Reports suggest a high prevalence of substance misuse in psychotic disorders but few studies examine comorbidity at onset of psychosis.

To identify the prevalence and pattern of substance use and misuse in first-episode psychosis, and relationships with diagnosis, mode of presentation and demographic variables.

Consensus diagnoses for 168 subjects presenting with first-episode psychosis were made using ICD–10 diagnostic criteria. Information on substance use and misuse was obtained from multiple sources. We examined associations between substance misuse, diagnosis and demographic factors.

Criteria for drug use, drug misuse or alcohol misuse were met by 37% of the sample. One-year prevalence rates were 19.5% (drug misuse) and 11.7% (alcohol misuse). Thirteen subjects (8.4%) received a primary diagnosis of substance-related psychotic disorder; a significant increase compared with an earlier cohort from the same catchment area. Drug misuse was associated with younger age of onset of psychosis, male gender and non–African–Caribbean ethnicity.

This study confirms high rates of substance misuse at onset of psychosis. There is evidence for an increase in diagnosis of substance-related psychotic disorders over time. Those most at risk of substance misuse are young males.

Personality disorder is a severe health issue. However, the epidemiology of personality disorders is insufficiently described and surveys report very heterogeneous rates.

We aimed to conduct a meta-analysis on the prevalence of personality disorders in adult populations and examine potential moderators that affect heterogeneity.

We searched PsycINFO, PSYNDEX and Medline for studies that used standardised diagnostics (DSM-IV/-5, ICD-10) to report prevalence rates of personality disorders in community populations in Western countries. Prevalence rates were extracted and aggregated by random-effects models. Meta-regression and sensitivity analyses were performed and publication bias was assessed.

The final sample comprised ten studies, with a total of 113 998 individuals. Prevalence rates were fairly high for any personality disorder (12.16%; 95% CI, 8.01–17.02%) and similarly high for DSM Clusters A, B and C, between 5.53 (95% CI, 3.20–8.43%) and 7.23% (95% CI, 2.37–14.42%). Prevalence was highest for obsessive–compulsive personality disorder (4.32%; 95% CI, 2.16–7.16%) and lowest for dependent personality disorder (0.78%; 95% CI, 0.37–1.32%). A low prevalence was significantly associated with expert-rated assessment (versus self-rated) and reporting of descriptive statistics for antisocial personality disorder.

Epidemiological studies on personality disorders in community samples are rare, whereas prevalence rates are fairly high and vary substantially depending on samples and methods. Future studies investigating the epidemiology of personality disorders based on the DSM-5 and ICD-11 and models of personality functioning and traits are needed, and efficient treatment should be a priority for healthcare systems to reduce disease burden.

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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.

Psychiatric disorders are common during young adulthood and comorbidity is frequent. Individual psychiatric disorders have been shown to be associated with negative economic and educational outcomes, but few studies have addressed the relationship between the total extent of psychiatric disorder and life outcomes.

To examine whether the extent of common psychiatric disorder between ages 18 and 25 is associated with negative economic and educational outcomes at age 30, before and after controlling for confounding factors.

Participants were 987 individuals from the Christchurch Health and Development Study, a longitudinal study of a birth cohort of individuals born in Christchurch, New Zealand, in 1977 and followed to age 30. Linear and logistic regression models were used to examine the associations between psychiatric disorder from age 18 to 25 and workforce participation, income and living standards, and educational achievement at age 30, before and after adjustment for confounding factors.

There were significant associations between the extent of psychiatric disorder reported between ages 18 and 25 and all of the outcome measures (all P<0.05). After adjustment for confounding factors, the associations between psychiatric disorder and workforce participation, income and living standards remained significant (all P<0.05), but the associations between psychiatric disorder and educational achievement were not significant (all P>0.10).

After due allowance had been made for a range of confounding factors, psychiatric disorder between ages 18 and 25 was associated with reduced workforce participation, lower income and lower economic living standards at age 30.

Little is known about personality disorders and normal personality dimensions in relatives of patients with obsessive-compulsive disorder (OCD).

To determine whether specific personality characteristics are part of a familial spectrum of OCD.

Clinicians evaluated personality disorders in 72 OCD case and 72 control probands and 198 case and 207 control first-degree relatives. The self-completed Revised NEO Personality Inventory was used for assessment of normal personality dimensions. The prevalence of personality disorders and scores on normal personality dimensions were compared between case and control probands and between case and control relatives.

Case probands and case relatives had a high prevalence of obsessive-compulsive personality disorder (OCPD) and high neuroticism scores. Neuroticism was associated with OCPD in case but not control relatives.

