Showing papers in "British Journal of Psychiatry in 2006"

Brain volume in first-episode schizophrenia: systematic review and meta-analysis of magnetic resonance imaging studies.

Abstract: Background Studies of people with schizophrenia assessed using magnetic resonance imaging (MRI) usually include patients with first-episode and chronic disease, yet brain abnormalities may be limited to those with chronic schizophrenia. Aims To determine whether patients with a first episode of schizophrenia have characteristic brain abnormalities. Method Systematic review and meta-analysis of 66 papers comparing brain volume in patients with a first psychotic episode with volume in healthy controls. Results A total of 52 cross-sectional studies included 1424 patients with a first psychotic episode; 16 longitudinal studies included 465 such patients. Meta-analysis suggests that whole brain and hippocampal volume are reduced (both P <0.0001) and that ventricular volume is increased ( P <0.0001) in these patients relative to healthy controls. Conclusions Average volumetric changes are close to the limit of detection by MRI methods. It remains to be determined whether schizophrenia is a neurodegenerative process that begins at about the time of symptom onset, or whether it is better characterised as a neurodevelopmental process that produces abnormal brain volumes at an early age.

Prevalence and correlates of personality disorder in Great Britain.

Abstract: Background Epidemiological data on personality disorders, comorbidity and associated use of services are essential for health service policy. Aims To measure the prevalence and correlates of personality disorder in a representative community sample. Method The Structured Clinical Interview for DSM–IVAxis II disorders was used to measure personality disorder in 626 persons aged 16–74 years in households in England, Scotland and Wales, in a two-phase survey. Results The weighted prevalence of personality disorder was 4.4% (95% CI 2.9–6.7).Rates were highest among men, separated and unemployed participants in urban locations. High use of healthcare services was confounded by comorbid mental disorder and substance misuse. Cluster B disorders were associated with early institutional care and criminality. Conclusions Personality disorder is common in the community, especially in urban areas. Services are normally restricted to symptomatic, help-seeking individuals, but a vulnerable group with cluster B disorders can be identified early, are in care during childhood and enter the criminal justice system when young. This suggests the need for preventive interventions at the public mental health level.

Cognitive-behavioural therapy for severe and recurrent bipolar disorders: randomised controlled trial.

Abstract: Background Efficacy trials suggest that structured psychological therapies may significantly reduce recurrence rates of major mood episodes in individuals with bipolar disorders. Aims To compare the effectiveness of treatment as usual with an additional 22 sessions of cognitive–behavioural therapy (CBT). Method We undertook a multicentre, pragmatic, randomised controlled treatment trial ( n =253). Patients were assessed every 8 weeks for18 months. Results More than half of the patients had a recurrence by 18 months, with no significant differences between groups (hazard ratio=1.05; 95% CI 0.74–1.50). Post hoc analysis demonstrated a significant interaction ( P =0.04) such that adjunctive CBT was significantly more effective than treatment as usual in those with fewer than 12 previous episodes, but less effective in those with more episodes. Conclusions People with bipolar disorder and comparatively fewer previous mood episodes may benefit from CBT. However, such cases form the minority of those receiving mental healthcare.

Personality disorder and the outcome of depression: meta-analysis of published studies.

Abstract: Background There is conflicting evidence about the influence of personality disorder on outcome in depressive disorders. Aims Meta-analysis of studies in which a categorical assessment of personality disorder or no personality disorder was made in people with depressive disorders, and categorical outcome (recovered/not recovered) also determined. Method Systematic electronic search of the literature for relevant publications. Hand searches of Journal of Affective Disorders and recent reviews, with subsequent meta-analysis of selected studies. Results Comorbid personality disorder with depression was associated with a doubling of the risk of a poor outcome for depression compared with no personality disorder (random effects model OR=2.18, 95% CI 1.70-2.80), a robust finding maintained with only Hamilton-type depression criteria at outcome (OR=2.20, 95% CI 1.61-3.01). All treatments apart from electroconvulsive therapy (ECT) showed this poor outcome, and the ECT group was small. Conclusions Combined depression and personality disorder is associated with a poorer outcome than depression alone.

