There is widespread belief in a ‘cycle’ of child sexual abuse, but little empirical evidence for this belief.

To identify perpetrators of such abuse who had been victims of paedophilia and/or incest, in order to: ascertain whether subjects who had been victims become perpetrators of such abuse; compare characteristics of those who had and had not been victims; and review psychodynamic ideas thought to underlie the behaviour of perpetrators.

Retrospective clinical case note review of 843 subjects attending a specialist forensic psychotherapy centre.

Among 747 males the risk of being a perpetrator was positively correlated with reported sexual abuse victim experiences. The overall rate of having been a victim was 35% for perpetrators and 11 % for non-perpetrators. Of the 96 females, 43% had been victims but only one was a perpetrator. A high percentage of male subjects abused in childhood by a female relative became perpetrators. Having been a victim was a strong predictor of becoming a perpetrator, as was an index of parental loss in childhood.

The data support the notion of a victim-to-victimiser cycle in a minority of male perpetrators but not among the female victims studied. Sexual abuse by a female in childhood may be a risk factor for a cycle of abuse in males.

Long-acting depot antipsychotic medication is a widely used treatment for schizophrenia.

To synthesise relevant systematic Cochrane reviews.

The Cochrane Database was searched and summary data were extracted from randomised controlled clinical trials of depots.

Standard dose depot v. placebo resulted in significantly less relapse but more movement disorders. Those on depots (v. oral drugs) showed more global change on one outcome measure; relapse and adverse effects showed no difference. Comparisons showed no convincing advantages for one depot over another.

Depot antipsychotics are safe and effective. They may confer a small benefit over oral drugs on global outcome. Those for whom depots are most indicated may not be represented. Large studies are required to discern differences in relapse rates and long-term adverse effects, and data on satisfaction, quality of life and economics.

In the 40 years since the first benzodiazepine was brought into clinical use there has been a substantial growth in understanding the molecular basis of action of these drugs and the role of their receptors in disease states.

To present current knowledge about the role of the GABAA–benzodiazepine receptor in anxiety disorders, new insights into the molecular biology of the receptor complex and neuroimaging studies suggesting involvement of these receptors in disease states.

An overview of published literature, including some recent data.

The molecular biology of this receptor is detailed. Molecular genetic studies suggesting involvement of the GABAA–benzodiazepine receptor in animal behaviour and learning are outlined; possible parallels with human psychopathology are discussed.

Current insights into the role of the GABAA–benzodiazepine receptor in the action of benzodiazepines and as a factor in disease states, in both animals and humans, may lead to new, more sophisticated interventions at this receptor complex and potentially significant therapeutic gains.

Somatoform disorders have few peers in terms of personal morbidity and cost to the health service, yet many psychiatrists train without any experience of them.

To review the prevalence, disability and economic burden of somatoform disorders, and to explore the reasons why they are neglected by psychiatrists.

A selective review of the key literature.

Psychiatrists' current preoccupation with so-called ‘serious mental illness’ gives somatoform disorders low priority. Some health planners have erroneously equated severity with diagnosis rather than level of need and disability. As a consequence the development of psychiatric services has been neglected.

Greater recognition of the importance of somatoform disorders will only occur if high quality research and teaching receive priority, and if the Royal Colleges continue to press for increasing public awareness of their importance. Services should be driven by clinical need rather than diagnosis.

The continuity in antisocial behaviour into adulthood from middle childhood is well established but it is not clear whether this is also true of the pre-school period.

To determine whether preschool behaviour problems increase the risk of later criminal convictions and add to risk associated with family and social circumstances.

The records of adult convictions were traced for a general population sample (n=828) initially assessed at age 3 years.

The risk of having any adult conviction was related to soiling, daytime enuresis, activity level and management difficulties, and that of having an adult violent offence to recent-onset daytime enuresis, management difficulties and temper tantrums. The only other predictors of later convictions were the child's gender and social competence at age 3 years.

The presence of specific behaviour problems in the pre-school period places the child at increased risk of being convicted of an adult offence. Family and social circumstances at age 3 years did not predict later convictions.

Child sexual abuse (CSA) and poor parental care (neglect and institutional care) are associated with depression in adult life. Little is known about possible mechanisms underlying these associations.

To examine the role of adult intimate-love relationships as differential mediators or moderators of the associations between CSA, poor parental care and adult depression.

Sampling was carried out in two phases. In the first, questionnaires were sent to women aged 25–36 years in five primary care practices. Second-phase subjects for interview (n=198) were drawn from three strata defined on the basis of childhood adversities. Recalled childhood experiences and recent adult relationships and depression were assessed and rated independently. Frequencies of predictor and response variables, effect estimates and their confidence intervals were weighted back to the general population questionnaire sample.

The risk for depression associated with CSA was unaffected by quality of adult relationships, while the risk associated with poor parental care was substantially altered.

