Case–control studies are vulnerable to selection and information biases which may generate misleading findings.

To assess the quality of methodological reporting of case–control studies published in general psychiatric journals.

All the case–control studies published over a 2-year period in the six general psychiatric journals with impact factors of more than 3 were assessed by a group of psychiatrists with training in epidemiology using a structured assessment devised for the purpose. The measured study quality was compared across type of exposure and journal.

The reporting of methods in the 408 identified papers was generally poor, with basic information about recruitment of participants often absent. Reduction of selection bias was described best in the ‘pencil and paper’ studies and worst in the genetic studies. Neuroimaging studies reported the most safeguards against information bias. Measurement of exposure was reported least well in studies determining the exposure with a biological test.

Poor reporting of recruitment strategies threatens the validity of reported results and reduces the generalisability of studies.

Psychiatric disorders are among the top causes worldwide of disease burden and disability. A major criterion for validating diagnoses is stability over time.

To evaluate the long-term stability of the most prevalent psychiatric diagnoses in a variety of clinical settings.

A total of 34 368 patients received psychiatric care in the catchment area of one Spanish hospital (1992–2004). This study is based on 10 025 adult patients who were assessed on at least ten occasions (360 899 psychiatric consultations) in three settings: in-patient unit, 2000–2004(n=546); psychiatric emergency room, 2000–2004(n=1408); and out-patient psychiatric facilities, 1992–2004 (n=10 016). Prospective consistency, retrospective consistency and the proportion of patients who received each diagnosis in at least 75% of the evaluations were calculated for each diagnosis in each setting and across settings.

The temporal consistency of mental disorders was poor, ranging from 29% for specific personality disorders to 70% for schizophrenia, with stability greatest for in-patient diagnoses and least for out-patient diagnoses.

The findings are an indictment of our current psychiatric diagnostic practice.

A limited case-load size is considered crucial for some forms of intensive case management and many countries have undertaken extensive reorganisation of mental health services to achieve this. However, there has been limited empirical work to explore this specifically.

To test whether there is a discrete threshold for changes in intensive case management practice determined by case-load size.

‘Virtual’ case-load sizes were calculated for patients from their actual contacts over a 2-year period and were compared with the proportions of contacts devoted to medical and non-medical care (as a proxy for a more comprehensive service model).

There were 39 025 recordings for 545 patients over 2 years, with a mean rate of contacts per full-time case manager per month of 48 (range 35–60). There was no variation in the proportion of non-medical contacts when case-load sizes were over 1:20 but there was a convincing linear relationship when sizes were between 1:10 and 1:20.

Case-load size between 1:10 and 1:20 does affect the practice of case management. However, there is no support for a paradigm shift in practice at a discrete level.

Treatment within medium secure forensic psychiatry services is expected to reduce risk to the public.

To measure the period prevalence and incidence of offending following discharge and identify associated risk factors.

Follow-up of patients from 7 of 14 regional services in England and Wales who spent time at risk (n=1344) for a mean of 6.2 years. Outcome was obtained from offenders index, hospital case-files and the central register of deaths.

One in 8 men and 1 in 16 women were convicted of grave offences. Incidence rates indicated low density and most patients were not subsequently convicted. Offence predictors included gender, younger age, early-onset offending, previous convictions and a comorbid or primary diagnosis of personality disorder. Longer in-patient stay and restriction on discharge were protective.

Risks of reoffending remain for a subgroup of discharged patients. Future research should aim to improve their identification and risk management following discharge.

Despite the high prevalence of cannabis use in schizophrenia, few studies have examined the potential relationship between cannabis exposure and brain structural abnormalities in schizophrenia.

To investigate prefrontal grey and white matter regions in patients experiencing a first episode of schizophrenia with an additional diagnosis of cannabis use or dependence (n=20) compared with similar patients with no cannabis use (n=31) and healthy volunteers (n=56).

Volumes of the superior frontal gyrus, anterior cingulate gyrus and orbital frontal lobe were outlined manually from contiguous magnetic resonance images and automatically segmented into grey and white matter.

Patients who used cannabis had less anterior cingulate grey matter compared with both patients who did not use cannabis and healthy volunteers.

A defect in the anterior cingulate is associated with a history of cannabis use among patients experiencing a first episode of schizophrenia and could have a role in poor decision-making and in choosing more risky outcomes.

