Culture-bound syndrome is a term used to describe the uniqueness of some syndromes in specific cultures. Dhat (semen-loss anxiety) has been considered to be an exotic ‘neurosis of the Orient’.

To ascertain the presence of similar symptoms and syndromes in different cultures and historical settings.

Electronic and manual literature searches were used to gather information on the existence and description of semen-loss anxiety in different cultures and settings.

Most of the empirical studies on dhat syndrome have emerged from Asia, whereas its concepts have been described historically in other cultures, including Britain, the USA and Australia. The different sources indicate the universality of symptoms and global prevalence of this condition, despite its image as a ‘neurosis of the Orient’.

It appears that dhat (semen-loss anxiety) is not as culture-bound as previously thought. We propose that the concept of culture-bound syndromes should be modified in line with DSM–IV recommendations.

There is a strong relationship between feeding problems in childhood and eating disorder in the mother. The mechanisms responsible for this relationship are not understood.

To elucidate family-environmental factors that could mediate this association.

A general population sample of children with feeding problems (n=35), other problems (shyness, fears or behavioural problems; n=58), or no problems (n=23) was identified. The mental state of their mothers was evaluated, including an assessment of current and past eating disorder. Video recordings were made in the families' homes of a mealtime and of the mothers and children participating in a standardised exploratory task.

Two family-environmental variables significantly distinguished the children with feeding problems from the other two groups: ‘mealtime disorganisation’ and ‘maternal strong control and disharmony’. Path analysis revealed the importance of these two environmental variables in mediating the association between child and maternal disturbance.

The degree of mealtime disorganisation and the level of maternal strong control and disharmony mediate the association between maternal eating disorder and child feeding disturbance.

Earlier adoption studies have convincingly confirmed the importance of a genetic contribution to schizophrenia. The designs, however, did not incorporate observations of the rearing-family environment.

To test the hypothesis that genetic factors moderate susceptibility to environmentally mediated risks associated with rearing-family functioning.

A Finnish national sample of adopted-away offspring of mothers with schizophrenia-spectrum disorders was compared blindly with adoptees without this genetic risk. Adoptive rearing was assessed using family rating scales based upon extended family observations at initial assessment. Adoptees were independently re-diagnosed after a median interval of 12 years, with register follow-up after 21 years.

In adoptees at high genetic risk of schizophrenia, but not in those at low genetic risk, adoptive-family ratings were a significant predictor of schizophrenia-spectrum disorders in adoptees at long-term follow-up.

Adoptees at high genetic risk are significantly more sensitive to adverse v. ‘healthy’ rearing patterns in adoptive families than are adoptees at low genetic risk.

Evidence suggests a reversal of the normal left-lateralised response to speech in schizophrenia.

To test the brain's response to emotional prosody in schizophrenia and bipolar disorder.

BOLD contrast functional magnetic resonance imaging of subjects while they passively listened or attended to sentences that differed in emotional prosody.

Patients with schizophrenia exhibited normal right-lateralisation of the passive response to ‘pure’ emotional prosody and relative left-lateralisation of the response to unfiltered emotional prosody. When attending to emotional prosody, patients with schizophrenia activated the left insula more than healthy controls. When listening passively, patients with bipolar disorder demonstrated less activation of the bilateral superior temporal gyri in response to pure emotional prosody, and greater activation of the left superior temporal gyrus in response to unfiltered emotional prosody. In both passive experiments, the patient groups activated different lateral temporal lobe regions.

Patients with schizophrenia and bipolar disorder may display some left-lateralisation of the normal right-lateralised temporal lobe response to emotional prosody.

The initial phase of a trial of cognitive–behavioural therapy (CBT) for acutely ill patients with schizophrenia of recent onset showed that it speeded recovery.

To test the hypothesis that CBT in addition to treatment as usual (TAU) during the first or second acute episode of schizophrenia will confer clinical benefit over a follow-up period.

This was an 18-month follow-up of a multicentre prospective trial of CBT or supportive counselling administered as an adjunct to TAU, compared with TAU alone, for patients hospitalised for an acute episode of schizophrenia of recent onset. Primary outcomes were total and positive symptom scales, time to relapse and re-hospitalisation.

There were significant advantages for CBT and supportive counselling over TAU alone on symptom measures at 18 months but no group difference was seen for relapse or re-hospitalisation. There was a significant centre–treatment interaction, reflecting centre differences in the effect of introducing either treatment, but not in the comparison of CBT and supportive counselling. Medication dosage and compliance did not explain group differences.

Adjunctive psychological treatments can have a beneficial longterm effect on symptom reduction.

Fatigue is a common complaint that may lead to long-term sick leave and work disability.

