The aim of this part of the Northern Ireland Suicide Study was to investigate the prevalence of DSM - III - R axis I (clinical syndrome) and axis II (personality) disorders among suicides (14 years and older) in Northern Ireland during a one-year period.

A psychological autopsy study based on a variety of documentary sources and interviews with bereaved informants and health care professionals.

Ninety per cent of suicides (106/118) had a current axis I and/or an axis II mental disorder. At least one current axis I disorder was diagnosed in 86% of suicides (102/118), and at least one axis II disorder was diagnosed in 44% (52/118). Suicides under 30 years (92% male) were less likely to have a current axis I disorder (68%; 26/38) than those 30 years and older (95%; 76/80). Psychiatric comorbidity was present in 55% of suicides (65/118). The time between the last contact with a health care professional and death was greater among suicides under 30 years and male suicides.

Notwithstanding the aetiological complexity of suicide, the prevention, recognition and treatment of mental disorder will continue to play key roles in suicide prevention.

Anecdotal and biographical reports suggest that bipolar disorder may be associated with high IQ or creativity, but evidence for any such connection is weak.

To investigate possible associations between scholastic achievement and later bipolar disorder, using prospective data, in a whole-population cohort study.

Using individual school grades from all individuals finishing compulsory schooling in Sweden between 1988 and 1997, we tested associations between scholastic achievement at age 15–16 and hospital admission for psychosis between ages 17 and 31, adjusting for potential confounders.

Individuals with excellent school performance had a nearly fourfold increased risk of later bipolar disorder compared with those with average grades (hazard ratio HR = 3.79, 95% CI 2.11–6.82). This association appeared to be confined to males. Students with the poorest grades were also at moderately increased risk of bipolar disorder (HR = 1.86, 95% CI 1.06–3.28).

These findings provide support for the hypothesis that exceptional intellectual ability is associated with bipolar disorder.

Many people confront potentially morally injurious experiences (PMIEs) in the course of their work which can violate deeply held moral values or beliefs, putting them at risk for psychological difficulties (e.g. post-traumatic stress disorder (PTSD), depression, etc.).

We aimed to assess the effect of moral injury on mental health outcomes.

We conducted a systematic review and meta-analysis to assess the association between work-related PMIEs and mental health disorders. Studies were independently assessed for methodological quality and potential moderator variables, including participant age, gender and PMIE factors, were also examined.

Thirteen studies were included, representing 6373 participants. PMIEs accounted for 9.4% of the variance in PTSD, 5.2% of the variance in depression and 2.0% of the variance in suicidality. PMIEs were associated with more symptoms of anxiety and behavioural problems (e.g. hostility), although this relationship was not consistently significant. Moderator analyses indicated that methodological factors (e.g. PMIE measurement tool), demographic characteristics and PMIE variables (e.g. military v. non-military context) did not affect the association between a PMIE and mental health outcomes.

Most studies examined occupational PMIEs in military samples and additional studies investigating the effect of PMIEs on civilians are needed. Given the limited number of high-quality studies available, only tentative conclusions about the association between exposure to PMIEs and mental health disorders can be made.

None.

Over the past decades, psychiatry, as a science and a clinical discipline, has witnessed profound changes.

To examine whether these changes are reflected in changes in the public's conceptualisation of mental disorders, the acceptance of mental health treatment and attitudes towards people with mental illness.

In 1990 and 2011, population surveys were conducted in Germany on public attitudes about schizophrenia, depression and alcohol dependence.

Although the public has become more inclined to endorse a biological causation of schizophrenia, the opposite trend was observed with the other two disorders. The public's readiness to recommend help-seeking from mental health professionals and using psychotherapy and psychotropic medication has increased considerably. Attitudes towards people with schizophrenia worsened, whereas for depression and alcohol dependence no or inconsistent changes were found.

The growing divide between attitudes towards schizophrenia and other mental disorders should be of particular concern to future anti-stigma campaigns.

Little is known about the effects of the physical environment on individual health.

The present study tested the hypothesis that the prevalence of depression is associated with independently rated measures of the built environment, after adjusting for individuals' socio-economic status and the internal characteristics of their dwellings.

Cross-sectional survey of 1887 individuals aged 16 years and over in two electoral wards in north London. Depression was ascertained using the Center for Epidemiologic Studies Depression scale (CES–D). The built environment was rated independently, using a validated measure.

After adjusting for socio-economic status, floor of residence and structural housing problems, statistically significant associations were found between the prevalence of depression and living in housing areas characterised by properties with predominantly deck access (odds ratio=1.28, 95% Cl 1.03–1.58; P=0.02) and of recent (post-1969) construction (odds ratio=l.43, 95% Cl 1.06–1.91; P=0.02).

