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A rationale for maintaining the existence of learned journals is put forward
on the 343rd anniversary of the first such journal, the
Philosophical Transactions of the Royal Society, and it
is argued that the main aim of such journals has hardly changed since this
time. The new-look British Journal of Psychiatry is
intended to educate and instruct, and even entice readers from the
functional and far less romantic online version.
Significant issues challenge the diagnosis of post-traumatic stress disorder
(PTSD). Yet, applications of the PTSD ‘model’ have been extended to an
increasing array of events and human reactions across diverse cultures.
These issues have implications for clinical practice and for those who
revise criteria in the DSM-V.
Pharmacological interventions alone do not provide sufficient benefit for
some individuals with bipolar disorder.
To determine the effectiveness of psychosocial interventions for the
prevention of relapse in bipolar disorder.
A systematic review and meta-analysis of randomised or quasi-randomised
controlled trials were conducted.
Cognitive-behavioural therapy or group psychoeducation may be effective
for relapse prevention in stable individuals. Family therapy was no more
or less effective than individual psychosocial therapy or crisis
management. There is no evidence that care management or integrated group
therapy is effective in the prevention of relapse.
Cognitive-behavioural therapy, group psychoeducation and possibly family
therapy may be beneficial as adjuncts to pharmacological maintenance
Depression may increase the risk of mortality among certain subgroups of
older people, but the part played by antidepressants in this association
has not been thoroughly explored.
To identify the characteristics of older populations who are most at risk
of dying, as a function of depressive symptoms, gender and antidepressant
Adjusted Cox proportional hazards models were used to determine the
association between depression and/or antidepressant use and 4-year
survival of 7363 community-dwelling elderly people. Major depressive
disorder was evaluated using a standardised psychiatric examination based
on DSM-IV criteria and depressive symptoms were assessed using the Center
for Epidemiological Studies Depression scale.
Depressed men using antidepressants had the greatest risk of dying, with
increasing depression severity corresponding to a higher hazard risk.
Among women, only severe depression in the absence of treatment was
significantly associated with mortality.
The association between depression and mortality is gender-dependent and
varies according to symptom load and antidepressant use.
Lack of social interaction, which is characteristically seen in people
with autistic-spectrum disorder, may be caused by malfunctioning of the
frontostriatal reward systems. However, no reported in
vivo brain imaging studies have investigated reward
mechanisms in autistic-spectrum disorder.
To investigate functional brain activation during reward feedback in
people with autistic-spectrum disorder and control individuals.
We used event-related functional magnetic resonance imaging to examine
the neural substrates of monetary reward in individuals with
autistic-spectrum disorder and matched controls.
When rewarded, individuals with autism compared with control individuals
showed significantly greater brain activation in the left anterior
cingulate gyrus. In addition, activation of this region was negatively
correlated with social interaction as measured by the Autism Diagnostic
In people with autistic-spectrum disorder, achieving reward is associated
with significant differences in the activation of areas known to be
responsible for attention and arousal, and this may partially underpin
some deficits in social behaviour.
Obsessive-compulsive disorder (OCD) may be related to a dysfunction in
frontostriatal pathways mediating inhibitory control. However, no
functional magnetic resonance imaging (fMRI) study has tested this in
To test whether adolescents with OCD in partial remission would show
abnormal frontostriatal brain activation during tasks of inhibition.
Event-related fMRI was used to compare brain activation in 10 adolescent
boys with OCD with that of 9 matched controls during three different
tasks of inhibitory control.
During a ‘stop’ task, participants with OCD showed reduced activation in
right orbitofrontal cortex, thalamus and basal ganglia; inhibition
failure elicited mesial frontal underactivation. Task switching and
interference inhibition were associated with attenuated activation in
frontal, temporoparietal and cerebellar regions.
These preliminary findings support the hypothesis that paediatric OCD is
characterised by a dysregulation of frontostriatothalamic brain regions
necessary for motor inhibition, and also demonstrate dysfunction of
temporoparietal and frontocerebellar attention networks during more
cognitive forms of inhibition.
Alexithymia has been shown to be related to many psychiatric and somatic
illnesses. Aberrant emotion processing in the brain may underlie several
psychiatric disorders. However, little is known about the neurobiological
underpinnings of alexithymia.
To determine the way in which the brain processes emotion in
The participants were 10 healthy women with alexithymia and 11 healthy
women without this condition, recruited into the study on the basis of
their scores on the 20-item Toronto Alexithymia Scale. Four films were
projected on a video screen to induce each of three emotional conditions
(neutral, amusement, sadness). The brain areas activated during emotional
stimuli in the alexithymia group were compared with those activated in
the non-alexithymia group. Scans of the distribution of
[15O]H2O were acquired using a positron emission
tomography (PET) scanner operated in three-dimensional mode.
In response to emotional stimuli participants with alexithymia activated
more parts of their sensory and motor cortices and insula, especially on
the left side, and less of their anterior cingulate, compared with the
Women with alexithymia seem to over-activate their ‘bodily’ brain
regions, implying a different mode of emotion processing. This may be
related to their tendency to experience physical symptoms.
The estimated prevalence of clinically significant psychiatric and
somatic symptoms in adults >1 year after the 2004 Asian tsunami is
To estimate the prevalence of psychiatric and somatic symptoms and
impairment in Sri Lanka 20–21 months after the 2004 Asian tsunami, and to
assess coping strategies used by tsunami-affected individuals that
contribute to post-tsunami adjustment.