Neuroticism and OCPD may share a common familial aetiology with OCD.

Strong evidence exists for an association between childhood trauma, particularly childhood sexual abuse, and hallucinations in schizophrenia. Hallucinations are also well-documented symptoms in people with bipolar affective disorder.

To investigate the relationship between childhood sexual abuse and other childhood traumas and hallucinations in people with bipolar affective disorder.

A sample of 96 participants was drawn from the Medical Research Council multi-centre trial of cognitive–behavioural therapy for bipolar affective disorder. The trial therapists recorded spontaneous reports of childhood sexual abuse made during the course of therapy. Symptom data were collected by trained research assistants masked to the hypothesis.

A significant association was found between those reporting general trauma (n=38) and auditory hallucinations. A highly significant association was found between those reporting childhood sexual abuse (n=15) and auditory hallucinations.

The relationship between childhood sexual abuse and hallucinations in bipolar disorder warrants further investigation.

Neurological soft signs (NSS) such as a disturbed finger-to-thumb opposition are frequently found in schizophrenia. To identify the underlying cerebral changes we investigated sensorimotor cortex and supplementary motor area (SMA) activation during finger-to-thumb opposition using functional magnetic resonance imaging (fMRI).

Ten DSM–III–R schizophrenics and seven healthy controls were included. All subjects were right-handed. fMRI was carried out in a resting condition followed by an activation state (finger-to-thumb opposition) and the activities in the sensorimotor cortices and SMA recorded.

All subjects showed a significant activation of the SMA and both ipsilateral and contralateral sensorimotor cortices. In the controls, ipsilateral finger-to-thumb opposition was associated with a greater left than right hemispheric sensorimotor cortex coactivation. When compared with the healthy controls, the schizophrenic patients showed a decreased activation of both sensorimotor cortices and SMA, as well as a reversed lateralisation effect.

Sensorimotor cortex and SMA dysfunction are associated with motor disturbances in schizophrenia.

Weight gain is a common consequence of antipsychotic drug treatment and can lead to further morbidity.

To assess the effects of antipsychotic drug therapy on abdominal fat deposition, on insulin and leptin secretion, and on circulating glucose and lipids.

Abdominal body fat was determined by magnetic resonance imaging in a group of previously untreated patients with schizophrenia, before and after 10 weeks'antipsychotic drug treatment. Body mass and blood concentrations of glucose, insulin, leptin and lipids were also measured.

Significant increases in both subcutaneous and intra-abdominal fat were identified after antipsychotic drug treatment. A three-fold increase in leptin secretion as well as significant increases in levels of circulating lipids and non-fasting glucose were also identified.

Patients first receiving antipsychotic drugs experience substantial deposition of both subcutaneous and intra-abdominal fat, reflecting a loss of the normal inhibitory control of leptin on body mass. Along with fat deposition, the increase in levels of fasting lipids and in non-fasting glucose may provide early signs of drug-induced progression towards the metabolic syndrome.

Little is known about the long-term outcome of involuntary admissions to psychiatric hospitals.

To assess involuntary readmissions and patients' retrospective views of the justification of the admission as 1-year outcomes and to identify factors associated with these outcomes.

Socio-demographic data and readmissions were collected for 1570 involuntarily admitted patients. Within the first week after admission 50% were interviewed, and of these 51% were re-interviewed after 1 year.

At 1 year, 15% of patients had been readmitted involuntarily, and 40% considered their original admission justified. Lower initial treatment satisfaction, being on benefits, living with others and being of African and/or Caribbean origin were associated with higher involuntary readmission rates. Higher initial treatment satisfaction, poorer initial global functioning and living alone were linked with more positive retrospective views of the admission.

Patients' views of treatment within the first week are a relevant indicator for the long-term prognosis of involuntarily admitted patients.

Little is known of the behavioural adjustment of children of postnatally depressed mothers. Previous studies have relied on maternal reports, and have produced inconsistent findings.

In a prospective, longitudinal study of the five-year-old children of a community sample of postnatally depressed and well women, evidence was collected concerning the children's adjustment in the context of school, teachers being asked to complete questionnaires after the children had finished their first term.

Family social class and the child's gender had the most pervasive influences on adjustment. However, both postnatal and recent maternal depression were associated with significantly raised levels of child disturbance, particularly among boys and those from lower social class families.

The findings indicate a persistent effect of postnatal depression on child adjustment. They highlight the need for resources devoted to supporting mothers of young children and particularly routine screening and treatment for postnatal mood disorder.

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.