Little is known about the long-term outcome of schizophrenia that has its onset during childhood and early adolescence (early-onset schizophrenia, or EO-SZ). Whether or not EO-SZ is an aetiologically separate form of schizophrenia (SZ) is unresolved.

The study was a 14.8-year follow-up, using methods such as systematic sampling, evaluation of possible non-respondent bias, consensus best-estimate diagnoses (DSM–III–R) made independently in childhood and adulthood, measures of positive and negative dimensions, of non-psychotic behaviour disturbances (NPBD) and of developmental problems before the appearance of SZ.

There was high stability of EO-SZ (n=40) diagnoses (mean onset at 14.0 years) until adulthood (mean age at follow-up 28.8 years) but a lower stability of positive and negative schizophrenic dimensions. There was a poor outcome of EO-SZ, a strong over-representation of males but few gender differences, and no effect of age of onset on clinical features and outcome.

EO-SZ taken as a whole shows no qualitative differences to adult-onset SZ. However, a distinction through the onset of preschizophrenic developmental problems or NPBD might be a way to investigate heterogeneity within EO-SZ.

Differences and similarities were examined of suicide in Hong Kong, Beijing and Taiwan, the populations of which are all ethnically Chinese and share some characteristics of culture but which have very different social and political environments.

The official death statistics were used for the periods 1981–94 (Hong Kong and Taiwan) and 1987–94 (Beijing).

Hong Kong has experienced a slight increase in suicide rate, whereas a significant decline was observed in Taiwan and Beijing. The suicide rates in all three increased with age, the rate among the elderly being four to five times the average. A relatively low male:female ratio (1.0–1.9) was also observed. Jumping and hanging were the most common methods of suicide in Hong Kong and Taiwan, respectively. Hong Kong had the most years of potential life lost.

Despite the remarkable economic growth in all three places during the study period, the differences in suicide trends suggest that the social and political environments may be more important than the economic environment in suicide. In Hong Kong the suicide rate is likely to remain high or even to increase.

In previously published papers from the Nottingham Study of Neurotic Disorder a short treatment package of cognitive–behaviour therapy was no more effective than placebo drug treatment after 10 weeks' assessment in a cohort of 210 patients with neurotic disorders. This paper examines the outcome over two years of the patients treated by cognitive–behaviour therapy separated into two therapist groups, those who were competent in administering treatment and those of uncertain competence.

The therapists (mainly community psychiatric nurses) of 70 patients with an original DSM–III diagnosis of either dysthymic, panic or generalised anxiety disorder were separated into two groups on the basis of their perceived competence by their supervisor (DK). Ratings of psychopathology were made at regular intervals over two years by assessors blind to knowledge of treatment or therapist.

The patients treated by competent therapists (n=30) generally showed greater improvement than those allocated to therapists of uncertain competence (n=40), mainly with respect to depressive symptoms, and the difference persisted over two years, long after the cognitive–behaviour therapy had been completed.

Cognitive–behaviour therapy given by competent therapists over a 10 week period is of lasting benefit in neurotic disorder.

Maternal stress during pregnancy has been suggested as a risk factor for schizophrenia We tested the hypothesis that being the child of an unwanted pregnancy would be associated with later schizophrenia.

Data were collected prospectively in the Northern Finland 1966 Birth Cohort of 11 017 individuals. In the sixth or seventh month of pregnancy mothers were asked whether the pregnancy was wanted, mistimed but wanted or unwanted. Schizophrenia diagnoses in the cohort members were obtained from the Finnish Hospital Discharge Register.

Seventy-six cases of DSM–III–R schizophrenia were identified in the whole cohort between the ages of 16 and 28 years; a cumulative incidence of 0.7%, compared with 1.5% for those bom from unwanted pregnancies. The risk of later schizophrenia among unwanted children was raised compared with wanted or mistimed children, even after adjustment for confounding by sociodemographic, pregnancy and perinatal variables (OR 2.4; 95% CI 1.2–4.8).

The results suggest that unwantedness may operate either directly as a psychosocial stress during development making children more liable to schizophrenia or it may be a marker for behaviours associated with risk in either the mother or the child.

An epidemiological survey of childhood autism as defined in ICD–10 Research Criteria was conducted in the northern part of Yokohama, Japan.