There may be different pathways linking CSA and poor parental care to adult depression.

Depot antipsychotic medication is used widely in the treatment and prophylaxis of severe mental illness.

To review the literature on patient and nurse satisfaction with, and attitudes towards, depots.

A systematic search of Medline, Embase, PsycINFO, CINAHL and The Cochrane Library was undertaken, along with citation searches. Studies were selected if satisfaction/attitude data were described in the title or abstract and original data were included. Study quality was rated.

The search produced 1374 articles; 22 articles met the inclusion criteria, 18 of which were cross-sectional surveys. Of the 12 studies with relevant data, 10 conveyed a positive opinion of depot medication. Five out of six studies comparing depot with oral medication showed patient preference for depot.

High-quality data examining patient and nurse attitudes regarding depot antipsychotics are sparse. What data there are show a positive attitude to depots from patients. Future randomised controlled trials should include satisfaction as an outcome.

Children in stepfamilies and single-parent families exhibit elevated levels of behavioural and emotional problems compared with children in intact (biological) families, but there is variation within and across these family types.

To examine the sources of variation in children's behavioural and emotional problems across diverse family settings.

Levels of behavioural and emotional problems in children from diverse stepfamilies and single-parent families were compared with children living with both biological parents. Psychosocial risks were measured at the individual child and family levels.

Behavioural and emotional problems were elevated in children in stepmother/complex stepfamilies and single-parent families, but not in simple stepfather families, relative to ‘biological’ families. Psychopathology associated with family type was explained by compromised quality of the parent–child relationship, parental depression and socio-economic adversity. Sibling similarity in behavioural and emotional problems was most pronounced in high-risk family settings.

Family type is a proxy for exposure to psychosocial risks; the extent of family-wide influence on children's development may be strongest in high-stress settings.

Knowledge of the course of psychopathology from adolescence into adulthood is needed to answer questions concerning origins and prognosis of psychopathology across a wide age range.

To investigate the 10-year course and predictive value of self-reported problems in adolescence in relation to psychopathology in adulthood.

Subjects from the general population, aged 11–19 years, were assessed with the Youth Self-Report (YSR) at initial assessment, and with the Young Adult Self-Report (YASR), the Composite International Diagnostic Interview (CIDI) and three sections of the Diagnostic Interview Schedule (DIS) 10 years later.

Of the subjects with deviant YSR total problem scores, 23% (males) and 22% (females) had deviant YASR total problem scores at follow-up. Subjects with initial deviant YSR total problem, internalising and externalising scores had higher prevalences of DSM–IV diagnoses at follow-up.

Adolescent problems tended to persist into adulthood to a moderate degree. High rates of problems during adolescence are risk factors for psychiatric disorders in adulthood.

Generalised anxiety disorder (GAD) has received less study than other anxiety disorders, particularly its long-term treatment.

To assess the efficacy and safety of venlafaxine extended release (ER) in patients with GAD.

A total of 541 out-patients, 18–86 years old, were recruited to this 24-week, placebo-controlled, double-blind study of three fixed doses (37.5, 75 and 150 mg/day) of venlafaxine ER.

All doses of venlafaxine ER showed efficacy superior to placebo, apparent from week 2, that was sustained throughout the 24-week study for the two higher doses. The discontinuation rate did not differ significantly among the treatment groups.

Venlafaxine ER is an effective and safe treatment for GAD for up to 6 months.

Individuals with velocardio-facial syndrome (VCFS), a genetic disorder associated with microdeletions of chromosome 22q11, are reported to have high rates of psychiatric disorder, particularly schizophrenia.

To review the evidence for an association between VCFS and schizophrenia: to outline recent neuropsychological, neuroanatomical and genetic studies of individuals with VCFS; and to make recommendations for future work.

A selective literature review was undertaken.

Individuals with VCFS have high rates of psychotic disorders, particularly schizophrenia. In addition, specific neuropsychological and neuroanatomical abnormalities have been reported although it is unclear whether such abnormalities relate to the presence of psychiatric disorder in affected individuals.

Deletion of chromosome 22q11 represents one of the highest known risk factors for the development of schizophrenia. It is likely that haploinsufficiency (reduced gene dosage) of a neurodevelopmental gene or genes mapping to chromosome 22q11, leading to disturbed neuronal migration, underlies susceptibility to psychosis in VCFS.

No controlled trial of treatment of generalised social phobia has been conducted in general practice.

To examine the efficacy of sertraline or exposure therapy, administered alone or in combination in this setting.

Study was of a randomised, double-blind design. Patients (n=387) received sertraline 50–150 mg or placebo for 24 weeks. Patients were additionally randomised to exposure therapy or general medical care.

