Skip to main content Accessibility help


  • Access


      • Send article to Kindle

        To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

        Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

        Find out more about the Kindle Personal Document Service.

        Highlights of this issue
        Available formats

        Send article to Dropbox

        To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

        Highlights of this issue
        Available formats

        Send article to Google Drive

        To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

        Highlights of this issue
        Available formats
Export citation


Poor compliance can reduce the efficacy of treatments, resulting in worse health outcomes for patients. Using a randomised design, Gray et al () trained community psychiatric nurses for 80 hours in medication management. Independent researchers interviewed their patients and the patients of nurses who did not receive training, at recruitment and 6 months later. Patients who were cared for by nurses who had received the training showed a greater reduction in overall psychopathology compared with treatment as usual. Attitudes towards treatment and compliance also improved more favourably in the intervention group. Given its positive effects, this manualised training package could be disseminated widely.


Hillegers et al () explore the impact of life events, familial loading and their interaction on mood disorder onset in a high-risk cohort of adolescent offspring of parents with bipolar disorder. Results revealed a strong relationship between life events and the risk of mood disorder, but familial loading did not confound or modify the relationship. Familial loading itself was an independent predictor of mood disorder in the cohort. Kim et al (), in a Korean community study, demonstrate an association between previous stroke and lower levels of high-density lipoprotein and late-life depression. The link with other established risk factors for cerebrovascular disease were not found. From a public health perspective with regard to preventing depression, these results support a focus on post-stroke populations and on reducing levels of general disability rather than specifically targeting those with vascular risk factors.


In recent years the use of atypical antipsychotics has been strongly linked to emergent diabetes. Questions have been raised as to whether this finding in part reflects greater monitoring, and hence detection, of glucose abnormalities in patients receiving the newer drugs. Taylor et al () obtained prescription cards and examined case files of 606 patients prescribed antipsychotics. Testing for diabetes was undertaken in less than half of the patients studied and was more common in those receiving atypical antipsychotics. These findings have important consequences for the interpretation of diabetes prevalence studies using databases.


Antipsychotic drugs vary widely in their binding affinity for the D2 dopamine receptor. Hyperprolactinaemia is associated with the tighter-binding agents at D2 receptors. The A1 allele of the D2 receptor gene is associated with significantly decreased density of D2 receptors and thus may influence D2 receptor antagonism. Young et al () examine the role of the DRD2 polymorphism on prolactin levels in patients treated with antipsychotic medication. Patients with this polymorphism had higher prolactin levels and were over-represented among those with hyperprolactinaemia. The authors suggest that the A1 allele of DRD2 may be a useful clinical marker for identification of those at risk of hyperprolactimaemia and associated adverse effects.


A small number of patients account for a disproportionately large amount of health care use. The reason for this is poorly understood. Using a nested case-control design, Kapur et al () reveal that childhood illness exposures and reports of childhood adversity were independently associated with adult consultation behaviour, even after adjustment for adult psychiatric disorder. Interventions for high users of health care should thus address childhood illness experiences and adversities in addition to adult psychiatric disorder.


Larsen et al () suggest that the heterogeneity of schizophrenia begins early, long before the onset of psychosis. They administered the Premorbid Adjustment Scale to 335 patients with schizophrenia and found that social and academic functioning constituted fairly independent dimensions. Patients with a stable social course compared with a deteriorating one had a shorter duration of untreated psychosis, were older, had more friends and fewer negative symptoms. Good academic childhood functioning was associated with meaningful activities, more education and better working memory. Results support both neurodevelopmental and neuroregressive pathways to psychosis. Hall et al (), in a small case-control study, show that people with schizophrenia have marked deficits in their ability to interpret social cues from faces. They suggest that impairments in social cognition represent a core deficit in schizophrenia, which is likely to be related to abnormal frontotemporal functioning.


Both Simon Wessely and Peter White provide remarkably convincing arguments in this month's debate (). Can functional somatic syndromes really be narrowed into a single entity, or is it a complex array of different disorders?