We report a randomised controlled trial, in both the acute and maintenance stage of treatment, in 75 outpatients with recurrent major depression.

Patients were allocated to three groups: 16 weeks of acute treatment and two years' maintenance treatment in the following way: antidepressants and maintenance antidepressants; cognitive therapy and maintenance cognitive therapy: antidepressants and maintenance cognitive therapy. Both completers' and end-point data were analysed.

In the acute phase of treatment, all patients improved significantly and there was no significant difference among treatments, or in the pattern of improvement over time. In the maintenance stage of treatment, patients kept improving over time in all three groups and there was no significant difference among treatments. Cognitive therapy was consistently superior to medication.

The results indicate that maintenance cognitive therapy has a similar prophylactic effect to maintenance medication and is a viable option for maintenance after acute treatment with medication in recurrent depression.

Although childhood adversities are known to predict increased risk of post-traumatic stress disorder (PTSD) after traumatic experiences, it is unclear whether this association varies by childhood adversity or traumatic experience types or by age.

To examine variation in associations of childhood adversities with PTSD according to childhood adversity types, traumatic experience types and life-course stage.

Epidemiological data were analysed from the World Mental Health Surveys (n = 27017).

Four childhood adversities (physical and sexual abuse, neglect, parent psychopathology) were associated with similarly increased odds of PTSD following traumatic experiences (odds ratio (OR)=1.8), whereas the other eight childhood adversities assessed did not predict PTSD. Childhood adversity–PTSD associations did not vary across traumatic experience types, but were stronger in childhood-adolescence and early-middle adulthood than later adulthood.

Childhood adversities are differentially associated with PTSD, with the strongest associations in childhood-adolescence and early-middle adulthood. Consistency of associations across traumatic experience types suggests that childhood adversities are associated with generalised vulnerability to PTSD following traumatic experiences.

There have been conflicting reports on whether the length polymorphism in the promoter of the serotonin transporter gene (5-HTTLPR) moderates the antidepressant effects of selective serotonin reuptake inhibitors (SSRIs). We hypothesised that the pharmacogenetic effect of 5-HTTLPR is modulated by gender, age and other variants in the serotonin transporter gene.

To test the hypothesis that the 5-HTTLPR differently influences response to escitalopram (an SSRI) compared with nortriptyline (a noradrenaline reuptake inhibitor).

The 5-HTTLPR and 13 additional markers across the serotonin transporter gene were genotyped in 795 adults with moderate-to-severe depression treated with escitalopram or nortriptyline in the Genome Based Therapeutic Drugs for Depression (GENDEP) project.

The 5-HTTLPR moderated the response to escitalopram, with long-allele carriers improving more than short-allele homozygotes. A significant three-way interaction between 5-HTTLPR, drug and gender indicated that the effect was concentrated in males treated with escitalopram. The single-nucleotide polymorphism rs2020933 also influenced outcome.

The effect of 5-HTTLPR on antidepressant response is SSRI specific conditional on gender and modulated by another polymorphism at the 5' end of the serotonin transporter gene.

This paper reports the results of the first systematic study of the reaction of people with learning disabilities to bereavement.

A sample of 5O parent-bereaved people with learning disabilities was compared with a matched control group of 50 non-bereaved people. A semi-structured bereavement questionnaire was used along with the following instruments: the Aberrant Behaviour Checklist (ABC), the Psychopathology Instrument for Mentally Retarded Adults (PIMRA) and the Life Events Checklist.

Highly significant differences are demonstrated between bereaved and non-bereaved samples on both the total scores and most of the subscores of the ABC and PIMRA. Staff and carers did not usually attribute behaviour problems to the bereavement and its concomitant life events, nor was there a recognition of psychopathology due to bereavement.

The impact in terms of psychiatric and behavioural morbidity of loss of a parent, with its concomitant life events, in adults with learning disabilities has been underestimated.

The prevalence of psychotic phenomena in confirmed Alzheimer's disease (AD) and their potential neuropathological correlates have rarely been the subject of prospective investigation.

Psychopathological disturbances were recorded prospectively according to the Geriatric Mental State Schedule and the CAMDEX. The frequency of these phenomena and neuropathological changes were examined in 56 patients with definite AD.

Hallucinations had been documented in 13 patients, paranoid delusions in 9 and delusional misidentification (e.g. the Capgras-type and the ‘phantom boarder’ symptoms) in 14 patients. Misidentifications were associated with lower neurone counts in the area CA1 of the hippocampus. Delusions and hallucinations were observed in patients with less severe cell loss in the parahippocampal gyrus and with lower cell counts in the dorsal raphe nucleus. A decrease of neurones in the locus coeruleus in a subset of depressed patients with AD had been reported earlier. Delusions and delusional misidentification were common in 5 patients with basal ganglia mineralisation, but there was no statistically significant association of these symptoms with the presence of Lewy bodies in the brainstem and neocortex of our patient sample.

