Evidence for the efficacy of cognitive–behavioural therapy for schizophrenia is promising but evidence for clinical effectiveness is limited.

To test the effectiveness of cognitive–behavioural therapy delivered by clinical nurse specialists in routine practice.

Of 274 referrals, 66 were allocated randomly to 9 months of treatment as usual (TAU), cognitive–behavioural therapy plus TAU (CBT) or supportive psychotherapy plus TAU (SPT) and followed up for 3 months.

Treatment effects were modest but the CBT condition gave significantly greater improvement in overall symptom severity than the SPT or TAU conditions combined (F (1,53)=4.14; P=0.05). Both the CBT and SPT conditions combined gave significantly greater improvement in severity of delusions than did the TAU condition (F (1,53)=4.83; P=0.03). Clinically significant improvements were achieved by 7/21 in the CBT condition (33%), 3/19 in the SPT condition (16%) and 2/17 in the TAU condition (12%).

Cognitive–behavioural therapy delivered by clinical nurse specialists is a helpful adjunct to routine care for some people with chronic psychosis.

Neuropsychological abnormalities in schizophrenia are well replicated and are present in unaffected relatives. Cognitive findings in bipolar disorder are less clearly established.

To examine the possibility that these abnormalities may provide a means by which the disorders might be separated and to clarify the associations of phenotypic expression and genetic liability.

A neuropsychological test battery was administered to 50 control participants, 74 patients and 76 unaffected relatives recruited for the study. Patients included those with schizophrenia from families affected by schizophrenia alone, those with bipolar disorder from families affected by bipolar disorder alone and those with bipolar disorder from families affected by both disorders. Unaffected relatives were also recruited.

Current, verbal and premorbid IQ were impaired in people with schizophrenia and in their close relatives. Memory was impaired in all patient and relative groups. Psychomotor performance and performance IQ were impaired in patients, regardless of diagnosis.

This study finds evidence that intellectual abnormalities are related to a genetic liability to schizophrenia. Abnormalities of memory appear to be related to an increased liability to psychosis in general. No impairment was specific to bipolar disorder.

This paper examines the feasibility of evaluating innovative models of working at the interface between primary care and secondary mental health services.

Methodological problems relevant to evaluation of innovative models of working at the interface are discussed.

Although there is some evidence that neurotic disorders can be more cost-effectively treated in primary care, many general practitioners (GPs), and possibly some patients, prefer referral to community mental health teams and community psychiatric nurses, which are provided by the secondary health care services. Since the latter are provided with the intention of improving serious mental illness their involvement in the care of neurotic illness can lead to tensions between GPs, local health authorities and service providers. There is little evidence to suggest that psychiatrists working in health centres using the ‘shifted out-patient’ model have eased this problem. By contrast the ‘consultation-liaison’ (C-L) model has a number of theoretical advantages; referrals to secondary care should be limited to those most in need of this level of expertise and GP management skills should improve, so leading to better quality of care for patients who are not referred.

Studies comparing the different models of service delivery are required to address the tensions that have arisen following changes in government policy. Further work is also needed to develop the necessary research tools.

Reality orientation therapy combined with cholinesterase inhibitors has not been evaluated in patients with Alzheimer's disease.

To perform such an evaluation.

We randomly assigned 79 of 156 patients treated with donepezil to receive a reality orientation programme. Caregivers of the treatment group were trained to offer the programme at home 3 days a week, 30 min/day for 25 consecutive weeks, and were invited to stimulate and involve patients in reality-based communication.

The treatment group showed a slight improvement in Mini-Mental State Examination (MMSE) scores (mean change + 0.2, s.e. = 0.4) compared with a decline in the control group (mean change −1.1, s.e. =0.4; P=0.02). Similarly for the Alzheimer's Disease Assessment Scale – Cognition (treatment group mean change +0.4, s.e.=0.8; control group –2.5, s.e.=0.8; P = 0.01). The intervention had an equal effect on cognition in those with mild (MMSE score ⩾20) and moderate (score < 20) dementia. No significant effect was observed for behavioural and functional outcomes.

Reality orientation enhances the effects of donepezil on cognition in Alzheimer's disease.

Neurocognitive deficits exist in euthymic patients with bipolar disorder, but relationships between symptoms, psychosocial and neurological factors remain uncertain.

To measure neurocognitive function in bipolar disorder and explore links to sub-syndromal mood symptoms, soft neurological signs and psychosocial impairment.

