Highlights of this issue

MENTAL INCAPACITY

Two papers examining mental incapacity among psychiatric in-patients are presented in the Journal this month – one investigation focuses on assessment reliability (Cairns et al, ) and one on the prevalence and predictors of incapacity (Cairns et al, ). The authors find that the MacArthur Competence Assessment Tool for Treatment (MacCAT–T) can be used reliably to assess capacity, particularly when the instrument is used in conjunction with clinical interview. They also find that mental incapacity is common among psychiatric in-patients; 43.8% of the sample lacked treatment-related decision capacity. Among the socio-demographic and clinical variables considered, having poor insight and either a psychotic illness or bipolar disorder were factors found to predict incapacity.

COMMUNITY-BASED INTERVENTION TRIALS IN SCHIZOPHRENIA

Since family members provide much of the non-institutional care required by those with schizophrenia in China, Li & Arthur () have targeted families in their controlled trial of an education intervention conducted in Beijing. They report improvements in illness knowledge, symptom scores and levels of functioning for those in the experimental group. In Scotland, providing free fruit and vegetables for a period of 6 months led to a dietary improvement for patients with a diagnosis of schizophrenia living in the community (McCreadie et al, ). The improvement was not, however, sustained at 12 months beyond the trial and no improvements were seen in the biological measures taken.

SCHIZOPHRENIA – INCIDENCE OF CANCER AND PREVALENCE OF CANNABIS MISUSE

Although it has long been suggested that schizophrenia might protect against cancer, Goldacre et al () find no evidence of a reduced risk for cancer overall or for most individual cancers in their epidemiological study. A deficit of skin and rectal cancer is reported for those with schizophrenia and an increased rate of oesophageal malignancy. In a systematic review of cannabis use and misuse among those with psychosis, Green et al () conclude that prevalence estimates vary widely between studies. Mean prevalence estimates based on treated sample studies are reported for current use (23.0%), current misuse (11.3%), 12-month use (29.2%), 12-month misuse (18.8%), lifetime use (42.1%) and lifetime misuse (22.5%).

BRAIN FINDINGS IN OCD AND PATHOLOGICAL LIARS

Dale et al () find that circulating levels of anti-basal ganglia antibodies were elevated in children with obsessive–compulsive disorder (OCD) compared with controls. They conclude that some cases of OCD in children may be due to post-streptococcal autoimmunity. Compared to an antisocial and a normal control group, 12 ‘liars’ were found to have increased prefrontal white matter volumes and reductions in prefrontal grey/white matter ratios on structural magnetic resonance imaging (Yang et al, ).

VENLAFAXINE IN PANIC DISORDER AND IN-PATIENT TREATMENT FOR OPIATE DEPENDENCE

Venlafaxine was shown to be an effective treatment for panic disorder in a double-blind, placebo-controlled study by Bradwejn et al (). Although it did not significantly reduce the number of out-patients free of full-symptom panic attacks when compared with placebo, significant improvements were seen in mean panic attack frequency, the proportion free from limited-symptom attacks, response rates, remission rates and the level of anticipatory symptoms experienced. Long-term outcome following in-patient treatment aimed at opiate abstinence is examined by Smyth et al (). Abstinence at 2- to 3-year follow-up had been achieved by 23% of those interviewed in the study and was found to be positively associated with completion of in-patient treatment and attendance at out-patient follow-up, and negatively associated with a family history of substance misuse.

THE BRIEF PSYCHIATRIC RATING SCALE – WHAT DO SCORES MEAN?

In a study by Leucht et al (), BPRS scores were linked to Clinical Global Impression ratings in a sample of patients with acute schizophrenia who had previously participated in drug trials. The authors intend their results to enhance clinical interpretation of BPRS scores, which are used widely in treatment trials.

ATTACHMENT AND ABNORMAL ILLNESS BEHAVIOUR BY PROXY

The vast majority of mothers with abnormal illness behaviour by proxy (90%) were rated as insecure in terms of their own childhood attachments in a study by Adshead & Bluglass (). A history of childhood trauma was reported by 47% and high levels of unresolved distress were found in relation to past trauma or loss.