Homes from one severely affected area were randomly selected, and adult
respondents were sampled utilising a modified Kish method. Instruments
were administered in Sinhala to assess exposure, post-traumatic stress
disorder (PTSD), depression, anxiety, somatic distress and impairment.
Demographic variables and culturally-relevant coping activities were
The prevalence of clinically significant PTSD, depression and anxiety was
21%, 16% and 30% respectively. Respondents reported a mean of eight
persistent and bothersome somatic complaints, which were associated with
psychiatric symptoms and impairment. Thinking that one's life was in
danger was the exposure item most strongly associated with symptoms and
impairment. The majority of respondents found their own strength, family
and friends, a Western-style hospital and their religious practice to be
the most helpful coping aids.
A large minority of adults in one area of Sri Lanka reported significant
psychiatric and somatic symptoms and impairment 20–21 months after the
tsunami. Accurate data about risk for and resilience to impairing
symptoms > 1 year after disasters are necessary in order to develop
rational surveillance and interventions.
Adolescents comprise a fifth of the population of India, but there is
little research on their mental health. We conducted an epidemiological
study in the state of Goa to describe the current prevalence of mental
disorders and its correlates among adolescents aged between 12 and 16
To estimate the prevalence and correlates of mental disorders in
Population-based survey of all eligible adolescents from six urban wards
and four rural communities which were randomly selected. We used a
Konkani translation of the Development and Well-Being Assessment to
diagnose current DSM-IV emotional and behavioural disorders. All
adolescents were also interviewed on socio-economic factors, education,
neighbourhood, parental relations, peer and sexual relationships,
violence and substance use.
Out of 2684 eligible adolescents, 2048 completed the study. The current
prevalence of any DSM-IV diagnosis was 1.81%; 95% CI 1.27–2.48. The most
common diagnoses were anxiety disorders (1.0%), depressive disorder
(0.5%), behavioural disorder (0.4%) and attention-deficit hyperactivity
disorder (0.2%). Adolescents from urban areas and girls who faced gender
discrimination had higher prevalence. The final multivariate model found
an independent association of mental disorders with an outgoing
‘non-traditional’ lifestyle (frequent partying, going to the cinema,
shopping for fun and having a boyfriend or girlfriend), difficulties with
studies, lack of safety in the neighbourhood, a history of physical or
verbal abuse and tobacco use. Having one's family as the primary source
of social support was associated with lower prevalence of mental
The current prevalence of mental disorders in adolescents in our study
was very low compared with studies in other countries. Strong family
support was a critical factor associated with low prevalence of mental
disorders, while factors indicative of adoption of a non-traditional
lifestyle were associated with an increased prevalence.
The Montgomery-Åsberg Depression Rating Scale (MADRS) is often used in
clinical trials to select patients and to assess treatment efficacy. The
scale was originally published without suggested questions for clinicians
to use in gathering the information necessary to rate the items.
Structured and semi-structured interview guides have been found to
improve reliability with other scales.
To describe the development and test-retest reliability of a structured
interview guide for the MADRS (SIGMA).
A total of 162 test-retest interviews were conducted by 81 rater pairs.
Each patient was interviewed twice, once by each rater conducting an
The intraclass correlation for total score between raters using the SIGMA
was r = 0.93, P < 0.0001. All ten
items had good to excellent interrater reliability.
Use of the SIGMA can result in high reliability of MADRS scores in
evaluating patients with depression.
There is current interest in exploring the different subtypes of mild
cognitive impairment (MCI), in terms of both their epidemiology and their
To examine the frequency of MCI subtypes presenting to a memory clinic
and to document detailed neuropsychological profiles of patients with the
Consecutive tertiary referrals (n = 187) were
psychiatrically evaluated; 45 patients met criteria for amnestic mild
cognitive impairment (aMCI). A subgroup of 33 patients with aMCI as well
as 21 healthy controls took part in a thorough neuropsychological
Of the patients who were examined in greater neuropsychological detail,
ten had pure aMCI (none with visual memory impairment only). Fifteen met
criteria for non-amnestic MCI. Fifteen had normal neuropsychological
profiles. Using more than one test increased sensitivity to detect
episodic memory impairment.
Amnestic MCI is an important diagnosis in secondary and tertiary memory
clinics. There is scope to improve the efficacy and sensitivity of the
clinical assessment of this impairment.
Few studies have assessed psychopathic traits in community samples of young
people. We investigated the predictive utility of callous and unemotional
traits in a representative sample of 5770 young people from Great Britain.
Teachers provided information on the presence of callous and unemotional
traits and parents completed the Strengths and Difficulties Questionnaire to
determine the level and impact of psychiatric problems at baseline, 12 and
24 months later. Baseline callous and unemotional trait scores independently
predicted the number and intensity of conduct, emotional and hyperactivity
symptoms at follow-up. Callous and unemotional traits are longitudinally
associated with the level and impact of childhood psychiatric problems.
Facial affect discrimination and identification were assessed in 86 clinical
high-risk individuals and compared with 50 individuals with first-episode
psychosis, 53 with multiepisode schizophrenia and 55 non-psychiatric
controls. On the identification task the non-psychiatric controls performed
significantly better than all other groups, and on discrimination
significantly better than both patient groups. Deficits in facial affect
recognition appear to be present before the onset of psychosis and may be a