The routine health checkup for 18-month-old children served as the initial mass-screening, and all facilities which provide child care services function to detect all cases with childhood autism and refer them to the Yokohama Rehabilitation Centre. Cumulative incidence of childhood autism up to 5 years of age among the birth cohort of 1988, and prevalence on 1 January 1994, among residents born in 1988 were estimated.

Cumulative incidence and prevalence were 16.2 per 10 000 and 21.1 per 10 000, respectively. Children with high-functioning autism who had IQs of 70 and over constituted approximately half of all the children with childhood autism.

It was confirmed through better detection of high-functioning cases that childhood autism in Japan is more common than formerly estimated.

In patients with bipolar disorder, admissions for manic and depressive episodes frequently display a seasonal pattern. We examined this variation and compared the patterns with the seasonal admission rates for schizophrenia.

Patients with bipolar disorder or schizophrenia were identified from the Finnish Hospital Discharge Register of in-patient admissions to all psychiatric hospitals during the years 1969–91. They were included in the analysis if the first admission had occurred before 30 years of age. A total of 295 bipolar patients were found and a sample of 295 schizophrenic patients was randomly selected for comparison.

There was no seasonal variation among all hospital admissions for bipolar disorder or schizophrenia However, the first admission for a depressive compared with a manic episode of bipolar disorder occurred significantly more often in the autumn (33% v. 21% respectively). The peak difference occurred during the week after the autumnal equinox in September.

Our findings suggest that there is no seasonal variation in bipolar disorder, although in some patients the clinical course might be influenced by the autumn, as far as the likelihood of a first admission for depression is concerned.

Reports on erotomania frequently include schizophrenic patients with secondary erotomania, but there are no reports on the prevalence and characteristics of erotomanic symptoms in schizophrenic patients.

A structured item on erotomanic delusions was added to the Chinese version of the Scale for Assessment of Positive Symptoms and administered to 448 randomly selected schizophrenic patients on admission to four psychiatric hospitals in China.

Erotomanic symptoms were identified in 9.4% of the patients (42/448; 95% CI 6.9–12.4%); 4.5% (20/448; CI 2.8–6.8%) had erotomanic ideation and 4.9% (22/448; CI 3.1–7.4%) had fixed erotomanic delusions. Compared with patients without erotomanic symptoms, erotomanic patients were more likely to be male and unmarried, and they had a higher level of education, more severe grandiose delusions, more prominent hostility, and less severe negative symptoms.

The relatively common occurrence of erotomanic symptoms in Chinese schizophrenic patients may be related to the indirect manner of expressing sexual interest in Chinese culture and, thus, be an example of the cultural moulding of psychiatric symptoms.

The aim of this study was to verify the presence and stability across life of the positive/negative distinction in early-onset schizophrenia (EO-SZ) through a longitudinal factor analysis of the schizophrenic dimensions, and to identify the factors predicting several indices of long-term outcome for EO-SZ.

Forty children consecutively referred for DSM–III–R schizophrenia (SZ) in a specific catchment area comprised the sample.

Across a 14.8-year follow-up, longitudinal factor analysis identified two separate factors corresponding to the positive and negative symptom dimensions. We also observed that: the GAS rated over the last three years of adult illness and the severity of negative symptoms during the stabilised interepisode intervals in adulthood were the indices of adult outcome that were most easily predicted; and the best childhood predictors of adult outcome were premorbid functioning and severity of positive and negative symptoms during acute episodes.

The presence of premorbid non-psychotic behaviour disturbances (NPBD) and premorbid developmental problems was not related to severity of outcome, in contrast to the former variables.

The aim of this study was to determine the association between physical and psychiatric morbidity among general practice patients and to explore the influence of possible intervening variables.

Physical and psychiatric morbidity in 1620 consecutive patients attending their general practitioner (GP) was assessed using a two-stage design. Ninety-four per cent of the patients (n=1523) were successfully screened using the General Health Questionnaire (GHQ–12); 428 of the 602 patients (71%) eligible for the second stage were interviewed using the Composite International Diagnostic Instrument adapted for use in primary health care (CIDI–PHC), the Brief Disability Questionnaire (BDQ) and the Groningen Social Disability Schedule (GSDS) to assess psychiatric, physical and social status. Assessments of physical and psychiatric morbidity were also obtained from the patients' GPs.

