There is increasing evidence that cognitive–behavioural therapy can be an effective intervention for patients experiencing drug-refractory positive symptoms of schizophrenia.

To investigate the effects of cognitive–behavioural therapy on in-patients with treatment-refractory psychotic symptoms.

Manualised therapy was compared with supportive counselling in a randomised controlled study. Both interventions were delivered by experienced psychologists over 16 sessions of treatment. Therapy fidelity was assessed by two independent raters. Participants underwent masked assessment at baseline, after treatment and at 6 months' follow-up. Main outcome measures were the Positive and Negative Syndrome Scale and the Psychotic Symptoms Rating Scale. The analysis was by intention to treat.

Participants receiving cognitive–behavioural therapy had improved with regard to auditory hallucinations and illness insight at the post-treatment assessment, but these findings were not maintained at follow-up.

Cognitive–behavioural therapy showed modest short-term benefits over supportive counselling for treatment-refractory positive symptoms of schizophrenia.

The association between body size, weight change and depression has not been systematically summarised, especially for individuals who are underweight.

To conduct a systematic review and a meta-analysis to examine the association between indices of body size, weight change and depression.

A total of 183 studies were selected. Fully adjusted hazard ratios (HRs) or odds ratios (ORs) were extracted. A total of 76 studies contributed to data synthesis with a random-effect model, and subgroup analyses were conducted to evaluate the effect of potential moderators.

In cohort studies, underweight at baseline increased the risk of subsequent depression (OR = 1.16, 95% CI 1.08–1.24). Overweight (BMI 25–29.9 kg/m2) showed no statistically significant relationship with depression overall; however, the subgroup analyses found different results according to gender (men: OR = 0.84, 95% CI 0.72–0.97, women: OR = 1.16, 95% CI 1.07–1.25). In cross-sectional designs, obesity with BMI >40kg/m2 showed a greater pooled odds ratio than obesity with BMI >30kg/m2.

Both underweight and obesity increase the risk of depression. The association between overweight and depression differs by gender.

Psychological therapies are rarely used in people with learning disabilities. Learning disability is often given as an exclusion criterion. There is insufficient published research to conduct a systematic review. Few outcome studies of psychoanalytic or cognitive psychotherapy have been reported.

To describe recent advances in understanding and practice within the learning disability field which have not received wider recognition within mainstream psychotherapy and psychiatry.

The availability of different psychotherapeutic approaches is discussed. We explore developmental issues including the contribution of attachment theory to our understanding, and the effects of trauma on the lives of people with learning disabilities.

Theoretical and clinical perspectives suggest that many therapeutic opportunities exist.

Practitioners are encouraged to extend their therapeutic repertoire, and to report measurable outcomes.

Psychiatric disorders are among the top causes worldwide of disease burden and disability. A major criterion for validating diagnoses is stability over time.

To evaluate the long-term stability of the most prevalent psychiatric diagnoses in a variety of clinical settings.

A total of 34 368 patients received psychiatric care in the catchment area of one Spanish hospital (1992–2004). This study is based on 10 025 adult patients who were assessed on at least ten occasions (360 899 psychiatric consultations) in three settings: in-patient unit, 2000–2004 (n=546); psychiatric emergency room, 2000–2004 (n=1408); and out-patient psychiatric facilities, 1992–2004 (n=10 016). Prospective consistency, retrospective consistency and the proportion of patients who received each diagnosis in at least 75% of the evaluations were calculated for each diagnosis in each setting and across settings.

The temporal consistency of mental disorders was poor, ranging from 29% for specific personality disorders to 70% for schizophrenia, with stability greatest for in-patient diagnoses and least for out-patient diagnoses.

The findings are an indictment of our current psychiatric diagnostic practice.

There is good evidence for the benefits of short-term cognitive stimulation therapy for dementia but little is known about possible long-term effects.

To evaluate the effectiveness of maintenance cognitive stimulation therapy (CST) for people with dementia in a single-blind, pragmatic randomised controlled trial including a substudy with participants taking acetylcholinesterase inhibitors (AChEIs).

The participants were 236 people with dementia from 9 care homes and 9 community services. Prior to randomisation all participants received the 7-week, 14-session CST programme. The intervention group received the weekly maintenance CST group programme for 24 weeks. The control group received usual care. Primary outcomes were cognition and quality of life (clinical trial registration: ISRCTN26286067).

For the intervention group at the 6-month primary end-point there were significant benefits for self-rated quality of life (Quality of Life in Alzheimer's Disease (QoL-AD) P = 0.03). At 3 months there were improvements for proxy-rated quality of life (QoL-AD P = 0.01, Dementia Quality of Life scale (DEMQOL) P = 0.03) and activities of daily living (P = 0.04). The intervention subgroup taking AChEIs showed cognitive benefits (on the Mini-Mental State Examination) at 3 (P = 0.03) and 6 months (P = 0.03).

Continuing CST improves quality of life; and improves cognition for those taking AChEIs.

The point prevalence of mental ill-health among adults with intellectual disabilities is 40.9%, but its incidence is unknown.

To determine the incidence and possible predictors of mental ill-health.

Prospective cohort study to measure mental ill-health in adults with mild to profound intellectual disabilities.

Cohort retention was 70% (n=651). The 2-year incidence of mental ill-health was 16.3% (12.6% excluding problem behaviours, and 4.6% for problem behaviours) and the standardised incidence ratio was 1.87 (95%CI1.51 2.28). Factors related to incident mental ill-health have some similarities with those in the general population, but also important differences. Type of accommodation and support, previous mental ill-health, urinary incontinence, not having impaired mobility, more severe intellectual disabilities, adult abuse, parental divorce in childhood and preceding life events predicted incident ill-health; however, deprivation, other childhood abuse or adversity, daytime occupation, and marital and smoking status did not.

This is a first step towards intervention trials, and identifying sub-populations for more proactive measures. Public health strategy and policy that is appropriate for this population should be developed.

Previous research has found that African–Caribbean and Black African patients are likely to come into contact with mental health services via more negative routes, when compared with White patients. We sought to investigate pathways to mental health care and ethnicity in a sample of patients with a first episode of psychosis drawn from two UK centres.

We included all White British, other White, African–Caribbean and Black African patients with a first episode of psychosis who made contact with psychiatric services over a 2-year period and were living in defined areas. Clinical, socio-demographic and pathways to care data were collected from patients, relatives and case notes.

Compared with White British patients, general practitioner referral was less frequent for both African–Caribbean and Black African patients and referral by a criminal justice agency was more common. With the exception of criminal justice referrals for Black African patients, these findings remained significant after adjusting for potential confounders.

These findings suggest that factors are operating during a first episode of psychosis to increase the risk that the pathway to care for Black patients will involve non-health professionals.

Traditional healers provide a popular and accessible service across the African continent. Little is known of the characteristics or mental health status of those using these services.

To determine and compare the prevalence of common mental disorder among, and the characteristics of, those attending primary health care clinics (PHCs) and traditional healer centres (THCs) in Dar-es-Salaam.

The Clinical Interview Schedule – Revised was used to determine the prevalence of mental disorders in 178 patients from PHCs and 176 from THCs, aged 16–65 years.

The prevalence of common mental disorders among THC patients (48%) was double that of PHC patients (24%). Being older, Christian, better educated, and divorced, separated or widowed were independently associated with THC attendance. None of these factors explained the excess of mental disorder among THC attenders.

The high prevalence of mental disorders among THC attenders may reflect the failure of primary health care services adequately to detect and treat these common and disabling disorders. Traditional healers should be involved in planning comprehensive mental health care.