Suicide risk is greatly increased in schizophrenia. Detection of those at risk is clinically important.

To identify risk factors for suicide in schizophrenia.

The international literature on case-control and cohort studies of patients with schizophrenia or related conditions in which suicide was reported as an outcome was systematically reviewed. Studies were identified through searching electronic databases and reference lists, and by consulting experts.

Twenty-nine eligible studies were identified. Factors with robust evidence of increased risk of suicide were previous depressive disorders (OR=3.03, 95% CI 2.06–4.46), previous suicide attempts (OR=4.09, 95% CI 2.79–6.01), drug misuse (OR=3.21, 95% CI 1.99–5.17), agitation or motor restlessness (OR=2.61, 95% CI 1.54–4.41), fear of mental disintegration (OR=12.1, 95% CI 1.89–81.3), poor adherence to treatment (OR=3.75, 95% CI 2.20–6.37) and recent loss (OR=4.03, 95% CI 1.37–11.8). Reduced risk was associated with hallucinations (OR=0.50, 95% CI 0.35–0.71).

Prevention of suicide in schizophrenia is likely to result from treatment of affective symptoms, improving adherence to treatment, and maintaining special vigilance in patients with risk factors, especially after losses.

It is unclear whether the effect of low birth weight on common affective disorders in later life is director mediated through childhood factors.

To determine whether birth weight has a direct effect on psychological distress in adulthood not mediated by childhood IQ or behavioural problems.

Participants (n=5572) of the Aberdeen Children of the 1950s study had data on birth weight for gestational age and adult psychological distress. Logistic regression was used to examine the association between these factors, with adjustment for confounders and potential childhood mediators.

Children born full term but weighing less than 5.5 lb had increased odds of psychological distress in later life after adjustment for potential confounders (OR=1.49, 95% CI 1.01–2.20). Further adjustment for childhood IQ and behaviour did not attenuate the association. A 1 s.d. decrease in birth weight for gestational age was associated with a 4% increased odds of psychological distress in adulthood (OR=1.04, 95% CI 0.97–1.12).

Low birth weight for gestational age, particularly atterm, was associated with adult psychological distress. This was not mediated by childhood factors, suggesting a direct effect of early life factors on adult mental health. A neurodevelopmental pathway may therefore be implicated.

There is little geographical variation in the prevalence of the common mental disorders. However, there is little longitudinal research.

To estimate variance in rates of common mental disorders at individual, household and electoral ward levels prospectively.

A 12-month cohort study of 7659 adults aged 16–74 years in 4338 private households, in 626 electoral wards. Data were collected as part of the British Household Panel Survey. Common mental disorders were assessed using the 12-item General Health Questionnaire (GHQ). Ward-level socio-economic deprivation was measured using the Carstairs index.

Less than 1% of total variance, in onset and maintenance of common mental disorders and change in GHQ score between waves, occurred at ward level. However, 12% of variance, which is a statistically significant difference, was found at household level (a much smaller geographical unit) and this difference remained after further analyses.

Ward level socio-economic deprivation does not influence the onset and maintenance of common mental disorders in Britain but local factors at the household level do. Reasons for this remain unclear.

Associations between physical health and depression are consistent across cultures among adults up to 65 years of age. In later life, the impact of physical health on depression is much more substantial and may depend on sociocultural factors.

To examine cross-national differences in the association between physical health and depressive symptoms in elderly people across western Europe.

Fourteen community-based studies on depression in later life in nine western European countries contributed to a total study sample of 22 570 respondents aged 65 years and older. Measures were harmonised for depressive symptoms (EURO-D scale), functional limitations and chronic physical conditions.

In the majority of the participating samples, the association of depressive symptoms with functional disability was stronger than with chronic physical conditions. Associations were slightly more pronounced in the UK and Ireland.

The association between physical health and depressive symptoms in later life is consistent across western Europe.

Very old people have higher suicide rates than the younger elderly population. Psychiatric disorders are known to have a strong association with suicide among elderly people.

To analyse the suicide risk associated with psychiatric hospitalisation among the very old (⩾80 years) compared with the middle-aged (50–64 years) and old (65–79 years) populations.

Individual-level data on the entire Danish population aged 50 years or over were analysed for the period 1994–1998. Relative suicide risks were calculated using event-history analysis.

Among 1 978 527 persons, 2323 died by suicide. Although the very old group exhibited a four-fold to five-fold increase in risk of suicide for those previously hospitalised, we noted an inverse interaction effect: the increase is distinctly smaller compared with that in the middle-aged and old groups.

The association between suicide and psychiatric hospitalisation is much weaker for the very old than for the old. Psychiatric disorders among very old people may be interacting with other disorders, may be underdiagnosed or treated in other healthcare settings.

