The pharmacological management of violence in people with psychiatric disorders is under-researched.

To compare interventions commonly used for controlling agitation or violence in people with serious psychiatric disorders.

We randomised 200 people to receive intramuscular lorazepam (4 mg) or intramuscular haloperidol (10 mg) plus promethazine (25–50 mg mix).

At blinded assessments 4 h later (99.5% follow-up), equal numbers in both groups (96%) were tranquil or asleep. However, 76% given the haloperidol-promethazine mix were asleep compared with 45% of those allocated lorazepam (RR=2.29, 95% CI 1.59–3.39; NNT=3.2, 95% CI 2.3–5.4). The haloperidol-promethazine mix produced a faster onset of tranquillisation/sedation and more clinical improvement over the first 2 h. Neither intervention differed significantly in the need for additional intervention or physical restraints, numbers absconding, or adverse effects.

Both interventions are effective for controlling violent/agitated behaviour. If speed of sedation is required, the haloperidol-promethazine combination has advantages over lorazepam.

Knowledge of when and how to implement treatments to prevent criminal offending among people with schizophrenia is urgently needed.

To identify opportunities for interventions to prevent offending among men with schizophrenic disorders by tracking their histories of offending and admissions to hospital.

We examined 232 men with schizophrenic disorders discharged from forensic and general psychiatric hospitals. Data were collected from participants, family members and official records.

More than three-quarters (77.8%) of the forensic patients had previously been admitted to general psychiatric services; 24.3% of the general psychiatric patients had a criminal record. Offences had been committed by 39.8% of the forensic patients and 10.8% of the general psychiatric patients before their first admission to general psychiatry, and after their first admission these 59 patients committed 195 non-violent and 59 violent offences. Subsequently, 49 of them committed serious violent offences that led to forensic hospital admission. The offenders were distinguished by a pervasive and stable pattern of antisocial behaviour evident from at least mid-adolescence.

General psychiatry requires resources in order to prevent criminal offending among a subgroup of patients with schizophrenic disorders.

Little is known about the efficacy of educational interventions for reducing the stigma associated with depression.

To investigate the effects on stigma of two internet depression sites.

A sample of 525 individuals with elevated scores on a depression assessment scale were randomly allocated to a depression information website (BluePages), a cognitive–behavioural skills training website (MoodGYM) or an attention control condition. Personal stigma (personal stigmatising attitudes to depression) and perceived stigma (perception of what most other people believe) were assessed before and after the intervention.

Relative to the control, the internet sites significantly reduced personal stigma, although the effects were small. BluePages had no effect on perceived stigma and MoodGYM was associated with an increase in perceived stigma relative to the control. Changes in stigma were not mediated by changes in depression, depression literacy or cognitive–behavioural therapy literacy.

The internet warrants further investigation as a means of delivering stigma reduction programmes for depression.

Studies using computer databases suggest that atypical antipsychotic agents are more likely to be associated with diabetes than are conventional drugs.

To discover the extent of testing for diabetes mellitus in hospital in-patients prescribed antipsychotics.

Prescription charts were screened to identify patients prescribed antipsychotics. Case notes were then searched for evidence of testing for diabetes.

In all, 606 patients were prescribed antipsychotics, of whom 250 (41.3%) had evidence of prior testing for diabetes. Patients prescribed atypicals were 40% more likely to have been tested than those prescribed conventional drugs (RR = 1.4, 95% C11.1–1.9). Adjusted odds ratios v. conventional antipsychotics for testing were significantly higher for clozapine (OR = 4.64, 95% C12.42–8.90), olanzapine (OR= 1.85, 95% C11.04–3.30) and antipsychotic polypharmacy (OR= 2.96, 95% C11.59–5.52).

Testing for diabetes was undertaken in less than half of the patients studied. Testing was more common in those receiving atypical antipsychotics. Apparent differences in claimed causal association of the use of some antipsychotics with diabetes may in part reflect different rates of testing.

The role of journals in disseminating research to clinicians is increasingly debated. Current measures of esteem for journals (e.g. impact factors) may not indicate clinical penetration.

To assess the perceived importance of different mental health journals to psychiatrists' clinical practice and compare this with impact factors.

Random samples of psychiatrists providing child and adolescent, adults of working age and old age services chose up to ten journals read or consulted with regard to their clinical work, ranking the top three. For these journals, comparisons were made with impact factors and importance as outlets for UK psychiatry research.

A total of 560 questionnaires were completed (47%). Two membership journals (the British Journal of Psychiatry and the BMJ) were most read and highest ranked. Associations between impact factors, clinicians' ratings and importance as outlets for psychiatry papers varied.

The results could lead to reconsideration of the importance of some journals. Academic assessments of the status of journals should not be assumed to reflect their influence on clinicians.

Repetition of deliberate self-harm (DSH) is a risk factor for suicide. Little information is available on the risk for specific groups of people who deliberately harm themselves repeatedly.

To investigate the long-term risk of suicide associated with repetition of DSH by gender, age and frequency of repetition.

