We investigated the effects of zuclopenthixol on aggressive behaviour in patients with intellectual disabilities by randomly withdrawing it after a 6-week period of open treatment. Of the 49 patients responding to the treatment, 39 took part in a randomised withdrawal trial. The placebo subgroup (n=20) showed more aggressive behaviour as indicated by outcomes observed by external raters on the Modified Overt Aggression Scale than did the continuing subgroup (n=19). The results indicate that discontinuation of zuclopenthixolin this population leads to an increase in aggressive behaviour.

Background Little is currently known about functioning and impairment during adulthood associated with the course of personality disorders.

Aims To investigate the association of personality disorder stability from adolescence through middle adulthood with measures of global functioning and impairment, using prospective epidemiological data.

Method A community-based sample of 658 individuals was interviewed at mean ages 14, 16, 22 and 33 years.

Results Individuals with persistent personality disorder had markedly poorer functioning and greater impairment at mean age 33 years than did those who had never been identified as having such disorder or who had a personality disorder that was in remission, after co-occurring Axis I disorders at age 33 years were taken into account. Remitted disorder was associated with mild long-term impairment. Adult-onset personality disorders, however, were also associated with significant impairment.

Conclusions Persistent and adult-onset personality disorders are associated with functional impairment among adults in the community. These effects are independent of co-occurring Axis I disorders.

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

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

Method 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.

Results 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.

Conclusions 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.

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

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

Method 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.

Results 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.

Conclusions 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.

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

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

Method 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.

Results 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).

Conclusions 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.

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

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

Method 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.

Results 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 (=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.

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

Cerebral ventricular enlargement and reduced cortical volume are correlates of chronic schizophrenia. We investigated whether genetic risk for psychosisis related to differences in foetal brain development as measured by prenatal ultrasonography. Routine foetal cerebral measures at 19–23 weeks of gestation were compared between the offspring of 35 women with a history of psychosis and 105 control women matched for gestational age. Overall, no significant differences were found between the high-risk and control groups. There was a non-significant trend in the adjusted analysis towards increased lateral ventricular width in the offspring of mothers with psychosis.