Virtual reality provides a means of studying paranoid thinking in controlled laboratory conditions. However, this method has not been used with a clinical group

To establish the feasibility and safety of using virtual reality methodology in people with an at-risk mental state and to investigate the applicability of a cognitive model of paranoia to this group

Twenty-one participants with an at-risk mental state were assessed before and after entering a virtual reality environment depicting the inside of an underground train

Virtual reality did not raise levels of distress at the time of testing or cause adverse experiences over the subsequent week. Individuals attributed mental states to virtual reality characters including hostile intent. Persecutory ideation in virtual reality was predicted by higher levels of trait paranoia, anxiety, stress, immersion in virtual reality, perseveration and interpersonal sensitivity

Virtual reality is an acceptable experimental technique for use with individuals with at-risk mental states. Paranoia in virtual reality was understandable in terms of the cognitive model of persecutory delusions

Major depression is an important and costly problem among adolescents, yet evidence to support the provision of cost-effective treatments is lacking.

To assess the short-term cost-effectiveness of combined selective serotonin reuptake inhibitors (SSRIs) and cognitive–behavioural therapy (CBT) together with clinical care compared with SSRIs and clinical care alone in adolescents with major depression.

Pragmatic randomised controlled trial in the UK. Outcomes and costs were assessed at baseline, 12 and 28 weeks.

The trial comprised 208 adolescents, aged 11–17 years, with major or probable major depression who had not responded to a brief initial psychosocial intervention. There were no significant differences in outcome between the groups with and without CBT. Costs were higher in the group with CBT, although not significantly so (P=0.057). Cost-effectiveness analysis and exploration of the associated uncertainty suggest there is less than a 30% probability that CBT plus SSRIs is more cost-effective than SSRIs alone.

A combination of CBT plus SSRIs is not more cost-effective in the short-term than SSRIs alone for treating adolescents with major depression in receipt of routine specialist clinical care.

Self-harm among young people in the UK is possibly increasing but little is known about the reasons young people give for cessation and their link with gender or employment status.

To investigate self-harm in young people, prevalence, methods used, motivations for starting and ceasing, service use, and how these are related to gender, parental social class and current labour market position.

Population-based survey of 1258 18-to 20-year-olds living in the Central Clydeside Conurbation, Scotland.

Both past and current rates of self-harm were highest among those outside the labour market. This group was most likely to want to kill themselves and did not cite specialist mental health services as helpful in ceasing self-harm. Those in full-time education more often self-harmed for a brief time, mainly to reduce anxiety.

Current labour market position was a stronger predictor than parental social class or gender for self-harm, and was linked to level of severity, motivation for starting and ceasing, and service utilisation.

Progressive volumetric changes in the brains of people with schizophrenia have been attributed to a number of factors.

To determine whether glutamatergic changes in patients with schizophrenia correlated with grey-matter losses during the first years of illness.

Left anterior cingulate and thalamic glutamatergic metabolite levels and grey-matter volumes were examined in 16 patients with first-episode schizophrenia before and after 10 months and 30 months of antipsychotic treatment and in 16 healthy participants on two occasions 30 months apart.

Higher than normal glutamine levels were found in the anterior cingulate and thalamus of never-treated patients. Thalamic levels of glutamine were significantly reduced after 30 months. Limited grey-matter reductions were seen in patients at 10 months followed by widespread grey-matter loss at 30 months. Parietal and temporal lobe grey-matter loss was correlated with thalamic glutamine loss.

Elevated glutamine levels in never-treated patients followed by decreased thalamic glutamine and grey-matter loss in connected regions could indicate either neurodegeneration or a plastic response to reduced subcortical activity.

Patient–clinician communication is central to mental healthcare but neglected in research.

To test a new computer-mediated intervention structuring patient–clinician dialogue (DIALOG) focusing on patients' quality of life and needs for care.

In a cluster randomised controlled trial, 134 keyworkers in six countries were allocated to DIALOG or treatment as usual; 507 people with schizophrenia or related disorders were included. Every 2 months for 1 year, clinicians asked patients to rate satisfaction with quality of life and treatment, and request additional or different support. Responses were fed back immediately in screen displays, compared with previous ratings and discussed. Primary outcome was subjective quality of life, and secondary outcomes were unmet needs and treatment satisfaction.

