The public health significance of mixed anxiety–depressive disorder (MADD) and the distinctiveness of its phenomenology have yet to be established.

To determine the public health significance of MADD, and to compare its phenomenology with ICD-10 anxiety, depressive, and comorbid anxiety and depressive disorders.

Weighted analysis of data from the Great Britain National Psychiatric Morbidity survey was conducted with a representative household sample of 8580 persons aged 16–74 years.

The 1-month prevalence of MADD was 8.8%. A fifth of all days off work in Britain occurred in this group. The symptom profile of MADD was similar to ‘pure’ ICD-10 anxiety and depression, but with a lower overall symptom count. The disorder was associated with significant impairment of health-related quality of life. Differences in health-related quality of life measures between diagnostic groups were accounted for by overall symptom severity, which remained strongly associated with health-related quality of life measures after adjusting for diagnostic group. The finding that half of the anxiety, depression and MADD cases and a third of the comorbid depression and anxiety cases grouped into a single latent class challenges the notion of these conditions as having distinct phenomenologies. Mixed presentations may be the norm in the population.

The data support the pathological significance of MADD in its negative impact upon population health. Dimensional approaches to classification may provide a more parsimonious description of anxiety and depressive disorders compared with categorical approaches.

How best to plan and provide psychosocial care following disasters remains keenly debated.

To develop evidence-informed post-disaster psychosocial management guidelines.

A three-round web-based Delphi process was conducted. One hundred and six experts rated the importance of statements generated from existing evidence using a one to nine scale. Participants reassessed their original scores in the light of others' responses in the subsequent rounds.

A total of 80 (72%) of 111 statements achieved consensus for inclusion. The statement ‘all responses should provide access to pharmacological assessment and management’ did not achieve consensus. The final guidelines recommend that every area has a multi-agency psychosocial care planning group, that responses provide general support, access to social, physical and psychological support and that specific mental health interventions are only provided if indicated by a comprehensive assessment. Trauma-focused cognitive–behavioural therapy (CBT) is recommended for acute stress disorder or acute post-traumatic stress disorder, with other treatments with an evidence base for chronic post-traumatic stress disorder being made available if trauma-focused CBT is not tolerated.

The Delphi process allowed a consensus to be achieved in an area where there are limitations to the current evidence.

The suicide rate in Scotland is twice as high as that in England. However, the prevalence of self-harm is unknown.

To determine the prevalence of self-harm in adolescents in Scotland and the factors associated with it.

A total of 2008 pupils aged 15–16 years completed an anonymous lifestyle and coping survey. Information was obtained on demographic characteristics, lifestyle, life events and problems, social influences, psychological variables and self-harm.

Self-harm was reported by 13.8% of the respondents. The majority (71%) of those who had self-harmed had done so in the past 12 months and girls were approximately 3.4 times more likely to report self-harm than boys. In multivariate analyses, smoking, bullying, worries about sexual orientation, self-harm by family and anxiety were associated with self-harm in both genders. In addition, drug use, physical abuse, serious boy/girlfriend problems, self-harm by friends and low levels of optimism were also associated with self-harm in girls.

Despite markedly different national suicide rates, the prevalence of self-harm in Scotland is similar to that in England with girls at least three times more likely to report self-harm than boys. The findings suggest a role for emotional literacy programmes in schools and highlight the importance of promoting positive mental health among adolescents.

Obsessive–compulsive disorder (OCD) often starts in childhood and adolescence and can be a chronic disorder with high persistence rates. There are few prospective long-term follow-up studies.

To follow up young people with OCD to clarify persistence rates and relevant predictors, presence of other psychiatric disorders, functional impairment, service utilisation and perceived treatment needs.

All young people with OCD assessed over 9 years at the National and Specialist Paediatric OCD clinic, Maudsley Hospital, London, were included. Sixty-one per cent (142 of 222) of all contactable young people and parents completed computerised diagnostic interviews and questionnaires.

We found a persistence rate of OCD of 41%; 40% of participants had a psychiatric diagnosis other than OCD at follow-up. The main predictor for persistent OCD was duration of illness at assessment. High levels of baseline psychopathology predicted other psychiatric disorders at follow-up. Functional impairment and quality of life were mildly to moderately affected. Approximately 50% of participants were still receiving treatment and about 50% felt a need for further treatment.

This study confirms that paediatric OCD can be a chronic condition that persists into adulthood. Early recognition and treatment might prevent chronicity. Important challenges for services are ensuring adequate treatment and a smooth transition from child to adult services.

Serotonin receptors may play an important role in the pathophysiology of affective disorders. We studied type-2 serotonin (5-HT2) receptors in the brain of patients with major depression.

