The relative efficacy of different psychological treatments for chronic post-traumatic stress disorder (PTSD) is unclear.

To determine the efficacy of specific psychological treatments for chronic PTSD.

In a systematic review of randomised controlled trials, eligible studies were assessed against methodological qualitycriteria and data were extracted and analysed.

Thirty-eight randomised controlled trials were included in the meta-analysis. Trauma-focused cognitive-behavioural therapy (TFCBT), eye movement desensitisation and reprocessing (EMDR), stress management and group cognitive-behavioural therapy improved PTSD symptoms more than waiting-list or usual care. There was inconclusive evidence regarding other therapies. There was no evidence of a difference in efficacy between TFCBT and EMDR butthere was some evidence that TFCBT and EMDR were superior to stress management and other therapies, and that stress management was superior to other therapies.

The first-line psychological treatment for PTSD should be trauma-focused (TFCBTor EMDR).

The stability of the diagnostic distinction between a substance-induced psychosis and a primary psychotic disorder co-occurring with substance use is not established.

To describe DSM – IV diagnostic changes over 1 year and determine the predictive validity of baseline indicators of the substance-induced psychosis v. primary psychosis distinction.

We conducted a 1-year follow-up study of 319 psychiatric emergency department admissions with diagnoses of early-phase psychosis and substance use comorbidity.

Of those with a baseline DSM—IV diagnosis of substance-induced psychosis, 25% had a diagnosis of primary psychosis at follow-up. These patients had poorer premorbid functioning, less insight into psychosis and greater family mental illness than patients with a stable diagnosis of substance-induced psychosis. Reclassifying change cases to primary psychoses on follow-up, key baseline predictors of the primary/substance-induced distinction at 1 year also included greater family history of mental illness in the primary psychosis group.

Further study of substance-induced psychoses should employ neuroscientific and behavioural approaches. Study findings can guide more accurate diagnoses at first treatment.

Low cholesterol has been reliably demonstrated in people who self-harm.

To determine whether people who self-harm also have low levels of essential fatty acids (EFAs) and to examine associations between the EFAs and serotonergic function.

Depression, impulsivity and suicidal intent were measured in patients with self-harm (n=40) and matched controls, together with plasma lipids and EFAs. Platelet serotonergic studies were carried out in a subgroup (n=27).

Patients with self-harm had significantly more pathology on all psychometric measures, lower mean total cholesterol levels (418 (s.d. =0.93) v. 4.87 (s.d.=0.83) mmol/l, P=0.003) and lower mean total EFA levels (89. 5 (15.6) v. 103.7 (17.1) μg/ml, P=0.0001) than controls after adjustment for confounding variables. Total n-3 and n-6 EFA levels were also significantly lower. Impulsivity and depression scores were significantly inversely correlated with both n-6 EFAs and n-3 EFAs, but were not associated with total or low-density lipoprotein cholesterol levels. Platelet serotonergic measures did not differ between groups, and were not related to psychobiological measures.

Lower plasma EFA levels combined with low cholesterol concentrations were associated with self-harm as well as impulsivity and affect. This was not related to platelet serotonergic measures.

Trials have demonstrated benefits of long-chain omega-3 essential fatty acid (n-3 EFA) supplementation in a variety of psychiatric disorders.

To assess the efficacy of n-3 EFAs in improving psychological well-being in patients with recurrent self-harm.

Patients (n=49) presenting after an act of repeated self-harm were randomised to receive 1.2 g eicosapentaenoic acid plus 0.9 g decosahexaenoic acid (n=22) or placebo (n=27) for 12 weeks in addition to standard psychiatric care. Six psychological domains were measured at baseline and end point.

At 12 weeks, the n-3 EFA group had significantly greater improvements in scores for depression, suicidality and daily stresses. Scores for impulsivity aggression and hostility did not differ.

Supplementation achieved substantial reductions in surrogate markers of suicidal behaviour and improvements in well-being. Larger studies are warranted to determine if insufficient dietary intake of n-3 EFAs is a reversible risk factor for self-harm.

Although effective therapies for social phobia exist, many individuals refrain from seeking treatment owing to the embarrassment associated with help-seeking. Internet-based cognitive-behavioural self-help can be an alternative, but adherence is a problem.

To evaluate a 9-week programme of internet-based therapy designed to increase treatment adherence by the addition of short weekly telephone calls, nine in all, with a total duration of 95 min.

In a randomised controlled trial the effects of internet-based cognitive– behavioural therapy in the treatment group (n=29) were compared with a waiting-list control group (n=28).

Compared with the control group the treated participants experienced greater reductions on measures of general and social anxiety avoidance and depression. Adherence to treatment was high, with 93% finishing the complete treatment package. One year later all improvements were maintained.

This study provides evidence to support the use of internet-based treatment supplemented by short, weekly telephone calls.

There is evidence of an association between decreased bone mineral density schizophrenia, and prolactin-raising antipsychotic medication. However, it is not known whether this is clinically significant.

To investigate whether patients with a history of schizophrenia are at increased risk of hip fracture.

In a case-control study, we compared cases of ‘hip fracture’ on the General Practice Research Database (n=16 341) with matched controls (n=29 889).

