We previously found that children of parents with depression showed impaired performance on a task of emotional categorisation.

To test the hypothesis that children of parents with depression would show abnormal neural responses in the anterior cingulate cortex, a brain region involved in the integration of emotional and cognitive information.

Eighteen young people (mean age 19.8 years) with no personal history of depression but with a biological parent with a history of major depression (FH+ participants) and 16 controls (mean age 19.9 years) underwent functional magnetic resonance imaging while completing an emotional counting Stroop task.

Controls showed significant activation in the pregenual anterior cingulate cortex to both positive and negative words during the emotional Stroop task. This activation was absent in FH+ participants.

Our findings show that people at increased familial risk of depression demonstrate impaired modulation of the anterior cingulate cortex in response to emotionally valenced stimuli.

In 1999 I estimated the expected number of UK prison suicides, taking into account that opioid users' deaths from suicide were 10 times the number expected for their age and gender. Changes have since taken place in Scottish prisons.

To estimate the expected number of male suicides in Scottish prisons in 1994–2003, having taken age and opioid dependency into account; and to consider the extremes of prisoner age.

The effective number that prisons safeguard in terms of suicide risk was approximated as 10 times the number of opioid-dependent inmates plus other inmates. By applying age-appropriate suicide rates for Scottish males to these effective numbers, expectations for male suicides in Scottish prisons were calculated.

In 1994-98, there were at least 57 male suicides, significantly exceeding the age- and opioid-adjusted expectation of 41. In 1999–2003, the 51 male suicides in prison were consistent with expectation (upper 95% limit: at least 54). During the decade 1994–2003, observed and expected suicides were mismatched at both extremes of age: 40 males aged 15-24 years died by suicide v. 24 expected, and 13 males aged 45+ v. 2 expected. Against 4.5 prison suicides expected for males aged 15-24 years during a 2-year period, actual suicides were 3 in 2002 + 2003 and 4 in 2004 + 2005.

Scotland has redressed an excess of male suicides, especially by its youngest prisoners.

Alexithymia has been shown to be related to many psychiatric and somatic illnesses. Aberrant emotion processing in the brain may underlie several psychiatric disorders. However, little is known about the neurobiological underpinnings of alexithymia.

To determine the way in which the brain processes emotion in alexithymia.

The participants were 10 healthy women with alexithymia and 11 healthy women without this condition, recruited into the study on the basis of their scores on the 20-item Toronto Alexithymia Scale. Four films were projected on a video screen to induce each of three emotional conditions (neutral, amusement, sadness). The brain areas activated during emotional stimuli in the alexithymia group were compared with those activated in the non-alexithymia group. Scans of the distribution of [15O]H2O were acquired using a positron emission tomography (PET) scanner operated in three-dimensional mode.

In response to emotional stimuli participants with alexithymia activated more parts of their sensory and motor cortices and insula, especially on the left side, and less of their anterior cingulate, compared with the control group.

Women with alexithymia seem to over-activate their ‘bodily’ brain regions, implying a different mode of emotion processing. This may be related to their tendency to experience physical symptoms.

Bipolar disorder is associated with dysfunction in prefrontal and limbic areas implicated in emotional processing.

To explore whether lamotrigine monotherapy may exert its action by improving the function of the neural network involved in emotional processing.

We used functional magnetic resonance imaging to examine changes in brain activation during a sad facial affect recognition task in 12 stable patients with bipolar disorder when medication-free compared with healthy controls and after 12 weeks of lamotrigine monotherapy.

At baseline, compared with controls, patients with bipolar disorder showed overactivity in temporal regions and underactivity in the dorsal medial and right ventrolateral prefrontal cortex, and the dorsal cingulate gyrus. Following lamotrigine monotherapy, patients demonstrated reduced temporal and increased prefrontal activation.

This preliminary evidence suggests that lamotrigine may enhance the function of the neural circuitry involved in affect recognition.

Schema-focused therapy (SFT) and transference-focused psychotherapy (TFP) for borderline personality disorder were recently compared in a randomised multicentre trial.

To assess the societal cost-effectiveness of SFT v. TFP in treating borderline personality disorder.

Costs were assessed by interview. Health-related quality of life was measured using EQ-5D. Outcomes were costs per recovered patient (recovery assessed with the Borderline Personality Disorder Severity Index) and costs per quality-adjusted life-year (QALY).

Mean 4-year bootstrapped costs were $37826 for SFT and $46 795 for TFP (95% uncertainty interval for difference −21 775 to 3546); QALYs were 2.15 for SFT and 2.27 for TFP (95% UI −0.51 to 0.28). The percentages of patients who recovered were 52% and 29% respectively. The SFT intervention was less costly and more effective than TFP (dominant), for recovery; it saved $90457 for one QALY loss.