Of 507 patients, 56 were lost to follow-up and 451 were included in intention-to-treat analyses. Patients receiving the DIALOG intervention had better subjective quality of life, fewer unmet needs and higher treatment satisfaction after 12 months.

Structuring patient–clinician dialogue to focus on patients' views positively influenced quality of life, needs for care and treatment satisfaction.

Antipsychotic drugs are associated with adverse effects that can lead to poor medication adherence, stigma, distress and impaired quality of life

To review the use of adverse effects of antipsychotic drugs as outcome measures, with a particular emphasis on methodological issues

Review of data on adverse effects from sources including randomised controlled trials (RCTs), post-marketing surveillance and naturalistic studies

All have advantages and disadvantages and the best overview comes from considering all sources of data together. Adverse effects are inconsistently reported, hampering cross-study comparisons. Many outcome measures lack clinical meaning. In both naturalistic studies and RCTs adverse effects often account for less treatment discontinuation than lack of efficacy

Standardisation in the reporting of adverse effects is needed. Patients' subjective experience of medication should be given more consideration. Total discontinuation rates provide a useful global outcome measure that incorporates tolerability and efficacy as well as patient and clinician viewpoints. Patients should be informed of common side-effects prior to treatment and monitored for their occurrence during treatment

Understanding of the psychological impact of politically motivated violence is poor.

To examine the prevalence of post-traumatic symptoms subsequent to the ‘troubles' in Northern Ireland.

A telephone survey of 3000 adults, representative of the population in Northern Ireland and the border counties of the Irish Republic, examined exposure to political violence, post-traumatic stress disorder (PTSD) and national identity.

Ten per cent of respondents had symptoms suggestive of clinical PTSD. These people were most likely to come from low-income groups, rate national identity as relatively unimportant and have higher overall experience of the ‘troubles' than other respondents.

Direct experience of violence and poverty increase the risk of PTSD, whereas strong national identification appears to reduce this risk.

People with schizophrenia may demonstrate cortical abnormalities, with gyri and sulci potentially being differentially affected.

To measure frontal and temporal sulcal cortical thickness, surface area and volume in the non-psychotic relatives of patients with schizophrenia as a potential vulnerability indicator for the disorder.

An automated parcellation method was used to measure the superior frontal, inferior frontal, cingulate, superior temporal and inferior temporal sulci in the relatives of patients (n=19) and controls (n=22).

Compared with controls, relatives had reversed hemispheric asymmetry in their cingulate sulcal thickness and a bilateral reduction in their superior temporal sulcal thickness.

Cingulate and superior temporal sulcal thickness abnormalities may reflect neural abnormalities associated with the genetic liability to schizophrenia. Cortical thinning in these regions suggests that liability genes affect the dendrites, synapses or myelination process during the neurodevelopment of the cortical mantle.

Treatment guidelines identify few adequately powered trials to guide recommendations for anorexia nervosa.

To evaluate the effectiveness of three readily available National Health Service treatments for adolescents (aged 12–18 years) with anorexia nervosa.

Multicentre randomised controlled trial of 167 young people comparing in-patient, specialist out-patient and general child and adolescent mental health service (CAMHS) treatment.

Each group made considerable progress at 1 year, with further improvement by 2 years. Full recovery rates were poor (33% at 2 years, 27% still with anorexia nervosa). Adherence to in-patient treatment was only 50%. Neither in-patient nor specialist out-patient therapy demonstrated advantages over general CAMHS treatment by intention to treat, although some CAMHS out-patients were subsequently admitted on clinical grounds. In-patient treatment (randomised or after out-patient transfer) predicted poor outcomes.

First-line in-patient psychiatric treatment does not provide advantages over out-patient management. Out-patient treatment failures do very poorly on transfer to in-patient facilities.

No systematic attempt has been made to calculate the costs of scaling up mental health services in low-and middle-income countries.

To estimate the expenditures needed to scale up the delivery of an essential mental healthcare package over a 10-year period (2006–2015).

A core package was defined, comprising pharmacological and/or psychosocial treatment of schizophrenia, bipolar disorder, depression and hazardous alcohol use. Current service levels in 12 selected low-and middle-income countries were established using the WHO–AIMS assessment tool. Target-level resource needs were derived from published need assessments and economic evaluations.

The cost per capita of providing the core package attarget coverage levels (in US dollars) ranged from $1.85 to $2.60 per year in low-income countries and $3.20 to $6.25 per year in lower-middle-income countries, an additional annual investment of $0.18–0.55 per capita.

