Cognitive impairment in schizophrenia-spectrum disorders is highly prevalent and notably influences functional outcomes.

To characterise the cognitive effectiveness of second-generation antipsychotic drugs.

One hundred consecutive and previously unmedicated patients with first-episode schizophrenia-spectrum disorders were admitted. Seventy-seven completed baseline, 1-month and 6-month psychopathological and neuropsychological assessments. Patients were randomised to risperidone or olanzapine treatment. Four final treatment allocation groups were defined since patients continued treatment in their normal setting: risperidone, olanzapine, mixed and no-antipsychotic groups.

There were no differences in cognitive effectiveness between the four treatment groups. Reliable change index methods demonstrated that nearly a half of patients showed an improvement in Global Cognitive Score at the 6-month assessment. Improvement on the neuropsychological tests ranged from 17 to 54%.

A strong predictor of cognitive response was poor performance on baseline neuropsychological tests; response was moderately influenced by a low premorbid scholastic performance and IQ.

Cognitive improvement related to second-generation antipsychotic drugs appeared within the first 4 weeks of treatment and persisted at 6 months irrespective of treatment group. Greater cognitive dysfunction at baseline and lower premorbid cognitive background predicted cognitive improvement in our sample.

The presence of schizotypal personality traits in some people with bipolar disorder, together with reports of greater cognitive dysfunction in patients with a history of psychotic features compared with patients without such a history, raises questions about the nosological relationship between bipolar disorder with psychotic features and bipolar disorder without psychotic features.

To test the impact of a history of DSM–IV-defined psychosis on the neuropsychological status of participants with bipolar disorder while statistically controlling for confounding factors such as mood, medication, alcohol misuse/dependence and childhood abuse, and to evaluate the impact of schizotypal personality traits (and thus potential vulnerability to psychotic illness) on the cognitive performance of people with bipolar disorder and their healthy relatives.

Neuropsychological data were obtained for 25 participants with type I bipolar disorder and a history of psychosis, 24 with type I bipolar disorder but no history of psychosis and 61 unaffected relatives. Schizotypal traits were measured with the Schizotypal Personality Scale (STA). Childhood trauma was measured with the Childhood Trauma Questionnaire.

The group with a history of psychosis performed significantly worse than the healthy relatives on measures of verbal working memory, cognitive flexibility and declarative memory. Nevertheless, the two bipolar disorder groups did not differ significantly from each other on any cognitive measure. Scores on the STA were negatively associated with verbal working and declarative memory, but positively associated with visual recall memory.

‘Psychotic’ and ‘non-psychotic’ subtypes of bipolar disorder may lie on a nosological continuum that is most clearly defined by verbal memory impairment.

Naltrexone has considerable potential in helping to prevent relapse in heroin dependency. A longer-lasting formulation for naltrexone treatment is desirable to further reduce non-adherence and relapse during treatment of opiate dependence.

To evaluate the safety and effectiveness of a 6-month naltrexone implant in reducing opioid use after in-patient treatment.

A group of 56 abstinence-oriented patients who completed in-patient treatment for opioid dependence were randomly and openly assigned to receive either a 6-month naltrexone implant or their usual aftercare. Drug use and other outcomes were assessed at 6-month follow-up.

Patients receiving naltrexone had on average 45 days less heroin use and 60 days less opioid use than controls in the 180-day period (both P<0.05). Blood tests showed naltrexone levels above 1 ng/ml for the duration of 6 months. Two patients died, neither of whom had received an implant.

Naltrexone implant treatment safely and significantly reduces opioid use in a motivated population of patients.

The long-term outcome of anorexia nervosa is insufficiently researched.

To study prospectively the long-term outcome and prognostic factors in a representative sample of people with teenage-onset anorexia nervosa.

Fifty-one people with anorexia nervosa, recruited by community screening and with a mean age at onset of 14 years were compared with 51 matched comparison individuals at a mean age of 32 years (18 years after disorder onset). All participants had been examined at ages 16 years, 21 years and 24 years. They were interviewed for Axis I psychiatric disorders and overall outcome (Morgan–Russell assessment schedule and the Global Assessment of Functioning).

There were no deaths. Twelve per cent (n=6) had a persisting eating disorder, including three with anorexia nervosa. Thirty-nine per cent of the anorexia nervosa group met the criteria for at least one psychiatric disorder. The general outcome was poor in 12%. One in four did not have paid employment owing to psychiatric problems. Poor outcome was predicted by premorbid obsessive–compulsive personality disorder, age at onset of anorexia nervosa and autistic traits.

The 18-year outcome of teenage-onset anorexia nervosa is favourable in respect of mortality and persisting eating disorder.

Mental health units in England had to become smoke-free by law from July 2008. Concerns regarding the implementation and enforcement of smoke-free policies in these settings have been raised.

