Although measures of psychopathology are designed for use in clinical populations, their meaning derives from comparison with normal populations.

To compare the distribution of scores on the Clinical Outcomes in Routine Evaluation — Outcome Measure (CORE-OM) from a general population sample with the distribution in an aggregated clinical sample to derive recommended cut-off points for determining clinical significance.

The CORE-OM general population sample was based on a weighted subsample of participants in the psychiatric morbidity follow-up survey who completed valid CORE-OM forms following their interview (effectiven=535).

Comparison of the CORE-OM general population sample with a clinical sample aggregated from previous studies (n=10761) yielded a cut-off score of 9.9 on the 0–40 scale of the CORE-OM. The CORE-OM was highly correlated (r=0.77) with the Clinical Interview Schedule — Revised, supporting convergent validity.

We recommend rounding the CORE-OM cut-off score to 10. However, cut-off scores must be used thoughtfully and adjusted to fit context and purpose.

A reduced risk of cancer has been noted among people with schizophrenia. Given that genetic causes have been proposed as an explanation of this finding, one would expect that the risk of cancer among first-degree relatives would be equally reduced.

To investigate the risk of cancer among the biological parents and full siblings of people receiving in-patient care for schizophrenia.

Linkage analysis was conducted between national population, psychiatric and cancer databases. Standardised incidence ratios for all cancer sites were calculated by comparing the incident rates among first-degree relatives with national incidence rates.

A reduced cancer risk was found across all groups examined. Among parents, whose numbers were adequately large, the findings reached statistical significance. For index cases and siblings – a markedly younger population – only a trend was elicited.

The genetic hypothesis – namely, the presence of a gene with the dual effect of reducing the cancer risk and disrupting neurodevelopment – is a plausible explanation for these findings.

Cognitive difficulties are prevalent in people with a diagnosis of schizophrenia and are associated with poor long-term functioning.

To evaluate the effectiveness of cognitive remediation therapy on cognitive difficulties experienced by people with schizophrenia.

Participants with a diagnosis of schizophrenia, a social behaviour problem and a cognitive difficulty (n=85) were randomised to 40 sessions of cognitive remediation or treatment as usual in a single-blind randomised controlled trial. Working memory, cognitive flexibility and planning, were measured at weeks 0, 14 and 40.

There were durable improvements in working memory (advantage 1.33 points, 95% CI 0.43–2.16, standardised effect size 0.34) as well as an indication of improvement in cognitive flexibility. Memory improvement predicted improvement in social functioning. Costs were lower in the cognitive remediation group following therapy but rose at follow-up. However, cost-effectiveness analyses showed that improvements in memory were achieved at little additional cost.

Cognitive remediation therapy is associated with durable improvements in memory, which in turn are associated with social functioning improvements in people with severe mental illness.

Long-term mortality and the risk factors for premature death among patients with schizophrenia living in rural communities are unknown.

To explore the 10-year mortality and its risk factors among patients with schizophrenia.

We used data from a 10-year prospective follow-up study (1994–2004) of mortality among people with schizophrenia, and death registration data for Xinjin County, Chengdu, China.

The mortality rate was 2228 per 100 000 person-years during follow-up. Both all-cause mortality and suicide rates were significantly greater in male than in female patients. Age at illness onset (>45 years), duration of illness (⩾10 years), age greater than 50 years, physical illness, inability to work, male gender, and never having received treatment were identified as independent predictors of increased mortality.

Higher mortality rates in male patients may contribute to the higher prevalence of schizophrenia in women compared with men in China. The findings of risk factors for mortality should be taken into account when developing interventions to improve outcomes among people with schizophrenia.

The neurocognitive basis of auditory verbal hallucinations is unclear.

To investigate whether people with a history of such hallucinations would misattribute their own speech as external and show differential activation in brain areas implicated in hallucinations compared with people without such hallucinations.

Participants underwent functional magnetic resonance imaging (fMRI) while listening to pre-recorded words. The source (self/non-self) and acoustic quality (undistorted/distorted) were varied across trials. Participants indicated whether the speech they heard was their own or that of another person. Twenty people with schizophrenia (auditory verbal hallucinations n=10, no hallucinations n=10) and healthy controls (n=11) were tested.

The hallucinator group made more external misattributions and showed altered activation in the superior temporal gyrus and anterior cingulate compared with both other groups.

The misidentification of self-generated speech in patients with auditory verbal hallucinations is associated with functional abnormalities in the anterior cingulate and left temporal cortex. This may be related to impairment in the explicit evaluation of ambiguous auditory verbal stimuli.

