The optimal pharmacological treatment of unipolar psychotic depression is uncertain.

To compare the clinical effectiveness of pharmacological treatments for patients with unipolar psychotic depression.

Systematic review and meta-analysis of randomised controlled trials.

Ten trials were included in the review. We found no evidence that the combination of an antidepressant with an antipsychotic is more effective than an antidepressant alone. This combination was statistically more effective than an antipsychotic alone.

Antidepressant mono-therapy and adding an antipsychotic if the patient does not respond, or starting with the combination of an antidepressant and an antipsychotic, both appear to be appropriate options for patients with unipolar psychotic depression. However, clinically the balance between risks and benefits may suggest the first option should be preferred for many patients. Starting with an antipsychotic alone appears to be inadequate.

Month of birth as a suicide risk factor has not been adequately explored. The findings of published studies are contradictory and inconclusive.

To examine the association between suicide and month of birth using suicide data for a 22-year period in England and Wales. The sample size of 26915 suicides greatly exceeds all previous studies.

We analysed all suicides (ICD-9 codes E950-959) and deaths from undetermined injury (E980-989) reported between 1979 and 2001 in England and Wales for persons born between 1955 and 1966, using Poisson and negative binomial generalised linear models with seasonal components.

Birthrates of people who later kill themselves show disproportionate excess for April, May and June compared with the other months. Overall, we found an increase of 17% in the risk of suicide for people born in the peak month (spring -early summer) compared with those born in the trough month (autumn-early winter); this risk increase was larger for women (29.6%) than for men (13.7%).

The ‘month of birth’ factor in suicide can be interpreted in terms of the foetal origins hypothesis. Our findings might have implications for our understanding of the multifaceted aetiology of suicide and may eventually offer new strategies for research and prevention.

Epidemiological data on personality disorders, comorbidity and associated use of services are essential for health service policy.

To measure the prevalence and correlates of personality disorder in a representative community sample.

The Structured Clinical Interview for DSM-IV Axis II disorders was used to measure personality disorder in 626 persons aged 16-74 years in households in England, Scotland and Wales, in atwo-phase survey.

The weighted prevalence of personality disorder was 4.4% (95% CI 2.9-6.7). Rates were highest among men, separated and unemployed participants in urban locations. High use of healthcare services was confounded by comorbid mental disorder and substance misuse. Cluster B disorders were associated with early institutional care and criminality.

Personality disorder is common in the community especially in urban areas. Services are normally restricted to symptomatic, help-seeking individuals, but a vulnerable group with cluster B disorders can be identified early are in care during childhood and enter the criminal justice system when young. This suggests the need for preventive interventions at the public mental health level.

Theories regarding how spontaneous panic and agoraphobia relate are based mostly on cross-sectional and/or clinic data.

To determine how spontaneous panic and agoraphobia relate longitudinally, and to estimate the incidence rate of and other possible risk factors for first-onset agoraphobia, using a general population cohort.

A sample of 1920 adults in east Baltimore were assessed in 1981 -1982 and the mid-1990s with the Diagnostic Interview Schedule (DIS). Psychiatristdiagnoses were made in a subset of the sample at follow-up (n=816).

Forty-one new cases of DIS/DSM–III–R agoraphobia were identified (about 2 per 1000 person-years at risk). As expected, baseline DIS/DSM-III panic disorder predicted first incidence of agoraphobia (OR=12, 95% CI 3.2-45), as did younger age, female gender and other phobias. Importantly, baseline agoraphobia without spontaneous panic attacks also predicted first incidence of panic disorder (OR=3.9, 95% CI 1.8-8.4). Longitudinal relationships between panic disorder and psychiatrist-confirmed agoraphobia were strong (panic before agoraphobia OR=20, 95% CI 2.3–180; agoraphobia before panic OR=16, 95% CI 3.2–78).

The implied one-way causal relationship between spontaneous panic attacks and agoraphobia in DSM–IV appears incorrect.

Few randomised controlled trials have been aimed specifically at substance use reduction among people with psychotic disorders.

To investigate whether a 10-session intervention consisting of motivational interviewing and cognitive-behavioural therapy (CBT) was more efficacious than routine treatment in reducing substance use and improving symptomatology and general functioning.

A community sample of people with a psychotic disorder and who reported hazardous alcohol, cannabis and/or amphetamine use during the preceding month was recruited. Participants were randomly allocated to motivational interviewing/CBT (n=65) or treatment as usual (n=65), and were assessed on multiple outcomes at baseline, 15 weeks, 6 months and 12 months.

There was a short-term improvement in depression and a similar trend with regard to cannabis use among participants who received the motivational interviewing/CBT intervention, together with effects on general functioning at 12 months. There was no differential benefit of the intervention on substance use at 12 months, except for a potentially clinically important effect on amphetamine use.

The motivational interviewing/CBT intervention was associated with modest improvements.

Major depression is associated with activation of the inflammatory response.

To examine C-reactive protein levels in depression and to determine the impact of selective serotonin reuptake inhibitor (SSRI) therapy.