Using positron emission tomography (PET) and the selective radioligand [18F]altanserin, we investigated 5-HT2 receptor distribution in eight drug-free unipolar depressed patients and 22 healthy subjects. Data were analysed using Statistical Parametric Mapping 95.

In depressed patients, [18F]altanserin uptake was significantly reduced in a region of the right hemisphere including the posterolateral orbitofrontal cortex and the anterior insular cortex. A trend to similar changes was found in the left hemisphere. No correlation was found between the uptake and the Hamilton rating scale score.

Pathophysiology of depression may involve changes in 5-HT2 receptor in brain regions selectively implicated in mood regulation.

This paper describes severe, disorders of maternal affection and behaviour and suggests that there is an early process of mother-to-infant bonding which can go seriously wrong.

Forty-four self-selected women who had suffered from at least one episode of postnatal mental illness described an unexpected and often catastrophic failure to love one or more of their babies.

These women reported absent affection, sometimes hate, rejection, neglect or impulses to harm, in relation to at least one of their children. These feelings often began immediately or very shortly after the birth, and with one exception, were specific to one child; such characteristics are best encapsulated by the term ‘maternal bonding disorder’. Twenty-nine of the women were multiparae; first-borns were not significantly more likely to be the focus for such feelings. There was no direct evidence of predisposing maternal personality traits or previous experiences. Postnatal mental illness and recalled severe pain during labour were significantly associated with such disorders which, in their severe forms, did not occur in the absence of postnatal mental illness.

The nature of the link between postnatal mental illness and disorders of maternal bonding remains unclear. Because, in multiparae, the disorder often ‘missed’ the first child, factors such as maternal personality traits or early childhood experiences cannot be regarded as sufficient causes.

It is unclear whether schizophrenia and psychotic bipolar disorder are associated with similar deviations of brain morphometry.

To assess volumetric abnormalities of grey and white matter throughout the entire brain in individuals with schizophrenia or with bipolar disorder compared with the same control group.

Brain scans were obtained by magnetic resonance imaging from 25 people with schizophrenia, 37 with bipolar disorder who had experienced psychotic symptoms and 52 healthy volunteers. Regional deviation in grey and white matter volume was assessed using computational morphometry.

Individuals with schizophrenia had distributed grey matter deficit predominantly involving the fronto-temporal neocortex, medial temporal lobe, insula, thalamus and cerebellum, whereas those with bipolar disorder had no significant regions of grey matter abnormality. Both groups had anatomically overlapping white matter deficits in regions normally occupied by major longitudinal and interhemispheric tracts.

Schizophrenia and psychotic bipolar disorder are associated with distinct grey matter deficits but anatomically coincident white matter abnormalities.

Trials evaluating efficacy of omega-3 highly unsaturated fatty acids (HUFAs) in major depressive disorder report discrepant findings.

To establish the reasons underlying inconsistent findings among randomised controlled trials (RCTs) of omega-3 HUFAs for depression and to assess implications for further trials.

A systematic bibliographic search of double-blind RCTs was conducted between January 1980 and July 2014 and an exploratory hypothesis-testing meta-analysis performed in 35 RCTs including 6665 participants receiving omega-3 HUFAs and 4373 participants receiving placebo.

Among participants with diagnosed depression, eicosapentaenoic acid (EPA)-predominant formulations (>50% EPA) demonstrated clinical benefits compared with placebo (Hedge's G = 0.61, P<0.001) whereas docosahexaenoic acid (DHA)-predominant formulations (>50% DHA) did not. EPA failed to prevent depressive symptoms among populations not diagnosed for depression.

Further RCTs should be conducted on study populations with diagnosed or clinically significant depression of adequate duration using EPA-predominant omega-3 HUFA formulations.

Although depression in childhood appears to be familial, transmission of symptoms could be genetic or environmental. Twin studies enable us to separate these effects. Our aim was to assess the importance of genetic and environmental factors on depressive symptoms during childhood and adolescence in an epidemiological sample of twins.

Questionnaires (including the Mood and Feelings questionnaire) were mailed to a systematically ascertained sample (411 twin pairs) aged between 8 and 16 years. The overall response rate was 77%.

Data for the whole sample were best explained by an additive genetic model, with heritability of depressive symptom scores estimated at 79%. However, on splitting the sample, symptoms in children (aged 8 to 11) could be explained by shared environmental factors only, while symptoms in adolescents (aged 11 to 16) remained highly heritable.

The results suggest that although depressive symptoms appear to be largely heritable, the influence of genetic and environmental factors may vary with age.

As the population ages, older people account for a greater proportion of the health and social care budget. Whereas some research has been conducted on the use of music therapy for specific clinical populations, little rigorous research has been conducted looking at the value of community singing on the mental health-related quality of life of older people.

