Prison mental health inreach teams have been established nationwide in England and Wales over the past 3 years to identify and treat mental disorders among prisoners. This paper summarises the policy content and what has been achieved thus far, and poses challenges that these teams face if they are to become a clear and effective component in the overall system of forensic mental healthcare.

Background Chinese herbal medicine has been used to treat millions of people with schizophrenia for thousands of years.

Aims To evaluate Chinese herbal medicine as a treatmentfor schizophrenia.

Method A systematic review of randomised controlled trials (RCTs).

Results Seven trials were included. Most studies evaluated Chinese herbal medicine in combination with Western antipsychotic drugs; in these trials results tended to favour combination treatment compared with antipsychotic alone (Clinical Global Impression `not improved/worse' n=123, RR=0.19, 95% CI 0.1-0.6, NNT=6,95% CI 5-11; n=109, Brief Psychiatric Rating Scale `not improved/worse' RR=0.78,95% CI 0.5-1.2; n=109, Scale for the Assessment of Negative Symptoms `not improved/worse' RR=0.87,95% CI 0.7-1.2; n=109, Scale for the Assessment of Positive Symptoms `not improved/worse' RR=0.69,95% CI 0.5-1.0, NNT=6 95% CI 4-162). Medium-term study attrition was significantlyless for people allocated the herbal/antipsychotic mix (n=897, four RCTs, RR=0.34,95% CI 0.2-0.7, NNT=23,95% CI18-43).

Conclusions Results suggest that combining Chinese herbal medicine with antipsychotics is beneficial.

Background Gulf War veterans reported multiple psychological symptoms immediately after the war; the temporal course of these symptoms remains unclear.

Aims To assess the prevalence of warera onset mental disorders in US veterans deployed to the Gulf War and in non-deployed veterans 10 years after the war.

Method Mental disorders were diagnosed using structured clinical interviews. Standard questionnaires assessed symptoms and quality of life.

Results Gulf War-era onset mental disorders were more prevalent in deployed veterans (18.1%, n=1061) compared with non-deployed veterans (8.9%, n=1128). The prevalence of depression and anxiety declined 10 years later in both groups, but remained higher in the deployed group, who also reported more symptoms and a lower quality of life than the non-deployed group. Remission of depression may be related to the presence of comorbid psychiatric disorders and level of education. Remission of anxiety was related to treatment with medication.

Conclusions Gulf War deployment was associated with an increased prevalence of mental disorders, psychological symptoms and a lower quality of life beginning during the war and persisting at a lower rate 10 years later.

Background There is growing research interest in the influence of the built environment on mental disorders.

Aims To estimate the variation in the prevalence of common mental disorders attributable to individuals and the built environment of geographical sectors where they live.

Method A sample of 3870 adults (response rate 90%) clustered in 248 geographical sectors participated in a household cross-sectional survey in Santiago, Chile. Independently rated contextual measures of the built environment were obtained. The Clinical Interview Schedule was used to estimate the prevalence of common mental disorders.

Results There was a significant association between the quality of the built environment of small geographical sectors and the presence of common mental disorders among its residents. The better the quality of the built environment, the lower the scores for psychiatric symptoms; however, only a small proportion of the variation in common mental disorder existed at sector level, after adjusting for individual factors.

Conclusions Findings from our study, using a contextual assessment of the quality of the built environment and multilevel modelling in the analysis, suggest these associations may be more marked in non-Western settings with more homogeneous geographical sectors.

Background Little is known about the epidemiology of adult attention-deficit hyperactivity disorder (ADHD).

Aims To estimate the prevalence and correlates of DSM–IV adult ADHD in the World Health Organization World Mental Health Survey Initiative.

Method An ADHD screen was administered to respondents aged 18-44 years in ten countries in the Americas, Europe and the Middle East (n=11422). Masked clinical reappraisal interviews were administered to 154 US respondents to calibrate the screen. Multiple imputation was used to estimate prevalence and correlates based on the assumption of cross-national calibration comparability.

Results Estimates of ADHD prevalence averaged 3.4% (range 1.2–7.3%), with lower prevalence in lower-income countries (1.9%) compared with higher-income countries (4.2%). Adult ADHD often co-occurs with other DSM–IV disorders and is associated with considerable role disability. Few cases are treated for ADHD, but in many cases treatment is given for comorbid disorders.

Conclusions Adult ADHD should be considered more seriously in future epidemiological and clinical studies than is currently the case.

Background Impulsive aggression in adulthood is associated with disturbances in serotonergic function. In contrast, research examining this association in childhood has yielded inconsistent results.