Atwo-part study. In study 1, which used a between-subjects design, C-reactive protein was measured in 32 patients (20 currently depressed, 12 euthymic) with a history of DSM–IV major depression, all of whom were treated with an SSRI, and in a healthy comparison group (n=20). Study 2 employed a within-subject design: C-reactive protein was measured in 20 patients with major depression both before and after SSRI treatment.

In study 1, C-reactive protein levels did not differ between the group with depressive disorder (either currently depressed or euthymic) treated with SSRIs and the healthy group. In study 2 the protein levels dropped significantly following treatment with antidepressant medication.

Following SSRI treatment for major depression there is a significant drop in C-reactive protein concentrations whether or not the depression resolves. These findings indicate that antidepressants induce an anti-inflammatory response independent of antidepressant action.

Several studies document an excess of psychiatric symptoms among veterans of the 1991 Gulf War. However, little is known about the prevalence of psychiatric disorders in those who were deployed to that conflict.

To compare the 12-month prevalence and associated risk factors for DSM Axis I psychiatric diagnoses between random samples of Gulf War-deployed veterans and veterans of the same era notdeployed to the Persian Gulf (era veterans).

Interview data from 967 Gulf War veterans and 784 era veterans were examined to determine current health status, medical conditions, symptoms and Axis I psychiatric disorders. Logistic regression models evaluated risk factors for psychiatric disorder.

Gulf War veterans had a significantly higher prevalence of psychiatric diagnoses, with twice the prevalence of anxiety disorders and depression. Lower rank, female gender and divorced or single marital status were significant independent predictors of psychiatric disorder.

Deployment to the Gulf War is associated with a range of mental health outcomes more than 10 years after deployment.

Many people with dementia live in residential homes, but little is known about their quality of life.

To compare the views of residents with dementia with the views of staff as to their quality of life, and to look at factors associated with these ratings.

The Quality of Life in Alzheimer's Disease (QoL-AD) scale was used to rate residents' and staff's perceptions of the quality of life of 238 residents of 24 residential homes in the UK.

There were 119 QoL-AD scales completed by both residents and staff. For the residents, high QoL-AD scores strongly correlated with lower scores for depression (ρ=–0.53, P < 0.0001) and anxiety (ρ= –0.50, P < 0.001). In contrast, better quality of life as rated by staff correlated most strongly with increased dependency (ρ=–0.53, P < 0.001) and behaviour problems (ρ=–0.40, P < 0.001).

The QoL-AD could be used as an effective measure of the quality of life of people with dementia in residential homes. Whereas mood was the main predictor of residents' own assessment of their quality of life, staff ratings were strongly linked with dependency. Staff should be aware that mood rather than level of dependency has agreater impacton residents' quality of life.

Large-scale community studies of the prevalence of mental disorders using standardised assessment tools are rare in sub-Saharan Africa.

To conduct such a study.

Multistage stratified clustered sampling of households in the Yoruba-speaking parts of Nigeria. Face-to-face interviews used the World Mental Health version of the Composite International Diagnostic Interview (WMH-CIDI).

Of the 4984 people interviewed (response rate 79.9%), 12.1% had a lifetime rate of at least one DSM–IV disorder and 5.8% had 12-month disorders. Anxiety disorders were the most common (5.7% lifetime, 4.1% 12-month rates) but virtually no generalised anxiety or post-traumatic stress disorder were identified. Of the 23% who had seriously disabling disorders, only about 8% had received treatment in the preceding 12 months. Treatment was mostly provided by general medical practitioners; only a few were treated by alternative practitioners such as traditional healers.

The observed low rates seem to reflect demographic and ascertainment factors. There was a large burden of unmet need for care among people with serious disorders.

Quantifying the contributions that different types of information make to the accurate prediction of offending offers the prospects of improved practice and better use of resources.

To quantify the contributions made by three types of information – demographic data alone, demographic and criminal record and demographic, criminal record and legal class of disorder – to the prediction of criminal conviction in patients.

All 425 patients discharged from the three special (high secure) hospitals in England and Wales over 2 years were followed for 10.5 years. The contribution of each type of information was described in terms of the area under the receiver operating characteristic curve (AUC) and the number needed to detain (NND).

The AUC values using the three types of information were 0.66, 0.72 and 0.73 respectively. Prediction based on the full model using an optimal probability cut-off implies an NND of 2. The AUCs for serious offences were 0.67, 0.69 and 0.75 respectively.

For long-term prediction of conviction on any charge, information on legal class adds little to the accuracy of predictions made using only a patient's age, gender and criminal record. In the prediction of serious offences alone the contribution of legal class is significant.

Polygraphy is used increasingly in the treatment and supervision of sex offenders, but little research has addressed its accuracy in this setting, or linked accuracy with utility.

To investigate the utility and accuracy of polygraphy in post-conviction testing of community-based sex offenders.

A self-report measure examined the experiences of offenders with polygraphy.

Based on self-report, the polygraph's accuracy was approximately 85%. False negatives and false positives were not associated with demographic characteristics, personality variables or IQ. The majority of offenders found the polygraph to be helpful in both treatment and supervision. Nine per cent of offenders claimed to have made false disclosures; these individuals had higher scores on ratings of neuroticism and lower scores on ratings of conscientiousness.

These results support the view that the polygraph is both accurate and useful in the treatment and supervision of sex offenders.