2.5, s.e.=0.8; P = 0.01). The intervention had an equal effect on cognition in those with mild (MMSE score ⩾20) and moderate (score < 20) dementia. No significant effect was observed for behavioural and functional outcomes.

Reality orientation enhances the effects of donepezil on cognition in Alzheimer's disease.

Major depression can be treated by means of cognitive–behavioural therapy but as skilled therapists are in short supply there is a need for self-help approaches. Many individuals with depression use the internet for discussion of symptoms and to share their experience.

To investigate the effects of an internet-administered self-help programme including participation in a monitored, web-based discussion group, compared with participation in web-based discussion group only.

A randomised controlled trial was conducted to compare the effects of internet-based cognitive–behavioural therapy with minimal therapist contact (plus participation in a discussion group) with the effects of participation in a discussion group only.

Internet-based therapy with minimal therapist contact, combined with activity in a discussion group, resulted in greater reductions of depressive symptoms compared with activity in a discussion group only (waiting-list control group). At 6 months' follow-up, improvement was maintained to a large extent.

Internet-delivered cognitive–behavioural therapy should be pursued further as a complement or treatment alternative for mild-to-moderate depression.

Adherence to treatment guidelines enhances treatment outcome. However, in clinical practice many patients with depression do not receive appropriate treatment.

To evaluate the treatment of depression in in-patients of German psychiatric hospitals with respect to treatment outcome and adherence to guidelines.

We recruited 1202 in-patients with depression from ten different hospitals. Quality data concerning treatment were collected at admission, during the treatment course and at discharge.

The level of depression was significantly decreased and most patients were satisfied with treatment. Many aspects of the treatment routine adhered to guideline recommendations. Adherence to guidelines could be improved with respect to adjustment of antidepressant dosage, reduction of benzodiazepine prescription, enhanced use of electroconvulsive therapy and wider use of interpersonal therapy.

The study reveals a high standard of psychiatric treatment of in-patients with depression. Nevertheless there is still room for improvement. Differences between hospitals in adherence to guidelines indicates the need for individual application of quality management tools.

Suicide reduction is government strategy in many countries. We need to quantify the connection between non-fatal self-poisoning and eventual suicide.

To determine mortality after an episode of self-poisoning and to identify predictors of death by any cause or by suicide.

A retrospective single-group cohort study was undertaken with 976 consecutive patients attending a large accident and emergency unit in 1985–1986 after non-fatal self-poisoning. Information about deaths was determined from the Office for National Statistics.

Of the original patients, 94% were traced 16 years later; 17% had died, 3.5% by probable suicide. Subsequent suicide was related to numerous factors evident at the time of the episode of self-poisoning but, when examined for their independent effects, only the severity of the self-poisoning episode and relevant previous history seemed important.

Patients attending a general hospital after self-poisoning all require good basic assessment and care responsive to their needs. Attempts to reduce the huge excess of suicide subsequent to self-harm are not likely to achieve much if they are based on the identification of subgroups through ‘risk assessment’

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.