Hip fracture was associated with schizophrenia (OR=1.73; 95% CI 1.32-2.28), and prolactin-raising antipsychotics (OR=2.6; 95% CI 2.432.78), in the univariate analysis. In the multivariate analysis, prolactin-raising antipsychotics were independently associated with hip fracture but schizophrenia was not. A significant interaction between gender and antipsychotics was found in the association with hip fracture (P=0.042); OR=2.12 (95% C11.73-2.59)for men, OR=l.93 (95% C11.78-2.10) for women.

The association between prolactin-raising antipsychotic medication and hip fracture may have serious implications for public health. Mental health service patients may require preventive measures including dietary and lifestyle advice.

Delirium phenomenology is understudied.

To investigate the relationship between cognitive and non-cognitive delirium symptoms and test the primacy of inattention in delirium.

People with delirium (n=100) were assessed using the Delirium Rating Scale-Revised-98(DRS-R98)and Cognitive Test for Delirium (CTD).

Sleep-wake cycle abnormalities and inattention were most frequent, while disorientation was the least frequent cognitive deficit. Patients with psychosis had either perceptual disturbances or delusions but not both. Neither delusions nor hallucinations were associated with cognitive impairments. Inattention was associated with severity of other cognitive disturbances but not with non-cognitive items. CTD comprehension correlated most closely with non-cognitive features of delirium.

Delirium phenomenology is consistent with broad dysfunction of higher cortical centres, characterised in particular by inattention and sleep-wake cycle disturbance. Attention and comprehension together are the cognitive items that best account for the syndrome of delirium. Psychosis in delirium differs from that in functional psychoses.

Caring for relatives with advanced cancer may cause psychological and physical ill health.

To evaluate the effectiveness of increased support for distressed, informal carers of patients receiving palliative care.

The sample was composed of 271 informal carers who scored over 5 on the 28-item General Health Questionnaire (GHQ-28). The intervention comprised six weekly visits by a trained advisor. Primary outcome was carer distress (GHQ-28) at 4-week, 9-week and 12-week follow-up. Secondary outcomes were carer strain and quality of life, satisfaction with care, and bereavement outcome.

Scores on the GHQ-28 fell below the threshold of 5/6 in a third of participants in each trial arm at any follow-up point. Mean scores in the intervention group were lower at all time points but these differences were not significant. No difference was observed in secondary outcomes. Carers receiving the intervention reported qualitative benefit.

The intervention might have been too brief, and ongoing help might have had accruing benefits. Alternatively, informal carers of patients with cancer may already receive considerable input and the advisor's help gave little additional advantage; or caring for a dying relative is extremely stressful and no amount of support is going to make it much better.

Service users with psychosis may not consent to sharing information with carers. However, carers require access to relevant information to support them in their role.

To inform clinical practice when service users withhold consent to share information with their carer.

Study data were derived from a synthesis of policy review (n=91), national survey (n=595) and individual interviews (n=24).

Key principles to guide information-sharing practices were identified. Service users highlighted confidentiality being guaranteed by consent processes. Carers suggested a ‘culture shift’ was required, with professionals trained to work with carers. Professionals emphasised mental capacity, professional judgement and the context of care. A best practice framework is proposed.

An important distinction is between general information, which can always be shared without consent, and personal information, which is new to the carer and where consent needs to be considered. Clinical judgement is central to balancing conflicting ethical imperatives in this area.

A reduced risk of cancer has been noted among people with schizophrenia. Given that genetic causes have been proposed as an explanation of this finding, one would expect that the risk of cancer among first-degree relatives would be equally reduced.

To investigate the risk of cancer among the biological parents and full siblings of people receiving in-patient care for schizophrenia.

Linkage analysis was conducted between national population, psychiatric and cancer databases. Standardised incidence ratios for all cancer sites were calculated by comparing the incident rates among first-degree relatives with national incidence rates.

A reduced cancer risk was found across all groups examined. Among parents, whose numbers were adequately large, the findings reached statistical significance. For index cases and siblings – a markedly younger population – only a trend was elicited.

The genetic hypothesis – namely, the presence of a gene with the dual effect of reducing the cancer risk and disrupting neurodevelopment – is a plausible explanation for these findings.

The neurocognitive basis of auditory verbal hallucinations is unclear.

To investigate whether people with a history of such hallucinations would misattribute their own speech as external and show differential activation in brain areas implicated in hallucinations compared with people without such hallucinations.

Participants underwent functional magnetic resonance imaging (fMRI) while listening to pre-recorded words. The source (self/non-self) and acoustic quality (undistorted/distorted) were varied across trials. Participants indicated whether the speech they heard was their own or that of another person. Twenty people with schizophrenia (auditory verbal hallucinations n=10, no hallucinations n=10) and healthy controls (n=11) were tested.

The hallucinator group made more external misattributions and showed altered activation in the superior temporal gyrus and anterior cingulate compared with both other groups.

The misidentification of self-generated speech in patients with auditory verbal hallucinations is associated with functional abnormalities in the anterior cingulate and left temporal cortex. This may be related to impairment in the explicit evaluation of ambiguous auditory verbal stimuli.