There was a significant association between physical and psychiatric morbidity, although patients with four symptoms or less of physical illness were no more likely to be psychiatric cases than those with none. The association was accounted for by patients at the severe end of the physical continuum with five or more medically explained somatic symptoms: these were twice as likely to be psychiatric cases as those with no such symptoms. Female gender, social disability and physical disability were all significantly more likely to be associated with psychiatric disorder, whether measured by GP or research interview; and these relationships remained after the data were corrected for age differences.

Patients in general practice with moderate to severe physical morbidity are at increased risk of developing psychiatric illness, and when medical illness is present, psychiatric symptoms are more severe. As physical and psychiatric comorbidity is relatively common in general practice, the specific needs of these patients should receive greater attention.

A long-term outcome study of DSM–III–R panic disorder included the Present State Examination (PSE) at baseline and follow up five to six years later.

PSE test–retest and individual within-patient change scores on various PSE syndromes were assessed for consistency with either a categorical view of panic disorder as a stable clinical entity or panic disorder as one facet only of a ‘general neurotic syndrome’.

PSE profile at baseline was virtually identical with that at follow up. Few patients had ‘changed’ in PSE syndrome diagnosis after five to six years.

These data, although not conclusive, are supportive of the concept of DSM–III–R panic disorder as a stable clinical entity and are correspondingly difficult to reconcile with the view that panic disorder is but one facet only of a general neurotic syndrome.

The high rate of schizophrenia among the second-generation African–Caribbean population in Britain has prompted much concern and speculation. Sugarman and Craufurd have reported that the morbid risk in the siblings of second-generation African–Caribbean schizophrenic patients was unusually high compared with that of the siblings of White patients.

We sought to replicate these findings by comparing the morbid risk for schizophrenia in the first-degree relatives of 111 White and 73 African–Caribbean psychotic probands. The latter comprised 35 first-generation (bom in the Caribbean) and 38 second-generation (born in Britain) probands.

The morbid risk for schizophrenia was similar for the parents and siblings of White and first-generation African–Caribbean patients, and for the parents of the second-generation African–Caribbean probands. However, the siblings of second-generation African–Caribbean psychotic probands had a morbid risk for schizophrenia that was seven times that of their White counterparts (P=0.007); similarly, the siblings of second-generation African–Caribbean schizophrenic probands had a morbid risk for schizophrenia that was four times that of their White counterparts (P=0.05).

These findings replicate those of the earlier report of Sugarman and Craufurd, and suggest either that the second-generation African–Caribbean population in Britain is particularly vulnerable to some environmental risk factors for schizophrenia, or that some environmental factors act selectively on this population in Britain.

Diagnostic classes (derived from catego) can be correlated with regional brain metabolism in patients with major psychiatric disorders.

Seventeen patients with schizophrenia, 15 with mania, 10 with depression and 10 healthy volunteers were examined with positron emission tomography (PET) and 18F-labelled fluorodeoxyglucose, as a marker for glucose metabolism. The number of possible comparisons of regions of interest was reduced by principal-components analysis, and differences in factor scores were determined between diagnostic groups.

Four independent factors, representing distributed brain systems, emerged: an anterior–posterior (1), a left–right temporal (2), a temporofrontal (3), and a mediofrontal (4) system, of which (1), (2) and (3) were abnormal in schizophrenia, (1) and (2) in mania, and (1) in depression.

Abnormal patterns of metabolism could be detected, in decreasing order, in schizophrenia, mania and depression. Some of these abnormalities are likely to be due to medication, but others will be associated with structural or functional abnormalities of the frontolimbic system in the diagnostic groups.

Reports of an association between restriction fragment length polymorphisms (RFLPs) at the dopamine D2 receptor (DRD2) locus and alcoholism have suggested involvement of that locus in the aetiology of alcoholism.

Sib pair linkage analyses were conducted in families multiply affected by alcoholism, using both the Taql ‘A’ RFLP and a microsatellite repeat polymorphism at the DRD2 locus.