Despite the initial slight disadvantage in QALYs, there is a high probability that compared with TFP, SFT is a cost-effective treatment for borderline personality disorder.

The 5HTTLPR genetic variant of the serotonin transporter gene (SERT or 5-HTT), which is comprised of a short (SERT-s) and a long (SERT-l) allele, is associated with major depressive disorder and post-traumatic brain disorder.

The present study sought to determine whether the total thalamus and major subregions are altered in size in major depressive disorder and in relation to the 5HTTLPR genotype.

We investigated the influence of 5HTTLPR genotype, psychiatric diagnosis, suicide and other clinical factors on the volume of the entire post-mortem thalamus.

Major depressive disorder, SERT-ss genotype and suicide emerged as independent factors contributing to an enlargement of the total thalamus. The majority of the volume enlargement associated with the SERT-ss genotype occurred in the pulvinar, whereas enlargement associated with major depressive disorder occurred in the limbic nuclei and in other regions of the thalamus. A history of antidepressant treatment was associated with reduced thalamic volume.

The 5HTTLPR genetic variation may affect behaviour and psychiatric conditions, in part, by altering the anatomy of the thalamus.

Clinical experience suggests that people with borderline personality disorder often meet criteria for attention-deficit hyperactivity disorder (ADHD). However, empirical data are sparse.

To establish the prevalence of childhood and adult ADHD in a group of women with borderline personality disorder and to investigate the psychopathology and childhood experiences of those with and without ADHD.

We assessed women seeking treatment for borderline personality disorder (n=118) for childhood and adult ADHD, co-occurring Axis I and Axis II disorders, severity of borderline symptomatology and traumatic childhood experiences.

Childhood (41.5%) and adult (16.1%) ADHD prevalence was high. Childhood ADHD was associated with emotional abuse in childhood and greater severity of adult borderline symptoms. Adult ADHD was associated with greater risk for co-occurring Axis I and II disorders.

Adults with severe borderline personality disorder frequently show a history of childhood ADHD symptomatology. Persisting ADHD correlates with frequency of co-occurring Axis I and II disorders. Severity of borderline symptomatology in adulthood is associated with emotional abuse in childhood. Further studies are needed to differentiate any potential causal relationship between ADHD and borderline personality disorder.

The estimated prevalence of clinically significant psychiatric and somatic symptoms in adults >1 year after the 2004 Asian tsunami is unknown.

To estimate the prevalence of psychiatric and somatic symptoms and impairment in Sri Lanka 20–21 months after the 2004 Asian tsunami, and to assess coping strategies used by tsunami-affected individuals that contribute to post-tsunami adjustment.

Homes from one severely affected area were randomly selected, and adult respondents were sampled utilising a modified Kish method. Instruments were administered in Sinhala to assess exposure, post-traumatic stress disorder (PTSD), depression, anxiety, somatic distress and impairment. Demographic variables and culturally-relevant coping activities were assessed.

The prevalence of clinically significant PTSD, depression and anxiety was 21%, 16% and 30% respectively. Respondents reported a mean of eight persistent and bothersome somatic complaints, which were associated with psychiatric symptoms and impairment. Thinking that one's life was in danger was the exposure item most strongly associated with symptoms and impairment. The majority of respondents found their own strength, family and friends, a Western-style hospital and their religious practice to be the most helpful coping aids.

A large minority of adults in one area of Sri Lanka reported significant psychiatric and somatic symptoms and impairment 20–21 months after the tsunami. Accurate data about risk for and resilience to impairing symptoms > 1 year after disasters are necessary in order to develop rational surveillance and interventions.

Adolescents comprise a fifth of the population of India, but there is little research on their mental health. We conducted an epidemiological study in the state of Goa to describe the current prevalence of mental disorders and its correlates among adolescents aged between 12 and 16 years.

To estimate the prevalence and correlates of mental disorders in adolescents.

Population-based survey of all eligible adolescents from six urban wards and four rural communities which were randomly selected. We used a Konkani translation of the Development and Well-Being Assessment to diagnose current DSM-IV emotional and behavioural disorders. All adolescents were also interviewed on socio-economic factors, education, neighbourhood, parental relations, peer and sexual relationships, violence and substance use.