Attention, memory and executive function were tested in 37 euthymic patients with bipolar disorder and 37 controls. Psychosocial functioning, soft neurological signs and residual mood symptoms were assessed.

Performances on tests reflecting executive function and verbal memory (but not attention) were significantly poorer in the bipolar disorder group. Sub-syndromal mood symptoms produced small cognitive effects, predominantly on verbal memory. Soft neurological signs, especially frontal signs, were marked; some patients showed marked social disability which correlated strongly with soft neurological signs but weakly with executive dysfunction, which was linked to illness episodes.

Cognitive dysfunction, social dysfunction and soft signs occur in euthymic patients with bipolar disorder and may represent trait deficits.

Benzodiazepine withdrawal programmes have never been experimentally compared with a nonintervention control condition.

To evaluate the efficacy and feasibility of tapering off long-term benzodiazepine use in general practice, and to evaluate the value of additional group cognitive–behavioural therapy (CBT).

A 3-month randomised, controlled trial was conducted in which 180 people attempting to discontinue long-term benzodiazepine use were assigned to tapering off plus group CBT, tapering off alone or usual care.

Tapering off led to a significantly higher proportion of successful discontinuations than usual care (62% v. 21%). Adding group CBT did not increase the success rate (58% v. 62%). Neither successful discontinuation nor intervention type affected psychological functioning. Both tapering strategies showed good feasibility in general practice.

Tapering off is a feasible and effective way of discontinuing long-term benzodiazepine use in general practice. The addition of group CBT is of limited value.

The aetiology of dementia is not yet fully understood. Stress can have a damaging effect on brain health. The prognostic effect of anxiety is still unclear regarding Alzheimer's disease as well as vascular dementia.

To explore the association between anxiety and future dementia.

Medline, PsycINFO, CINAHL, Web of Science and ALOIS were searched for publications up to 12 January 2018. Longitudinal studies with a follow-up of at least 2 years were included, if the trait or state anxiety had been assessed at baseline. Studies with cognitive impairment at baseline were not included. We used a random effects model to calculate the pooled time to Alzheimer's disease and incidence of vascular dementia.

Anxiety predicts risk of Alzheimer's disease (n = 26 193 out of seven studies, hazard ratio1.53, 95% CI 1.16–2.01, P < 0.01) and vascular dementia (n = 4916 out of two studies, odds ratio1.88, 95% CI 1.05–3.36, P < 0.01). The pooled hazard ratio regarding risk of Alzheimer's disease was still significant when excluding studies with critical risk of bias (n = 14 110 out of six studies, hazard ratio 1.35, 95% CI 1.08–1.70, P < 0.01).

Anxiety is a risk factor for both types of dementia. The temporal and functional relation between anxiety and dementia needs investigation in future studies. The protective value of treating anxiety should be explored further.

None.

People born in densely populated areas have a higher risk of developing schizophrenia, bipolar disorder and autism.

The purpose of this study was to investigate whether urban–rural differences in place of birth influence a broad range of mental disorders.

Population-based cohort study of everyone born in Denmark between 1955 and 2006 (n = 2 894 640). Main outcome measures were incidence rate ratios for five levels of urbanisation and summary estimates contrasting birth in the capital with birth in rural areas.

For all psychiatric disorders, except intellectual disability (ICD-10 ‘mental retardation’) and behavioural and emotional disorders with onset in childhood, people born in the capital had a higher incidence than people born in rural areas.

Birth in an urban environment is associated with an increased risk for mental illness in general and for a broad range of specific psychiatric disorders. Given this new evidence that urban–rural differences in incidence are not confined to the well-studied psychotic disorders, further work is needed to identify the underlying aetiopathogenic mechanisms.

Although there have been many studies of the biological and psychosocial causations of postnatal depression, studies of sociocultural risk factors are rare.

To investigate the sociocultural risk factors of postnatal depression using ethnographically informed epidemiological methods.

Atotal of 959 women were assessed at their first ante-partum visit (baseline), in the third trimester, immediately after delivery, and 3 months post-partum. Six domains of risk factors were examined. The dependent variable was postnatal depression (as defined by the Edinburgh Postnatal Depression Scale) at 3 months post-partum.

Conflict with mother-in-law, marital dissatisfaction, past depression and antenatal depression independently predicted the occurrence of postnatal depression. The cultural practice of peiyue – a Chinese post-partum custom of mandated family support – was associated with better social support and a slightly lower risk of postnatal depression.