Aims The current study examined the prospective relationship between serotonergic function measured in childhood and the later emergence of antisocial personality disorder.

Method Hormonal response to fenfluramine, an index of serotonergic function, was assessed in 58 children with attention-deficit hyperactivity disorder between 1990 and 1997 when they were aged 7-11 years. Approximately 9 years later these individuals were evaluated for antisocial personality disorder.

Results Lower serotonergic responsivity assessed in childhood predicted the development of antisocial personality disorder (t (56)=2.25, P=0.028).

Conclusions These results provide a critical link between the child and adult literature on the covariation of impulsive aggression and serotonergic function and suggest a potential explanation for inconsistencies in the childhood literature.

The human brain has a remarkable capacity for plasticity, but does it have the capacity for repair and/or regeneration? On the basis of controversial new evidence we speculate that the answer may be `yes', and suggest that clinicians should therefore approach cognitive impairment and dementia with a new, cautious optimism.

Background Use of bibliometric assessments of research quality is growing worldwide. So far, a narrow range of metrics have been applied across the whole of biomedical research. Without specific sets of metrics, appropriate to each sub-field of research, biased assessments of research excellence are possible.

Aims To discuss the measures used to evaluate the merits of psychiatric biomedical research, and to propose a new approach using a multidimensional selection of metrics appropriate to each particular field of medical research.

Method Three steps: (a) a definition of scientific ‘domains’, (b) translating these into ‘filters’ to identify publications from bibliometric databases, leading to (c) the creation of standardised measures of merit.

Results We propose using: (a) established metrics such as impact factors and citation indices, (b) new derived measures such as the ‘worldscale’ score, and (c) new indicators based on journal peer esteem, impact on clinical practice, medical education and health policy.

Conclusions No single index or metric can be used as a fair rating to compare nations, universities, research groups, or individual investigators across biomedical science. Rather, we propose using a multidimensional profile composed of a carefully selected array of such metrics.

Background Children looked after by local authorities are at higher risk of poor psychosocial outcomes than children living in private households, but nationally representative and random samples of the two groups of children have not previously been compared.

Aims To find explanations for the increased prevalence of psychiatric disorder in children looked after by local authorities.

Method We examined socio-demographic characteristics and psychopathology by type of placement among children looked after in Britain by local authorities (n=1453), and compared these children with deprived and non-deprived children living in private households (n=10 428).

Results Children looked after by local authorities had higher levels of psychopathology, educational difficulties and neurodevelopmental disorders, and ‘looked after’ status was independently associated with nearly all types of psychiatric disorder after adjusting for these educational and physical factors. The prevalence of psychiatric disorder was particularly high among those living in residential care and with many recent changes of placement.

Conclusions Our findings indicate a need for greater support of this vulnerable group of children.

Background Measurement of health-related quality of life (HRQoL) with generic preference-based instruments enables comparisons of severity across different conditions and treatments. This is necessary for rational public health policy.

Aims To measure HRQoL decrement and loss of quality-adjusted life-years (QALYs) associated with pure and comorbid forms of depressive and anxiety disorders and alcohol dependence.

Method A general population survey was conducted of Finns aged 30 years and over. Psychiatric disorders were diagnosed with the Composite International Diagnostic Interview and HRQoL was measured with the 15D and EQ–5D questionnaires.

Results Dysthymia, generalised anxiety disorder and social phobia were associated with the largest loss of HRQoL on the individual level before and after adjusting for somatic and psychiatric comorbidity. On the population level, depressive disorders accounted for 55%, anxiety disorders 30%, and alcohol dependence for 15% of QALY loss identified in this study.

Conclusions Chronic anxiety disorders and dysthymia are associated with poorer HRQoL than previously thought.

Background Burden on the relatives of patients with schizophrenia may be influenced not only by patient and caregiver characteristics, but also by differences in mental health service provision.

Aims To analyse whether family burden is affected by national differences in the provision of mental health services.

Method Patients with schizophrenia and their key relatives were examined in Germany (n=333) and Britain (n=170). Differences in family burden in both countries were analysed with regression models controlling for patient and caregiver characteristics.

Results Family burden was associated with patients’symptoms, male gender, unemployment and marital status, as well as caregivers’coping abilities, patient contact and being a patient’s parent. However, even when these attributes were controlled for, British caregivers reported more burden than German caregivers.

Conclusions National differences in family burden may be related to different healthcare systems in Germany and Britain. Support for patients with schizophrenia may be shifted from the professional to the informal healthcare sector more in Britain than in Germany.