In individual studies and limited meta-analyses venlafaxine has been reported to be more effective than comparator antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs).

To perform a systematic review of all such studies.

We conducted a systematic review of double-blind, randomised trials comparing venlafaxine with alternative antidepressants in the treatment of depression. The primary outcome was the difference in final depression rating scale value, expressed as a standardised effect size. Secondary outcomes were response rate, remission rate and tolerability.

A total of 32 randomised trials were included. Venlafaxine was more effective than other antidepressants (standardised effect size was −0.14, 95% Cl −0.07 to −0.22). A similar significant advantage was found against SSRIs (20 studies) but nottricyclic antidepressants (7 studies).

Venlafaxine has greater efficacy than SSRIs although there is uncertainty in comparison with other antidepressants. Further studies are required to determine the clinical importance of this finding.

The high risk for dementia in adults with Down's syndrome has been attributed to triplication and overexpression of the gene for amyloid precursor protein (APP). But the wide variation in age at onset must be due to other risk factors.

To identify factors which influence age at onset of dementia in Down's syndrome.

Studies of factors which influence formation of beta-amyloid (Aβ) were reviewed, including atypical karyotypes, susceptibility genotypes, gender and oestrogen deficiency, and individual differences in Aβ peptide levels.

The apolipoprotein E $4 allele, oestrogen deficiency and high levels of Aβl-42 peptide are associated with earlier onset of dementia, while atypical karyotypes and the apolipoprotein E $2 allele are associated with reduced mortality and reduced risk of dementia.

Factors which influence Aβ levels, rather than overexpression of APP, may account for the differences in age at onset of dementia in Down's syndrome.

Depression is common in later life.

To determine whether exercise is effective as an adjunct to antidepressant therapy in reducing depressive symptoms in older people.

Patients were randomised to attend either exercise classes or health education talks for 10 weeks. Assessments were made ‘blind’ at baseline, and at 10 and 34 weeks. The primary outcome was seen with the 17-item Hamilton Rating Scale for Depression (HRSD). Secondary outcomes were seen with the Geriatric Depression Scale, Clinical Global Impression and Patient Global Impression.

At 10 weeks a significantly higher proportion of the exercise group (55% v. 33%) experienced a greater than 30% decline in depression according to HRSD (OR=2.51, P=0.05, 95% Cl 1.00–6.38).

Because exercise was associated with a modest improvement in depressive symptoms at 10 weeks, older people with poorly responsive depressive disorder should be encouraged to attend group exercise activities.

Psychotherapy research rarely has studied outcome in the longer term.

To evaluate the effectiveness of brief group dynamic psychotherapy (BGDP) intervention in patients with minor psychiatric disorders compared with the usual clinical management shortly after treatment termination and to investigate whether intervention would show a differential effect at 2-year follow-up.

Patients were allocated randomly to an experimental or control group. The General Health Questionnaire (GHQ) was used as a primary outcome measure.

Based on improvement in the GHQ, at termination of treatment the BGDP group showed a significant improvement in 23 out of 42 (54.8%) compared with II out of 41 (26.8%) in the clinical management group. The difference in the total improvement rate is 28% (95% Cl 8–48) (χ2=67; d.f.=l; P=0.009). In contrast, no differential follow-up effects were found between the BGDP and clinical management groups.

Psychotherapy appears to have beneficial effects at termination of treatment but the changes attained were not stable.

Community surveys have reported a higher rate of mental health problems in combined groups of homosexual and bisexual participants, but have not separated these two groups.

To assess separately the mental health of homosexual and bisexual groups compared with heterosexuals.

A community survey of 4824 adults was carried out in Canberra, Australia. Measures covered anxiety depression, suicidality alcohol misuse, positive and negative affect and a range of risk factors for poorer mental health.

The bisexual group was highest on measures of anxiety depression and negative affect, with the homosexual group falling between the other two groups. Both the bisexual and homosexual groups were high on suicidality. Bisexuals also had more current adverse life events, greater childhood adversity, less positive support from family, more negative support from friends and a higher frequency of financial problems. Homosexuals reported greater childhood adversity and less positive support from family.

The bisexual group had the worst mental health, although homosexual participants also tended to report more distress.

Little is known about the effects of the physical environment on individual health.

The present study tested the hypothesis that the prevalence of depression is associated with independently rated measures of the built environment, after adjusting for individuals' socio-economic status and the internal characteristics of their dwellings.

