Pharmacological interventions alone do not provide sufficient benefit for some individuals with bipolar disorder.

To determine the effectiveness of psychosocial interventions for the prevention of relapse in bipolar disorder.

A systematic review and meta-analysis of randomised or quasi-randomised controlled trials were conducted.

Cognitive-behavioural therapy or group psychoeducation may be effective for relapse prevention in stable individuals. Family therapy was no more or less effective than individual psychosocial therapy or crisis management. There is no evidence that care management or integrated group therapy is effective in the prevention of relapse.

Cognitive-behavioural therapy, group psychoeducation and possibly family therapy may be beneficial as adjuncts to pharmacological maintenance treatments.

Mental well-being underpins many aspects of health and social functioning, and is economically important.

To describe mental well-being in a general population sample and to determine the extent to which mental well-being and mental illness are independent of one another.

Secondary analysis of a survey of 7293 adults in England. Nine survey questions were identified as possible indicators of mental well-being. Common mental disorders (ICD-10) were ascertained using the Revised Clinical Interview Schedule (CIS-R). Principal components analysis was used to describe the factor structure of mental well-being and to generate mental well-being indicators.

A two-factor solution found eight out of nine items with strong loadings on well-being. Eight items corresponding to hedonic and eudaemonic well-being accounted for 36.9% and 14.3% of total variance respectively. Separate hedonic and eudaemonic well-being scales were created. Hedonic well-being (full of life; having lots of energy) declined with age, while eudaemonic well-being (getting on well with family and friends; sense of belonging) rose steadily with age. Hedonic well-being was lower and eudaemonic well-being higher in women. Associations of well-being with age, gender, income and self-rated health were little altered by adjustment for symptoms of mental illness.

In a large nationally representative population sample, two types of well-being were distinguished and reliably assessed: hedonic and eudaemonic. Associations with mental well-being were relatively independent of symptoms of mental illness. Mental well-being can remain even in the presence of mental suffering.

The effects of in utero exposure to atypical antipsychotics on infant birth weight are unknown.

To determine whether atypical and typical antipsychotics differ in their effects on birth weight after maternal exposure during pregnancy.

Prospective data on gestational age and birth weight collected by the National Teratology Information Service for infants exposed to typical (n=45) and atypical (n=25) antipsychotics was compared with data for a reference group of infants (n=38).

Infants exposed to atypical antipsychotics had a significantly higher incidence of large for gestational age (LGA) than both comparison groups and a mean birth weight significantly heavier than those exposed to typical antipsychotics. In contrast those exposed to typical antipsychotics had a significantly lower mean birth weight and a higher incidence of small for gestational age infants than the reference group.

In utero exposure to atypical antipsychotic drugs may increase infant birth weight and risk of LGA.

Previously reported associations between advancing paternal age and schizophrenia could be due to an increase in paternal germ cell mutations or be confounded by heritable personality traits associated with schizophrenia that result in delayed parenthood.

To investigate this association while adjusting for personality traits related to poor social integration in the subjects.

A cohort of 50 087 adolescent males was followed up by record linkage to determine hospital admissions for schizophrenia between 1970 and 1996.

Advancing paternal age was associated with an increased risk of developing schizophrenia in a ‘dose-dependent’ manner. The adjusted odds ratio for each 10-year increase in paternal age was 1.3 (95% Cl 1.0–1.5; P=0.015).

Advancing paternal age is an independent risk factor for schizophrenia. Adjusting for social integration in subjects made little difference to this association, consistent with the hypothesis that advancing paternal age may increase liability to schizophrenia owing to accumulating germ cell mutations.

The Outcomes of Depression International Network (ODIN) trial evaluated the effect of two psychological interventions for the treatment of depression in primary care. Only about half of the patients in the treatment arm complied with the offer of treatment, prompting the question: ‘what was the effect of treatment in those patients who actually received it?’

To illustrate the estimation of the effect of receipt of treatment in a randomised controlled trial subject to non-compliance and loss to follow-up.

We estimated the complier average causal effect (CACE) of treatment.

In the ODIN trial the effect of receipt of psychological intervention (an average of about 4 points on the Beck Depression Inventory) is about twice that of offering it.

The statistical analysis of the results of a clinical trial subject to noncompliance to allocated treatment is now reasonably straightforward through estimation of a CACE and investigators should be encouraged to present the results of analyses of this type as a routine component of a trial report.

Cognitive–behavioural therapy has been shown to be effective in reducing psychotic symptoms, but few patients have access to these services. Group cognitive treatment may provide a less costly service with similar benefits.

To explore the effectiveness of group cognitive–behavioural therapy on insight and symptoms, particularly auditory hallucinations.

Twenty-one DSM–IV diagnosed patients with schizophrenia with treatment-resistant, distressing auditory hallucinations were referred to a group programme consisting of six sessions of cognitive treatment following a strict protocol which emphasised individual power and control as well as coping strategies.

There were significant changes in all three main outcome measures following treatment; those changes were maintained at follow-up and were greater than changes over the waiting-list period. Specifically, there were changes in perceived power and distress as well as increases in the number and effectiveness of the coping strategies.

Group treatment for auditory hallucinations needs further investigation but does look promising and may provide a less costly alternative to individual cognitive treatment.

Excessive use of the internet is increasingly recognised as a global public health concern. Individual studies have reported cognitive impairment in problematic internet use (PIU), but have suffered from various methodological limitations. Confirmation of cognitive deficits in PIU would support the neurobiological plausibility of this disorder.

To conduct a rigorous meta-analysis of cognitive performance in PIU from case–control studies; and to assess the impact of study quality, the main type of online behaviour (for example gaming) and other parameters on the findings.