The ‘Identical By Descent’ analysis provided significant evidence of an effect of the DRD2 locus on the liability to develop heavy drinking (P<0.0016) and Research Diagnostic Criteria alcoholism (P<0.0003) in the first sample of families studied. However, this result was explicable by the segregation of alleles in a single large sibship, and it was not replicated in a second sample of families.

The results do not support linkage between the DRD2 locus and alcoholism in most of the families studied. It remains possible that this locus influences the predisposition to alcoholism in some families.

Despite 30 years of research, some surprisingly fundamental gaps remain in our understanding of schizophrenic input dysfunctions.

In a provisional test of a ‘hyperattention’ hypothesis, schizophrenic patients and control subjects performed a behavioural test that was adapted from a paradigm originally developed for characterising vigilance or sustained attention in animals. On this computerised operant testing procedure, subjects discriminated between signals of various salience and non-signal presentations. Hits and correct rejections resulted in monetary rewards while misses and false alarms entailed monetary costs.

Data from in-patients with schizophrenia and age, education and gender-matched controls support hypotheses not only about hyperattentional dysfunctions in schizophrenia with respect to overall signal detectability but also in terms of resistance to the vigilance decrement that normally occurs over trials.

The theoretical importance of impairments of this sort are discussed with respect to the cognitive and perceptual consequences of hypervigilance and ‘input dysfunction’.

Demographic data, family history, psychopathological features, comorbidity and course of obsessive–compulsive disorder (OCD) are investigated and data generated to support the possible existence of two subgroups with gender-related differences of a broader nature.

Two hundred and sixty-three OCD patients, consecutive admissions to the Institute of Psychiatry, University of Pisa over a period of 5 years, not excluding those with comorbid Axis I and Axis II conditions, were studied. Patients were evaluated with a specifically designed semi-structured OCD interview.

We found a significantly greater history of perinatal trauma in men who also had an earlier onset, greater likelihood of never having been married and a higher frequency of such symptoms as sexual, exactness and symmetry obsessions and odd rituals; by contrast, women suffered a later onset of the disorder, were more likely to be married, had higher rates of associated panic attacks after the onset of OCD and a higher frequency of aggressive obsessions at the onset of their illness, and were less frequently associated with bipolar disorders.

Pathophysiological mechanisms in OCD seem to differ by gender. Perinatal trauma might predispose to earlier onset in men, whereas in women there is a close association between OCD and panic disorder.

Non-institutionalised patients treated with antidepressants have been shown to have indicators of a generalised vulnerability, such as high rates of health service use and excessive prescription drug use. Therefore, mortality in this patient group is of interest.

All first-incidence antidepressant users in a defined population during a five-year period were identified. Their total mortality during a nine-year follow-up was analysed. Cox proportional hazards regression was used to analyse total mortality, and mortality in cardiovascular disease, controlling for baseline chronic medical disease.

Antidepressant treatment at the index date was a statistically significant predictor for increased long-term mortality in the over-65s, even when controlling for pre-existing chronic medical disease. Baseline ischaemic heart disease and concurrent antidepressant treatment significantly predicted mortality from cardiovascular causes.

Prescribed antidepressant treatment identifies patients who are at risk of increased mortality. For the physician in ambulatory care, knowledge of a patient's antidepressant treatment history may be a valuable tool in managing patient care.

Very little is known about the adequacy and safety of maternal parenting behaviour in the context of severe postpartum psychiatric illness, about specific difficulties in relation to different types of mental illness, or about the potential for improvement over the course of an episode of illness. The Bethlem Mother–Infant Interaction Scale (BMIS) was thus developed as an aid to assessment on a specialist psychiatric Mother and Baby Unit.

Nurses' ratings of the quality of mother–infant interaction using the BMIS were collected throughout the consecutive admissions of 78 in-patient pairs. The ratings from three points during the admissions were examined according to the mothers' RDC diagnoses and also according to the eventual outcome of the admission.

The nature of the mother's illness was associated with the quality of her infant care-taking using the BMIS ratings. The nurses' ratings during the second week of admission together with maternal psychiatric diagnosis, were strongly predictive of the eventual outcome of the admission. The majority of women who were separated from their infants on discharge or who required formal supervision belonged to the schizophrenic group.

The results suggest that the BMIS can be used in this in-patient setting to aid clinical decisions about the safety of parenting by individual mothers with severe mental illness in the postpartum period.