To evaluate the effectiveness and cost-effectiveness of community group singing for a population of older people in England.

A pilot pragmatic individual randomised controlled trial comparing group singing with usual activities in those aged 60 years or more.

A total of 258 participants were recruited across five centres in East Kent. At 6 months post-randomisation, significant differences were observed in terms of mental health-related quality of life measured using the SF12 (mean difference = 2.35; 95% CI = 0.06–4.76) in favour of group singing. In addition, the intervention was found to be marginally more cost-effective than usual activities. At 3 months, significant differences were observed for the mental health components of quality of life (mean difference = 4.77; 2.53–7.01), anxiety (mean difference =–1.78; –2.5 to –1.06) and depression (mean difference =–1.52; –2.13 to –0.92).

Community group singing appears to have a significant effect on mental health-related quality of life, anxiety and depression, and it may be a useful intervention to maintain and enhance the mental health of older people.

We consider how far it is possible to predict a chronic course of a depressive disorder from psychosocial and clinical material available at the point of onset.

A population survey found 404 working-class mothers living in an inner-city area of London. The majority were interviewed three times over a 3-year period.

Chronicity (more than 12 months' duration) was strongly related to both childhood adversity (parental indifference, family violence or any sexual abuse) and current adult interpersonal difficulties. The lack of positive events during the course of the episode was also independently related to chronicity, but to a lesser degree. Clinical characteristics were relatively unimportant compared with psychosocial factors.

The childhood risk factors were particularly important (judged by a path analysis), and a challenge for future research will be to establish the intervening processes involved with this distal link.

Low birth weight, prematurity and higher miscarriage rates have previously been reported in women with eating disorders.

To determine whether women with a history of eating disorders are at higher risk of major adverse perinatal outcomes.

Adjusted birth weight, preterm delivery and miscarriage history were compared in those with a history of eating disorders (anorexia nervosa (n=171), bulimia nervosa (n=199) and both (n=82)) and those with other (n=1166) and no psychiatric disorders (n=10 636) in a longitudinal cohort study.

The group with bulimia nervosa had significantly higher rates of past miscarriages (relative risk ratio 2.0, P=0.01) and the group with anorexia nervosa delivered babies of significantly lower birth weight than the general population (P=0.01), which was mainly explained by lower pre-pregnancy body mass index. Preterm delivery rates were comparable across groups.

Women with a history of eating disorders are at higher risk of major adverse obstetric outcomes. Antenatal services should be aware of this higher risk.

Patient–clinician communication is central to mental healthcare but neglected in research.

To test a new computer-mediated intervention structuring patient–clinician dialogue (DIALOG) focusing on patients' quality of life and needs for care.

In a cluster randomised controlled trial, 134 keyworkers in six countries were allocated to DIALOG or treatment as usual; 507 people with schizophrenia or related disorders were included. Every 2 months for 1 year, clinicians asked patients to rate satisfaction with quality of life and treatment, and request additional or different support. Responses were fed back immediately in screen displays, compared with previous ratings and discussed. Primary outcome was subjective quality of life, and secondary outcomes were unmet needs and treatment satisfaction.

Of 507 patients, 56 were lost to follow-up and 451 were included in intention-to-treat analyses. Patients receiving the DIALOG intervention had better subjective quality of life, fewer unmet needs and higher treatment satisfaction after 12 months.

Structuring patient–clinician dialogue to focus on patients' views positively influenced quality of life, needs for care and treatment satisfaction.

Tricyclic antidepressants have similar efficacy and slightly lower tolerability than selective serotonin reuptake inhibitors (SSRIs). However, there are no systematic reviews assessing amitriptyline, the reference tricyclic drug, v. other tricyclics and SSRIs directly.

To review the tolerability and efficacy of amitriptyline in the management of depression.

A systematic review of randomised controlled trials (RCTs) comparing amitriptyline with other tricyclics/heterocyclics or with an SSRI.

We reviewed 186 RCTs. The overall estimate of the efficacy of amitriptyline revealed a standardised mean difference of 0.147 (95% CI 0.05–0.243), significantly favouring amitriptyline. The overall OR for dropping out was 0.99 (95% CI 0.91–1.08) and that for side-effects was 0.62 (95% CI 0.54–0.70), favouring the control drugs. With drop-outs included as treatment failures, the estimate of the effectiveness of amitriptyline v. tricyclics/heterocyclics and SSRIs showed a 2.5% difference in the proportion of responders in favour of amitriptyline (number needed to treat 40, CI 21–694; OR 1.12 (95%CI 1.01–1.24)).

Amitriptyline is less well tolerated than tricyclics/heterocyclics and SSRIs, but slightly more patients treated on it recover than on alternative antidepressants.