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.

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.

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.

Most studies of the recognition of depression in primary care have used a categorical definition of depression. This may overstate the extent of the problem.

Our objective was to investigate the relationship between severity and recognition of depression, and its modification by patient and practitioner characteristics.

An association study in multiple consecutive adult cohorts of 18 414 primary care consultations drawn from a representative sample of 156 general practitioners in Hampshire, UK.

There was a curvilinear relationship between the severity of depression and practitioners' ratings of depression. One case of probable depression was missed in every 28.6 consultations. Anxiety and unemployment altered the chances of recognition, but age, gender and deprivation scores did not.

A dimensional approach to severity of depression shows that general practitioners may be better able to recognise depression than previous categorical studies have suggested. Efforts to improve the care of depression should therefore focus on doctors who have been shown to have difficulty making the diagnosis and on improving the treatment of identified patients.

Obsessive–compulsive disorder (OCD) is a disorder that appears to be underdiagnosed and undertreated, despite the evidence for effective treatments. There are variable estimates of OCD prevalence in the under-16s and published rates give little indication of age trends.

To establish the prevalence and associates of OCD in young people aged 5–15 years.

A nationwide (UK) epidemiological study of rates of psychiatric disorder in 5— to 15-year-olds (1999 British Child Mental Health Survey): 10 438 children were assessed.

Twenty-five children with OCD were identified (weighted overall prevalence 0.25%; 95% Cl 0.14–0.35), with prevalence rising exponentially with increasing age. Compared with normal controls, children with OCD were more likely to be from lower socio-economic class and of lower intelligence. Only three of these children had been seen by specialist children's services.

Although OCD is rare in young children, the rate increases towards the adult rates at puberty. Children with OCD have additional psychosocial disadvantage. The majority of the childhood cases identified in this survey appear to have been undetected and untreated.

Although a number of functional imaging studies are in agreement in suggesting orbitofrontal and subcortical hyperfunction in the pathophysiology of obsessive–compulsive disorder (OCD), the structural findings have been contradictory.

To investigate grey matter abnormalities in patients with OCD by employing a novel voxel-based analysis of magnetic resonance images.

Statistical parametric mapping was utilised to compare segmented grey matter images from 25 patients with OCD with those from 25 matched controls.

Increased regional grey matter density was found in multiple cortical areas, including the left orbitofrontal cortex, and in subcortical areas, including the thalamus. On the other hand, regions of reduction were confined to posterior parts of the brain, such as the left cuneus and the left cerebellum.

Increased grey matter density of frontal–subcortical circuits, consonant with the hypermetabolic findings from functional imaging studies, seems to exist in patients with OCD, and cerebellar dysfunction may be involved in the pathophysiology of OCD.

Being born or living in urban areas is associated with high rates of schizophrenia. However, few studies have compared the incidence in urban/rural areas using the same methodology.

To compare service-based incidence rates for schizophrenia in rural Dumfries and Galloway in south-west Scotland with urban Camberwell in south-east London.

Using Research Diagnostic Criteria diagnoses from the OPCRIT computer algorithm, we compared the incidence of schizophrenia over 12 years (1979–1984 and 1992–1997) using indirect standardisation techniques and Poisson regression modelling.

The incidence was 61% higher in urban Camberwell than in rural Dumfries and Galloway (standardised incidence ratio (SIR)= 1.61; 95% Cl=1.42–1.81). There was no difference in incidence when we compared the White population in Camberwell with Dumfries and Galloway (SIR=1.12; 95% CI=0.86–1.43).

The incidence of schizophrenia in urban Camberwell was higher than that in rural Dumfries and Galloway; the high incidence of non-Whites in Camberwell largely explains the urban/rural difference.

The ‘toxicity’ model of duration of untreated psychosis (DUP) suggests that longer DUP will be associated with poorer performance on cognitive tests in first-episode patients.

To test this hypothesis on a sample of 113 patients in a community-based early intervention programme for psychosis.

Information was collected concerning a number of possible predictors of cognitive functioning including DUP. These were examined for their relation to performance on an extensive battery of cognitive tests administered shortly after the patients' admission to the programme.

