The neuropharmacological actions of antidepressants are well characterised but our understanding of how these changes translate into improved mood are still emerging.

To investigate whether actions of antidepressant drugs on emotional processing are a mediating factor in the effects of these drugs in depression.

We examined key published findings that explored the effects of antidepressants on behavioural and functional magnetic resonance imaging (fMRI) measures of emotional processing.

Negative emotional bias has been reliably associated with depression. Converging results suggest that antidepressants modulate emotional processing and increase positive emotional processing much earlier than effects on mood. These changes in emotional processing are associated with neural modulation in limbic and prefrontal circuitry.

Antidepressants may work in a manner consistent with cognitive theories of depression. Antidepressants do not act as direct mood enhancers but rather change the relative balance of positive to negative emotional processing, providing a platform for subsequent cognitive and psychological reconsolidation.

Reducing use of hospital wards and improving their quality are central aims of mental health service policy. However, no comprehensive synthesis is available of evidence on residential alternatives to standard acute psychiatric wards.

To assess the effectiveness and cost-effectiveness of and satisfaction with residential alternatives to standard acute in-patient mental health services.

A systematic search identified controlled studies comparing residential alternatives with standard in-patient services. Studies were described and assessed for methodological quality. Results from higher quality studies are presented and discussed.

Twenty-seven relevant studies were identified. Nine studies of moderate quality provide no contraindication to identified alternative service models and limited preliminary evidence that community-based alternatives may be cheaper and individuals more satisfied than in standard acute wards.

More research is needed to establish the effectiveness of service models and target populations for residential alternatives to standard acute wards. Community-based residential crisis services may provide a feasible and acceptable alternative to hospital admission for some people with acute mental illness.

Depression is reported to be associated with increased mortality, although underlying mechanisms are uncertain. Associations between anxiety and mortality are also uncertain.

To investigate associations between individual and combined anxiety/depression symptom loads (using the Hospital Anxiety and Depression Scale (HADS)) and mortality over a 3–6 year period.

We utilised a unique link between a large population survey (HUNT–2, n = 61 349) and a comprehensive mortality database.

Case-level depression was associated with increased mortality (hazard ratio (HR) = 1.52, 95% CI 1.35–1.72) comparable with that of smoking (HR = 1.59, 95% CI 1.44–1.75), and which was only partly explained by somatic symptoms/conditions. Anxiety comorbid with depression lowered mortality compared with depression alone (anxiety depression interaction P = 0.017). The association between anxiety symptom load and mortality was U-shaped.

Depression as a risk factor for mortality was comparable in strength to smoking. Comorbid anxiety reduced mortality compared with depression alone. The relationship between anxiety symptoms and mortality was more complex with a U-shape and highest mortality in those with the lowest anxiety symptom loads.

Many people with schizophrenia remain untreated in the community. Long-term mortality and suicidal behaviour among never-treated individuals with schizophrenia in the community are unknown.

To explore 10-year mortality and suicidal behaviour among never-treated individuals with schizophrenia.

We used data from a 10-year prospective follow-up study (1994–2004) among people with schizophrenia in Xinjin County, Chengdu, China.

The mortality rate for never-treated individuals with schizophrenia was 2761 per 100 000 person-years during follow-up. There were no significant differences of rates of suicide and all-cause mortality between never-treated and treated individuals. The standardised mortality ratio (SMR) for never-treated people was 10.4 (95% CI 7.2–15.2) and for treated individuals 6.5 (95% CI 5.2–8.5). Compared with treated people, never-treated individuals were more likely to be older, poorer, have a longer duration of illness, marked symptoms and fewer family members.

The never-treated individuals have similar mortality to and a higher proportion of marked symptoms than treated people, which may reflect the poor outcome of the individuals without treatment. The higher rates of mortality, homelessness and never being treated among people with schizophrenia in low- and middle-income nations might challenge presumed wisdom about schizophrenia outcomes in these countries.

Although schizotypal traits, such as anhedonia and aberrant perceptions, may increase the risk for schizophrenia-spectrum disorders, little is known about early-life characteristics that predict more pronounced schizotypal traits.

To examine whether birth size or several other early-life factors that have been previously linked with schizophrenia predict schizotypal traits in adulthood.

Participants of the Northern Finland 1966 Birth Cohort Study (n = 4976) completed a questionnaire on positive and negative schizotypal traits at the age of 31 years.

Lower placental weight, lower birth weight and smaller head circumference at 12 months predicted elevated positive schizotypal traits in women after adjusting for several confounders (P<0.02). Moreover, higher gestational age, lower childhood family socioeconomic status, undesirability of pregnancy, winter/autumn birth, higher birth order and maternal smoking during pregnancy predicted some augmented schizotypal traits in women, some in men and some in both genders.

The results point to similarities in the aetiology of schitzotypal traits and schizophrenia-spectrum disorders.

Existing neuropsychological studies of obsessive–compulsive disorder (OCD) are cross-sectional and do not provide evidence of whether deficits are trait-related (antecedent and independent of symptomatology) or state-related (a consequence, dependent on symptomatology).

