Little is known about the development of stigma towards people with mental disorders.

To investigate stigma in young Australians and the influence of exposure to mental disorders, parental attitudes and information campaigns.

A national telephone survey was carried out with 3746 people aged 12–25 years and 2005 co-resident parents. Stigmatising attitudes were assessed in relation to four vignettes (depression, depression with alcohol misuse, social phobia and psychosis).

Stigma was found to have multiple components labelled ‘social distance’, ‘dangerous/unpredictable’, ‘weak not sick’, ‘stigma perceived in others' and ‘reluctance to disclose’. Exposure to mental disorders and help-seeking in oneself or others was associated with lower scores on some components of stigma but not on others. Young people's attitudes showed specific associations with those of parents. Exposure to campaigns was associated with reductions in beliefs that the person is ‘weak not sick’.

Personal experiences, parental attitudes and campaigns all affect stigmatising attitudes.

No controlled trial of treatment of generalised social phobia has been conducted in general practice.

To examine the efficacy of sertraline or exposure therapy, administered alone or in combination in this setting.

Study was of a randomised, double-blind design. Patients (n=387) received sertraline 50–150 mg or placebo for 24 weeks. Patients were additionally randomised to exposure therapy or general medical care.

Sertraline-treated patients were significantly more improved than non-sertraline-treated patients (χ2=12.53, P<0.001; odds ratio=0.534; 95% CI 0.347–0.835). No significant difference was observed between exposure— and non-exposure-treated patients (χ2=2.18, P=0.140; odds ratio=0.732; 95% CI 0.475–1.134). In the pairwise comparisons, combined sertraline and exposure (χ2=12.32; P<0.001) and sertraline (χ2=10.13; P=0.002) were significantly superior to placebo.

Sertraline is an effective treatment for generalised social phobia. Combined treatment with sertraline and exposure therapy, conducted by the general practitioner, may enhance the treatment efficacy in primary care.

The provision of early intervention services for people with psychosis is UK government policy, although evidence for benefit of such services is sparse.

To evaluate the effects of a service providing specialised care for early psychosis (the Lambeth Early Onset team) on clinical and social outcomes, and on service user satisfaction.

One hundred and forty-four people with psychosis, presenting to mental health services for the first or second time (if previously failed to engage in treatment), were randomly allocated to care by the early onset team or to standard care. Information was obtained on symptoms, treatment adherence, social and vocational functioning, satisfaction and quality of life. Relapse and rehospitalisation data have been reported separately.

Outcomes for the participants treated by the early onset team were significantly better at 18 months for aspects of social and vocational functioning, satisfaction, quality of life and medication adherence. Symptom improvement did not significantly differ between the groups.

The provision of specialised care for early psychosis can achieve better outcomes. The study therefore provides support for current policy.

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.

Research into the relationship between gender identity disorder and psychiatric problems has shown contradictory results.

To investigate psychiatric problems in adults fulfilling DSM-IVTR criteria for a diagnosis of gender identity disorder.

Data were collected within the European Network for the Investigation of Gender Incongruence using the Mini International Neuropsychiatric Interview – Plus and the Structured Clinical Interview for DSM-IV Axis II Disorders (n = 305).

In 38% of the individuals with gender identity disorder a current DSM-IV-TR Axis I diagnosis was found, mainly affective disorders and anxiety disorders. Furthermore, almost 70% had a current and lifetime diagnosis. All four countries showed a similar prevalence, except for affective and anxiety disorders, and no difference was found between individuals with early-onset and late-onset disorder. An Axis II diagnosis was found in 15% of all individuals with gender identity disorder, which is comparable to the general population.

People with gender identity disorder show more psychiatric problems than the general population; mostly affective and anxiety problems are found.

Numerous studies have examined the neural correlates of episodic memory deficits in schizophrenia, yielding both consistencies and discrepancies in the reported patterns of results.

To identify in schizophrenia the brain regions in which activity is consistently abnormal across imaging studies of memory.

Data from 18 studies meeting the inclusion criteria were combined using a recently developed quantitative meta-analytic approach.