These findings are compatible with the view that morphological changes in certain brain areas may promote the development of psychotic phenomena in AD. AD may offer a model for the understanding of pathomechanisms underlying the development of psychopathological disturbances in other psychoses with more discrete neuropathological changes.

Some questionnaire studies have shown increased mental health problems, including probable posttraumatic stress disorder (PTSD), in soldiers deployed to Iraq.

To test prospectively whether such problems change over time and whether questionnaires provide accurate estimates of deployment-related PTSD compared with a clinical interview.

Dutch infantry troops from three cohorts completed questionnaires before deployment to Iraq (n=479), and about 5 months (n=382, 80%) and 15 months (n=331, 69%) thereafter. Post-traumatic stress disorder was evaluated by questionnaire and clinical interview.

There were no group changes for general distress symptoms. The rates of PTSD for each cohort were 21, 4 and 6% based on questionnaires at 5 months. The deployment-related rates of PTSD based on the clinical interview were 4, 3 and 3%.

There was a specific effect of deployment on mental health for a small minority. Questionnaires eliciting stress symptoms gave substantial overestimations of the rate of PTSD.

A trial of CT in acute psychosis conducted by the authors has shown a significant impact on the rate and degree of recovery of positive symptoms, the focus of the intervention. This paper seeks to determine whether these effects generalise to other features of acute psychosis including dysphoria, insight and ‘low level’ psychotic thinking which were not directly targeted.

Measures of dysphoria, insight and psychotic thinking were taken over a six-month period following presentation for acute psychosis. Using survival analysis, time to recovery from psychosis using three definitions of increasing stringency was compared between the CT and control group.

CT was associated with a 25–50% reduction in recovery time depending on the definition used.

The impact of the CT intervention extended beyond positive symptoms to include insight, dysphoria and ‘low level’ psychotic thinking. Nevertheless this kind of ‘clinical’ recovery required a median of 20 weeks to complete. Implications for clinical models of acute care are discussed.

The prevalence of psychiatric disorders in rural Punjab is unknown. Previous studies in rural areas elsewhere in the Indian subcontinent have yielded widely differing estimates.

First-stage screening of a village near Gujar Khan used the Bradford Somatic Inventory and Self Reporting Questionnaire. Psychiatric interviews were conducted with stratified samples using the ICD-10 Diagnostic Criteria for Research.

It is estimated that 66% of women and 25% of men suffered from anxiety and depressive disorders. Levels of emotional distress increased with age in both genders. Women living in unitary households reported more distress than those living in extended or joint families. With younger men and women, lower levels of education were associated with greater risk of psychiatric disorders. Social disadvantage was associated with more emotional distress.

This study in rural Punjab confirms the findings of a previous study in Chitral, northern Pakistan, of high levels of emotional distress and psychiatric morbidity among women in rural areas of Pakistan.

About 30% of people with depression do not respond to an antidepressant at the recommended dose and can be described as having treatment-refractory depression.

To summarise the findings from all randomised controlled trials (RCTs) that have assessed the efficacy of a pharmacological or psychological intervention for treatment-refractory depression.

We used a systematic search strategy to identify RCTs that included adults aged 18–75 years with a diagnosis of unipolar depression that had not responded to a 4-week course of a recommended dose of an antidepressant.

We identified 16 RCTs. None of the included trials assessed the efficacy of psychotherapy. All the trials were too small to detect an important clinical response. We found only two trials on lithium augmentation, which randomised 50 subjects in total.

There is little evidence to guide the management of depression that has not responded to a course of antidepressants. Treatment-refractory depression is an important public health problem and large pragmatic trials are needed to inform clinical practice.

The aim of this review is to integrate research findings on the role of sociocultural factors in hallucinations and to relate these factors to current psychological theory and research.

The literature was surveyed by manual search, and the more reliable studies selected for the review.

One hundred and thirteen publications were scrutinised and 30 of them were included in this review.

Cross-cultural concepts of reality are related to the development and the threshold of hallucinations. Attitudes toward hallucinations tend to affect the emotional reaction to, and the degree of control of, these experiences. Awareness of these attitudes may help the diagnostician to distinguish between pathological and culturally sanctioned hallucinations. It is important that therapists consider the functional significance and meaning of hallucinations as well as the social context and the stimuli associated with them.