Although several variables such as gender, premorbid adjustment, education and handedness predicted cognitive functioning, no relation was found between DUP and performance on any component of the test battery.

Findings do not provide support for a toxic effect of DUP on cognitive functioning. Other mechanisms through which DUP might affect outcome such as psychological engulfment, social support and adherence to medication are discussed.

The association between social inequality at birth and subsequent risk of schizophrenia is uncertain.

To investigate the relationship between adult-onset schizophrenia and two indicators of social inequality at birth: social class and area of residence.

A matched case–control design was used with data from birth certificates of first-episode cases and age— and gender-matched controls.

Risk increased with increasing levels of deprivation at birth. Subjects whose fathers were social class IV–V or who were born in deprived areas were at increased risk of schizophrenia (odds ratio=2.1; 95% Cl=0.8–5.5). Risk was greater in those with both of these indicators (odds ratio=8.1; 95% CI=2.7–23.9). There was some evidence that associations were stronger in older subjects. Exclusion of African–Caribbeans or cases with positive family history somewhat attenuated the association.

Indicators of social inequality at birth are associated with increased risk of adult-onset schizophrenia, suggesting that environmental factors are important determinants of schizophrenic disorders.

Evidence exists for an association between aggression and schizophrenia. Although the aetiology of aggression is multifactorial, three studies have reported associations between polymorphisms of the catechol-O-methyltransferase (COMT) gene and aggression in schizophrenia.

To replicate these findings in a larger sample using the Overt Aggression Scale (OAS).

A sample of 180 people with DSM–IV schizophrenia were rated for aggression using the OAS. Kruskal–Wallis and contingency table analyses were applied to the OAS results.

The high-activity homozygotes showed significantly higher scores of aggression, whereas the heterozygotes showed significantly lower scores. The odds ratio for aggression for the high-activity homozygotes was 2.07 (95% Cl=1.03–4.15), whereas that for the heterozygotes was 0.54 (95% CI=0. 30–1.00).

The high-activity COMT homozygote confers a higher risk of recorded aggression in schizophrenia. Heterozygotes had a significantly lower risk, which may represent an example of heterosis/heterozygote advantage.

In rats, amino acid mixtures lacking tyrosine and its precursor phenylalanine decrease the release of dopamine produced by the psychostimulant drug amphetamine. Amphetamine has been proposed as a model for clinical mania.

To assess whether dietary tyrosine depletion attenuates the psychostimulant effects of methamphetamine in healthy volunteers and diminishes the severity of mania in acutely ill patients.

Sixteen healthy volunteers received a tyrosine-free amino acid mixture and a control mixture in a double-blind crossover design 4 h before methamphetamine (0.15 mg/kg). Twenty in-patients meeting DSM–IV criteria for mania were allocated blindly and randomly to receive either the tyrosine-free mixture or the control mixture.

The tyrosine-free mixture lowered both subjective and objective measures of the psychostimulant effects of methamphetamine. Ratings of mania were lower in the patients who received the tyrosine-free mixture.

Decreased tyrosine availability to the brain attenuates pathological increases in dopamine neurotransmission following methamphetamine administration and putatively in mania.

In the UK, 6% of those aged 65 years and over were born abroad, most of whom now live in inner-city areas. It has been suggested that ethnic elders are particularly vulnerable to mental illness.

To compare the prevalence of dementia and depression in older migrants with those born in the UK.

A cross-sectional community study of 1085 people aged 65 years or older in an inner-London borough.

Compared with those born in the UK, the prevalence of dementia was raised in African–Caribbeans (17.3%, relative risk=1.72, Cl=1.06–2.81) and lower for the Irish-born (3.6%, relative risk=0.36, Cl=0.17–0.87). All those of African–Caribbean country of birth were significantly younger (P=0.000) but no more likely to be taking antihypertensive drugs. They were no more likely to report having cardiovascular problems but had increased rates of diabetes (P < 0.0000). The overall prevalence of depression was 18.3% (95% Cl=16.1–20.7). The highest prevalence rate was found among those born in Greece and Turkey (27.2%, Cl=179–39.6). Migration per se does not appear to be a risk for depression and dementia in this population.

The excess of dementia may be of vascular aetiology. There is the potential for primary or secondary prevention.