Hyperprolactinaemia has for decades been an inevitable and neglected side-effect of antipsychotic medication. The recent introduction of prolactin-sparing antipsychotic agents makes a re-examination of this problem timely.

To review the literature on antipsychotic-induced hyperprolactinaemia and its consequences.

A search was made of the Medline database (1966–2002) for key articles, supplemented by cross-referencing.

During antipsychotic treatment prolactin concentrations can rise to ten times normal levels or above, and existing data indicate that 17–78% of female patients have amenorrhoea with or without galactorrhoea. Survey data, however, suggest that clinicians underestimate the prevalence of these conditions. Long-term consequences of antipsychotic-related hypo-oestrogenism require further research but are likely to include premature bone loss.

Antipsychotic-induced hyperprolactinaemia should become a focus of interest in the drug treatment of psychiatric patients.

Inequalities of service use across ethnic groups are important to policy makers, service providers and service users.

To identify ethnic variations in pathways to specialist mental health care, continuity of contact, voluntary and compulsory psychiatric in-patient admissions; to assess the methodological strength of the findings.

A systematic review of all quantitative studies comparing use of mental health services by more than one ethnic group in the UK. Narrative analysis supplemented by meta-analysis, where appropriate.

Most studies compared Black and White patients, finding higher rates of in-patient admission among Black patients. The pooled odds ratio for compulsory admission, Black patients compared with White patients, was 4.31 (95% CI 3.33–5.58). Black patients had more complex pathways to specialist care, with some evidence of ethnic variations in primary care assessments.

There is strong evidence of variation between ethnic groups for voluntary and compulsory admissions, and some evidence of variation in pathways to specialist care.

There are few publications concerning the psychological reactions of people with learning disabilities to sexual abuse. Most significantly, there are no controlled studies and few which demonstrate a systematic approach to documenting the sequelae of trauma.

To critically review the published research in this field.

A literature search in peer-reviewed psychiatry, psychology nursing and social care journals for the years 1974 to 2001 was conducted and 25 studies were reviewed.

Several studies suggest that, following sexual abuse, people with learning disabilities may experience a range of psychopathology similar to that experienced by adults and children in the general population. However, because of methodological limitations, these results are not conclusive.

Whether people with learning disabilities experience reactions to sexual abuse similar to the general population has yet to be explored by systematic research.

Unexplained fatigue has been extensively studied but most of the samples used were from Western countries.

To present international data on the prevalence of unexplained fatigue and fatigue as a presenting complaint in primary care.

Secondary analysis of the World Health Organization study of psychological problems in general health care. A total of 5438 primary care attenders from 14 countries were assessed with the Composite International Diagnostic Interview.

The prevalence of unexplained fatigue of 1-month duration differed across centres, with a range between 2.26 (95% CI 1.17–4.33) and 15.05 (95% CI 10.85–20.49). Subjects from more-developed countries were more likely to report unexplained fatigue but less likely to present with fatigue to physicians compared with subjects from less developed countries.

In less-developed countries fatigue might be an indicator of unmet psychiatric need, but in more-developed countries it is probably a symbol of psychosocial distress.

Veterans of the Persian Gulf War of 1991 have reported symptoms attributed to their military service.

To review all studies comparing the prevalence of psychiatric disorders in Gulf War veterans and in a comparison group of service personnel not deployed to the Gulf War.

Studies of military personnel deployed to the Gulf published between 1990 and 2001 were identified from electronic databases. Reference lists and websites were searched and key researchers were contacted for information. Atotal of 2296 abstracts and 409 complete articles were reviewed and data were extracted independently by two members of the research team.

The prevalence of psychiatric disorder in 20 studies of Gulf War veterans was compared with the prevalence in the comparison group. Prevalence of post-traumatic stress disorder (PTSD) and common mental disorder were higher in the Gulf War veterans. Heterogeneity between studies was significant, but all reported this increased prevalence.

Veterans of the Persian Gulf War reported an increased prevalence of PTSD and common mental disorder compared with other active service personnel not deployed to the Gulf. These findings are attributable to the increase in psychologically traumatic events in wartime.