To investigate whether there are premorbid neuropsychological deficits associated with adult OCD.

Longitudinal data were collected from participants of the Dunedin Multidisciplinary Health and Developmental study. Neuropsychological data collected at age 13 were linked with age 32 diagnosis of OCD.

The group who had OCD at age 32 differed significantly from the control group with no OCD on their performance at age 13 on neuropsychological tests of visuospatial, visuoconstructive and visuomotor skills, controlling for gender and socioeconomic status, but did not differ on tests of general IQ or verbal ability. Performance of the group with OCD on tests of executive functioning was mixed.

Individuals with OCD have premorbid impairment in visuospatial abilities and some forms of executive functioning, consistent with biological models of OCD.

Studies examining the impact of childhood disaster exposure on the development of adult psychopathology report increased rates of post-traumatic stress disorder (PTSD) and other psychopathology.

To examine the rates of PTSD and other lifetime DSM–IV disorders in adults exposed to an Australian bushfire disaster as children in 1983 using a matched control sample recruited at the time of the original study.

A total of 1011 adults recruited from an original sample of 1531 were assessed 20 years following the fires using the Composite International Diagnostic Interview (CIDI–2.1).

Results showed only a small direct impact of the fires on adult psychiatric morbidity. A higher proportion of bushfire survivors met criteria for ‘any DSM–IV disorder’ and ‘any anxiety’.

Findings suggest that the long-term impact of a prominent trauma in childhood should be assessed in the context of other lifetime trauma in order to provide a more accurate account of PTSD prevalence rates.

Prospective data on the association between common mental disorders and obesity are scarce, and the impact of ageing on this association is poorly understood.

To examine the association between common mental disorders and obesity (body mass index 30 kg/m2) across the adult life course.

The participants, 6820 men and 3346 women, aged 35–55 were screened four times during a 19-year follow-up (the Whitehall II study). Each screening included measurements of mental disorders (the General Health Questionnaire), weight and height.

The excess risk of obesity in the presence of mental disorders increased with age (P = 0.004). The estimated proportion of people who were obese was 5.7% at age 40 both in the presence and absence of mental disorders, but the corresponding figures were 34.6% and 27.1% at age 70. The excess risk did not vary by gender or according to ethnic group or socioeconomic position.

The association between common mental disorders and obesity becomes stronger at older ages.

The mechanism underlying the association between urban birth/upbringing and increased schizophrenia risk is unknown. This study explored whether an urban effect might be present in a low-income country setting, where the ‘urban’ environment may have radically different components, for example urban architecture, pollution levels or social cohesion.

To investigate the potential association of urbanicity of place of birth and symptoms of psychosis, depression and anxiety in Uganda.

Ugandans aged 18–30 years (n = 646) were interviewed using the Peters et al Delusions Inventory (PDI–21), the Hopkins Symptoms Checklist (HSCL–25) and psychoticism items from the Symptoms Checklist 90-items version (SCL–90) in Mbarara and Kampala districts and asked about their birthplace.

Urban birth (but not semi-urban) was associated with more lifetime psychotic experiences, especially grandiosity, and more symptoms of psychosis, depression and anxiety during the past week.

The urban risk factor for schizophrenia may be universally present across different levels of human development, albeit the nature of the mechanism remains elusive.

Late-life depression has been associated with cerebrovascular disease and especially with ischaemic white matter hyperintensities on magnetic resonance imaging. Neuroimaging and morphometric studies have identified abnormalities in the dorsolateral prefrontal cortex.

To examine glial and neuronal density and neuronal volume in the dorsolateral prefrontal cortex in late-life major depression.

We used the disector and nucleator methods to estimate neuronal density and volume and glial density of cells in the dorsolateral prefrontal cortex in a post-mortem study of 17 individuals with late-life major depression and 10 age-matched controls.

We found a reduction in the volume of pyramidal neurones in the whole cortex, which was also present in layer 3 and more markedly in layer 5. There were no comparable changes in non-pyramidal neurones and no glial differences.

Overall, we found a decrease in pyramidal neuronal size in the dorsolateral prefrontal cortex in late-life depression.

The UK National Institute for Health and Clinical Excellence (NICE) has recommended that cost-effectiveness analysis includes the EQ–5D; however, this is often not implemented in the area of mental health.

To assess the appropriateness of using the EQ–5D to measure improvements in mental health.

Seventy-seven participants with psychosis were rated according to the EQ–5D and seven measures of mental health at both pre- and post-intervention. To assess construct validity we compared the (pre-intervention) mean EQ–5D scores for those with milder and more severe scores, according to each of the seven measures. To assess responsiveness we estimated the mean EQ–5D change score for those who improved (post-intervention), according to each of the measures.

The mean EQ–5D score was more favourable for both those with milder scores (mean difference: 0.044 to 0.301) and for those who improved post-intervention (mean change: 0.029 to 0.117).

This suggests the EQ–5D should be considered for use in future cost-effectiveness studies in the area of mental health.