The prevalence of depression was associated with independently rated features of the built environment, independent of individuals' socio-economic status and internal characteristics of dwellings.

Antipsychotic-induced weight gain is a major concern in the treatment of psychosis. The efficacy of non-pharmacological interventions as well as the optimal intervention approach for this side-effect remain unclear.

To determine the effectiveness of non-pharmacological interventions and specific treatment approaches to control antipsychotic-induced weight gain in patients with firstepisode or chronic schizophrenia.

Systematic review and meta-analysis of randomised controlled trials.

Ten trials were included in the meta-analysis. Adjunctive non-pharmacological interventions, either individual or group interventions, or cognitive-behavioural therapy as well as nutritional counselling were effective in reducing or attenuating antipsychotic-induced weight gain compared with treatment as usual, with treatment effects maintained over follow-up.

Non-pharmacological weight-management interventions should be a priority, particularly during the early stages of antipsychotic treatment. Preventive approaches have the potential to be more effective, acceptable, cost-efficient and beneficial.

A study was conducted to validate a comprehensive self-rating scale for measuring side-effects of neuroleptic drugs.

The Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS), which includes ‘red herring’ items, was twice administered to 50 DSM–III–R schizophrenic patients, who were also interviewed using the UKU side-effect rating scale; 50 unmedicated controls also completed the LUNSERS.

The test-retest reliability of the LUNSERS was good (r = 0.811, P< 0.001) as was its concurrent validity against the UKU (r = 0.828, P< 0.001). Scores correlated with chlorpromazine equivalent doses (r = 0.310, P< 0.02). ROC analysis demonstrated that the scale discriminated between patients and non-medicated controls, who scored differently for real side-effects but not for ‘red herring’ items.

The LUNSERS is an efficient, reliable and valid method of assessing neuroleptic side-effects.

Psychiatric hospital inpatients are known to be at high risk of suicide, yet there is little reliable knowledge of risk factors or their predictive power.

To identify risk factors for suicide in psychiatric hospital in-patients and to evaluate their predictive power in detecting people at risk of suicide.

Using a case–control design, 112 people who committed suicide while in-patients in psychiatric hospitals were compared with 112 randomly selected controls. Univariate analysis and multivariate analyses were used to estimate odds ratios and adjusted likelihood ratios.

The rate of suicide in psychiatric in-patients was 13.7 (95% CI 11.7–16.1) per 10 000 admissions. There were five predictive factors with likelihood ratios >2, following adjustment: planned suicide attempt, 4.1; actual suicide attempt, 4.9; recent bereavement, 4.0; presence of delusions, 2.3; chronic mental illness, 2.2; and family history of suicide, 4.6. On this basis, only two of the patients who committed suicide had a predicted risk of suicide above 5%.

Although several factors were identified that were strongly associated with suicide, their clinical utility is limited by low sensitivity and specificity, combined with the rarity of suicide, even in this high-risk group.

Better indicators are needed for identifying children with early signs of developmental psychopathology.

To identify measures of autonomic nervous system reactivity that discriminate children with internalising and externalising behavioural symptoms.

A cross-sectional study of 122 children aged 6–7 years examined sympathetic and parasympathetic reactivity to standardised field-laboratory stressors as predictors of parent— and teacher-reported mental health symptoms.

Measures of autonomic reactivity discriminated between children with internalising behaviour problems, externalising behaviour problems and neither. Internalisers showed high reactivity relative to low-symptom children, principally in the parasympathetic branch, while externalisers showed low reactivity, in both autonomic branches.

School-age children with mental health symptoms showed a pattern of autonomic dimorphism in their reactivity to standardised challenges. This observation may be of use in early identification of children with presyndromal psychopathology.

Many theorists posit that childhood sexual abuse has a central role in the aetiology of self-injurious behaviour. Studies that report statistically significant associations between a history of such abuse and self-injury are cited to support this view.

A meta-analysis was conducted to determine systematically the magnitude of the association between childhood sexual abuse and self-injurious behaviour.

Forty-five analyses of the association were identified. Effect sizes were converted to a standard metric and aggregated.

The relationship between childhood sexual abuse and self-injurious behaviour is relatively small (mean weighted aggregate ϕ=0.23). This figure may be inflated owing to publication bias. In studies that statistically controlled for psychiatric risk factors, childhood sexual abuse explained little or no unique variance in self-injurious behaviour.

Theories that childhood sexual abuse has a central or causal role in the development of self-injurious behaviour are not supported by the available empirical evidence. Instead, it appears that the two are modestly related because they are correlated with the same psychiatric risk factors.