Black and minority ethnic (BME) patients are disproportionately detained under the Mental Health Act 1983. There has been no systematic exploration of differences within and between ethnic groups, nor of the explanations put forward for this excess.

To systematically review detention and ethnicity, with meta-analyses of detention rates for BME groups, and to explore the explanations offered for ethnic differences in detention rates.

Literature search and metaanalysis. Explanations offered were categorised, supporting literature was accessed and the strength of the evidence evaluated.

In all, 49 studies met inclusion criteria; of these, 19 were included in the meta-analyses. Compared with White patients, Black patients were 3.83 times, BME patients 3.35 times and Asian patients 2.06 times more likely to be detained. The most common explanations related to misdiagnosis and discrimination against BME patients, higher incidence of psychosis and differences in illness expression. Many explanations, including that of racism within mental health services, were not supported by clear evidence.

Although BME status predicts psychiatric detention in the UK, most explanations offered for the excess detention of BME patients are largely unsupported.

Seasonal fluctuation in suicide has been observed in many populations. High temperature may contribute to this, but the effect of short-term fluctuations in temperature on suicide rates has not been studied.

To assess the relationship between daily temperature and daily suicide counts in England and Wales between 1 January 1993 and 31 December 2003 and to establish whether heatwaves are associated with increased mortality from suicide.

Time-series regression analysis was used to explore and quantify the relationship between daily suicide counts and daily temperature. The impact of two heatwaves on suicide was estimated.

No spring or summer peak in suicide was found. Above 18 °, each 1 ° increase in mean temperature was associated with a 3.8 and 5.0% rise in suicide and violent suicide respectively. Suicide increased by 46.9% during the 1995 heatwave, whereas no change was seen during the 2003 heat wave.

There is increased risk of suicide during hot weather.

Several, although not all, of the previous small diffusion-weighted imaging (DWI) studies have shown cortical white-matter disruption in schizophrenia.

To investigate cortical white-matter microstructure with DWI in a large community-based sample of people with schizophrenia.

Sixty-eight people with schizophrenia and 64 healthy controls underwent a session of DWI to obtain the apparent diffusion coefficient (ADC) of white-matter water molecules. Regions of interest were placed in cortical lobes.

Compared with controls, the schizophrenia group had significantly greater ADCs in frontal, temporal and occipital white matter (analysis of covariance, P < 0.05).

Our findings confirm the presence of cortical white-matter microstructure disruption in frontal and temporo-occipital lobes in the largest sample of people with schizophrenia thus for studied with this technique. Future brain imaging studies, together with genetic investigations, should further explore white-matter integrity and genes encoding myelin-related protein expression in people with first-episode schizophrenia and those at high risk of developing the disorder.

Frontal release signs, a subset of neurological soft signs, are common in schizophrenia.

To explore the relationship between frontal release signs and neuropsychological tests of frontal lobe function in people with schizophrenia, their siblings and healthy controls.

Neuropsychological tests and frontal release signs were measured in a cohort of index cases (n=302), their siblings (n=240) and healthy controls (n=346).

The mean total score of frontal release signs was 1.5 (s.d. = 1.58) in the schizophrenia group, 0.54 (s.d.=0.92) for siblings and 0.42 (s.d.=0.77) for controls. Schizophrenia group scores were greater than healthy control or sibling cohort scores (P < 0.0001), which did not differ. In all three cohorts, right grasp reflex scores positively correlated with number of perseverative errors on the Wisconsin Card Sort Task (P<0.05). In the schizophrenia group, frontal release signs scores showed an inverse correlation with IQ (R = −0.199, P<0.0005).

Our findings of relationships between frontal release signs and cognitive assays of cortical dysfunction and the increased frequency of these signs in people with schizophrenia implicate a cortical origin for these clinical signs and evidence of frontal lobe dysfunction in this disorder.

Epidemiological studies of schizophrenia suggest that this disorder has a substantial genetic component. Cognitive and social abilities, as well as the volumes of brain regions involved in emotion processing, have been found to be distributed along a continuum when comparing patients, siblings and controls, with siblings showing intermediate scores.

To establish whether facial expression recognition is impaired in unaffected siblings of patients.

Emotion and gender recognition were evaluated in a three-group pre–post study design in drugnaive patients with first-episode schizophrenia (n=40) and their unaffected siblings (n=30) compared with controls (n=26).

Patients and their healthy siblings showed impaired emotion recognition but normal gender recognition compared with controls. Patients' performance did not improve despite effective clinical stabilisation.

Impaired performance in healthy siblings and time stability in patients provides evidence of impairment of facial emotion recognition as an actual phenotype of schizophrenia.

The efficacy and safety of long-acting injectable risperidone have not been compared with those of an oral atypical antipsychotic.

To compare long-acting risperidone and oral olanzapine in 377 patients with DSM–IV schizophrenia or schizoaffective disorder.

Patients were randomised to receive long-acting risperidone (25 mg or 50 mg every 14 days) or olanzapine (5–20 mg/day).

In the 13-week phase, long-acting risperidone was at least as effective as (not inferior to) oral olanzapine. In the 12-month phase, significant improvements in the Positive and Negative Syndrome Scale (PANSS) total and factor scores from baseline to month 12 and end-point were seen in both groups of patients. Few patients discontinued treatment because of an adverse event.

