Concern exists that antidepressants can cause suicidality in youths with depression.

To determine the pooled risk of self-harm and suicidal behaviour from randomised trials of newer antidepressants.

A meta-analysis was carried out to calculate odds ratios for the combined data.

Self-harm or suicide-related events occurred in 71 of 1487 (4.8%) of depressed youths treated with antidepressants v. 38 of 1254 (3.0%) of those given placebo (fixed effects odds ratio 1.70, 95% CI 1.13–2.54, P=0.01). There was a trend for individual suicidal thoughts, attempts and self-harm to occur more often in youths taking antidepressants than in those given placebo, but none of these differences was statistically significant.

Antidepressants may cause a small short-term risk of self-harm or suicidal events in children and adolescents with major depressive disorder.

Although selective serotonin reuptake inhibitors (SSRIs) are frequently used for major depressive disorder, only 50–60% of patients respond to a standard dose. For non-responders, dose escalation is often applied.

To systematically review the evidence for dose escalation of SSRIs.

A systematic literature search in MEDLINE, EMBASE, CINAHL and PsycInfo was performed. Randomised controlled trials and meta-analyses investigating dose escalation of SSRIs were identified. Relevant articles were retrieved and critically appraised. Results were summarised in an evidence table. Pooling was not justified because of heterogeneity of the identified studies.

Eight true dose-escalation studies and three meta-analyses were identified. The available data provided no unequivocal base for dose escalation. Dose escalation before 4 weeks of treatment at a standard dose appeared to be ineffective.

Dose escalation of SSRIs is equivocally supported by evidence of randomised controlled trials; methodological difficulties in the studies may account for this lack of evidence.

Studies of conversion from mild cognitive impairment to dementia suggest a linear progression over time. Conversion rates during lifetime may extend to 80–90%.

This study examines the time-dependent evolution from mild cognitive impairment to dementia. Current assumptions regarding yearly and lifetime conversion rates are challenged.

A community sample of 1045 dementia-free individuals aged 75 years and over was examined by neuropsychological testing based on 6 years of observation.

Approximately 60–65% of people with mild cognitive impairment develop clinical dementia during their life. Progression from mild cognitive impairment to dementia appears to be time dependent, occurring primarily within the initial 18 months.

Further long-term studies are needed to examine the time-dependent evolution from mild cognitive impairment to dementia and to establish age-specific conversion rates during lifetime.

Research has suggested an association between obstetric complications and bipolar disorder. However, no quantitative evaluation has been made of the pooled data from existing studies.

To systematically review studies comparing exposure to obstetric complications in cases of bipolar disorder v. non-psychiatric controls, and in cases of bipolar disorder v. cases of other mental disorders.

Publications were identified by computer searches of seven databases, by hand searches of reference lists and from raw data received from researchers.

Forty-six studies were identified, of which 22 met the inclusion criteria. The pooled odds ratio for exposure to obstetric complications and subsequent development of bipolar disorder was 1.01 (95% Cl 0.76–1.35) compared with healthy controls, 1.13 (95% Cl 0.64–1.99) compared with cases of unipolar disorder and 0.61 (95% Cl 0.39–0.95) compared with those who developed schizophrenia.

There is no robust evidence that exposure to obstetric complications increases the risk of developing bipolar disorder. However, the range of events regarded as obstetric complications and methodological inadequacies make definitive conclusions difficult.

One factor contributing to impaired awareness of illness (poor insight) in psychotic disorders may be neurocognitive deficits.

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 finegrained analyses investigated whether there was a specific relation with frontal executive functioning, and whether this was influenced by diagnosis or the insight scales used.

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.

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.

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.

To use meta-regression to identify ‘active ingredients' in collaborative care models for depression in primary care.

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.

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.

Meta-regression may be useful in examining ‘active ingredients' in complex interventions in mental health.

Music therapy may provide a means of improving mental health among people with schizophrenia, but its effects in acute psychoses have not been explored.

To examine the feasibility of a randomised trial of music therapy for in-patients with schizophrenia, and explore its effects on mental health.

Up to 12 weeks of individual music therapy plus standard care were compared with standard care alone. Masked assessments of mental health, global functioning and satisfaction with care were conducted at 3 months.

