Previous work suggests that the association between urbanicity and schizophrenia may be greatest in those with pre-existing vulnerability.

To test for synergism in risk of schizophrenia between population density and a combined exposure of poor premorbid social and cognitive functioning.

For 371 603 adolescent males examined by the Israeli Draft Board on social and cognitive functioning, data on population density of place of residence and later hospitalisation for schizophrenia were obtained from population-based registries.

There was an interaction between population density (five levels) and poor premorbid social and cognitive functioning (interaction χ2=4.6, P=0.032). The adjusted increase in cumulative incidence associated with one unit change in population density was 0.10% in the vulnerable group (95% CI 0.019–0.18, P=0.015), nine times larger than that in the non-vulnerable group (0.011%, 95% CI 0.0017–0.020, P=0.021).

Risk of schizophrenia may increase when people with a genetic liability to the disorder, expressed as poor social and cognitive functioning, need to cope with city life.

Investigating the relationship between premorbid functioning and treatment response in schizophrenia is relevant to understanding the illness and predicting treatment outcomes.

To examine the relationship between premorbid characteristics and treatment response of people with recent-onset schizophrenia.

Data came from a large, double-blind trial of recent-onset psychosis treated with a flexible dose of risperidone or haloperidol. Median treatment length was 206 days. Premorbid functioning was categorised using the Cannon-Spoor Premorbid Adjustment Scale.

There were significant differences between the premorbid groups on change on the Positive and Negative Syndrome Scale, Clinical Global Impression severity and cognitive functioning and Extrapyramidal Symptoms Rating Scale. Patients in the ‘stable–good’ premorbid group (n=251) improved more than those in the ‘stable–poor’ (n=198) and ‘declining’ (n=81) groups. The ‘stable–good’ group received the lowest doses of antipsychotic and had the least extrapyramidal symptoms. Patients in the declining’ group had the highest dosages and the most extrapyramidal symptoms.

In first-episode psychosis good premorbid functioning is associated with better response to treatment and fewer extrapyramidal symptoms.

The extent to which antipsychotics improve patients' well-being is uncertain.

To examine psychopathology and patient-rated functioning and well-being in patients treated with risperidone.

In a 1-year, open-label, international multicentre trial of long-acting risperidone in 615 stable adult patients with schizophrenia, self-rated functioning and well-being were measured every 3 months using the Short Form 36-item questionnaire (SF–36). Psychopathology was quantified using the Positive and Negative Syndrome Scale (PANSS).

Significant improvements were found on the SF–36 mental component summary score and vitality and social functioning scales. PANSS and mental component summary scores were moderately correlated.

Patient-reported functioning and well-being appear to differ from investigator-rated psychotic symptoms. Patient-rated well-being should be assessed with symptoms to help measure treatment outcomes.

The extent of premorbid changes associated with the onset of schizophrenia are debated.

The study examined cognitive and behavioural functioning prior to, and after, first hospitalisation for schizophrenia.

Data from the Israeli Draft Board Register of intelligence, social functioning and behaviour testing for all Israeli males aged 16–17 was linked with data from the National Psychiatric Hospitalisation Case Register. This identified 692 men who had been admitted to hospital for schizophrenia. Cases and non-cases matched on age and school were compared, as were cases aggregated by the time that had elapsed between testing and first admission to hospital.

Cases performed worse than non-cases on all measures. On Social Functioning and on Raven's Progressive Matrices–R, differences between cases and non-cases were progressively greater for cases admitted closer to the time of testing. These differences were greatest for persons tested after first psychiatric hospitalisation.

The results confirm premorbid deficits associated with schizophrenia and support the hypothesis that decline is progressive.

Clozapine's effectiveness in reducing symptoms and facilitating discharge among patients with chronic schizophrenia who were resistant to neuroleptics was studied.

All 169 such patients in a public psychiatric hospital were given clozapine. BPRS ratings (0–5 scale) were completed before treatment and 21 months later. Patients were followed for about 2.5 years.

Clozapine was discontinued in 37.8% of cases due to non-compliance, non-response, or side-effects. At follow-up 41 % of clozapine recipients and 25.9% of the drop-outs were discharged and remained so, and 33% of recipients and 24.1% of drop-outs were being prepared for discharge. Longer treatment was associated with more improvement. Decline in average BPRS total scores of recipients was significantly more than drop-outs (32.7, s.d. 16.8 v. 12.1, s.d. 14.1, d.f. = 155, t = 7.5, P = 0.000).

Clozapine appears to be effective for treating some chronic neuroleptic non-responding schizophrenic patients.