Attention to the eyes and fear-recognition deficits in child psychopathy

Abstract: The ability to recognise fear is impaired in people with damage to the amygdala and, interestingly, in adult psychopathy. Here we confirm that deficits in recognising fear exist in children with psychopathic traits. We show for the first time that, as with patients with amygdala damage, this deficit can be temporarily corrected by simply asking them to focus on the eyes of other people. These data support models of psychopathy that emphasise specific dysfunction of the amygdala and suggest an innovative approach for intervening early in the development of psychopathy.

Impact of immigration detention and temporary protection on the mental health of refugees

Abstract: Background Over the past decade, developed Western countries have supplied increasingly stringent measures to discourage those seeking asylum. Aims To investigate the longer-term mental health effects of mandatory detention and subsequent temporary protection on refugees. Method Lists of names provided by community leaders were supplemented by snowball sampling to recruit 241 Arabic-speaking Mandaean refugees in Sydney (60% of the total adult Mandaean population). Interviews assessed post-traumatic stress disorder (PTSD), major depressive episodes, and indices of stress related to past trauma, detention and temporary protection. Results A multilevel model which included age, gender, family clustering, pre-migration trauma and length of residency revealed that past immigration detention and ongoing temporary protection each contributed independently to risk of ongoing PTSD, depression and mental health-related disability. Longer detention was associated with more severe mental disturbance, an effect that persisted for an average of 3 years after release. Conclusions Policies of detention and temporary protection appear to be detrimental to the longer-term mental health of refugees.

Collaborative care for depression in primary care. Making sense of a complex intervention: systematic review and meta-regression

Abstract: Background The management of depression in primary care is a significant issue for health services worldwide. ‘Collaborative care’ interventions are effective, but little is known about which aspects of these complex interventions are essential. Aims To use meta-regressionto identify ‘active ingredients’ in collaborative care models for depression in primary care. Method Studies were identified using systematic searches of electronic databases. The content of collaborative care interventions was coded, together with outcome data on antidepressant use and depressive symptoms. Meta-regression was used to examine relationships between intervention content and outcomes. Results There was no significant predictor of the effect of collaborative care on antidepressant use. Key predictors of depressive symptom outcomes included systematic identification of patients, professional background of staff and specialist supervision. Conclusions Meta-regression may be usefulin examining‘active ingredients’ in complex interventions in mental health.

Schizophrenia, neuroleptic medication and mortality

Abstract: Background There is an excess of death from natural causes among people with schizophrenia. Aims Schizophrenia and its treatment with neuroleptics were studied for their prediction of mortality in a representative population sample of 7217 Finns aged ≥ 30 years. Method A comprehensive health examination was carried out at baseline. Schizophrenia was determined using the Present State Examination and previous medical records. Results During a 17-year follow-up, 39 of the 99 people with schizophrenia died. Adjusted for age and gender, the relative mortality risk between those with schizophrenia and others was 2.84 (95% CI 2.06–3.90), and was 2.25 (95% CI1.61–3.15) after further adjusting for somatic diseases, bloodpressure, cholesterol, body mass index, smoking, exercise, alcohol intake and education. The number of neuroleptics used at the time of the baseline survey showed a graded relation to mortality. Adjusted for age, gender, somatic diseases and other potential risk factors for premature death, the relative risk was 2.50 (95% CI1.46–4.30) per increment of one neuroleptic. Conclusions There is an urgent need to ascertain whether the high mortality in schizophrenia is attributable to the disorder itself or the antipsychotic medication.

Impact of psychological trauma on the development of psychotic symptoms: relationship with psychosis proneness.