Substance use is implicated in the cause and course of psychosis.

To characterise substance and alcohol use in an epidemiologically representative treatment sample of people experiencing a first psychotic episode in south Cambridgeshire.

Current and lifetime substance use was recorded for 123 consecutive referrals to a specialist early intervention service. Substance use was compared with general population prevalence estimates from the British Crime Survey.

Substance use among people with first-episode psychosis was twice that of the general population and was more common in men than women. Cannabis abuse was reported in 51% of patients (n=62) and alcohol abuse in 43% (n=53). More than half (n=68, 55%) had used Class A drugs, and 38% (n=43) reported polysubstance abuse. Age at first use of cannabis, cocaine, ecstasy and amphetamine was significantly associated with age at first psychotic symptom.

Substance misuse is present in the majority of people with first-episode psychosis and has major implications for management. The association between age at first substance use and first psychotic symptoms has public health implications.

Surveys have found that otherwise well individuals report delusional experiences. Previous studies have shown an association between psychotic symptoms and exposure to trauma.

To explore the association between trauma and delusional experiences in a community sample.

Respondents (n = 10 641) were assessed for delusional experiences, exposure to various types of traumatic experiences and the presence of post-traumatic stress disorder (PTSD). The endorsement of delusional items was examined in people exposed to traumatic events who did or did not have PTSD.

Exposure to any traumatic event but without the development of PTSD was associated with increased endorsement of delusional experiences (relative risk 2.68, 95% CI 2.18–3.30) and there was a significant dose–response relationship between the number of types of traumatic events and endorsement of such experiences (χ2 =26.74, d.f. =2, P < 0.001). A diagnosis of PTSD further increased endorsement of delusional experiences (RR = 9.24, 95% CI 6.95–12.27). The association between PTSD and delusional experiences remained significant after adjusting for factors associated with psychotic symptoms.

Further investigation into the pathways between trauma, delusions and psychosis may provide insights into shared aetiological mechanisms underpinning these conditions.

Economic evaluation of the Dangerous and Severe Personality Disorder Programme is essential to ensure value for money. The collection of individual-level service use information is crucial to any such evaluation, but the best way to collect these data in secure facilities is unclear.

To develop a method for the collection of individual-level service use information for prisoners/patients in secure facilities.

Services provided within secure facilities were identified through examination of facility and policy literature, and discussions with managerial and clinical staff. Appropriate methods of measuring the quantities of services used were then explored and a new research tool capable of capturing all relevant services was developed and pilot tested.

The Secure Facilities Service Use Schedule (SF–SUS) records service use information from records and is capable of capturing data on the use of all individual-level services provided within a secure facility plus external services commonly accessed by occupants.

The SF–SUS is able to collect meaningful individual-level service use information for the economic evaluation of services provided within secure facilities.

Lack of insight has been observed in people with schizophrenia across cultures but assessment of insight must take into account prevailing illness models.

To determine whether culturally specific and Western biomedical interpretations of insight and psychosis can be reconciled.

Patients with schizophrenia (n=131) were assessed during their first contact with psychiatric services in Vellore, South India. Patients' explanatory models, psychopathology and insight were investigated using a standard schedule translated into Tamil.

Supernatural explanations of symptoms were frequent. Some insight dimensions were weakly associated (inversely) with severity of symptoms whereas preserved insight was associated with anxiety, help-seeking and perception of change. Willingness to attribute symptoms to disease, in others and in one's self, but not to supernatural forces was strongly associated with insight.

The relationship between insight, awareness of illness and other clinical variables is similar in South India to elsewhere. However, the assessment of insight might have failed to capture locally accepted explanatory frameworks. An inclusive conceptual model which emphasises help-seeking is recommended.

Anxiety disorders in older people are highly prevalent, yet there is little evidence to guide targeted prevention strategies.

To identify subgroups at increased risk of developing anxiety in later life.

Anxiety was measured with the Hospital Anxiety and Depression anxiety sub-scale in 1931 people aged 55–85 years followed over 3 years. Risk factors were identified that had a high combined attributable fraction, indicative of substantial health gains when the adverse effect of the risk factors can be contained.

Factors significantly associated with increased risk of developing anxiety included sub-threshold anxiety depression, two or more chronic illnesses, poor sense of mastery, poor self-rated health and low educational level.

The identified risk groups are small, thus providing prevention with a narrow focus, and health gains are likely to be more substantial than in groups not exposed to these risk factors. Nevertheless, more research is needed to produce evidence on target groups where prevention has optimal impacts.

