Reform of mental health legislation for England and Wales is due. MHRTs offer an important check in the balance between patient and public rights.

To study the quantity and outcome of MHRTs in special (high-security) hospitals.

Data were extracted from the records of 1670 patients detained under mental illness or psychopathic disorder classifications in special hospitals during 1992.

There were 661 MHRT hearings, mostly requested by patients. Forty-three (7%) discharges were ordered, often without key data about continuing care in the written evidence. There were 56 recommendations for transfer to lesser security. Correlates of MHRT discharge were: female gender, younger age (in women), a legal classification of psychopathic disorder and shorter length of stay. Conditional discharge did not necessarily mean departure from special hospital.

Special hospital MHRTs result in few changes in patient status. A probable need for improvement in the evidence put before an MHRT was found. Legislation reformers should consider an extension of MHRT powers to order transfer between levels of security.

We have previously reported that people who are cocaine-dependent have reduced blue cone b-wave electroretinogram (ERG) responses. In this preliminary study, we examined the relationship between blue cone ERG amplitudes and craving response to cocaine cues.

A new series of 14 recently withdrawn subjects who were cocaine-dependent completed a cocaine craving questionnaire at baseline, and again following exposure to laboratory cues; an ERG was also performed.

Cocaine-dependent subjects with a blunted ERG blue cone response (<0.5 μV) showed significantly greater increases in craving following cue-exposure than subjects without the blunted ERG blue cone response.

Subjects with a blunted ERG response may represent a subgroup more vulnerable to cocaine craving and relapse.

One hundred years ago psychiatrists thought that ear disease could cause insanity by irritation of the brain. Current understanding of the role of the temporal lobes in schizophrenia and their proximity to the middle ear supports this hypothesis.

To establish the rate of middle-ear disease pre-dating the onset of schizophrenia.

Eighty-four patients with schizophrenia were each matched to four non-psychiatric controls by age, gender and season of birth. History of ear disease was obtained from general practice records. Additional information on symptoms was collected for participants in the case group, who also had audiometry.

The odds ratio of recorded middle-ear disease pre-dating schizophrenia was 3.68 (95% CI 1.86–7.28). This excess was particularly marked on the left (OR=4.15, 95% CI 2.08–8.29). Auditory hallucinations were associated with middle-ear disease but not with hearing loss.

There is an association between middle-ear disease and schizophrenia which may have aetiological significance.

Amino acid mixtures that lower brain availability of the serotonin (5-HT) precursor tryptophan produce acute depressive relapse in women with a history of major depression. Dieting also lowers brain tryptophan availability, but its effects on brain 5-HT function in recovered depressed women have not been studied.

To test the hypothesis that women with a history of major depression would show impaired regulation of brain 5-HT function during a period of dieting-induced tryptophan depletion.

Women with and without a history of major depression were placed on a daily 1000 kcal (approximately 4200 kJ) diet for three weeks. Before the diet and in the final week we measured fasting plasma tryptophan levels and the prolactin response to an intravenous tryptophan challenge.

Dieting lowered plasma tryptophan levels equivalently in women with and without a history of depression. In women without a history of depression, dieting also increased the prolactin response to tryptophan. This increase did not occur in women with a history of depression.

Women with a history of depression showed impaired regulation of brain 5-HT function in response to dieting.

Few studies have systematically investigated the psychiatric antecedents of accidental death.

To examine the patterns of psychiatric morbidities contributing to accidental death in three ethnic groups (Han, Ami and Atayal) in Taiwan.

A case–control psychological autopsy was conducted among 90 accidental deaths (randomly selected from a total of 413) and 180 living controls matched for age, gender, ethnicity and area of residence in Taiwan.

The risk of accidental death was significantly associated with alcohol use disorder and with other common mental disorders. When jointly considered, it was greatest when these two types of disorders co-existed, followed by common mental disorders alone. The risk of accidental death increased with the number of comorbid conditions.

The prevention of accidental death should be incorporated into preventive psychiatry, not just for alcohol use disorder, but also for all other common mental disorders.

Studies involving clinically recruited samples show that genetic liability to schizophrenia overlaps with that for several psychiatric disorders including bipolar disorder, major depression and, in a population study, anxiety disorder and negative symptoms in adolescence.

We examined whether, at a population level, association between schizophrenia liability and anxiety disorders continues into adulthood, for specific anxiety disorders and as a group. We explored in an epidemiologically based cohort the nature of adult psychopathology sharing liability to schizophrenia.

Schizophrenia polygenic risk scores (PRSs) were calculated for 590 European-descent individuals from the Christchurch Health and Development Study. Logistic regression was used to examine associations between schizophrenia PRS and four anxiety disorders (social phobia, specific phobia, panic disorder and generalised anxiety disorder), schizophrenia/schizophreniform disorder, manic/hypomanic episode, alcohol dependence, major depression, and – using linear regression – total number of anxiety disorders. A novel population-level association with hypomania was tested in a UK birth cohort (Avon Longitudinal Study of Parents and Children).

Schizophrenia PRS was associated with total number of anxiety disorders and with generalised anxiety disorder and panic disorder. We show a novel population-level association between schizophrenia PRS and manic/hypomanic episode.

The relationship between schizophrenia liability and anxiety disorders is not restricted to psychopathology in adolescence but is present in adulthood and specifically linked to generalised anxiety disorder and panic disorder. We suggest that the association between schizophrenia liability and hypomanic/manic episodes found in clinical samples may not be due to bias.

None.

Over the past 20 years the prevalence of child and adolescent mental disorders in high-income countries has not changed despite increased investment in mental health services. Insufficient contact with mental health services may be a contributing factor; however, it is not known what proportion of children have sufficient contact with health professionals to allow delivery of treatment meeting minimal clinical practice guidelines, or how long children experience symptoms prior to receiving treatment.

To investigate the level of mental healthcare received by Australian children from age 4 years to 14 years.

Trajectories of mental health symptoms were mapped using the Strengths and Difficulties Questionnaire. Health professional attendances and psychotropic medications dispensed were identified from linked national Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme records.

Four trajectories of mental health symptoms were identified (low, high-decreasing, moderate-increasing and high-increasing). Most children with mental health symptoms had few MBS mental health attendances, and only a minority received care meeting study criteria for minimally adequate treatment. Children in the high-increasing and moderate-increasing trajectories were more likely to access care, yet there was no evidence of improvement in symptoms.

It is important that children and adolescents with mental health problems receive treatment that meets minimal practice guidelines. Further research is needed to identify the quality of care currently provided to children with mental health difficulties and how clinicians can be best funded and supported to provide care meeting minimal practice guidelines.

None.

Professional boundaries between psychiatrists and other mental health professionals are difficult to set. Empirical evidence for the distribution of diagnostic and treatment tasks among professionals is lacking.

This study examines the ‘collective sense of the profession’ about the relationship between patient characteristics and the contribution of tasks by disciplines.

An adapted RAND appropriateness method was used. Eighty-six professionals judged 77 case descriptions of psychiatric patients on the contribution to diagnostic and treatment tasks of eight selected disciplines.

In two multi-level models the variance explained by the judges' characteristics was 3.7% for diagnostic tasks and 4.5% for treatment tasks. The variance explained by the patient characteristics was zero for diagnostic and 0.5% for treatment tasks. The variance explained by the indicated disciplines was 36.8% for diagnostic and 12.6% for treatment tasks.

The collective sense of the profession on the contribution of psychiatrists to mental healthcare is unambiguous but not related to patient characteristics. It seems to be based on an apriori ranking order of disciplines.