A growing body of evidence suggests that migration is a risk factor for the development of schizophrenia, although the putative mechanism remains obscure.

To examine immigrant background and history of foreign residence as risk factors for schizophrenia.

Using data from the Danish Civil Registration System, we established a population-based cohort of 2.14 million persons resident in Denmark by their fifteenth birthday. Schizophrenia in cohort members and parental psychiatric disorder were identified by cross-linkage with the Danish Psychiatric Case Register.

The relative risk of developing schizophrenia was 2.45 (95% CI 2.25–2.67) and 1.92 (95% CI 1.74–2.12) among first- and second-generation immigrants respectively, and 1.60 (95% CI 1.25–2.05) among Danes with a history of foreign residence.

Migration confers an increased risk for schizophrenia that is not solely attributable to selection factors and may also be independent of foreign birth.

The World Health Organization (WHO) ICD–10 Primary Health Care (PHC) Guidelines for Diagnosis and Management of Mental Disorders (1996) have not been evaluated in a pragmatic randomised controlled trial (RCT).

To evaluate the effect of local adaptation and dissemination of the guidelines.

Pragmatic, pair-matched, cluster RCT involving 30 practices.

Guideline practices were less sensitive but more specific in identifying morbidity, but these differences were not significant. Guideline patients did not differ from usual-care patients on 12-item General Health Questionnaire scores at 3-month follow-up or in the proportion who were still cases. There were no significant differences in secondary outcomes.

Attempts to influence clinician behaviour through a process of adaptation and extension of guidelines are unlikely to change detection rates or outcomes.

Repetitive transcranial magnetic stimulation (rTMS) may be useful in the treatment of depression but results from trials have been inconclusive to date.

To assess the efficacy of rTMS in treating depression.

We conducted a systematic review of randomised controlled trials that compared rTMS with sham in patients with depression. We assessed the quality of design of all studies and conducted a metaanalysis of data from trials with similar rTMS delivery.

We included a total of 14 trials. The quality of the included studies was low. Pooled analysis using the Hamilton Rating Scale for Depression showed an effect in favour of rTMS compared with sham after 2 weeks of treatment (standardised mean difference=–0.35; 95% CI –0.66 to –0.04), but this was not significant at the 2-week follow-up (standardised mean difference= — 0.33; 95% CI —0.84 to 0.17).

Current trials are of low quality and provide insufficient evidence to support the use of rTMS in the treatment of depression.

Thought insertion is commonly regarded as diagnostic of schizophrenia. Little is known of its aetiology or pathophysiology.

To examine the definition and application of thought insertion in psychiatric and allied literatures.

A semi-structured literature review and conceptual analysis.

When ‘narrowly’ defined, thought insertion is reliably identified but not specific to schizophrenia. There is a range of related phenomena (‘alienated’, ‘influenced’, ‘made’ and ‘passivity’ thinking), less consistently defined but also not specific to schizophrenia. Whether thought insertion is solely an abnormal belief (or may also be an experience) is open to question. Nevertheless, the symptom has been used to explain schizophrenia, predict dangerousness and advance theories of ‘normal’ agency. Most applications have been subject to critique.

Despite its widespread occurrence and diagnostic application, thought insertion is an ill-understood and under researched symptom of psychosis. Its pathophysiology remains obscure.

People with mental illness suffer excess mortality due to physical illnesses.

To investigate the association between mental illness and ischaemic heart disease (IHD) hospital admissions, revascularisation procedures and deaths.

A population-based record-linkage study of 210 129 users of mental health services in Western Australia during 1980–1998. IHD mortality rates, hospital admission rates and rates of revascularisation procedures were compared with those of the general population.

IHD (not suicide) was the major cause of excess mortality in psychiatric patients. In contrast to the rate in the general population, the IHS mortality rate in psychiatric patients did not diminish over time. There was little difference in hospital admission rates for IHD between psychiatric patients and the general community, but much lower rates of revascularisation procedures with psychiatric patients, particularly in people with psychoses.

People with mental illness do not receive an equitable level of intervention for IHD. More attention to their general medical care is needed.