Research has suggested an association between obstetric complications and bipolar disorder. However, no quantitative evaluation has been made of the pooled data from existing studies.

To systematically review studies comparing exposure to obstetric complications in cases of bipolar disorder v. non-psychiatric controls, and in cases of bipolar disorder v. cases of other mental disorders.

Publications were identified by computer searches of seven databases, by hand searches of reference lists and from raw data received from researchers.

Forty-six studies were identified, of which 22 met the inclusion criteria. The pooled odds ratio for exposure to obstetric complications and subsequent development of bipolar disorder was 1.01 (95% Cl 0.76–1.35) compared with healthy controls, 1.13 (95% Cl 0.64–1.99) compared with cases of unipolar disorder and 0.61 (95% Cl 0.39–0.95) compared with those who developed schizophrenia.

There is no robust evidence that exposure to obstetric complications increases the risk of developing bipolar disorder. However, the range of events regarded as obstetric complications and methodological inadequacies make definitive conclusions difficult.

It is unclear whether psychiatric morbidity contributes to the small proportion of the population responsible for a large percentage of antisocial behaviour, including violence.

To measure associations between psychiatric morbidity and severity chronicity and types of victims of violence in the national household population of Britain.

Cross-sectional survey of persons in households (n=8397). Data included self-reported location, victims and outcome of violence over the previous 5 years. Diagnoses were determined by computer-assisted interviews.

Hazardous drinking was associated with over half of all incidents involving injury. Antisocial personality disorder conveyed an attributable risk of 24% of respondents reporting victim injuries, but screening positive for psychosis conveyed an attributable risk of only 1.2%.

The burden of care resulting from violence associated with hazardous drinking supports population interventions. Despite exceptional risks, half of respondents with antisocial personality disorder were not violent, indicating limitations in targeted interventions to detain high-risk individuals.

The impact of anxiety disorders has not been well delineated in prospective studies of bipolar disorder.

To examine the association between anxiety and course of bipolar disorder, as defined by mood episodes, quality of life and role functioning.

A thousand out-patients with bipolar disorder were followed prospectively for 1 year.

A current comorbid anxiety disorder (present in 31.9% of participants) was associated with fewer days well, a lower likelihood of timely recovery from depression, risk of earlier relapse, lower quality of life and diminished role function over 1 year of prospective study. The negative impact was greater with multiple anxiety disorders.

Anxiety disorders, including those present during relative euthymia, predicted a poorer bipolar course. The detrimental effects of anxiety were not simply a feature of mood state. Treatment studies targeting anxiety disorders will help to clarify the nature of the impact of anxiety on bipolar course.

Causal relationships between vascular factors and late-life depression are controversial.

To investigate prospective associations between risk factors for vascular disease and incidence of late-life depression.

Of 661 community participants aged 65 years or over, without depression at baseline, 521 (79%) were re-evaluated 2 years later. At baseline and follow-up, a diagnostic interview for depression was carried out and information on vascular status, disability and cognitive function was gathered.

Pre-existing heart disease, incident stroke and lower baseline high-density lipoprotein cholesterol level were significantly associated with incidence of late-life depression, independently of disability and cognitive function.

These results provide some support for a vascular aetiology of late-life depression. However, important risk factors for cerebrovascular disease such as hypertension and diabetes were not implicated, and the associations with lipid levels might still be explained by affective states earlier in life.

Investigating the relationship between premorbid functioning and treatment response in schizophrenia is relevant to understanding the illness and predicting treatment outcomes.

To examine the relationship between premorbid characteristics and treatment response of people with recent-onset schizophrenia.

Data came from a large, double-blind trial of recent-onset psychosis treated with a flexible dose of risperidone or haloperidol. Median treatment length was 206 days. Premorbid functioning was categorised using the Cannon-Spoor Premorbid Adjustment Scale.

There were significant differences between the premorbid groups on change on the Positive and Negative Syndrome Scale, Clinical Global Impression severity and cognitive functioning and Extrapyramidal Symptoms Rating Scale. Patients in the ‘stable–good’ premorbid group (n=251) improved more than those in the ‘stable–poor’ (n=198) and ‘declining’ (n=81) groups. The ‘stable–good’ group received the lowest doses of antipsychotic and had the least extrapyramidal symptoms. Patients in the declining’ group had the highest dosages and the most extrapyramidal symptoms.

In first-episode psychosis good premorbid functioning is associated with better response to treatment and fewer extrapyramidal symptoms.

Little is known about the medium-term durability of cognitive–behavioural therapy (CBT) in a community sample of people with schizophrenia.

To investigate whether brief CBT produces clinically important outcomes in relation to recovery, symptom burden and readmission to hospital in people with schizophrenia at 1-year follow-up.

Participants (336 of 422 randomised at baseline) were followed up at a mean of 388 days (s.d. =53) by raters masked to treatment allocation (CBT or usual care).