To study difficulties and challenges associated with smoke-free policy implementation in English National Health Service (NHS) mental health settings.

Questionnaire survey of all 72 English NHS trusts providing mental health in-patient services and facilities, supplemented by semi-structured telephone interviews at a systematic sample of 7 trusts and site visits at a convenience sample of 5 trusts.

Questionnaires were returned by 79% of the trusts, all of whom had implemented smoke-free policies. Most respondents (91%) believed that mental health settings faced particular challenges, arising from the high smoking prevalence among patients (81%), related safety risks (70%), adverse effects on the clinician–patient relationship (36%), and potential interactions with antipsychotic medication (34%). Interviews indicated that sustained policy enforcement was perceived as difficult, but that despite challenges and concerns, the impact of the policy was regarded as beneficial, with some evidence of positive behavioural changes occurring in people.

Many mental health trusts across England have implemented comprehensive smoke-free policies but the majority state that they are facing specific difficulties. Challenges and concerns need to be explored in depth and addressed to ensure that smoke-free policies implemented under the terms of the Health Act in July 2008 are not undermined.

Tricyclic antidepressants and serotonin reuptake inhibitors are considered to be equally effective, but differences may have been obscured by internally inconsistent measurement scales and inefficient statistical analyses.

To test the hypothesis that escitalopram and nortriptyline differ in their effects on observed mood, cognitive and neurovegetative symptoms of depression.

In a multicentre part-randomised open-label design (the Genome Based Therapeutic Drugs for Depression (GENDEP) study) 811 adults with moderate to severe unipolar depression were allocated to flexible dosage escitalopram or nortriptyline for 12 weeks. The weekly Montgomery–Åsberg Depression Rating Scale, Hamilton Rating Scale for Depression, and Beck Depression Inventory were scored both conventionally and in a more novel way according to dimensions of observed mood, cognitive symptoms and neurovegetative symptoms.

Mixed-effect linear regression showed no difference between escitalopram and nortriptyline on the three original scales, but symptom dimensions revealed drug-specific advantages. Observed mood and cognitive symptoms improved more with escitalopram than with nortriptyline. Neurovegetative symptoms improved more with nortriptyline than with escitalopram.

The three symptom dimensions provided sensitive descriptors of differential antidepressant response and enabled identification of drug-specific effects.

Children with attention-deficit hyperactivity disorder (ADHD) are thought to be at higher risk of psychopathy. Early biological and social adversity may contribute to this risk.

To examine psychopathy traits in ADHD.

In a sample of children with ADHD who had reached adolescence, total psychopathy and ‘emotional-dysfunction’ scores (e.g. callousness, lack of affect) were assessed using the Hare Psychopathy Checklist–Youth Version.

A total of 156 (79%) eligible families participated. Total psychopathy and emotional-dysfunction scores were elevated in comparison to published UK norms but none scored in the clinical range for psychopathy. Adjusting for associated conduct problems, total psychopathy scores were associated with maternal smoking during pregnancy, emotional-dysfunction scores were associated with birth complications, and neither was associated with family adversity.

Children with ADHD show psychopathy traits but are not ‘psychopaths’. Early adversity, indexed by pre- or perinatal adversity but not family factors, appears to be associated.

Animal experimental studies have prompted concerns that widespread use of 3,4-methylenedioxymethamphetamine (MDMA; ‘ecstasy’) by young people may pose a major public health problem in terms of persistent serotonin neurotoxicity.

To determine the status of brain serotonin neurons in a group of abstinent MDMA users.

We assessed the integrity of brain serotonin neurons by measuring serotonin transporter (SERT) binding using positron emission tomography (PET) and [11C]DASB in 12 former MDMA users, 9 polydrug users who had never taken MDMA and 19 controls who reported no history of illicit drug use.

There was no significant difference in the binding potential of [11C]DASB between the groups in any of the brain regions examined.

To the extent that [11C]DASB binding provides an index of the integrity of serotonin neurons, our findings suggest that MDMA use may not result in long-term damage to serotonin neurons when used recreationally in humans.

The development of early intervention services for young people with first-episode psychosis is a priority internationally.

To evaluate the development, implementation and impact of existing and newly formed early intervention services in England.

Multiple-case study involving staff, users, carers and commissioners of 14 early intervention services.

Service numbers increased in response to national policy directives. They were still actively working with 90.6% of service users 12 months after inception. They were highly valued by users and carers as providing a personal service that contrasted with previous experiences of care. Tensions between providing a quality service and meeting case-load targets linked to future funding led teams to adopt a series of survival strategies with some unintended consequences.

Early intervention services are highly valued by consumers and engage users effectively after 12 months. Implementation of these services is threatened unless sufficient consistent funding is made available.

Knowledge of suicide in people with dementia is limited to small case series.