Although significant new resources need to be invested, the absolute amount is not large when considered at the population level and against other health investment strategies.

Outcome of schizophrenia has been described as favourable in low-and middle-income countries. Recently, researchers have questioned these findings

To examine the outcome studies carried out in different countries specifically looking atthose from low-and middle-income countries

Long-term course and outcome studies in schizophrenia were reviewed

A wide variety of outcome measures are used. The most frequent are clinical symptoms, hospitalisation and mortality (direct indicators), and social/ occupational functioning, marriage, social support and burden of care (indirect indicators). Areas such as cognitive function, duration of untreated psychosis, quality of life and effect of medication have not been widely studied in low-and middle-income countries

The outcome of schizophrenia appears to be better in low-and middle-income countries. A host of sociocultural factors have been cited as contributing to this but future research should aim to understand this better outcome. There is a need for more culture-specific instruments to measure outcomes

Neuroanatomical abnormalities are a well-established feature of schizophrenia. However, the timing of their emergence and the extent to which they are related to vulnerability to the disorder as opposed to psychotic illness itself is unclear

To assess regional grey matter volume in the at-risk individuals who subsequently developed psychosis

Magnetic resonance imaging data from at-risk individuals who developed psychosis (n = 12) within the following 25 months were compared with data from healthy volunteers (n=22) and people with first-episode psychosis (n=25)

Compared with healthy volunteers, individuals who subsequently developed psychosis had smaller grey matter volume in the posterior cingulate gyrus, precuneus, and paracentral lobule bilaterally and in the left superior parietal lobule, and greater grey matter volume in a left parietal/posterior temporal region. Compared with first-episode patients, they had relatively greater grey matter volume in the temporal gyrus bilaterally and smaller grey matter volume in the right lentiform nucleus

Some of the structural brain abnormalities in individuals with an at-risk mental state may be related to an increased vulnerability to psychosis, while others are associated with the development of a psychotic illness

Diagnosis of dementia is complex in adults with intellectual disability owing to their pre-existing deficits and different presentation.

To describe the clinical features and prevalence of dementia and its subtypes, and to compare the concurrent validity of dementia criteria in older adults with intellectual disability.

The Becoming Older with Learning Disability (BOLD) memory study is a two-stage epidemiological survey of adults with intellectual disability without Down syndrome aged 60 years and older, with comprehensive assessment of people who screen positive. Dementia was diagnosed according to ICD-10, DSM-IV and DC-LD criteria.

The DSM – IV dementia criteria were more inclusive. Diagnosis using ICD – 10 excluded people with even moderate dementia. Clinical subtypes of dementia can be recognised in adults with intellectual disability. Alzheimer's dementia was the most common, with a prevalence of 8.6% (95% CI 5.2–13.0), almost three times greater than expected.

Dementia is common in older adults with intellectual disability, but prevalence differs according to the diagnostic criteria used. This has implications for clinical practice.

It is unclear how the recurrence of major depression in adolescence affects later life outcomes.

To examine the associations between the frequency of major depression at ages 16–21 and later outcomes, both before and after controlling for potentially confounding factors.

Data were gathered from a 25-year longitudinal study of a birth cohort of New Zealand children (n=982). Outcome measures included DSM–IV symptom criteria for major depression and anxiety disorders, suicidal ideation and attempted suicide, achieving university degree or other tertiary education qualification, welfare dependence and unemployment, and income at ages 21–25 years.

There were significant (P<0.05) associations between the frequency of depression at ages 16–21 years and all outcome measures. After adjustment for confounding factors, the association between frequency of depression and all mental health outcomes, and welfare dependence and unemployment, remained significant (P<0.05).

The frequency of depression in adolescence and young adulthood is associated with adverse mental health and economic outcomes in early adulthood.

There are numerous instruments for screening for depression. A feasible screen is good at both recognising and predicting depression.

To study the ability of the Depression Scale and its items to recognise and predict a depressive episode.

A sample of patients attending primary care was examined in 1991–1992 and again 7 years later. The accuracy of the Depression Scale at baseline and at follow-up was tested against the Short Form of the Composite International Diagnostic Interview (CIDI-SF) diagnosis of depression at follow-up. The sensitivity and specificity of the Depression Scale and its items were assessed.

