Behavioural activation appears as effective as cognitive– behaviour therapy (CBT) in the treatment of depression. If equally effective, then behavioural activation may be the preferred treatment option because it may be suitable for delivery by therapists with less training. This is the first randomised controlled trial to look at this possibility.

To examine whether generic mental health workers can deliver effective behavioural activation as a step-three high-intensity intervention.

A randomised controlled trial (ISRCTN27045243) comparing behavioural activation (n = 24) with treatment as usual (n = 23) in primary care.

Intention-to-treat analyses indicated a difference in favour of behavioural activation of –15.79 (95% CI –24.55 to –7.02) on the Beck Depression Inventory–II and Work and Social Adjustment Scale (mean difference –11.12, 95% CI –17.53 to –4.70).

Effective behavioural activation appears suitable for delivery by generic mental health professionals without previous experience as therapists. Large-scale trial comparisons with an active comparator (CBT) are needed.

The prevalence of benzodiazepine consumption in European countries remains at 2–3% of the general population despite the well-documented disadvantages of long-term use.

To review systematically the success rates of different benzodiazepine discontinuation strategies.

Meta-analysis of comparable intervention studies.

Twenty-nine articles met inclusion criteria. Two groups of interventions were identified; minimal intervention (e.g. giving simple advice in the form of a letter or meeting to a large group of people; n=3), and systematic discontinuation (defined as treatment programmes led by a physician or psychologist; n=26). Both were found to be significantly more effective than treatment as usual: minimal interventions (pooled OR=2.8, 95% CI 1.6–5.1); systematic discontinuation alone (one study, OR=6.1, 95% CI 2.0–18.6). Augmentation of systematic discontinuation with imipramine (two studies, OR=3.1, 95% CI 1.1–9.4) or group cognitive-behavioural therapy for patients with insomnia (two studies, OR=5.5, 95% CI 2.3–14.2) was superior to systematic discontinuation alone.

Evidence was found for the efficacy of stepped care (minimal intervention followed by systematic discontinuation alone) in discontinuing long-term benzodiazepine use.

This study investigated biological correlates of depression in patients with idiopathic Parkinson's disease (PD). We tested the hypothesis that in patients with PD and depression, there was regional dysfunction involving brain areas previously implicated in functional imaging studies of patients with primary depression.

Using positron emission tomographic measurements of regional cerebral blood flow (rCBF), patterns of resting rCBF were measured in ten patiens with PD and major depression, and ten patients with PD alone. The results were compared with findings from ten patients with primary depression and ten normal controls, scanned using identical methods as part of an earlier study. Groups were matched for age, sex and symptom severity.

Bilateral decreases in rCBF were observed in anteromedial regions of the medial frontal cortex and the cingulate cortex (Brodmann's areas (BA) 9 and 32) in the depressed PD group, compared with those with PD alone and compared with normal controls. This regional disturbance overlapped that observed in patients with primary depression.

The findings indicate that the medial prefrontal cortex is a common area of neural dysfunction in the manifestation of both primary depression and depression in PD.

We test the hypothesis that negative attitudes to mentally ill people may be fuelled by a lack of knowledge.

A census of knowledge of mental illness was conducted in two areas prior to the opening of long-stay supported houses for the mentally ill in each area. Three attitudinal factors (Fear and Exclusion, Social Control and Goodwill) which had been extracted by factor analysis of the Community Attitudes toward the Mentally III (CAMI) inventory (see previous paper) were analysed in respect of their associations with knowledge of mental illness.

Most respondents (80%) knew of somebody who had a mental illness but a substantial proportion of respondents had little knowledge about mental illness. Social Control showed an association with knowledge of mental illness. Groups who showed more socially controlling attitudes (especially those over 50 years old, those of lower social class, and those of non-Caucasian ethnic origin) had less knowledge about mental illness. Regression analysis revealed that when knowledge was taken into account age had no effect on Social Control, and the effect of social class and ethnic origin was diminished Respondents with children, who showed more Fear and Exclusion, were not less knowledgeable about mental illness.

The results support the hypothesis that negative attitudes, especially in older people, are fuelled by a lack of knowledge. Negative attitudes among people with children are not related to a lack of knowledge.

High rates of osteoporosis in schizophrenia may result from the prolactin-raising effects of some antipsychotic medication.

To examine bone mineral density in relation to relevant endocrine variables in patients with schizophrenia taking prolactin-raising antipsychotics.

Fifty-five patients who had been receiving prolactin-raising antipsychotic medication for > 10 years underwent dual-energy X-ray absorptiometry of their lumbar and hip bones. Among the endocrine variables assessed were plasma prolactin and sex hormones.

