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Attention-deficit hyperactivity disorder (ADHD) varies in its clinical
presentation and course. Susceptibility gene variants for ADHD and
associated antisocial behaviour are being identified with emerging evidence
of gene–environment interaction. Genes and environmental factors that
influence the origins of disorder are not necessarily the same as those that
contribute to its course and outcome.
Attention-deficit hyperactivity disorder (ADHD) is a common disorder
affecting children and adults. Many young people treated with stimulants, as
well as those in whom ADHD went unrecognised in childhood, need treatment as
adults. Stimulants and atomoxetine effectively reduce ADHD symptoms at all
ages and should be a standard treatment in general adult psychiatric
Migration is a risk factor for the development of schizophrenia.
To examine whether migration is also a risk factor for bipolar affective
disorder, unipolar depressive disorder and mood disorders in general.
Medline was searched for population-based incidence studies concerning
mood disorders among migrants and mean relative risks were computed using
a mixed-effects statistical model.
Only a few studies of unipolar depressive disorder were retrieved. The
mean relative risk of developing bipolar affective disorder among
migrants was 2.47 (95% C11.33–4.59). However, after excluding people of
African-Caribbean origin in the UK this risk was no longer significantly
increased. The mean relative risk of mood disorders of unspecified
polarity was 1.25 (95% CI 1.04–1.49) and that of any mood disorder was
1.38 (95% CI 1.17–1.62).
There is no conclusive evidence for a large increase in the risk of mood
disorders associated with migration.
With almost a million people dying by suicide worldwide each year,
reducing the rate of suicidal behaviour is a priority in many
To examine whether additional psychosocial interventions following an
episode of self-harm reduce the likelihood of subsequent suicide.
We conducted a systematic review and meta-analysis of data from
randomised controlled trials of interventions for people following
self-harm. Likelihood of suicide was compared by calculating the pooled
root difference in suicide rate with 95% confidence intervals.
We obtained suicide data from 18 studies with a total population of 3918.
Eighteen suicides occurred among people offered active treatment and 19
among those offered standard care (pooled root difference in suicide rate
0.0, 95% CI – 0.03 to 0.03). The overall rate of suicide among people
participating in trials was similar to that reported in observational
studies of people who self-harm.
Results of this meta-analysis do not provide evidence that additional
psychosocial interventions following self-harm have a marked effect on
the likelihood of subsequent suicide.
Little is known of the epidemiology and care needs of people with
To examine prevalence and the cross-sectional disability, needs and
service provision for adolescent-onset psychosis in areas of central
Scotland with a total population of 1.75 million.
We identified and contacted 103 young people using an opt-out research
design. Fifty-three participants and their carers and keyworkers were
interviewed using a modified version of the Cardinal Needs Schedule.
The 3-year prevalence was 5.9 per 100 000 general population. Twenty-one
(20%) adolescents were not in contact with mental health services; 80% of
first admissions were to adult acute psychiatric wards. Those interviewed
had high levels of morbidity: 29 (55%) had serious to pervasive
impairment of functioning; there were relatively high levels of
side-effects, negative symptoms, anxiety, occupational, friendship and
family difficulties. Care provision was better for ‘clinical' than for
‘social' domains; 20% had five or more unmet needs; 17% had at least one
This low-prevalence disorder requires an assertive multi-agency approach
in the context of a national planning framework.
Reported prevalence of mental ill-health among adults with intellectual
disabilities ranges from 7 to 97%, owing to methodological limitations.
Little is known about associations.
To determine the prevalence of mental ill-health in adults with
intellectual disabilities and to investigate factors independently
associated with it.
Population-based study (n=1023) with comprehensive
individual assessments modelled using regression analyses.
Point prevalence of mental ill-health was 40.9% (clinical diagnoses),
35.2%(DC–LD), 16.6% (ICD–10–DCR) and 15.7% (DSM–IV–TR). The most
prevalent type was problem behaviours. Mental ill-health was associated
with more life events, female gender, type of support, lower ability,
more consultations, smoking, incontinence, not having severe physical
disabilities and not having immobility; it was not associated with
deprived areas, no occupation, communication impairment, epilepsy,
hearing impairment or previous institutional residence.
This investigation informs further longitudinal study, and development of
appropriate interventions, public health strategy and policy. ICD–10–DCR
and DSM–IV–TR undercount mental ill-health in this population compared
Depression is common in Pakistan but no research on this subject has been
reported from the North West Frontier Province (NWFP), host to numerous
To measure depressive symptoms and associated features in a
A Pushto translation of the Self Reporting Questionnaire (SRQ) was
administered to 471 adults living in a village in one of the federally
administered tribal areas. Respondents were also assessed with a life
events checklist for social problems, a social support questionnaire and
the Brief Disability Questionnaire.
Sixty per cent (95/158) of women and 45% (140/313) of men scored 9 or
more on the SRQ. High SRQ score was associated with few years of
education, higher social problem score, less social support and greater
disability. High social problem score was the strongest correlate.
This population reports more depressive symptoms than other communities
in Pakistan and this probably reflects the very high degree of social
stress experienced in the NWFP, which has been affected by years of
turmoil in neighbouring Afghanistan.
Few studies have prospectively examined psychosocial and psychiatric
predictors of adolescent substance use disorders simultaneously.
To identify psychosocial and psychiatric predictors of substance use
disorders in adolescence.
