In Western countries depression and suicide attempts are more prevalent among women, and completed suicides among men; but in China women die more often than men by suicide. How can we interpret these contrasting findings?

Prospective studies of population cohorts.

The Zurich Study found that suicidal ideation was equally prevalent in women and men but suicide attempts more frequent in women. Suicidality was associated with multiple risk factors: both men and women with a depressive personality and severe punishment in childhood were more at risk. Furthermore, women more often reported a broken home, sexual trauma and a lower education level and men that they grew up in a tense family atmosphere.

In another study of 2768 19-year old Swiss army conscripts followed up until age 36, higher external aggression scores were found in the 46 men who died by suicide than in controls. In the Zurich Study women scored lower in external aggression than men.

Men generally choose more violent and women softer methods of suicide. Following the detoxification of gas in England and Wales, women's suicides fell sharply. In country areas in China women's free access to pesticides is considered to explain the high female suicide rates.

The findings call into question the hypothesis that suicide attempts in women are more of an appeal for help. Restricting the availability of weapons and toxic substances can prevent suicide.

Episodic-autobiographical memory (EAM) is the highest ontogenetic human achievement and is defined as the conjunction of subjective time, autonoetic consciousness and the experiencing self. The EAM system is more susceptible to insults than other memory systems and is predominantly affected in amnesic disorders. Dissociative amnesia is triggered by psychological stress and usually presents with retrograde memory impairment in the EAM domain.

This work's objectives are establishing greater recognition of the changes in the area of personality dimensions, self and autonoetic consciousness, accompanying dissociative amnesia.

We review data from own patients with dissociative amnesia or fugue

Patients were investigated medically, neuropsychologically and neuroradiologically.

We found impairments of self and self-referential processing in patients with dissociative amnesia, such as profound loss of personal identity, decreased ability for self-reflection and self projection and anomalous self-face processing. We also identified changes in personality dimensions involving affectivity, perception, cognition (e.g. social cognition) and behavior.

The observed changes in self and autonoetic consciousness may represent a consequence of amnesia. Studies indicate a right hemispheric bias for higher forms of self awareness. In retrograde dissociative amnesia, we found a hypometabolism in right fronto-temporal areas, suggesting a defective synchronization during retrieval between processing of affectively-loaded personal events and fact-based processing. This synchronization abnormality in our opinion not only leads to a memory blockade, but also to a shrinkage of self and loss of autonoetic consciousness in dissociative amnesic conditions.

It has been hypothesized that the first five years after first episode of psychosis constitutes a critical period in with opportunities for ameliorating the course of illness. Based on this rationale, specialized assertive early intervention services were developed. We wanted to investigate the evidence basis for such interventions.

The evidence for the effectiveness of specialized assertive early intervention services is mainly based on one large randomized clinical trial, the OPUS trial, but it is supported by the findings in smaller trials such as the Lambeth Early Onset (LEO) trial, the Croydon Outreach and Assertive Support Team COAST trial and the Norwegian site of Optimal Treatment (OTP) trial. There are positive effects on psychotic and negative symptoms, on substance abuse and user satisfaction, but the clinical effects are not sustainable when patients are transferred back to standard treatment. However the positive effects on service use and ability to live independently seem to be durable.

Implementation of specialized assertive early intervention services is recommended, but the evidence basis needs to be strengthened through replication in large high quality trials. Recommendation regarding the duration of treatment must await results of ongoing trials comparing two years of intervention with extended treatment periods.

Linden, D. E., Habes, I., Johnston, S. J., Linden, S., Tatineni, R., Subramanian, L., . . . Goebel, R. (2012). Real-time self-regulation of emotion networks in patients with depression. PLoS One, 7(6), e38115.

The recent publication of the DSM-5 has been preceded and followed by a lively debate, in which recurring arguments have been that the manual, referred to as’the bible of psychiatry’, mislabels many people who are basically normal and that the diagnostic categories it contains are invalid, not being based on objective laboratory tests. We present data on the utilization of the ICD and DSM worldwide, showing that the DSM is used by only a minority of European psychiatrists in clinical settings. We highlight the gap between diagnostic systems and ordinary diagnostic practice, which should be addressed by future research and action. We discuss the need to assess systematically the pros and cons of the operational and prototype approaches to psychiatric diagnosis, with a special focus on their applicability in ordinary practice and clinical utility. We consider different views about what qualifies as mental disorder and how the boundary between pathology and normality should be fixed for each mental disorder. We review the role of laboratory tests as applied in medicine, emphasizing that most of them are probabilistic, not pathognomonic, markers of disease, and that their availability has not prevented some non-psychiatric conditions which are on a continuum with normality to become the subject of controversy as to the appropriate’threshold’ for the diagnosis. We summarize the promise and limitations of the Research Domain Criteria project, aiming to’transform psychiatric diagnosis’.