At 1-year follow-up, participants who received CBT had significantly more insight (P=0.021) and significantly fewer negative symptoms (P=0.002). Brief therapy protected against depression with improving insight and against relapse; significantly reduced time spent in hospital for those who did relapse and delayed time to admission. It did not improve psychotic symptoms or occupational recovery, nor have a lasting effect on overall symptoms or depression at follow-up.

Mental health nurses should be trained in brief CBT for schizophrenia to supplement case management, family interventions and expert therapy for treatment resistance.

Family intervention in schizophrenia can reduce patient relapse and improve medication adherence, but few studies on this have involved a Chinese population.

To examine the effects of a mutual support group for Chinese families of people with schizophrenia, compared with psychoeducation and standard care.

Randomised controlled trial in Hong Kong with 96 families of out-patients with schizophrenia, of whom 32 received mutual support, 33 psychoeducation and 31 standard care. The psychoeducation group included patients in all the sessions, the mutual support group did not. Intervention was provided over 6 months, and patient- and family-related psychosocial outcomes were compared over an 18-month follow-up.

Mutual support consistently produced greater improvement in patient and family functioning and caregiver burden over the intervention and follow-up periods, compared with the other two conditions. The number of readmissions did not decrease significantly, but their duration did.

Mutual support for families of Chinese people with schizophrenia can substantially benefit family and patient functioning and caregiver burden.

UK general practitioners (GPs) refer patients with common mental disorders to community mental health nurses.

To determine the effectiveness and cost-effectiveness of this practice.

Randomised trial with three arms: usual GP care, generic mental health nurse care, and care from nurses trained in problem-solving treatment; 98 GPs in 62 practices referred 247 adult patients with new episodes of anxiety, depression and life difficulties, to 37 nurses.

There were 212 (86%) and 190 (77%) patients followed up at 8 and 26 weeks respectively. No significant differences between groups were found in effectiveness at either point. Mean differences in Clinical Interview Schedule – Revised scores at 26 weeks compared with GP care were –1.4 (95% Cl –5.5 to 2.8) for generic nurse care, and 1.1 (–2.9 to 5.1) for nurse problem-solving. Satisfaction was significantly higher in both nurse-treated groups. Mean extra costs per patient were £283 (95% Cl 154–411) for generic nurse care, and £315 (183–481) for nurse problem-solving treatment.

GPs should not refer unselected patients with common mental disorders to specialist nurses. Problem-solving should be reserved for patients who have not responded to initial GP care.

There is a paucity of controlled trials examining the effectiveness of individual psychotherapy in personality disorders, especially in patients with cluster C disorders.

To compare the effectiveness of brief dynamic therapy and cognitive–behavioural therapy as out-patient treatment for people with avoidant personality disorder.

Patients who met the criteria for avoidant personality disorder (n=62) were randomly assigned to 20 weekly sessions of either brief dynamic therapy (n=23) or cognitive–behavioural therapy (n=21), or they were assigned to the waiting-list control group (n=18). After the waiting period, patients in the control group were randomly assigned to one of the two therapies.

Patients who received cognitive–behavioural therapy showed significantly more improvements on a number of measures in comparison with those who had brief dynamic psychotherapy or were in the waiting-list control group. Results were maintained at follow-up.

Cognitive–behavioural therapy is more effective than waiting-list control and brief dynamic therapy. Brief dynamic therapy was no better than the waiting-list control condition.

Studies conducted in the USA have found the individual placement and support model of supported employment to be more effective than traditional vocational rehabilitation at helping people with severe mental illness to find and maintain competitive employment.

To determine the effectiveness of the individual placement and support (supported employment) model in a Canadian setting.

A total of 150 adults with severe mental illness, who were not currently employed and who desired competitive employment, were randomly assigned to receive either supported employment (n=75) or traditional vocational services (n=75).

Over the 12 months of follow-up, 47% of clients in the supported employment group obtained at least some competitive employment, v. 18% of the control group (P<0.001). They averaged 126 h of competitive work, v. 72 inthe control group (P<0.001).

Supported employment proved more effective than traditional vocational services in a setting significantly different from settings in the USA, and may therefore be generalised to settings in other countries.

Refugee doctors constitute a potentially valuable resource for reducing the recruitment crisis in psychiatry. However, various hurdles make their route into the National Health Service (NHS) difficult.

To explore the perceptions and experiences of refugee doctors trying to practise psychiatry in the UK.

Thirty-one refugee doctors participated in qualitative interviews designed to elicit their experiences in trying to practise as doctors in the UK. Twenty were re-interviewed about 6 months later.

Doctors identified a range of practical problems that made it difficult for them to take the required steps towards practising in the UK. These included lack of appropriate information, lack of a clear route through the system and feelings of isolation. The English language examination was seen as a particular bottleneck, as were finding clinical attachments. The psychological impact of the experience was profound.

These findings have important implications for how refugee doctors are introduced to the practice of psychiatry in the NHS.