To assess the efficacy of cognitive–behavioural therapy by general practitioners for unexplained, persistent fatigue among employees.

A randomised controlled trial, using a pre-randomisation design in primary care, investigated 151 employees on sick leave with fatigue. Participants in the experimental group were offered five to seven 30 min sessions of cognitive–behavioural therapy by a general practitioner; those in the control group were offered no treatment. Main outcome measures (fatigue severity self-reported absenteeism, registered absenteeism and clinical recovery) were assessed at 4 months, 8 months and 12 months.

At baseline, 44% of the patients already met research criteria for chronic fatigue syndrome. There was no significant difference between the experimental group and the control group on primary or secondary outcomes at any point.

Cognitive–behavioural therapy by general practitioners for unexplained, persistent fatigue did not prove to be an effective intervention. Since these doctors were unable to deliver this therapy effectively under ideal circumstances, it is unlikely that doctors in routine practice would be more successful in doing so.

Post-traumatic stress is thought to account for significant disability. It is also known to be highly comorbid with other psychiatric conditions such as depression and alcohol dependence.

To determine the relationship between post-traumatic stress, depression, alcohol dependence and disability.

Seventy armed services personnel were assessed for DSM–IV diagnoses of post-traumatic stress disorder, major depressive disorder and alcohol dependence, and with continuous measures of symptoms of post-traumatic stress, depression and alcohol dependence following a traumatic event. These variables, as predictors of disability (using the Sheehan Disability Scale), were analysed using multivariate analysis of variance, analysis of covariance and multiple regression backward elimination models.

No significant interaction was found for the diagnostic variables even after controlling for the continuous symptom measures. In the regression models, symptoms of depression were a significant predictor of total disability (R2=0.39). Symptoms of alcohol dependence and post-traumatic stress did not significantly predict disability.

Since post-traumatic stress was not found to be associated with disability, its clinical importance may be questionable.

The effectiveness of the testimony method has not been established in rural communities with survivors of prolonged civil war.

To examine the effectiveness and feasibility of a testimony method to ameliorate post-traumatic stress symptoms.

Participants (n=206) belonged to former war zones in Mozambique. They were divided into a case (n= 137) and a non-case group (n=69). The case group was randomly divided into an intervention (n=66) and a control group (n=71). Symptoms were measured during baseline assessment, post-intervention and at an 11-month follow-up.

Post-intervention measurements demonstrated significant symptom reduction in both the intervention and the control group. No significant differences were found between the intervention and the control group. Follow-up measurements showed sustained lower levels of symptoms in both groups, and some indications of a positive intervention effect in women.

A remarkable drop in symptoms could not be linked directly to the intervention. Feasibility of the intervention was good, but controlling the intervention in a small rural community appeared to be a difficult task to accomplish.

Significant ethnic differences have been found previously on a forensic unit in the management of psychiatric patients after a violent incident.

To study the management of violent incidents on all general wards in a large psychiatric hospital in South London. The main question is whether there are differences in the management of Black patients involved in violent incidents compared with White patients and, if so, what are the factors leading to it?

All recorded violent incidents (1515 in total) on 14 general wards over three years (1994, 1996, 1998) were analysed using mixed logistic regression to estimate the odds ratio that the corresponding management decision (emergency medication, physical restraint, seclusion) was taken for Black patients compared with White patients after controlling for covariates and unobserved heterogeneity between subjects.

Black patients were more likely than White patients to be given emergency medication and to be secluded after a violent incident, but not to be physically restrained. However, differences disappeared when the odds ratios were adjusted for other variables.

Racial ‘stereotyping’ was unlikely to have played a major direct role in determining nurses' responses.

The number of suicides in prison has increased over recent years. This is the first study to describe the clinical care of a national sample of prison suicides.

To describe the clinical and social circumstances of self-inflicted deaths among prisoners.

A national clinical survey based on a 2-year sample of self-inflicted deaths in prisoners. Detailed clinical and social information was collected from prison governors and prison health care staff.

There were 172 self-inflicted deaths: 85 (49%; 95% CI 42–57) were of prisoners on remand; 55 (32%; 95% CI 25–39) occurred within 7 days of reception into prison. The commonest method was hanging or self-strangulation (92%; 95% CI 88–96). A total of 110 (72%; 95% CI 65–79) had a history of mental disorder. The commonest primary diagnosis was drug dependence (39, 27%; 95% CI 20–35). Eighty-nine (57%; 95% CI 49–64) had symptoms suggestive of mental disorder at reception into prison.

Suicide prevention measures should be concentrated in the period immediately following reception into prison. Because hanging is the commonest method of suicide, removal of potential ligature points from cells should be a priority.