Long-term mortality and the risk factors for premature death among patients with schizophrenia living in rural communities are unknown.

To explore the 10-year mortality and its risk factors among patients with schizophrenia.

We used data from a 10-year prospective follow-up study (1994–2004) of mortality among people with schizophrenia, and death registration data for Xinjin County, Chengdu, China.

The mortality rate was 2228 per 100 000 person-years during follow-up. Both all-cause mortality and suicide rates were significantly greater in male than in female patients. Age at illness onset (>45 years), duration of illness (⩾10 years), age greater than 50 years, physical illness, inability to work, male gender, and never having received treatment were identified as independent predictors of increased mortality.

Higher mortality rates in male patients may contribute to the higher prevalence of schizophrenia in women compared with men in China. The findings of risk factors for mortality should be taken into account when developing interventions to improve outcomes among people with schizophrenia.

Lack of insight has been observed in people with schizophrenia across cultures but assessment of insight must take into account prevailing illness models.

To determine whether culturally specific and Western biomedical interpretations of insight and psychosis can be reconciled.

Patients with schizophrenia (n=131) were assessed during their first contact with psychiatric services in Vellore, South India. Patients' explanatory models, psychopathology and insight were investigated using a standard schedule translated into Tamil.

Supernatural explanations of symptoms were frequent. Some insight dimensions were weakly associated (inversely) with severity of symptoms whereas preserved insight was associated with anxiety, help-seeking and perception of change. Willingness to attribute symptoms to disease, in others and in one's self, but not to supernatural forces was strongly associated with insight.

The relationship between insight, awareness of illness and other clinical variables is similar in South India to elsewhere. However, the assessment of insight might have failed to capture locally accepted explanatory frameworks. An inclusive conceptual model which emphasises help-seeking is recommended.

There is concern about the stigma of mental illness, but it is difficult to measure stigma consistently.

To develop a standardised instrument to measure the stigma of mental illness.

We used qualitative data from interviews with mental health service users to develop a pilot scale with 42 items. We recruited 193 service users in order to standardise the scale. Of these, 93 were asked to complete the questionnaire twice, 2 weeks apart, of whom 60 (65%) did so. Items with a test–retest reliability kappa coefficient of 0.4 or greater were retained and subjected to common factor analysis.

The final 28-item stigma scale has a three-factor structure: the first concerns discrimination, the second disclosure and the third potential positive aspects of mental illness. Stigma scale scores were negatively correlated with global self-esteem.

This self-report questionnaire, which can be completed in 5–10 min, may help us understand more about the role of stigma of psychiatric illness in research and clinical settings.

Low birth weight, prematurity and higher miscarriage rates have previously been reported in women with eating disorders.

To determine whether women with a history of eating disorders are at higher risk of major adverse perinatal outcomes.

Adjusted birth weight, preterm delivery and miscarriage history were compared in those with a history of eating disorders (anorexia nervosa(n=171), bulimia nervosa (n=199) and both (n=82)) and those with other (n=1166) and no psychiatric disorders(n=10 636) in a longitudinal cohort study.

The group with bulimia nervosa had significantly higher rates of past miscarriages (relative risk ratio 2.0, P=0.01) and the group with anorexia nervosa delivered babies of significantly lower birth weight than the general population (P=0.01), which was mainly explained by lower pre-pregnancy body mass index. Preterm delivery rates were comparable across groups.

Women with a history of eating disorders are at higher risk of major adverse obstetric outcomes. Antenatal services should be aware of this higher risk.

Executive dysfunction is common after stroke and may impair long-term outcome. Remedies for this condition are limited.

To examine the effect of antidepressants on executive function after stroke.

Forty-seven patients who had had a stroke during the prior 6 months received 12 weeks of antidepressant treatment in double-blind placebo-controlled fashion, followed by assessment of executive function at the end of treatment and after 2 years.

No significant group effect was found at the end of treatment. However, 21 months after the end of treatment the placebo group showed deterioration of executive function, whereas the active treatment group showed clear and significant improvement independent of depressive symptoms (F=12.1, d.f.=1,45, P= 0.001).

Antidepressant treatment fosters long-term improvement of executive function following stroke. This phenomenon is consistent with a reorganisation of neuronal networks associated with prefrontal functions based on modulation of monoaminergic neurotransmission and the activity of neurotrophins.