Abstract: Background The reported link between psychological trauma and onset of psychosis remains controversial. Aims To examine associations between self-reported psychological trauma and psychotic symptoms as a function of prior evidence of vulnerability to psychosis (psychosis proneness). Method At baseline, 2524 adolescents aged 14–24 years provided self-reports on psychological trauma and psychosis proneness, and at follow-up (on average 42 months later) participants were interviewed for presence of psychotic symptoms. Results Self-reported trauma was associated with psychotic symptoms, in particular at more severe levels (adjusted OR 1.89, 95% CI1.16–3.08) and following trauma associated with intense fear, helplessness or horror. The risk difference between those with and without self-reported trauma at baseline was 7% in the group with baseline psychosis proneness, but only 1.8% in those without (adjusted test for difference between these two effect sizes: χ 2=4.6, P =0.032). Conclusions Exposure to psychological trauma may increase the risk of psychotic symptoms in people vulnerable to psychosis.

Efficacy of ethyl-eicosapentaenoic acid in bipolar depression: randomised double-blind placebo-controlled study.

Abstract: Background Epidemiological and clinical studies suggest that increased intake of eicosapentaenoic acid (EPA) alleviates unipolar depression. Aims To examine the efficacy of EPA in treating depression in bipolar disorder. Method In a12-week, double-blind study individuals with bipolar depression were randomly assigned to adjunctive treatment with placebo ( n =26) or with 1 g/day ( n =24) or 2 g/day ( n =25) of ethyl-EPA. Primary efficacy was assessed by the Hamilton Rating Scale for Depression (HRSD), with changes in the Young Mania Rating Scale and Clinical Global Impression Scale (CGI) as secondary outcome measures. Results There was no apparent benefit of 2 g over 1 g ethyl-EPA daily. Significant improvement was noted with ethyl-EPA treatment compared with placebo in the HRSD ( P =0.04) and the CGI ( P =0.004) scores. Both doses were well tolerated. Conclusions Adjunctive ethyl-EPA is an effective and well-tolerated intervention in bipolar depression.

Life events, first depression onset and the serotonin transporter gene.

Abstract: Background A relationship between the serotonin transporter gene, adverse events and onset of major depression has been reported. Aims To replicate a gene × environment interaction in a cohort with longitudinal data for life events, experience of depression, parental bonding and neuroticism. Method At the 25-year follow-up, genomic DNA was obtained from 127 cohort members (mean age 48 years) to determine the genotype of the serotonin transporter gene-linked promoter region (5-HTTLPR). Associations were investigated between the 5-HTTLPR genotype, positive and adverse life events and the gene × environment interaction, and also between the 5-HTTLPR genotype and risk factors for depression. Results No relationship was found between 5-HTTLPR genotype and either risk factors for depression or positive life events. Adverse life events had a significantly greater impact on the onset of depression for individuals with the s/s genotype. Conclusions The 5-HTTLPR genotype is a significant predictor of onset of major depression following multiple adverse events. This is one of the more robust findings concerning specific biological risk factors for depression.

Insight in psychosis and neuropsychological function - Meta-analysis

Abstract: Background One factor contributing to impaired awareness of illness (poor insight) in psychotic disorders may be neurocognitive deficits. Method A systematic review and meta-analysis were conducted after data extraction. Following an overall analysis, in which measures of different cognitive domains were taken together, more fine-grained analyses investigated whether there was a specific relation with frontal executive functioning, and whether this was influenced by diagnosis or the insight scales used. Results There was a significant mean correlation between insight ratings and neurocognitive performance (mean weighted r =0.17, 95% CI 0.13-0.21, z =8.3, P <0.0001), based on 35 studies with a total of 2354 individuals. Further analyses revealed that the effect of general intellectual impairment was smaller than the specific association with executive function. This was only the case for psychosis in general, and not in an analysis limited to schizophrenia, where all cognitive domains were associated with impaired insight to a similar degree. Conclusions Neuropsychological dysfunction, specifically impairment of set-shifting and error monitoring, contributes to poor insight in psychosis. Specific relations with different dimensions of insight and the putative role of metacognitive functions require further study.