Social factors have been shown to be predictors of suicide. It is not known whether these factors vary between countries.

To present a first European overview of socio-economic inequalities in suicide mortality among men and women.

We used a prospective follow-up of censuses matched with vital statistics in ten European populations. Directly standardised rates of suicide were computed for each country.

In men, a low level of educational attainment was a risk factor for suicide in eight out often countries. Suicide inequalities were smaller and less consistent in women. In most countries, the greater the socio-economic disadvantage, the higher is the risk of suicide. The population of Turin evidenced no socio-economic inequalities.

Socio-economic inequalities in suicide are a generalised phenomenon in western Europe, but the pattern and magnitude of these inequalities vary between countries. These inequalities call for improved access to psychiatric care for lower socio-economic groups.

Schizophrenia is associated with widespread cognitive deficits that have an impact on social function. Modafinil promotes wakefulness and is reported to enhance cognition.

To study the acute effects of modafinil administration upon brain activity and cognitive performance in people with chronic schizophrenia.

In a randomised double-blind placebo-controlled crossover design, 19 patients received either modafinil (100 mg) or placebo prior to undertaking a working memory task with functional magnetic resonance imaging.

Seventeen patients completed the study and another underwent acute relapse 4 days post-drug. Modafinil administration was associated with significantly greater activation in the anterior cingulate cortex during the working memory task. The anterior cingulate cortex signal correlated with cognitive performance, although only a subset of patients exhibited ‘enhancement’.

Modafinil modulates anterior cingulate cortex function in chronic schizophrenia but its beneficial cognitive effects may be restricted to a subset of patients requiring further characterisation.

Domestic spousal violence against women has far-reaching mental health implications.

To determine the association of domestic spousal violence with poor mental health.

In a household survey of rural, urban non-slum and urban slum areas from seven sites in India, the population of women aged 15–49 years was sampled using probability proportionate to size. The Self Report Questionnaire was used to assess mental health status and a structured questionnaire elicited spousal experiences of violence.

Of 9938 women surveyed, 40% reported poor mental health. Logistic regression showed that women reporting ‘any violence’ – ‘slap’, ‘hit’, ‘kick’ or ‘beat’ (OR 2.2, 95% CI 2.0–2.5) – or ‘all violence’ – all of the four types of physically violent behaviour (OR 3.5, 95% CI 2.94–3.51) – were at increased risk of poor mental health.

Findings indicate a strong association between domestic spousal violence and poor mental health, and underscore the need for appropriate interventions.

Crisis resolution teams (CRTs) are being introduced throughout England, but their evidence base is limited.

To compare outcomes of crises before and after introduction of a CRT.

A new methodology was developed for identification and operational definition of crises. A quasi-experimental design was used to compare cohorts presenting just before and just after a CRT was established.

Following introduction of the CRT, the admission rate in the 6 weeks after a crisis fell from 71% to 49% (OR 0.38, 95% CI 0.21–0.70). A difference of 5.6 points (95% CI 2.0–8.3) on mean Client Satisfaction Questionnaire (CSQ–8) score favoured the CRT. These findings remained significant after adjustment for baseline differences. No clear difference emerged in involuntary hospitalisations, symptoms, social functioning or quality of life.

CRTs may prevent some admissions and patients prefer them, although other outcomes appear unchanged in the short term.

Patients attending an accident and emergency department may exhibit psychological disturbances post-injury. Early interventions have been suggested to reduce the risk of post-injury disorder, including psychoeducation.

We assessed the efficacy of providing such self-help information.

Patients who had experienced trauma were randomised to two groups: those given (n=75) and not given (n=67) a self-help booklet. Psychological assessments were completed within 2, 10–12 and 24–26 weeks.

Post-traumatic stress disorder (PTSD), anxiety and depression decreased (P < 0.05) with time but there were no group differences in PTSD or anxiety. The controls were less depressed (P < 0.05) at follow-up. There was a reductionin PTSD caseness within the control (50%) compared with the intervention (20%) group which was almost significant (P < 0.06).

This trial failed to support the efficacy of providing self-help information as a preventive strategy to ameliorate PTSD.

‘Autistic savants' are individuals with autism who have extraordinary skills. Brain mechanisms underlying such capacities are still unknown.

To map the exceptional calendar capacity of a man with primary autism.

Positron emission tomography was used to map brain activity in a man who is able to associate a day of the week with the corresponding calendar date.

During the calendar task, the left hippocampus, the left frontal cortex and the left middle temporal lobe were activated.

The cerebral circuit involved in this man's prodigious calendar skill is similar to that normally involved in memory retrieval tasks. These results suggest that the prodigious capacities may be sustained by memory processing.