Of 115 eligible patients 81 (70%) were randomised. Two-thirds of those randomised to music therapy attended at least four sessions (median attendance, eight sessions). Multivariate analysis demonstrated a trend towards improved symptom scores among those randomised to music therapy, especially in general symptoms of schizophrenia.

A randomised trial of music therapy for in-patients with schizophrenia is feasible. The effects and cost-effectiveness of music therapy for acute psychosis should be further explored in an explanatory randomised trial.

Treatment options for depression include antidepressants, psychological therapy and a combination of the two.

To develop cost-effective clinical guidelines.

Systematic literature reviews were used to identify clinical, utility and cost data. A decision analysis was then conducted to compare the benefits and costs of antidepressants with combination therapy for moderate and severe depression in secondary care in the UK.

Over the 15-month analysis period, combination therapy resulted in higher costs and an expected 0.16 increase per person in the probability of remission and no relapse compared with antidepressants. The cost per additional successfully treated patient was £4056 (95% CI 1400–18 300); the cost per quality-adjusted life year gained was £5777 (95% CI 1900–33 800) for severe depression and £14 540 (95% CI 4800–79 400) for moderate depression.

Combination therapy is likely to be a cost-effective first-line secondary care treatment for severe depression. Its cost-effectiveness for moderate depression is more uncertain from current evidence. Targeted combination therapy could improve resource utilisation.

Aripiprazole is an atypical antipsychotic that is reported to be effective in the treatment of schizophrenia.

To investigate the effects of aripiprazole on patients with schizophrenia and schizophrenia-like psychoses by conducting a systematic review of randomised controlled trials (RCTs).

Database and manual searches and direct contact were used to identify relevant RCTs.

We included 10 randomised controlled studies (involving a total of 4125 patients), but study attrition was large and the standard of data reporting was poor. Compared with placebo, aripiprazole treatment was associated with a significant decrease in relapse rates, increased compliance with the study protocol, and a decrease in prolactin levels below the expected values. Compared with risperidone, aripiprazole caused less elevation of prolactin levels and less prolongation of the average QTc interval.

Aripiprazole has been licensed despite the fact that few reliable data on this drug are publicly available. It may be effective for treatment of schizophrenia, but in terms of tolerability and global outcomes it shows little difference from existing antipsychotics.

We have previously reported the Val66Met and GT(n) repeat polymorphisms of the brain-derived neurotrophic factor (BDNF) gene to be associated with bipolar disorder. However, these findings have not been replicated consistently.

To dissect the association of the BDNF gene with bipolar disorder by examining additional markers at the DNA level and by testing the illness categories of bipolar disorder I and II and rapid cycling.

We performed a family-based association study and haplotype analyses with 312 nuclear families using four single nucleotide polymorphisms (SNPs) and the Val66Met and GT(n) repeat polymorphisms.

The SNPs hCVI1592756 and rs2049045, the Val66Met and GT(n) were significantly associated with bipolar disorder using transmission disequilibrium analyses (P=0.02, 0.009, 0.001 and 0.008 respectively). The effect at these markers was mainly driven by the rapid-cycling patients.

Within bipolar disorder, variation in the BDNF gene appears to predict risk for developing rapid cycling according to DSM–IV. Incorporating this clinical sub-phenotyping into other studies of the BDNF gene may help to resolve some of the inconsistencies reported thus far concerning BDNF and bipolar disorder.

It is unclear whether psychiatric morbidity contributes to the small proportion of the population responsible for a large percentage of antisocial behaviour, including violence.

To measure associations between psychiatric morbidity and severity chronicity and types of victims of violence in the national household population of Britain.

Cross-sectional survey of persons in households (n=8397). Data included self-reported location, victims and outcome of violence over the previous 5 years. Diagnoses were determined by computer-assisted interviews.

Hazardous drinking was associated with over half of all incidents involving injury. Antisocial personality disorder conveyed an attributable risk of 24% of respondents reporting victim injuries, but screening positive for psychosis conveyed an attributable risk of only 1.2%.

The burden of care resulting from violence associated with hazardous drinking supports population interventions. Despite exceptional risks, half of respondents with antisocial personality disorder were not violent, indicating limitations in targeted interventions to detain high-risk individuals.