Sertraline-treated patients were significantly more improved than non-sertraline-treated patients (χ2=12.53, P<0.001; odds ratio=0.534; 95% CI 0.347–0.835). No significant difference was observed between exposure— and non-exposure-treated patients (χ2=2.18, P=0.140; odds ratio=0.732; 95% CI 0.475–1.134). In the pairwise comparisons, combined sertraline and exposure (χ2=12.32; P<0.001) and sertraline (χ2=10.13; P=0.002) were significantly superior to placebo.

Sertraline is an effective treatment for generalised social phobia. Combined treatment with sertraline and exposure therapy, conducted by the general practitioner, may enhance the treatment efficacy in primary care.

Previous research has found an association between obstetric complications and schizophrenia, but in many studies the sample size was limited, and no assessment of specific exposures was possible.

To assess the role of different complications, and in particular to distinguish between disordered foetal development and hypoxia at birth.

From the Stockholm County In-Patient Register and community registers, we identified 524 cases of schizophrenia and 1043 controls, matched for age, gender, hospital and parish of birth. Data on obstetric complications were obtained from birth records.

There was a strong association between signs of asphyxia at birth and schizophrenia (OR 4.4; 95% C11.9–10.3) after adjustment for other obstetric complications, maternal history of psychotic illness and social class.

Signs of asphyxia at birth are associated with an increased risk of schizophrenia in adults.

This is the first report on the epidemiology of depressive disorders from the European Outcome of Depression International Network (ODIN) study.

To assess the prevalence of depressive disorders in randomly selected samples of the general population in five European countries.

The study was designed as a cross-sectional two-phase community study using the Beck Depression Inventory during Phase 1, and the Schedule for Clinical Assessment in Neuropsychiatry during Phase 2.

An analysis of the combined sample (n=8.764) gave an overall prevalence of depressive disorders of 8.56% (95% Cl 7.05–10.37). The figures were 10.05% (95% Cl 7.80–12.85) for women and 6.61% (95% Cl 4.92–8.83) for men. The centres fall into three categories: high prevalence (urban Ireland and urban UK), low prevalence (urban Spain) and medium prevalence (the remaining sites).

Depressive disorder is a highly prevalent condition in Europe. The major finding is the wide difference in the prevalence of depressive disorders found across the study sites.

Strong links exist between juvenile and adult depression but comorbid conduct disorder in childhood may mitigate this continuity.

To test the impact of comorbid conduct disorder on psychiatric adult outcomes.

A group of 149 subjects assessed at the Maudsley Hospital in the period 1970–1983 and meeting DSM–IV criteria for major depressive disorder with (n=53) or without (n=96) conduct disorder were interviewed 20 years later. Data were collected on the lifetime history of psychiatric disorders.

Adult depressive recurrence was high for major depression (62.4%) and any depression (75.2%), and survival analyses showed no difference between the two groups. The group with conduct disorders had higher rates of drug misuse and dependence, alcoholism and antisocial personality disorders.

Adolescent depression carries an elevated risk of adult depression irrespective of comorbidity. Comorbid conduct disorder in childhood is associated with raised rates of other psychiatric outcomes.

The impact of clinically diagnosed mental disorders on mortality in the general population has not been established.

To examine mental disorders for their prediction of cause-specific mortality.

Mental disorders were determined using the 36-item version of the General Health Questionnaire and the Present State Examination in a nationally representative sample of 8000 adult Finns.

During the 17-year follow-up period 1597 deaths occurred. The presence of a mental disorder detected at baseline was associated with an elevated mortality rate. The relative risk in men was 1.6 (95% confidence interval 1.3–1.8) and in women, 1.4 (95% Cl 1.2–1.6). In men and women with schizophrenia the relative risks of death during the follow-up period were 3.3 (95% Cl 2.3–4.9) and 2.3 (95% Cl 1.3–3.8) respectively, compared with the rest of the sample. In both men and women with schizophrenia the risk of dying of respiratory disease was increased, but the risk of dying of cardiovascular disease was increased only in men with neurotic depression.

Schizophrenia and depression are associated with an elevated risk of natural and unnatural deaths.

There is huge individual variation in people's response to negative life events.

To test the hypothesis that genetic factors moderate susceptibility to the environmentally mediated risks associated with negative life events.

The Virginia Twin Study of Adolescent Behavioral Development (VTSABD) was used to study the effects of independent life events (assessed from maternal interview) on depression/anxiety (assessed from child interview) in 184 same-gender female twin pairs, aged 14–17 years, measured on two occasions.

There was no genetic effect on the independent negative life events studied. A significant gene–environment interaction was found using structural equation modelling. There was no effect of independent life events on adolescents' depression in the absence of parental emotional disorder, but a significant effect in its presence.

There is an environmentally mediated effect of life events on depression/anxiety. Genetic factors play a significant role in individual differences in susceptibility to these environmentally mediated risks.