School children aged 12 years (s. d. =0. 3) free from any substance use
disorder at grade7(n=428) were assessed in three
consecutive years, using a standardised psychiatric interview. Their
baseline psychosocial information was also collected. The outcome was the
onset age of a substance use disorder. The Cox regression model was used
for data analysis.
The most significant predictive factors for adolescent substance use
disorder included male gender, attention-deficit hyperactivity disorder,
conduct disorder and sibling use of tobacco. Three protective factors
against such morbidity included living in a household with two parents, a
good academic grade at grade 7 and objection to the use of
Early intervention for disruptive behaviour disorders and specific
psychosocial risk factors might prevent substance use disorders in early
Few psychosocial interventions have been developed in China that are
suitable for use in the community.
To evaluate the effectiveness of the Chinese version of the Community
Re-Entry Module (CRM; a module of a standardised, structured social
skills training programme devised at the University of California, Los
Angeles) for patients with schizophrenia compared with standard group
Patients with schizophrenia (n=103) were randomly
allocated to CRM or psychoeducation groups and followed up for 24 months.
Outcome measures included social functioning, psychiatric symptoms,
insight, re-employment, relapse and re-hospitalisation rates.
The CRM group significantly improved in terms of social functioning,
insight and psychiatric symptoms compared with the psychoeducation group;
the re-employment rate was significantly higher and relapse and
rehospitalisation rates were significantly lower in the CRM group.
The findings support the feasibility and effectiveness of CRM as a
psychosocial intervention for Chinese patients with schizophrenia in the
Hallucinations are perceptions in the absence of a corresponding external
sensory stimulus. However, during auditory verbal hallucinations,
activation of the primary auditory cortex has been described.
The objective of this study was to investigate whether this activation of
the auditory cortex contributes essentially to the character of
hallucinations and attributes them to alien sources, or whether the
auditory activation is a sign of increased general auditory attention to
The responsiveness of the auditory cortex was investigated by auditory
evoked potentials (N100) during the simultaneous occurrence of
hallucinations and external stimuli. Evoked potentials were computed
separately for periods with and without hallucinations; N100 power,
topography and brain electrical sources were analysed.
Hallucinations lowered the N100 amplitudes and changed the topography,
presumably due to a reduced left temporal responsivity.
This finding indicates competition between auditory stimuli and
hallucinations for physiological resources in the primary auditory
cortex. The abnormal activation of the primary auditory cortex may thus
be a constituent of auditory hallucinations.
Although electroconvulsive therapy (ECT) is widely used to treat
psychiatric disorders such as depression, its precise neural mechanisms
To investigate the time course of changes in cerebral blood flow during
Cerebral blood flow was quantified serially prior to, during and after
acute ECT in six patients with depression under anaesthesia using
[15O]H2O positron emission tomography (PET).
Cerebral blood flow during ECT increased particularly in the basal
ganglia, brain-stem, diencephalon, amygdala, vermis and the frontal,
temporal and parietal cortices compared with that before ECT. The flow
increased in the thalamus and decreased in the anterior cingulate and
medial frontal cortex soon after ECT compared with that before ECT.
These results suggest a relationship between the centrencephalic system
and seizure generalisation. Further, they suggest that some neural
mechanisms of action of ECT are mediated via brain regions including the
anterior cingulate and medial frontal cortex and thalamus.
Although measures of psychopathology are designed for use in clinical
populations, their meaning derives from comparison with normal
To compare the distribution of scores on the Clinical Outcomes in Routine
Evaluation — Outcome Measure (CORE-OM) from a general population sample
with the distribution in an aggregated clinical sample to derive
recommended cut-off points for determining clinical significance.
The CORE-OM general population sample was based on a weighted subsample
of participants in the psychiatric morbidity follow-up survey who
completed valid CORE-OM forms following their interview (effective
Comparison of the CORE-OM general population sample with a clinical
sample aggregated from previous studies (n=10761)
yielded a cut-off score of 9.9 on the 0–40 scale of the CORE-OM. The
CORE-OM was highly correlated (r=0.77) with the Clinical
Interview Schedule — Revised, supporting convergent validity.
We recommend rounding the CORE-OM cut-off score to 10. However, cut-off
scores must be used thoughtfully and adjusted to fit context and
There is lack of evidence on the health effects of perceived discrimination.
We analysed the association between perceived discrimination and
psychological distress, and whether socio-economic disadvantage explains
this association in 15 406 men and 17 922 women in Sweden during 2004. After
adjustment for age and long-term illness, frequent experiences of
discrimination were associated with increased likelihood of psychological
distress. Socio-economic disadvantage explained about 25% of this
We aimed to describe the contribution of low- and middle-income (LAMI)
countries to leading general psychiatric journals. We reviewed original
research published over a 3-year period (2002–2004) in the six
highest-impact general psychiatry journals and contacted editorial offices
to gather data on country of origin of submitted and accepted articles. Only
3.7% of published research emerges from these less affluent countries, which
account for over 80% of the global population. Compared with the findings of
a similar review of the period 1996–1998, there has been little change. The
three European journals had a higher representation than the three American
Journals. The proportion of psychiatrists in a country was associated with
that country's research output. As much as 50% of the research from LAMI
countries is led by authors from high-income countries. The proportion of
submissions from LAMI countries was very low, and articles from them were
more frequently rejected. Strengthening the research capacity of these
countries and reviewing the editorial policies of leading journals can help
increase the international representation of LAMI countries in psychiatric