Comorbid substance use and age at onset of schizophrenia

Abstract: Background Substance use may be a risk factor for the onset of schizophrenia. Aims To examine the association between substance use and age at onset in substance use and age at onset in a UK, inner-city sample of people with recent-onset schizophrenia. Method The study sample consisted of 152 people recruited to the West London First-Episode Schizophrenia Study. Self-reported data on drug and alcohol use, as well asinformation on age at onset of psychosis, were collected.Mental state, cognition (IQ, memory and executive function) and social function were also assessed. Results Intotal, 60% ofthe participants were smokers, 27% reported a history of problems with alcohol use, 35% reported current substance use (not including alcohol), and 68% reported lifetime substance use (cannabis and psychostimulants were most commonly used).Cannabis use and gender had independent effects on age at onset of psychosis, after adjusting for alcohol misuse and use of other drugs. Conclusions The strong association between self-reported cannabis use and earlier onset of psychosis provides further evidence that schizophrenia may be precipitated by cannabis use and/or that the early onset of symptoms is a risk factor for cannabis use.

Mental health, burnout and job satisfaction among mental health social workers in England and Wales

Abstract: Background Previous research suggests that social workers experience high levels of stress and burnout but most remain committed to their work. Aims To examine the prevalence of stress and burnout, and job satisfaction among mental health social workers (MHSWs) and the factors responsible for this. Method A postal survey incorporating the General Health Questionnaire, Maslach Burnout Inventory, Karasek Job Content Questionnaire and a job satisfaction measure was sent to 610 MHSWs in England and Wales. Results Eligible respondents ( n =237) reported high levels of stress and emotional exhaustion and low levels of job satisfaction; 111 (47%) showed significant symptomatology and distress, which is twice the level reported by similar surveys of psychiatrists. Feeling undervalued at work, excessive job demands, limited latitude in decision-making, and unhappiness about the place of MHSWs in modern services contributed to the poor job satisfaction and most aspects of burnout. Those who had approved social worker status had greater dissatisfaction. Conclusions Stress may exacerbate recruitment and retention problems. Employers must recognise the demands placed upon MHSWs and value their contribution to mental health services.

Mood switch in bipolar depression: comparison of adjunctive venlafaxine, bupropion and sertraline

Abstract: Background: Few studies have examined the relative risks of switching into hypomania or mania associated with second-generation antidepressant drugs in bipolar depression. Aims: To examine the relative acute effects of bupropion, sertraline and venlafaxine as adjuncts to mood stabilisers. Method: In a 10-week trial, participants receiving out-patient treatment for bipolar disorder (stratified for rapid cycling) were randomly treated with a flexible dose of one of the antidepressants, or their respective matching placebos, as adjuncts to mood stabilisers. Results: A total of 174 adults with bipolar disorder 1, 11 or not otherwise specified, currently in the depressed phase, were included. All three antidepressants were associated with a similar range of acute response (49-53%) and remission (34-41%). There was a significantly increased risk of switches into hypomania or mania in participants treated with venlafaxine compared with bupropion or sertraline. Conclusions: More caution appears indicated in the use of venlafaxine rather than bupropion or sertraline in the adjunctive treatment of bipolar depression, especially if there is a prior history of rapid cycling. Declaration of interest: None.

Longitudinal investigation into childhood- and adolescence-onset depression: psychiatric outcome in early adulthood.

Abstract: Background Major depression in childhood or adolescence increases the riskof affective disorder in adulthood. The precise nature and course of the subsequent disorder remain unclear. Aims To investigate long-term psychiatric outcome of school-age depression in community and clinic samples. Method A group of 113 young adults were followed up after a mean of 7.8 years (s.e.=15). Results Groups with persistent and recurrent depression were identified. Recurrence of affective disorder was similar in clinic and community groups. The clinic group had significantly longer index episodes; these were predicted by an early psychiatric history, longer episode duration before treatment and greater impairment. Being female, having higher self-report depression scores and comorbidity at index episode predicted earlier recurrence. Males were more likely to have persistentdepression. Conclusions Prognosis is similar in young people with depression from community and clinical samples. Boys from a clinical sample are at higher risk than girls of becoming persistently and severely mentally ill.

Lifetime and 12-month prevalence of mental disorders in the Nigerian Survey of Mental Health and Well-Being.