The prevalence of benzodiazepine consumption in European countries remains at 2–3% of the general population despite the well-documented disadvantages of long-term use.

To review systematically the success rates of different benzodiazepine discontinuation strategies.

Meta-analysis of comparable intervention studies.

Twenty-nine articles met inclusion criteria. Two groups of interventions were identified; minimal intervention (e.g. giving simple advice in the form of a letter or meeting to a large group of people; n=3), and systematic discontinuation (defined as treatment programmes led by a physician or psychologist; n=26). Both were found to be significantly more effective than treatment as usual: minimal interventions (pooled OR=2.8, 95% CI 1.6–5.1); systematic discontinuation alone (one study, OR=6.1, 95% CI 2.0–18.6). Augmentation of systematic discontinuation with imipramine (two studies, OR=3.1, 95% CI 1.1–9.4) or group cognitive-behavioural therapy for patients with insomnia (two studies, OR=5.5, 95% CI 2.3–14.2) was superior to systematic discontinuation alone.

Evidence was found for the efficacy of stepped care (minimal intervention followed by systematic discontinuation alone) in discontinuing long-term benzodiazepine use.

The impact of anxiety disorders has not been well delineated in prospective studies of bipolar disorder.

To examine the association between anxiety and course of bipolar disorder, as defined by mood episodes, quality of life and role functioning.

A thousand out-patients with bipolar disorder were followed prospectively for 1 year.

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 1 year of prospective study. The negative impact was greater with multiple anxiety disorders.

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.

Minor physical anomalies are more prevalent among people with psychosis. This supports a neurodevelopmental aetiology for psychotic disorders, since these anomalies and the brain are both ectodermally derived. However, little is understood about the brain regions implicated in this association.

To examine the relationship between minor physical anomalies and grey matter structure in a sample of patients with first-episode psychosis.

Sixty patients underwent assessment of minor physical anomalies with the Lane scale. High-resolution magnetic resonance images and voxel-based methods of image analysis were used to investigate brain structure in these patients.

The total anomalies score was associated with a grey matter reduction in the prefrontal cortex and precuneus and with a grey matter excess in the basal ganglia, thalamus and lingual gyrus.

Minor physical anomalies in a sample of patients with first-episode psychosis are associated with regional grey matter changes. These regional changes may be important in the pathogenesis of psychotic disorder.

Very few studies have examined the cross-national prevalence of suicidal ideation in the general population or variables associated with it.

To examine the risk factors for suicidal ideas in the general population.

As part of a five-country two stage epidemiological study of depressive disorder (the ODIN study) a random sample of over 12 000 people were screened using the Beck Depression Inventory (BDI). There followed detailed analysis of item 9 of the BDI, which measured the severity of suicidal ideation.

Age, marriage, concern by others and severity of depressed mood independently increased or decreased the odds of suicidal ideation overall. An interaction between life events and social supports was identified, although this differed between men and women. Only concern by others and severity of depression were independently associated with serious suicidal ideation. The study does not allow for interpretation of the direction of the association.

A number of social, clinical and demographic variables were independently associated with all suicidal ideation and with serious suicidal ideation. Longitudinal studies are required to confirm whether these are risk factors for or the result of suicidal ideation or have some other relationship.

Children of mothers with eating disorders are at increased risk of developmental disturbance, but there has been little research in middle childhood, when disturbed eating habits tend to emerge.

To examine whether maternal eating disorders identified in the postnatal year are associated with the development of disturbed eating habits and attitudes in children at 10 years of age.

Follow-up comparative study of 56 families (33 mothers with eating disorders and 23 controls). Psychopathology of children, mothers and fathers was assessed by interview, and mother-child interaction observed.

The index group of children scored higher than controls on three of four domains of eating disorder psychopathology and on a global score. Children's eating disturbance was associated with length of exposure to mothers' eating disorder and mother-child mealtime conflict at 5 years. There was some evidence of increased emotional problems in index children.

The children of mothers with eating disorders manifested disturbed eating habits and attitudes compared with controls, and may be at heightened risk of developing frank eating disorder psychopathology.