Out of 2684 eligible adolescents, 2048 completed the study. The current prevalence of any DSM-IV diagnosis was 1.81%; 95% CI 1.27–2.48. The most common diagnoses were anxiety disorders (1.0%), depressive disorder (0.5%), behavioural disorder (0.4%) and attention-deficit hyperactivity disorder (0.2%). Adolescents from urban areas and girls who faced gender discrimination had higher prevalence. The final multivariate model found an independent association of mental disorders with an outgoing ‘non-traditional’ lifestyle (frequent partying, going to the cinema, shopping for fun and having a boyfriend or girlfriend), difficulties with studies, lack of safety in the neighbourhood, a history of physical or verbal abuse and tobacco use. Having one's family as the primary source of social support was associated with lower prevalence of mental disorders.

The current prevalence of mental disorders in adolescents in our study was very low compared with studies in other countries. Strong family support was a critical factor associated with low prevalence of mental disorders, while factors indicative of adoption of a non-traditional lifestyle were associated with an increased prevalence.

There is evidence that the prevalence of common mental disorders varies across Europe.

To compare prevalence of common mental disorders in general practice attendees in six European countries.

Unselected attendees to general practices in the UK, Spain, Portugal, Slovenia, Estonia and The Netherlands were assessed for major depression, panic syndrome and other anxiety syndrome. Prevalence of DSM–IV major depression, other anxiety syndrome and panic syndrome was compared between the UK and other countries after taking account of differences in demographic factors and practice consultation rates.

Prevalence was estimated in 2344 men and 4865 women. The highest prevalence for all disorders occurred in the UK and Spain, and lowest in Slovenia and The Netherlands. Men aged 30–50 and women aged 18–30 had the highest prevalence of major depression; men aged 40–60 had the highest prevalence of anxiety, and men and women aged 40–50 had the highest prevalence of panic syndrome. Demographic factors accounted for the variance between the UK and Spain but otherwise had little impact on the significance of observed country differences.

These results add to the evidence for real differences between European countries in prevalence of psychological disorders and show that the burden of care on general practitioners varies markedly between countries.

Self-harm by young people is occurring with increasing frequency. Conventional in-patient and out-patient treatment has yet to be proved efficacious.

To investigate the efficacy of a short cognitive-behavioural therapy intervention with 90 adolescents and adults who had recently engaged in self-harm.

Participants (aged 15–35 years) were randomly assigned to treatment as usual plus the intervention, or treatment as usual only. Assessments were completed at baseline and at 3 months, 6 months and 9 months follow-up.

Patients who received cognitive-behavioural therapy in addition to treatment as usual were found to have significantly greater reductions in self-harm, suicidal cognitions and symptoms of depression and anxiety, and significantly greater improvements in self-esteem and problem-solving ability, compared with the control group.

These findings extend the evidence that a time-limited cognitive-behavioural intervention is effective for patients with recurrent and chronic self-harm.

There is conflicting evidence about comorbid personality pathology in depression treatments.

To test the effects of antidepressant drugs and cognitive therapy in people with depression distinguished by the presence or absence of personality disorder.

Random assignment of 180 out-patients with depression to 16 weeks of antidepressant medication or cognitive therapy. Random assignment of medication responders to continued medication or placebo, and comparison with cognitive therapy responders over a 12-month period.

Personality disorder status led to differential response at 16 weeks; 66% v. 44% (antidepressants v. cognitive therapy respectively) for people with personality disorder, and 49% v. 70% (antidepressants v. cognitive therapy respectively) for people without personality disorder. For people with personality disorder, sustained response rates over the 12-month follow-up were nearly identical (38%) in the prior cognitive therapy and continuation-medication treatment arms. People with personality disorder withdrawn from medication evidenced the lowest sustained response rate (6%). Despite the poor response of people with personality disorder to cognitive therapy, nearly all those who did respond sustained their response.

Comorbid personality disorder was associated with differential initial response rates and sustained response rates for two well-validated treatments for depression.

It is not clear whether the severity of depressive episodes changes during the course of depressive disorder.

To investigate whether the severity of depressive episodes increases during the course of illness.

Using a Danish nationwide case register, all psychiatric inpatients and out-patients with a main ICD-10 diagnosis of a single mild, moderate or severe depressive episode at the end of first contact were identified. Patients included in the study were from the period 1994–2003.

A total of 19 392 patients received a diagnosis of a single depressive episode at first contact. The prevalence of severe depressive episodes increased from 25.5% at the first episode to 50.0% at the 15th episode and the prevalence of psychotic episodes increased from 8.7% at the first episode to 25.0% at the 15th episode. The same pattern was found regardless of gender, age at first contact and calendar year.

The increasing severity of depressive episodes emphasises the importance of early and sustained prophylactic treatment.