A systematic literature review was conducted of peer-reviewed case–controlled studies comparing cognition in people with PIU (broadly defined) with that of healthy controls. Findings were extracted and subjected to a meta-analysis where at least four publications existed for a given cognitive domain of interest.

The meta-analysis comprised 2922 participants across 40 studies. Compared with controls, PIU was associated with significant impairment in inhibitory control (Stroop task Hedge's g = 0.53 (s.e. = 0.19–0.87), stop-signal task g = 0.42 (s.e. = 0.17–0.66), go/no-go task g = 0.51 (s.e. = 0.26–0.75)), decision-making (g = 0.49 (s.e. = 0.28–0.70)) and working memory (g = 0.40 (s.e. = 0.20–0.82)). Whether or not gaming was the predominant type of online behaviour did not significantly moderate the observed cognitive effects; nor did age, gender, geographical area of reporting or the presence of comorbidities.

PIU is associated with decrements across a range of neuropsychological domains, irrespective of geographical location, supporting its cross-cultural and biological validity. These findings also suggest a common neurobiological vulnerability across PIU behaviours, including gaming, rather than a dissimilar neurocognitive profile for internet gaming disorder.

S.R.C. consults for Cambridge Cognition and Shire. K.I.’s research activities were supported by Health Education East of England Higher Training Special interest sessions. A.E.G.'s research has been funded by Innovational grant (VIDI-scheme) from ZonMW: (91713354). N.A.F. has received research support from Lundbeck, Glaxo-SmithKline, European College of Neuropsychopharmacology (ECNP), Servier, Cephalon, Astra Zeneca, Medical Research Council (UK), National Institute for Health Research, Wellcome Foundation, University of Hertfordshire, EU (FP7) and Shire. N.A.F. has received honoraria for lectures at scientific meetings from Abbott, Otsuka, Lundbeck, Servier, Astra Zeneca, Jazz pharmaceuticals, Bristol Myers Squibb, UK College of Mental Health Pharmacists and British Association for Psychopharmacology (BAP). N.A.F. has received financial support to attend scientific meetings from RANZCP, Shire, Janssen, Lundbeck, Servier, Novartis, Bristol Myers Squibb, Cephalon, International College of Obsessive-Compulsive Spectrum Disorders, International Society for Behavioral Addiction, CINP, IFMAD, ECNP, BAP, the World Health Organization and the Royal College of Psychiatrists. N.A.F. has received financial royalties for publications from Oxford University Press and payment for editorial duties from Taylor and Francis. J.E.G. reports grants from the National Center for Responsible Gaming, Forest Pharmaceuticals, Takeda, Brainsway, and Roche and others from Oxford Press, Norton, McGraw-Hill and American Psychiatric Publishing outside of the submitted work.

Recent studies have raised issues concerning the replicability of gene × environment (G × E) interactions involving the monoamine oxidase A (MAOA) gene in moderating the associations between abuse or maltreatment exposure and antisocial behaviour. This study attempted to replicate the findings in this area using a 30-year longitudinal study that has strong resemblance to the original research cohort.

To test the hypothesis that the presence of the low-activity MAOA genotype was associated with an increased response to abuse exposure.

Participants were 398 males from the Christchurch Health and Development Study who had complete data on: MAOA promoter region variable number tandem repeat genotype; antisocial behaviour to age 30; and exposure to childhood sexual and physical abuse.

Regression models were fitted to five antisocial behaviour outcomes (self-reported property offending; self-reported violent offending; convictions for property/violent offending; conduct problems; hostility) observed from age 16 to 30, using measures of childhood exposure to sexual and physical abuse. The analyses revealed consistent evidence of G × E interactions, with those having the low-activity MAOA variant and who were exposed to abuse in childhood being significantly more likely to report later offending, conduct problems and hostility. These interactions remained statistically significant after control for a range of potentially confounding factors. Findings for convictions data were somewhat weaker.

The present findings add to the evidence suggesting that there is a stable G × E interaction involving MAOA, abuse exposure and antisocial behaviour across the life course.

Neuroimaging studies of major depressive disorder (MDD) indicate interhemispheric differences in prefrontal cortical activity (right greater than left).

To investigate whether there are any interhemispheric differences of motor cortical excitability in MDD.

Eight patients with treatment-refractory MDD off medication were assessed for the severity of their depression, and transcranial magnetic stimulation studies (bilateral motor threshold and paired-pulse studies) were conducted. Eight normal controls were also studied.

MDD patients showed significant interhemispheric differences in motor threshold and paired-pulse curves, both of which showed lower excitability on the left hemisphere. Such differences were absent in controls.

Our findings may aid the further understanding of the neurophysiology underlying MDD.

The MacArthur Violence Risk Assessment Study (MacVRAS) in the USA provided strong evidence to support an actuarial approach in community violence risk assessment.

To examine the predictive accuracy of the MacVRAS measures, in addition to structured professional judgement, in a UK sample of patients discharged from in-patient care in the north-west of England.

A prospective study of 112 participants assessed pre-discharge and followed up at 24 weeks post-discharge. Pre-discharge measures were compared with prevalence of violent behaviour to determine predictive validity of risk factors.

Historical measures of risk and measures of psychopathy, impulsiveness and anger were highly predictive of community violence. The more dynamic clinical and risk management factors derived from structured professional judgement (rated at discharge) added significant incremental validity to the historical factors in predicting community violence.

Although static measures of risk relating to past history and personality make an important contribution to assessment of violence risk, consideration of current dynamic factors relating to illness and risk management significantly improves predictive accuracy.