Abstract: Background Large-scale community studies of the prevalence of mental disorders using standardised assessment tools are rare in sub-Saharan Africa. Aims To conduct such a study. Method Multistage stratified clustered sampling of households in the Yoruba-speaking parts of Nigeria. Face-to-face interviews used the World Mental Health version of the Composite International Diagnostic Interview (WMH-CIDI). Results Of the 4984 people interviewed (response rate 79.9%), 12.1% had a lifetime rate of at least one DSM-IV disorder and 5.8% had 12-month disorders. Anxiety disorders were the most common (5.7% lifetime, 4.1% 12-month rates) but virtually no generalised anxiety or post-traumatic stress disorder were identified. Of the 23% who had seriously disabling disorders, only about 8% had received treatment in the preceding 12 months. Treatment was mostly provided by general medical practitioners; only a few were treated by alternative practitioners such as traditional healers. Conclusions The observed low rates seem to reflect demographic and ascertainment factors. There was a large burden of unmet need for care among people with serious disorders.

Self-reported psychotic symptoms in the general population: results from the longitudinal study of the British National Psychiatric Morbidity Survey

Abstract: Background: Scarce longitudinal data exist on the occurrence of psychotic symptoms in the general population. Aims: To estimate the incidence of, and risk factors for, self-reported psychotic symptoms in great britain. Method: Data from the 18-month follow-up of a national survey were used. Incident cases were those who endorsed one or more items on the psychosis screening questionnaire at follow-up, but not at baseline. The association between factors recorded at baseline and incident self-reported symptoms was examined. Results: At follow-up, 4.4% of the general population reported incident psychotic symptoms. Six factors were independently associated with incident symptoms: living in a rural area; having a small primary support group; more adverse life events; smoking tobacco; neurotic symptoms; and engaging in a harmful pattern of drinking. Conclusions: A small but not insignificant percentage of the population of great britain reported incident psychotic symptoms over 18 months. The risk factors for psychotic symptoms showed some similarities with risk factors for schizophrenia, but there were also some striking differences. The relationship between such risk factors and the factors that perpetuate psychotic symptoms remains to be ascertained.

Quality of life of people with dementia in residential care homes

Abstract: Background Many people with dementia live in residential homes, but little is known about their quality of life. Aims To compare the views of residents with dementia with the views of staff as to their quality of life, and to look at factors associated withthese ratings. Method The Quality of Life in Alzheimer’s Disease (QoL–AD) scale was used to rate residents’and staff’s perceptions of the quality of life of 238 residents of 24 residential homes in the UK. Results There were 119 QoL–AD scales completed by both residents and staff. For the residents, high QoL–AD scores strongly correlated with lower scores for depression (ρ=-0.53, P <0.0001) and anxiety (ρ=-0.50, P <0.001). In contrast, better quality of life as rated by staff correlated most strongly with increased dependency (ρ=-0.53, P <0.001) and behaviour problems (ρ=-0.40, P <0.001). Conclusions The QoL–AD could be used as an effective measure of the quality of life of people with dementia in residential homes. Whereas mood was the main predictor of residents’own assessment of their quality of life, staff ratings were strongly linked with dependency. Staff should be aware that mood rather than level of dependency has a greater impacton residents’ quality of life.

Internet information-seeking in mental health: Population survey

Abstract: Background A major use of the of the internet is for health information-seeking. There has been little research into its use in relation to mental health. Aims To investigate the prevalence of internet use for mental health information-seeking and its relative importance as a mental health information source. Method General population survey. Questions covered internet use, past psychiatric history and the 12-item General Health Questionnaire. Results Eighteen per cent of all internet users had used the internet for information related to mental health. The prevalence was higher among those with a past history of mental health problems and those with current psychological distress. Only 12% of respondents selected the internet as one of the three most accurate sources of information, compared with 24% who responded that it was one of the three sources they would use. Conclusions The internet has a significant role in mental health information-seeking. The internet is used more than it is trusted.

Deaths from pesticide poisoning: a global response.