Studies investigating mortality secondary to electroconvulsive therapy (ECT) are few.

To assess the risk of mortality from natural and unnatural causes among ECT recipients compared with other psychiatric in-patients over a 25-year period.

Register-based cohort study of all in-patients admitted to a psychiatric hospital from 1976 to 2000. Cause-specific mortality was analysed using log–linear Poisson regression.

There were 783 deceased in-patients who had received ECT compared with 5781 who had not. Patients who had received ECT had a lower overall mortality rate from natural causes (RR=0.82,95% CI 0.74–0.90) but a slightly higher suicide rate (RR=1.20,95% CI 0.99–1.47), especially within the first 7 days after the last ECT treatment (RR=4.82,95% CI 2.12–10.95).

Further investigation of the effect of ECT on physical health and the observed increased suicide rate immediately following treatment are needed, although the last finding is likely to result from selection bias.

No national data on lifetime prevalence and risk factors for DSM–IV psychiatric disorders are available in Mexico.

To present data on lifetime prevalence and projected lifetime risk, age at onset and demographic correlates of DSM–IV psychiatric disorders assessed in the Mexican National Comorbidity Survey.

The survey was based on a multistage area probability sample of non-institutionalised people aged 18–65 years in urban Mexico. The World Mental Health Survey version of the Composite International Diagnostic Interview was administered by lay interviewers.

Of those surveyed, 26.1% had experienced at least one psychiatric disorder in their life and 36.4% of Mexicans will eventually experience one of these disorders. Half of the population who present with a psychiatric disorder do so by the age of 21 and younger cohorts are at greater risk for most disorders.

Our results suggest an urgent need to re-evaluate the resources allocated for the detection and treatment of psychiatric illnesses in Mexico.

Comorbid anxiety is common in depressive disorders in both middle and late life, and it affects response to antidepressant treatment.

To examine whether anxiety symptoms predict acute and maintenance (2 years) treatment response in late-life depression.

Data were drawn from a randomised double-blind study of pharmacotherapy and interpersonal psychotherapy for patients age 70 years and over with major depression. Anxiety symptoms were measured using the Brief Symptom Inventory. Survival analysis tested the effect of pre-treatment anxiety on response and recurrence.

Patients with greater pre-treatment anxiety took longer to respond to treatment and had higher rates of recurrence. Actuarial recurrence rates were 29% (pharmacotherapy, lower anxiety), 58% (pharmacotherapy, higher anxiety), 54% (placebo, lower anxiety) and 81% (placebo, higher anxiety).

Improved identification and management of anxiety in late-life depression are needed to achieve response and stabilise recovery.

There is concern about the stigma of mental illness, but it is difficult to measure stigma consistently.

To develop a standardised instrument to measure the stigma of mental illness.

We used qualitative data from interviews with mental health service users to develop a pilot scale with 42 items. We recruited 193 service users in order to standardise the scale. Of these, 93 were asked to complete the questionnaire twice, 2 weeks apart, of whom 60 (65%) did so. Items with a test–retest reliability kappa coefficient of 0.4 or greater were retained and subjected to common factor analysis.

The final 28-item stigma scale has a three-factor structure: the first concerns discrimination, the second disclosure and the third potential positive aspects of mental illness. Stigma scale scores were negatively correlated with global self-esteem.

This self-report questionnaire, which can be completed in 5–10 min, may help us understand more about the role of stigma of psychiatric illness in research and clinical settings.

Many adults with Down's syndrome develop Alzheimer's dementia relatively early in their lives, but accurate clinical diagnosis remains difficult.

To develop a user-friendly observer-rated dementia screening questionnaire with strong psychometric properties for adults with intellectual disabilities.

We used qualitative methods to gather information from carers of people with Down's syndrome about the symptoms of dementia. This provided the items for the Dementia Screening Questionnaire for Individuals with Intellectual Disabilities (DSQIID), which we then tested for its psychometric properties.

The DSQIID was administered to carers of 193 adults with Down's syndrome, 117 of whom were examined by clinicians who confirmed a diagnosis of dementia for 49 according to modified ICD–10 criteria. We established that a total score of 20 provides maximum sensitivity (0.92) and optimum specificity (0.97) for screening. The DSQIID has sound internal consistency (α = 0.91) for all its 53 items, and good test–retest and interrater reliability. We established a good construct validity by dividing the items into four factors.

The DSQIID is a valid, reliable and user-friendly observer-rated questionnaire for screening for dementia among adults with Down's syndrome.