To describe behavioural, clinical and care characteristics of people with dementia who died by suicide.

All dementia cases (n=118) from a 9-year national clinical survey of suicides in England and Wales (n=11 512) were compared with age- and gender-matched non-dementia cases (control group) (n=492) by conditional logistic regression.

The most common method of suicide in patients with dementia was self-poisoning, followed by drowning and hanging, the latter being less frequent than in controls. In contrast to controls, significantly fewer suicides occurred within 1 year of diagnosis in patients with dementia. Patients with dementia were also less likely to have a history of self-harm, psychiatric symptoms and previous psychiatric admissions.

Known indicators of suicide risk are found less frequently in dementia suicide cases than non-dementia suicide cases. Further research should clarify whether suicide in dementia is a response to worsening dementia or an under-appreciation of psychiatric symptoms by clinicians.

None.

Funding detailed in Acknowledgements.

The long-term efficacy of psychological interventions for bipolar disorders has not been tested.

This study assessed the efficacy of group psychoeducation to prevent recurrences and to reduce time spent ill for people with bipolar disorders.

A randomised controlled trial with masked outcome assessment comparing group psychoeducation and non-structured group intervention during 5-year follow-up. One hundred and twenty people with bipolar disorders were included in the study and 99 completed 5-year follow-up. Time to any recurrence, number of recurrences, total number of days spent ill, frequency and length of hospitalisations were the main outcome measures.

At the 5-year follow-up, time to any recurrence was longer for the psychoeducation group (log rank=9.953, P<0.002). The psychoeducation group had fewer recurrences (3.86 v. 8.37, F=23.6, P<0.0001) of any type and they spent less time acutely ill (154 v. 586 days, F=31.66, P=0.0001). The median number of days of hospitalisation per hospitalised participant was also lower for the psychoeducation group (45 v. 30, F=4.26, P=0.047).

Six-month group psychoeducation has long-lasting prophylactic effects in individuals with bipolar disorders. Group psychoeducation is the first psychological intervention showing such a long-term maintained efficacy in people with bipolar disorders.

Whether the development of tardive dyskinesia leads to an increase in mortality is still unclear.

To explore the relationship between tardive dyskinesia and mortality over a 10-year period, using the National Death Index.

Death certificates were obtained from the National Death Index on 1621 people repeatedly assessed for tardive dyskinesia by trained raters. Variables with the potential for influencing survival time were also investigated.

Tardive dyskinesia was significantly associated with an increase in mortality (P<0.001), but this association became non-significant when drug course and age were entered in the regression analysis. Those who had taken only conventional antipsychotics were twice as likely to die compared with those taking atypical agents (P<0.02). For those aged 53–65 years, conventional agents were associated with a sevenfold increase in mortality.

Older individuals with tardive dyskinesia treated with conventional antipsychotics appear to have a shortened survival time.

Routine outcome monitoring may improve clinical services but remains controversial, partly because the absence of a control group makes interpretation difficult.

To test a computer algorithm designed to allow practitioners to compare their outcomes with epidemiological data from a population sample against data from a randomised controlled trial, to see if it accurately predicted the trial's outcome.

We developed an ‘added value’ score using epidemiological data on the Strengths and Difficulties Questionnaire (SDQ). We tested whether it correctly predicted the effect size for the control and intervention groups in a randomised controlled trial.

As compared with the a priori expectation of zero, the Added Value Score applied to the control group predicted an effect size of 70.03 (95% CI 70.30 to 0.24, t = 0.2, P = 0.8). As compared with the trial estimate of 0.37, the Added Value Score applied to the intervention group predicted an effect size of 0.36 (95% CI 0.12 to 0.60, t = 0.1, P = 0.9).

Our findings provide preliminary support for the validity of this approach as one tool in the evaluation of interventions with groups of children who have, or are at high risk of developing, significant psychopathology.

There is an almost total lack of empirical research on stalking among juveniles.

To examine the characteristics, nature and impacts of stalking by juveniles.

Analysis of consecutive court applications for a restraining order against a juvenile because of stalking behaviours.

A total of 299 juvenile stalkers were identified. The majority were male (64%) and their victims predominantly female (69%). Most pursued a previously known victim (98%), favouring direct means of contact via unwanted approaches (76%) and telephone calls or text messaging (67%). Threats (75%) and physical and sexual assaults (54%) were common. The contexts for juvenile stalking involved an extension of bullying (28%), retaliation for a perceived harm (22%), a reaction to rejection (22%), sexual predation (5%) and infatuation (2%).

Juvenile stalking is characterised by direct, intense, overtly threatening and all too often violent forms of pursuit. The seriousness that is afforded to adult forms of stalking should similarly apply to this behaviour among juveniles given the even greater rates of disruption to the victim's life and risks of being attacked.