Both treatments were efficacious and well tolerated.

Some questionnaire studies have shown increased mental health problems, including probable posttraumatic stress disorder (PTSD), in soldiers deployed to Iraq.

To test prospectively whether such problems change over time and whether questionnaires provide accurate estimates of deployment-related PTSD compared with a clinical interview.

Dutch infantry troops from three cohorts completed questionnaires before deployment to Iraq (n=479), and about 5 months (n=382, 80%) and 15 months (n=331, 69%) thereafter. Post-traumatic stress disorder was evaluated by questionnaire and clinical interview.

There were no group changes for general distress symptoms. The rates of PTSD for each cohort were 21, 4 and 6% based on questionnaires at 5 months. The deployment-related rates of PTSD based on the clinical interview were 4, 3 and 3%.

There was a specific effect of deployment on mental health for a small minority. Questionnaires eliciting stress symptoms gave substantial overestimations of the rate of PTSD.

Understanding of the psychological impact of politically motivated violence is poor.

To examine the prevalence of post-traumatic symptoms subsequent to the ‘troubles' in Northern Ireland.

A telephone survey of 3000 adults, representative of the population in Northern Ireland and the border counties of the Irish Republic, examined exposure to political violence, post-traumatic stress disorder (PTSD) and national identity.

Ten per cent of respondents had symptoms suggestive of clinical PTSD. These people were most likely to come from low-income groups, rate national identity as relatively unimportant and have higher overall experience of the ‘troubles' than other respondents.

Direct experience of violence and poverty increase the risk of PTSD, whereas strong national identification appears to reduce this risk.

Diagnosis of dementia is complex in adults with intellectual disability owing to their pre-existing deficits and different presentation.

To describe the clinical features and prevalence of dementia and its subtypes, and to compare the concurrent validity of dementia criteria in older adults with intellectual disability.

The Becoming Older with Learning Disability (BOLD) memory study is a two-stage epidemiological survey of adults with intellectual disability without Down syndrome aged 60 years and older, with comprehensive assessment of people who screen positive. Dementia was diagnosed according to ICD-10, DSM-IV and DC-LD criteria.

The DSM – IV dementia criteria were more inclusive. Diagnosis using ICD – 10 excluded people with even moderate dementia. Clinical subtypes of dementia can be recognised in adults with intellectual disability. Alzheimer's dementia was the most common, with a prevalence of 8.6% (95% CI 5.2–13.0), almost three times greater than expected.

Dementia is common in older adults with intellectual disability, but prevalence differs according to the diagnostic criteria used. This has implications for clinical practice.

The relationship between the Mental Illness Needs Index (MINI) and the common mental disorders is not known.

To investigate associations between the small-area MINI score and common mental disorder at individual level.

Mental health status was measured using the Mental Health Inventory of the Short Form 36 instrument (SF-36). Data from the Caerphilly Health and Social Needs population survey were analysed in multilevel models of 10 653 individuals aged 18–74 years nested within the 2001 UK census geographies of 110 lower super output areas and 33 wards.

The MINI score was significantly associated with common mental disorder after adjusting for individual risk factors. This association was stronger at the smaller spatial scale of the lower super output area and for individuals who were permanently sick or disabled.

The MINI is potentially useful for small-area needs assessment and service planning for common mental disorder in community settings.

Depression is prevalent, costly and often undertreated.

To test the hypothesis that people with low socio-economic status are least likely to receive and adhere to evidence-based treatments for depression, after controlling for clinical need.

Individuals with an ICD-10 depressive episode in the past 12 months (n = 866) were recruited from 7271 attendees in 36 general practices in England and Wales. Depressive episodes were identified using the 12-month Composite International Diagnostic Interview. Treatment receipt and adherence were assessed by structured interview, and rated using evidence-based criteria.

We identified 332 individuals (38.3%) who received and adhered to evidence-based treatment. There were few socio-economic differences in treatment allocation. Although those without educational qualifications were least likely to receive psychological treatments (OR = 0.55, 95% CI 0.34–0.89, P = 0.02), this association was not statistically significant after adjusting for depression severity.

We found no evidence of inverse care in the treatment of moderate and severe depression in primary care in England and Wales.

Legislation in 1978 led to the gradual replacement of mental hospitals in Italy with a full range of community-based services, including facilities for acute in-patient care.

To survey the main characteristics of Italian public and private in-patient facilities for acute psychiatric disorders.

Structured interviews were conducted with each facility's head psychiatrist in all Italian regions, with the exception of Sicily.

Overall, Italy (except Sicily) has atotal of 4108 public in-patient beds in 319 facilities, with 0.78 beds for every 10 000 inhabitants, and 4862 beds in 54 private in-patient facilities, with 0.94 beds per 10 000 inhabitants. In 2001 the rates of psychiatric admissions and admitted patients per 10 000 inhabitants were 26.7 and 17.8 respectively. In the same year the percentage of involuntary admissions was 12.9%, for atotal of 114 570 hospital days. Many in-patient facilities showed significant limitations in terms of architectural and logistic characteristics. Staffing showed a great variability among facilities.

The overall number of acute beds per 10 000 inhabitants is one of the lowest in Europe. The survey has provided evidence of two parallel systems of in-patient care, a public one and a private one, which are not fully interchangeable.