Both baseline and follow-up Depression Scale scores were consistent with the CIDI–SF diagnoses. It was possible to find single items efficient at both recognising and predicting depression.

The Depression Scale is a useful screening instrument for depression, with both diagnostic and predictive validity.

Insight in psychosis has previously been associated with both depression and cognitive ability. Some studies have found a curvilinear relationship between insight and cognitive ability but the roles of self-esteem and depression have not been taken into account.

To investigate the relationships between insight and IQ, depression, and self-esteem.

Correlations between self-reported and observer-rated insight, and measures of IQ, depression and self-esteem were examined in 67 people with psychosis.

Better self-reported insight was associated with higher IQ and poorer self-esteem, but not depression. There was some evidence for a curvilinear relationship between IQ and self-reported insight, specifically the ‘awareness of illness' dimension, which survived correction for symptom variables.

The relationship between insight and IQ might reflect both the basis of insight in intellectual ability and the influence of a psychological mechanism that preserves self-esteem.

Second-generation antipsychotics may have few advantages over older, cheaper drugs, except for possibly reduced risk of tardive dyskinesia.

To evaluate the cost-effectiveness of second-generation antipsychotics with regard to reducing tardive dyskinesia.

Literature was reviewed on risk of tardive dyskinesia with second-generation antipsychotics; on severity duration and impairment of tardive dyskinesia; and on the relationship of this disorder to quality of life and quality-adjusted life-years (QALYs). Diverse cost and benefit assumptions and of 1-year and 5-year planning horizons were examined in a deterministic sensitivity analysis.

Estimating 0.143 QALYs lost per case of severe tardive dyskinesia, 1-year cost-effectiveness estimates for second-generation antipsychotics ranged from $185 000 ($370 000) to $850 000 ($1.7 million) per QALY, and 5-year cumulative estimates ranged from $74 000 ($ 149 000) to $342 000 ($683 000) per QALY, all above the conventional policy threshold of $25 000 ($50 000).

Reduction of tardive dyskinesia with second-generation antipsychotics appears unlikely to meet standards for cost-effectiveness.

The relationship between the Mental Illness Needs Index (MINI) and the common mental disorders is not known.

To investigate associations between the small-area MINI score and common mental disorder at individual level.

Mental health status was measured using the Mental Health Inventory of the Short Form 36 instrument (SF-36). Data from the Caerphilly Health and Social Needs population survey were analysed in multilevel models of 10 653 individuals aged 18–74 years nested within the 2001 UK census geographies of 110 lower super output areas and 33 wards.

The MINI score was significantly associated with common mental disorder after adjusting for individual risk factors. This association was stronger at the smaller spatial scale of the lower super output area and for individuals who were permanently sick or disabled.

The MINI is potentially useful for small-area needs assessment and service planning for common mental disorder in community settings.

The nosological status of auditory hallucinations in non-clinical samples is unclear

To investigate the functional neural basis of non-clinical hallucinations

After selection from 1206 people, 68 participants of high, medium and low hallucination proneness completed a task designed to elicit verbal hallucinatory phenomena under conditions of stimulus degradation. Eight subjects who reported hearing a voice when none was present repeated the task during functional imaging

During the signal detection task, the high hallucination-prone participants reported a voice to be present when it was not (false alarms) significantly more often than the average or low participants (P<0.03, d.f. =2). On functional magnetic resonance imaging, patterns of activation during these false alarms showed activation in the superior and middle temporal cortex (P<0.001)

Auditory hallucinatory experiences reported in non-clinical samples appear to be mediated by similar patterns of cerebral activation as found during hallucinations in schizophrenia

Reattribution is frequently taught to general practitioners (GPs) as a structured consultation that provides a psychological explanation for medically unexplained symptoms.

To determine if practice-based training of GPs in reattribution changes doctor–patient communication, thereby improving outcomes in patients with medically unexplained symptoms of 3 months' duration.

Cluster randomised controlled trial in 16 practices, 74 GPs and 141 patients with medically unexplained symptoms of 6 hours of reattribution training v. treatment as usual.

With training, the proportion of consultations mostly consistent with reattribution increased (31 v. 2%, P=0.002). Training was associated with decreased quality of life (health thermometer difference −0.9, 95% CI −1.6 to −0.1; P=0.027) with no other effects on patient outcome or health contacts.

Practice-based training in reattribution changed doctor–patient communication without improving outcome of patients with medically unexplained symptoms.