Cross-sectional survey of 1887 individuals aged 16 years and over in two electoral wards in north London. Depression was ascertained using the Center for Epidemiologic Studies Depression scale (CES–D). The built environment was rated independently, using a validated measure.

After adjusting for socio-economic status, floor of residence and structural housing problems, statistically significant associations were found between the prevalence of depression and living in housing areas characterised by properties with predominantly deck access (odds ratio=1.28, 95% Cl 1.03–1.58; P=0.02) and of recent (post-1969) construction (odds ratio=l.43, 95% Cl 1.06–1.91; P=0.02).

The prevalence of depression was associated with independently rated features of the built environment, independent of individuals' socio-economic status and internal characteristics of dwellings.

Treatment-resistant depression (TRD) is relatively common but its neurobiological basis is poorly understood. Fronto-striatal structural brain changes have been reported in patients with depression but their association with treatment resistance and chronicity has not been established.

Magnetic resonance images of 20 patients with TRD were compared with images of 20recovered patients and 20 healthy controls. Images were compared using a voxel-based analysis (VBA) method; the results were validated by conventional volumetric analysis. The clinical associations of magnetic resonance imaging (MRI) changes with illness duration and severity were examined by VBA.

Only the TRD group exhibited right fronto-striatal atrophy, and subtle MRI changes in the left hippocampus on VBA. Atrophy was confirmed on volumetric analysis, the degree correlating with the cumulative number of electroconvulsive therapy (ECT) treatments received, suggesting an acquired deficit.

This is the first study to demonstrate fronto-striatal atrophy in patients with depression with poor outcome; the atrophy is more marked in those with more severe illness.

The psychiatric outcome of whiplash neck injury is controversial.

To describe outcomes and predictors as compared with other types of road accident injury.

Consecutive emergency department attenders (n=1148; whiplash 278) assessed by self-report at baseline, 3 months, 1 year and 3 years.

Moderate to severe pain was reported by 27% of whiplash sufferers at I year and by 30% at 3 years. Psychiatric consequences were common and persistent. Whiplash victims and those with bony injury were more likely to seek compensation. Accident and early post-accident psychosocial variables predicted the pain at 1 year. Claiming compensation at 3 months predicted the pain at 1 year for those with whiplash or bony injury.

There is no special psychiatry of whiplash neck injury. Psychological variables and consequences are important following whiplash in a similar manner to other types of injury.

Little is known about the presentation and management of seasonal affective disorder (SAD) in primary care.

To determine the use of health care services by people suffering from SAD.

Following a screening of patients consulting in primary care, 123 were identified as suffering from SAD. Each was age— and gender-matched with two primary care consulters with minimal seasonal morbidity yielding 246 non-seasonal controls. From primary care records, health care usage over a 5-year period was established.

Patients with SAD consulted in primary care significantly more often than controls and presented with a wider variety of symptoms. They received more prescriptions, under went more investigations and had more referrals to secondary care.

Patients with SAD are heavy users of health care services. This may reflect the condition itself, its comorbidity or factors related to the personality or help-seeking behaviour of sufferers.

Mutations in tau have been found in a group of related disorders including the frontal lobe dementias.

To describe the clinical features and molecular pathology changes in a single case of a patient with frontal lobe dementia.

A case report was compiled from neuropathological reports and genomic and gene expression analyses.

A case with a splice-site mutation resulting in a typical frontotemporal clinical and neuropathological phenotype was found. Gene expression analysis suggests differential expression of isoforms of tau in regions in the brain.

Frontotemporal dementia can result from gene mutations that alter splicing and expression of tau.

Patients' perspectives concerning impaired functioning provide important information.

To evaluate the reliability and validity of the Work and Social Adjustment Scale (WSAS).

Data from two studies were analysed. Reliability analyses included internal scale consistency, test – retest and parallel forms. Convergent and criterion validities were examined with respect to disorder severity.

Cronbach's α measure of internal scale consistency ranged from 0.70 to 0.94. Test – retest correlation was 0.73. Interactive voice response administrations of the WSAS gave correlations of 0.81 and 0.86 with clinician interviews. Correlations of WSAS with severity of depression and obsessive–compulsive disorder symptoms were 0.76 and 0.61, respectively. The scores were sensitive to patient differences in disorder severity and treatment-related change.

The WSAS is a simple, reliable and valid measure of impaired functioning. It is a sensitive and useful outcome measure offering the potential for readily interpretable comparisons across studies and disorders.