Age-related reduced bone mineral density measures were found in 17 (57%) of the male and 8 (32%) of the female patients. Higher doses of medication were associated with increased rates of both hyperprolactinaemia and bone mineral density loss. Bone loss for the whole group was correlated with medication dose, and for men was inversely correlated with testosterone values.

These results suggestthat patients with schizophrenia on long-term prolactin-raising antipsychotic medication are at high risk of developing reduced bone mineral density as a consequence of hyperprolactinaemia-induced hypogonadism.

Depersonalisation disorder is a poorly understood and underresearched syndrome.

To carry out a large and comprehensive clinical and psychopathological survey of a series of patients who made contact with a research clinic.

A total of 204 consecutive eligible referrals were included: 124 had a full psychiatric examination using items of the Present State Examination to define depersonalisation/derealisation and 80 had either a telephone interview (n=22) or filled out a number of self-report questionnaires. Cases assessed were diagnosed according to DSM–IV criteria.

The mean age of onset was 22.8 years; early onset was associated with greater severity There was a slight male preponderance. The disorder tended to be chronic and persistent. Seventy-one per cent met DSM–IV criteria for primary depersonalisation disorder. Depersonalisation symptom scores correlated with both anxiety and depression and a past history of these disorders was commonly reported. ‘Dissociative amnesia’ was not prominent.

Depersonalisation disorder is a recognisable clinical entity but appears to have significant comorbidity with anxiety and depression. Research into its aetiology and treatment is warranted.

Strong links exist between juvenile and adult depression, but comorbid conduct disorder may be associated with worse adult social difficulties.

To test the impact of comorbid conduct disorder on social adjustment and dysfunction, suicidality and criminality of adults who had had depression as youths.

Subjects (n=149) assessed at the Maudsley Hospital in 1970–1983 and meeting DSM–IV criteria for major depressive disorder with (CD–MDD; n=53) or without (MDD; n=96) conduct disorder were interviewed 20 years later. Data were collected on lifetime psychiatric disorders and adult social/personality functioning. Death certificates and criminal records were obtained.

The suicide risk was 2.45%, and 44.3% of the sample had attempted suicide once in their lives. Compared with the MDD group, the CD–MDD group had higher rates of suicidal behaviours and criminal offences, and exhibited more pervasive social dysfunction.

Adolescent depression is associated with raised risks of adult suicidality and with persistent interpersonal difficulties. Youths with CD–MDD show more severe and pervasive social dysfunction.

The efficacy of low doses of certain neuroleptics in improving negative symptoms is still controversial. This study assessed the efficacy of amisulpride, a benzamide which increases dopaminergic transmission at low doses via presynaptic dopamine receptor blockade, on negative symptoms of schizophrenia.

The study was designed as a parallel-group, double-blind, placebo-controlled trial. Patients had to fulfil DSM–III criteria for schizophrenia, Andreasen's criteria for negative schizophrenia, and to have a total score of at least 75 on the SANS; those treated with neuroleptics or antidepressants underwent a six-week placebo wash-out. One hundred and four in-patients were randomly assigned to amisulpride 100 mg/d, amisulpride 300 mg/d, or placebo for six weeks; 85 patients completed the study.

Both amisulpride doses were significantly more effective than placebo on the primary evaluation criterion (SANS total score, MANOVA P < 0.02). No significant changes were found in positive symptoms or in extrapyramidal symptoms.

Negative symptoms can be improved by low doses of amisulpride, favouring the hypothesis of dopaminergic hypofunction as one of the causes of negative symptoms.

There have been relatively few surveys in Latin America that have attempted to estimate the prevalence of psychiatric morbidity in private households.

To determine the prevalence of common mental disorders and socio-demographic correlates among adults from Santiago, Chile.

Cross-sectional survey of private households with a probabilistic sampling design was used. Common mental disorders were measured using the Clinical Interview Schedule–Revised (CIS–R).

Three thousand eight hundred and seventy adults were interviewed. Twenty-five per cent were CIS–R cases and 13% met criteria for an ICD–10 diagnosis. Low education, female gender, unemployment, separation, low social status and lone parenthood were associated with a higher prevalence.

Prevalence rates were higher than those found in urban areas of Great Britain, both for ICD–10 diagnoses and ‘non-specific neurotic disorders’. Similar socio-demographic factors were associated with an increased prevalence of common mental disorders in Chile as in the UK. There is a need to unify methodologies to be able to compare results internationally.

Tailored psychosocial interventions can help families to manage behavioural and psychological symptoms in dementia (BPSD), but carer responses to their relative's behaviours contribute to the success of support programmes.