Abstract: Self-poisoning with pesticides accounts for about a third of all suicides worldwide. To tackle this problem, the World Health Organization announced a global public health initiative in the second half of 2005. Planned approaches were to range from government regulatory action to the development of new treatments for pesticide poisoning. With broad-based support, this strategy should have a major impact on the global burden of suicide.

Cognitive impairment in bipolar II disorder

Abstract: Background Persistentimpairments in neurocognitive function have been described in bipolar disorder. Aims To compare the cognitive performance of patients with bipolar II disorder with that of patients with bipolar I disorder and a healthy control group. Method The study included 71 euthymic patients with bipolar disorder (38 bipolar I, 33 bipolar II), who were compared on clinical and neuropsychological variables (e.g. executive function, attention, verbal and visual memory) and contrasted with 35 healthy controls on cognitive performance. Results Compared with controls, both bipolar groups showed significant deficits in most cognitive tasks including working memory (DigitSpan Backwards, P =0.002) and attention (DigitSpan Forwards, P =0.005; Trail Making Test, P =0.001). Those with type II disorders had an intermediate level of performance between the bipolar I group and the control group in verbal memory ( P <0.005) and executive functions (Stroop interference task, P =0.020). Conclusions Cognitive impairment exists in both subtypes of bipolar disorder, although more so in the bipolar I group. The best predictors of poor psychosocial functioning in bipolar II disorder were subclinical depressive symptoms, early onset of illness and poor performance on a measure related to executive function.

Suicide in mental health in-patients and within 3 months of discharge. National clinical survey.

Abstract: BACKGROUND: Suicide prevention is a health service priority. Suicide risk may be greatest during psychiatric in-patient admission and following discharge. AIMS: To describe the social and clinical characteristics of a comprehensive sample of in-patient and post-discharge cases of suicide. METHOD: A national clinical survey based on a 4-year (1996-2000) sample of cases of suicide in England and Wales who had been in recent contact with mental health services (n=4859). RESULTS: There were 754 (16%) current in-patients and a further 1100 (23%) had been discharged from psychiatric in-patient care less than 3 months before death. Nearly a quarter of the in-patient deaths occurred within the first 7 days of admission; 236 (31%) occurred on the ward, the majority by hanging. Post-discharge suicide was most frequent in the first 2 weeks after leaving hospital; the highest number occurred on the first day. CONCLUSIONS: Suicide might be prevented among in-patients by improving ward design and removing fixtures that can be used in hanging. Prevention of suicide after discharge requires early community follow-up and closer supervision of high-risk patients.

The 10/90 divide in mental health research: trends over a 10-year period

Abstract: Summary A search (precision value 94%, recall value 93%) of the ISI Web of Science database (1992-2001) revealed that mental health publications accounted for 3-4% of the health literature. A 10/90 divide in internationally accessible mental health literature was evident and remained undiminished through 10 years as low- and middle-income countries ( n =152) contributed only 6%, high-income countries ( n =54) 94%, and 14 leading high-income countries (with more than 1% contribution for majority of years under consideration) contributed 90% of internationally accessible mental health research. Steps should be taken to improve the research infrastructure and capacity to conduct and disseminate mental health research in general, and on a priority basis in low- and middle-income countries.

Group interpersonal psychotherapy for depression in rural Uganda: 6-Month outcomes: Randomised controlled trial

Abstract: Background A randomised controlled trial comparing group interpersonal psychotherapy with treatment as usual among rural Ugandans meeting symptom and functional impairment criteria for DSM–IV major depressive disorder or sub-threshold disorder showed evidence of effectiveness immediately following the intervention. Aims To assess the long-term effectiveness of this therapy over a subsequent 6-month period. Method A follow-up study of trial participants was conducted in which the primary outcomes were depression diagnosis, depressive symptoms and functional impairment. Results At 6 months, participants receiving the group interpersonal psychotherapy had mean depression symptom and functional impairment scores respectively 14.0 points (95% CI 12.2–15.8; P <0.0001) and 5.0 points (95% CI 3.6–6.4; P <0.0001) lower than the control group. Similarly, the rate of major depression among those in the treatment arm (11.7%) was significantly lower than that in the control arm (54.9%) ( P <0.0001). Conclusions Participation in a 16-week group interpersonal psychotherapy intervention continued to confer a substantial mental health benefit 6 months after conclusion of the formal intervention.