Sociocultural aspects of the immediate puerperium shape maternal emotional well-being. In-law conflict is an important source of household distress in many Asian societies. The findings have implications for clinical practice and future studies.

An epidemiological survey of childhood autism as defined in ICD–10 Research Criteria was conducted in the northern part of Yokohama, Japan.

The routine health checkup for 18-month-old children served as the initial mass-screening, and all facilities which provide child care services function to detect all cases with childhood autism and refer them to the Yokohama Rehabilitation Centre. Cumulative incidence of childhood autism up to 5 years of age among the birth cohort of 1988, and prevalence on 1 January 1994, among residents born in 1988 were estimated.

Cumulative incidence and prevalence were 16.2 per 10 000 and 21.1 per 10 000, respectively. Children with high-functioning autism who had IQs of 70 and over constituted approximately half of all the children with childhood autism.

It was confirmed through better detection of high-functioning cases that childhood autism in Japan is more common than formerly estimated.

Negative symptoms observed in patients with psychotic disorders undermine quality of life and functioning. Antipsychotic medications have a limited impact. Psychological and psychosocial interventions, with medication, are recommended. However, evidence for the effectiveness of specific non-biological interventions warrants detailed examination.

To conduct a meta-analytic and systematic review of the literature on the effectiveness of non-biological treatments for negative symptoms in psychotic disorders.

We searched for randomised controlled studies of psychological and psychosocial interventions in psychotic disorders that reported outcome on negative symptoms. Standardised mean differences (SMDs) in values of negative symptoms at the end of treatment were calculated across study domains as the main outcome measure.

A total of 95 studies met our criteria and 72 had complete quantitative data. Compared with treatment as usual cognitive–behavioural therapy (pooled SMD −0.34, 95% CI −0.55 to −0.12), skills-based training (pooled SMD −0.44, 95% CI −0.77 to −0.10), exercise (pooled SMD −0.36, 95% CI −0.71 to −0.01), and music treatments (pooled SMD −0.58, 95% CI −0.82 to −0.33) provide significant benefit. Integrated treatment models are effective for early psychosis (SMD −0.38, 95% CI −0.53 to −0.22) as long as the patients remain in treatment. Overall quality of evidence was moderate with a high level of heterogeneity.

Specific psychological and psychosocial interventions have utility in ameliorating negative symptoms in psychosis and should be included in the treatment of negative symptoms. However, more effective treatments for negative symptoms need to be developed.

Trauma-focused cognitive–behavioural therapy (CBT) and eye movement desensitisation and reprocessing therapy (EMDR) are efficacious treatments for post-traumatic stress disorder (PTSD), but few studies have directly compared them using well-powered designs and few have investigated response patterns.

To compare the efficacy and response pattern of a trauma-focused CBT modality, brief eclectic psychotherapy for PTSD, with EMDR (trial registration: ISRCTN64872147).

Out-patients with PTSD were randomly assigned to brief eclectic psychotherapy (n = 70) or EMDR (n = 70) and assessed at all sessions on self-reported PTSD (Impact of Event Scale – Revised). Other outcomes were clinician-rated PTSD, anxiety and depression.

Both treatments were equally effective in reducing PTSD symptom severity, but the response pattern indicated that EMDR led to a significantly sharper decline in PTSD symptoms than brief eclectic psychotherapy, with similar drop-out rates (EMDR: n = 20 (29%), brief eclectic psychotherapy: n = 25 (36%)). Other outcome measures confirmed this pattern of results.

Although both treatments are effective, EMDR results in a faster recovery compared with the more gradual improvement with brief eclectic psychotherapy.

The families of patients with first-episode psychosis often play a major role in care and often experience lack of support.

To determine the effect of integrated treatment v. standard treatment on subjective burden of illness, expressed emotion (EE), knowledge of illness and satisfaction with treatment in key relatives of patients with a first episode of schizophrenia-spectrum disorder.

Patients with ICD-10 schizophrenia-spectrum disorders (first episode) were randomly assigned to integrated treatment or to standard treatment. Integrated treatment consisted of assertive community treatment, psychoeducational multi-family groups and social skills training. Key relatives were assessed with the Social Behaviour Assessment Schedule (SBAS, burden of illness), the 5-min speech sample (EE), and a multiple choice questionnaire at entry and after 1 year.

Relatives in integrated treatment felt less burdened and were significantly more satisfied with treatment than relatives in standard treatment. There were no significant effects of intervention groups on knowledge of illness and EE.

The integrated treatment reduced family burden of illness and improved satisfaction with treatment.