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Management Training for Psychiatrists. Edited by D. Bhugra and A. Burns. (Pp. 260; illustrated; £15.00.) Royal College of Psychiatrists: London. 1992

because the patients in developing countries are actually less impaired. The sixth assessment which showed no difference between the two groups was the amount of time spent in psychotic episodes. The reasons for these differences in outcome between developing and developed countries are unknown, but the evidence from this study was sufficient to reject the hypothesis that the inclusion of atypical transient psychotic illnesses among the schizophrenic cases in the developing countries could explain the better course and outcome in these areas. It is concluded that some factor related to cultural environment is responsible for the different outcomes, but the nature of this remains obscure. Although many of the findings regarding predictions of outcome are in keeping with previous knowledge, one was not, and will be of interest to many. This was the fact that 'street drug' use was a predictor of poor outcome. It is stated that the initial expectation of those involved in the study had been that drug use might be a triggering factor in the precipitation of relatively benign schizophreniform illnesses. The result was the reverse of this expectation. This finding must parallel the clinical experience of many practising psychiatrists, and highlights an area deserving of further investigation.