Cognitive stimulation therapy for people with dementia: cost-effectiveness analysis.

Abstract: Background Psychological therapy groups for people with dementia are widely used, but their cost-effectiveness has not been explored. Aims To investigate the cost-effectiveness of an evidence-based cognitive stimulation therapy (CST) programme for people with dementia as part of a randomised controlled trial. Method A total of 91 people with dementia, living in care homes or the community, received a CST group intervention twice weekly for 8 weeks; 70 participants with dementia received treatment as usual. Service use was recorded 8 weeks before and during the 8-week intervention and costs were calculated. A cost-effectiveness analysis was conducted with cognition as the primary outcome, and quality of life as the secondary outcome. Cost-effectiveness acceptability curves were plotted. Results Cognitive stimulation therapy has benefits for cognition and quality of life in dementia, and costs were not different between the groups. Under reasonable assumptions, there is a high probability that CST is more cost-effective than treatment as usual, with regard to both outcome measures. Conclusions Cognitive stimulation therapy for people with dementia has effectiveness advantages over, and may be more cost-effective than, treatment as usual.

Prospective 12-month course of bipolar disorder in out-patients with and without comorbid anxiety disorders.

Abstract: Background The impact of anxiety disorders has not been well delineated in prospective studies of bipolar disorder. Aims To examine the association between anxiety and course of bipolar disorder, as defined by mood episodes, quality of life and role functioning. Method A thousand thousand out-patients with bipolar disorder were followed prospectively for 1 year. Results A current comorbid anxiety disorder (present in 31.9% of participants) was associated with fewer days well, a lower likelihood of timely recovery from depression, risk of earlier relapse, lower quality of life and diminished role function over I year of prospective study. The negative impact was greater with multiple anxiety disorders. Conclusions Anxiety disorders, including those present during relative euthymia, predicted a poorer bipolar course. The detrimental effects of anxiety were not simply a feature of mood state. Treatment studies targeting anxiety disorders will help to clarify the nature of the impact of anxiety on bipolar course.

Specialised care for early psychosis: symptoms, social functioning and patient satisfaction: randomised controlled trial.

Abstract: Background The provision of early intervention services for people with psychosisis UK government policy, although evidence for benefit of such services is sparse. Aims To evaluate the effects of a service providing specialised care for early psychosis (the Lambeth Early Onsetteam) on clinical and social outcomes, and on service user satisfaction. Method One hundred and forty-four people with psychosis, presenting to mental health services for the first or second time (if previously failed to engage in treatment), were randomly allocated to care by the early onsetteam or to standard care. Information was obtained on symptoms, treatment adherence, social and vocational functioning, satisfaction and quality of life. Relapse and rehospitalisation data have been reported separately. Results Outcomes for the participants treated by the early onsetteam were significantly better at18 months for aspects of social and vocational functioning, satisfaction, quality of life and medication adherence. Symptom improvementdid not significantly differ between the groups. Conclusions The provision of specialised care for early psychosis can achieve better outcomes. The study therefore provides support for current policy.

Socio-economic position and common mental disorders - Longitudinal study in the general population in the UK

Abstract: Background Individuals in lower socio socio-economic groups have an increased prevalence of common mental disorders. Aims To investigate the longitudinal association between socio-economic position and common mental disorders in a general population sample in the UK. Method Participants ( n =2406) were assessed at two time points 18 months apart with the Revised Clinical Interview Schedule. The sample was stratified into two cohorts according to mental health status at baseline. Results None of the socio-economic indicators studied was significantly associated with an episode of common mental disorder at follow-up after adjusting for baseline psychiatric morbidity. The analysis of separate diagnostic categories showed that subjective financial difficulties at baseline were independently associated with depression at follow-up in both cohorts. Conclusions These findings support the view that apart from objective measures of socio-economic position, more subjective measures might be equally important from an aetiological or clinical perspective.