A mortality follow-up study to the year 2000 was conducted on 11583 people who presented to the general hospital in Oxford between 1978 and 1997. Repetition of DSH was determined from reported episodes prior to the index episode and episodes presenting to the same hospital during the follow-up period. Deaths were identified through national registers.

Thirty-nine percent of patients repeated the DSH. They were at greater relative risk of suicide than the single-episode DSH group (2.24; 95% CI 1.77–2.84). The relative risk of suicide in the repeated DSH group compared with the single-episode DSH group was greater in females (3.5; 95% C11.3–2.4) than males (1.8; 95% C1 2.3–5.3) and was inversely related to age (up to 54 years). Suicide risk increased further with multiple repeat episodes of DSH in females.

Repetition of DSH is associated with an increased risk of suicide in males and females. Repetition may be a better indicator of risk in females, especially young females.

Non-compliance attenuates the efficacy of treatments for physical and mental disorders.

To assess the effectiveness of a medication management training package for community mental health nurses (CMHNs) in improving compliance and clinical outcomes in patients with schizophrenia.

Pragmatic randomised controlled trial. Sixty CMHNs in geographical clusters were assigned randomly to medication management training or treatment as usual. Each CMHN identified two patients on their case-load who were assessed at baseline and again after 6 months by a research worker. The primary efficacy outcome of interest was psycho-pathology, measured using the Positive and Negative Syndrome Scale (PANSS).

Nurses who had received medication management training produced a significantly greater reduction in patients' overall psychopathology compared with treatment as usual at the end of the 6-month study period (change in PANSS total scores: medication management – 16.62, treatment as usual 1.17; difference – 17.79; 95% CI – 24.12 to – 11.45; P<0.001).

Medication management training for CMHNs is effective in improving clinical outcomes in patients with schizophrenia.

Few studies have systematically investigated the psychiatric antecedents of accidental death.

To examine the patterns of psychiatric morbidities contributing to accidental death in three ethnic groups (Han, Ami and Atayal) in Taiwan.

A case–control psychological autopsy was conducted among 90 accidental deaths (randomly selected from a total of 413) and 180 living controls matched for age, gender, ethnicity and area of residence in Taiwan.

The risk of accidental death was significantly associated with alcohol use disorder and with other common mental disorders. When jointly considered, it was greatest when these two types of disorders co-existed, followed by common mental disorders alone. The risk of accidental death increased with the number of comorbid conditions.

The prevention of accidental death should be incorporated into preventive psychiatry, not just for alcohol use disorder, but also for all other common mental disorders.

The prevalence of depression has not fallen despite effective treatments being available.

To examine the effectiveness of a psycho-educational intervention designed to be easily accessible.

Large-scale, self-referral ‘How to improve your self-confidence’ workshops were run in a leisure centre at weekends. The day-long programme used a cognitive–behavioural approach. A randomised controlled trial design using waiting-list controls was employed. Three months after the workshop, results of workshop participants were compared with those of the waiting list control group.

Among 120 people who self-referred, 75% of participants had General Health Questionnaire scores of 3 and above. Over 39% had never previously consulted their general practitioners about their depression. At 3-month follow-up, members of the experimental group were significantly less depressed, less distressed and reported higher self-esteem.

Workshops were shown to be accessible and effective; a larger, more rigorous trial is now needed.

The Geriatric Mental State (GMS) is the most widely used psychiatric research assessment for older persons. Evidence for validity comes from the developed world.

To assess the validity of GMS/AGECAT organicity and depression diagnoses in 26 centres in India, China, Latin America and Africa.

We studied 2941 persons aged 60 years and over: 742 people with dementia and three groups free of dementia (697 with depression, 719 with high and 783 with low levels of education). Local clinicians diagnosed dementia (DSM–IV) and depression (Montgomery – Åsberg Depression Rating Scale score ⩾18).

For dementia diagnosis GMS/AGECAT performed well in many centres but educational bias was evident. Specificity was poor in India and sensitivity sub-optimal in Latin America. A predictive algorithm excluding certain orientation items but including interviewer judgements improved upon the AGECAT algorithm. For depression, sensitivity was high. The EURO–D depression scale, derived from GMS items using European data, has a similar factor structure in Latin America, India and, to a lesser extent, China.

Valid, comprehensive mental status assessment across cultures seems achievable in principle.

Surveys have shown high levels of unmet need in representative samples of people with severe mental illness. Introducing standardised needs assessment into the care planning process might reduce these needs and improve outcome.

To determine whether feedback from a standardised assessment of need enhances the effectiveness of care planning and whether exposing care coordinators to feedback on some patients improves their care of other patients.

A single-blind, cluster-randomised trial involving a within-cluster individually randomised arm: patients' needs were evaluated using the Cardinal Needs Schedule and the findings were fed back to their care coordinators under the care programme approach. Atotal of 304 patients were recruited from 72 care coordinators and 242 patients (79.6%) were reassessed at 12 months.

The only significant effect of the intervention was on patient satisfaction. Patients cluster-randomised to receive feedback were more satisfied than controls, but patients individually randomised to receive feedback were not.

Standardised needs assessment did not substantially enhance care planning in this trial. However, giving care coordinators some experience of feedback from a standardised assessment of need could improve satisfaction.