Background. Several studies have investigated the issue of the natural course of schizophrenia. Our study addressed whether there is evidence for progression, potentially deteriorating, over the long-term course of the disorder.

Method. Modern survival analysis techniques were applied to case-register data on the pattern of readmission to in-patient psychiatric facilities. The sample consisted of a total of 8953 persons with schizophrenia.

Results. No evidence of a progressive course of schizophrenia was found in the present study. The accelerating pattern of the course of schizophrenia described by some authors, including a previous analysis of an almost identical dataset, can be explained by selection.

Conclusions. Heterogeneity reflecting the various levels of individual vulnerability may govern the overall individual course of schizophrenia. We hypothesize that the persistent deficit syndrome and negative symptoms are influential determinants of this heterogeneity.

Background. The authors' goal was to investigate the presence or absence of theory of mind impairments among people with schizophrenia during remission. Recent research results interpret theory of mind deficits as state rather than trait characteristics, connecting these impairments mainly to the acute episode of psychosis.

Methods. Twenty patients with schizophrenia in remission and 20 matched control subjects were evaluated. Participants were presented with one first-order theory of mind task, one second-order theory of mind task, two metaphor and two irony tasks adapted from previous studies.

Results. The schizophrenic patients performed a statistically significant impairment in the irony task, as there were no significant differences in the cases of the other evaluated tasks.

Conclusions. These preliminary results suggest that theory of mind impairments can be detected not only in the acute phase as found in previous research studies, but also in remission.

Background. In evidence-based medicine, stratum-specific likelihood ratios (SSLRs) are now being increasingly recognized as a more convenient and generalizable method to interpret diagnostic information than an optimal cut-off and its associated sensitivity and specificity. We previously examined the SSLRs of the General Health Questionnaire (GHQ) in primary care settings. The present paper aims to examine if these SSLRs are generalizable to the community settings.

Methods. The Composite International Diagnostic Interview (CIDI) and the GHQ were administered on a representative sample of the Australian population in the Australian National Survey of Mental Health and Well-Being. We first compared the SSLRs of GHQ in urban Australia with the estimates that we had previously obtained from the developed urban centres in the WHO Psychological Problems in General Health Care study. If the SSLRs in the community were found to differ significantly from those in the primary care, we sought for explanatory variables.

Results. The SSLRs in urban Australia and in the urban centres in the WHO study were significantly different for three out of the six strata. When we limited the sample to those with physical problems who visited a health professional, however, the SSLRs in the Australian study were strikingly close to those observed for primary care settings.

Conclusions. Different sets of SSLRs apply to primary care and general population samples. For general population surveys in developed countries, the results of the Australian National Survey represent the currently available best estimates. For developing countries or rural areas, the results are less definitive and an investigator may wish to conduct a pilot study.

Background. Suicide rates, anxiety/depression scores and stress scores are routinely used as mental health indicators in populations, but their inter-relationships have not been explored. Our aim was to explore the association of suicide rates with anxiety/depression and stress scores, while also referring to deprivation scores, which are known to be linked to suicide rates.

Methods. We undertook an ecological analysis of English Health Authorities, regressing suicide rates (1993–1994), on General Health Questionnaire and stress scores (1994), and also on Jarman deprivation scores (1991).

Results. Overall, Jarman deprivation score was a better predictor of suicide rate than the psychological distress measures. There were no statistically significant associations between suicide rates and GHQ scores, although there was a weak association between suicide rate and mean stress level in women.

Conclusions. Suicide rates, though important in themselves, are not reliable indicators of the levels of neurotic symptoms or stress in populations. Suicide rates are more strongly associated with area-based measures of social disadvantage, though a possible stress–suicide relationship in women could be investigated further.

Background. We aimed to evaluate the diagnostic accuracy of a highly structured diagnostic interview in relation to a semi-structured diagnostic procedure. We compared the World Health Organization Composite International Diagnostic Interview Short Form (CIDI-SF) in diagnosing major depressive episode (MDE) to consensus diagnoses based on the SCAN interview (Schedules for Clinical Assessment in Neuropsychiatry).

Method. Subjects comprised a follow-up sample of 239 20–24-year-old former high-school students who were administered the SCAN and immediately thereafter the CIDI-SF. Concordance was estimated for 12-month MDE, using different cut-points of the CIDI-SF and for any affective disorders.

Results. Correspondence between instruments was moderate for MDE (κ = 0.43, sensitivity 0.71, specificity 0.82), but better for any affective disorder (κ = 0.60, sensitivity 0.70, specificity 0.90). Most false negatives suffered from their depression as much as those correctly identified by the CIDI-SF. False negativity was mainly due to not endorsing the stem questions of the CIDI-SF. Of the false positives almost half had an affective disorder other than MDE.

Conclusions. The CIDI-SF seems to function best in identifying a broader category of affective disorders. It could be useful in large-scale community surveys where more extensive psychiatric interviews are not feasible.

Channi Kumar was born in India (Punjab) and came alone, without his family, to England at the age of 13 years: this experience surely contributed to his originality and to the openness of his mind. His medical and psychiatric training, his doctorate in pharmacology as well as his work with midwives on the maternity ward and his interest in psychology – all of these attributes led him to be open to, for example, the physiological and hormonal aspects of medication and also, especially in recent years, to the psychological and relational dimensions of maternal disease. He was also interested in the French psychoanalytical approaches but felt always exterior to this dimension.

Background. A randomized controlled trial of problem-solving treatment, antidepressant medication and the combination of the two treatments found no difference in treatment efficacy for major depressive disorders in primary care. In addition to treatment outcome, the trial sought to determine possible mechanisms of action of the problem-solving intervention.

Method. Two potential mechanisms of action of problem-solving treatment were evaluated by comparison with drug treatment. First, did problem-solving treatment work by achieving problem resolution and secondly, did problem-solving treatment work by increasing the patients' sense of mastery and self-control?

Results. Problem-solving treatment did not achieve a greater resolution in the patients' perception of their problem severity by comparison with drug treatment, neither did problem-solving treatment result in a greater sense of mastery or self-control.

Conclusions. The results from this study did not support the hypotheses that for patients with major depression, by comparison with antidepressant medication: problem-solving treatment would result in better problem resolution; or that problem-solving treatment would increase the patients' sense of mastery and self-control.

In analysing the results of a survey of electro-convulsive therapy (ECT) practice in Metropolitan New York community hospitals in 1997, Prudic et al. (2001) focus their attention on the psychological side-effects of ECT, and in so doing, ignore the reasons why ECT is given.