To understand why some family carers have difficulty in dealing with BPSD, in order to improve the quality of personalised care that is offered.

A systematic review and meta-ethnographic synthesis was conducted of high-quality quantitative and qualitative studies between 1980 and 2012.

We identified 25 high-quality studies and two main reasons for behaviours being reported as challenging by family carers: changes in communication and relationships, resulting in ‘feeling bereft’; and perceptions of transgressions against social norms associated with ‘misunderstandings about behaviour’ in the relative with dementia. The underlying belief that their relative had lost, or would inevitably lose, their identity to dementia was a fundamental reason why family carers experienced behaviour as challenging.

Family carers' perceptions of BPSD as challenging are associated with a sense of a declining relationship, transgressions against social norms and underlying beliefs that people with dementia inevitably lose their ‘personhood’. Interventions for the management of challenging behaviour in family settings should acknowledge unmet psychological need in family carers.

There is a lack of comparative data on the prevalence and effects of exposure to violence in African youth.

We assessed trauma exposure, post-traumatic stress symptoms and gender differences in adolescents from two African countries.

A sample of 2041 boys and girls from 18 schools in Cape Town and Nairobi completed anonymous self-report questionnaires.

More than 80% reported exposure to severe trauma, either as victims or witnesses. Kenyan adolescents, compared with South African, had significantly higher rates of exposure to witnessing violence (69% v. 58%), physical assault by a family member (27% v. 14%) and sexual assault (18% v. 14%). But rates of current full-symptom post-traumatic stress disorder (PTSD) (22.2% v. 5%) and current partial-symptom PTSD (12% v. 8%) were significantly higher in the South African sample. Boys were as likely as girls to meet PTSD symptom criteria.

Although the lifetime exposure to trauma was comparable across both settings, Kenyan adolescents had much lower rates of PTSD. This difference may be attributable to cultural and other trauma-related variables. High rates of sexual assault and PTSD, traditionally documented in girls, may also occur in boys and warrant further study.

An international six-centre randomised controlled trial comparing individual placement and support (IPS) with usual vocational rehabilitation for people with serious mental illness found IPS to be more effective for all vocational outcomes.

To determine which patients with severe mental illness do well in vocational services and which process and service factors are associated with better outcomes.

Patient characteristics and early process variables were tested as predictors of employment outcomes. Service characteristics were explored as predictors of the effectiveness of IPS.

Patients with previous work history, fewer met social needs and better relationships with their vocational workers were more likely to obtain employment and work for longer. Remission and swifter service uptake were associated with working more. Having an IPS service closer to the original IPS model was the only service characteristic associated with greater effectiveness.

The IPS service was found to be more effective for all vocational outcomes. In addition, maintaining high IPS fidelity and targeting relational skills would be a valuable focus for all vocational interventions, leading to improved employment outcomes. Motivation to find work may be decreased by satisfaction with current life circumstances.

The association between depression after myocardial infarction and increased risk of mortality and cardiac morbidity may be due to cardiac disease severity.

To combine original data from studies on the association between post-infarction depression and prognosis into one database, and to investigate to what extent such depression predicts prognosis independently of disease severity.

An individual patient data meta-analysis of studies was conducted using multilevel, multivariable Cox regression analyses.

Sixteen studies participated, creating a database of 10 175 post-infarction cases. Hazard ratios for post-infarction depression were 1.32 (95% CI 1.26–1.38, P<0.001) for all-cause mortality and 1.19 (95% CI 1.14–1.24, P<0.001) for cardiovascular events. Hazard ratios adjusted for disease severity were attenuated by 28% and 25% respectively.

The association between depression following myocardial infarction and prognosis is attenuated after adjustment for cardiac disease severity. Still, depression remains independently associated with prognosis, with a 22% increased risk of all-cause mortality and a 13% increased risk of cardiovascular events per standard deviation in depression z-score.

In recent years, studies of the risk of recurrence in affective disorder in relation to the number of prior episodes have given contradictory results.

Survival analysis was used to calculate the rate of recurrence after successive episodes in a case register study including all hospital admissions with primary affective disorder in Denmark during 1971–1993. A total of 20 350 first-admission patients were discharged with a diagnosis of affective disorder, depressive or manic/cyclic type.

The rate of recurrence increased with the number of previous episodes in both unipolar and bipolar disorder. Initially, the two types of disorders followed markedly different courses, but later in the course of the illness the rate of recurrence was the same for the two disorders.

The course of severe unipolar and bipolar disorder seems to be progressive in nature despite the effect of treatment.