Regions of consistent differential activation between groups were observed in the left inferior prefrontal cortex, medial temporal cortex bilaterally, left cerebellum, and in other prefrontal and temporal lobe regions. Subsequent analyses explored memory encoding and retrieval separately and identified between-group differences in specific prefrontal and medial temporal lobe regions.

Beneath the apparent heterogeneity of published findings on schizophrenia and memory, a consistent and robust pattern of group differences is observed as a function of memory processes.

The authors of a recent systematic review concluded that the use of non-pharmacological containment methods, excluding restraint and seclusion, was not supported by evidence. Their focus on randomised, controlled trials, however, does not reflect the research that has been, or could be, conducted.

To find empirically supported interventions that allow reduction in the use of seclusion in psychiatric facilities.

We reviewed English-language, peer-reviewed literature on interventions that allow reduction in the use of seclusion.

Staff typically used multiple interventions, including state-level support, state policy and regulation changes, leadership, examinations of the practice contexts, staff integration, treatment plan improvement, increased staff to patient ratios, monitoring seclusion episodes, psychiatric emergency response teams, staff education, monitoring of patients, pharmacological interventions, treating patients as active participants in seclusion reduction interventions, changing the therapeutic environment, changing the facility environment, adopting a facility focus, and improving staff safety and welfare.

Reducing seclusion rates is challenging and generally requires staff to implement several interventions.

Whether individual differences in cortisol contribute to subsequent major depressive disorder (MDD) is unknown.

To determine whether premorbid levels of salivary cortisol and dehydroepiandrosterone (DHEA) were associated with subsequent MDD and how these related to psychosocial factors known to increase the risk for MDD.

Adult women (n=116) were recruited from general practices. None was currently depressed; 83 were ‘psychosocially vulnerable’ to MDD, 33 were not. Salivary steroids (cortisol and DHEA at 08.00 h and 20.00 h), recent life events, current mood and social support were assessed at entry. Onset of MDD was recorded during 13 months' follow-up.

There were no associations between salivary cortisol or DHEA and recent life events or vulnerability. Twenty-eight onsets of MDD occurred during the follow-up period. This was associated with: severe adverse life events and difficulties during the follow-up period; mean morning cortisol levels at entry; and the presence of any of three vulnerability factors.

Individual differences in morning salivary cortisol levels may represent an independent risk factor for subsequent MDD. The origin of these differences in cortisol is not yet understood.

Obsessive–compulsive behaviours are common and disabling in autistic-spectrum disorders (ASD) but little is known about how they compare with those experienced by people with obsessive–compulsive disorder (OCD).

To make such a comparison.

A group of adults with high-functioning ASD (n=40) were administered the Yale–Brown Obsessive–Compulsive Scale and Symptom Checklist and their symptoms compared with a gender-matched group of adults with a primary diagnosis of OCD (n=45). OCD symptoms were carefully distinguished from stereotypic behaviours and interests usually displayed by those with ASD.

The two groups had similar frequencies of obsessive–compulsive symptoms, with only somatic obsessions and repeating rituals being more common in the OCD group. The OCD group had higher obsessive–compulsive symptom severity ratings but up to 50% of the ASD group reported at least moderate levels of interference from their symptoms.

Obsessions and compulsions are both common in adults with high-functioning ASD and are associated with significant levels of distress.

In the past two decades the suicide rate in young people has risen in the UK and other countries.

To identify the characteristics of people aged under 35 who commit suicide.

Psychological autopsy study with case–control design. Cases were 84 suicides and probable suicides (open verdicts). Controls were 64 age- and gender-matched non-suicides obtained through the general practices of the matched cases. Main variables: social, including employment status, marital status and living circumstances; life events and interpersonal difficulties; clinical, including current psychiatric disorder, alcohol and drug misuse, previous self-harm and personality disorder.

A large number of highly significant social, interpersonal and clinical differences between suicides and controls was found. Factor analysis identified two groups of variables within each of the social, interpersonal and clinical domains which were independently linked to suicide, corresponding to: acute, severe mental disorder and chronic disorder of behaviour; rootlessness and social withdrawal; chronic and recent interpersonal problems.

A broad prevention strategy is needed to reverse the recent rise in the suicide rate in young people.