Recent studies show that individual single-session psychological debriefing does not prevent and can even aggravate symptoms of post-traumatic stress disorder (PTSD).

We studied the effect of emotional ventilation debriefing and educational debriefing v. no debriefing on symptoms of PTSD, anxiety and depression.

We randomised 236 adult survivors of a recent traumatic event to either emotional ventilation debriefing, educational debriefing or no debriefing (control) and followed up at 2 weeks, 6 weeks and 6 months.

Psychiatric symptoms decreased in all three groups over time, without significant differences between the groups in symptoms of PTSD (P=0.33). Participants in the emotional debriefing group with high baseline hyperarousal score had significantly more PTSD symptoms at 6 weeks than control participants (P=0.005).

Our study did not provide evidence for the usefulness of individual psychological debriefing in reducing symptoms of PTSD, anxiety and depression after psychological trauma.

Depression and alcohol dependence are frequently found to co-exist but the relationship between these disorders requires further elucidation. This study tested several hypotheses related to the relevance of whether the diagnosis of depression was made before admission or after detoxification in the current episode for those with alcohol dependence.

The Schedule for Affective Disorders and Schizophrenia (SADS) was administered to obtain Research Diagnostic Criteria (RDC) on 82 randomly selected alcohol dependent in-patients. Alcohol-related (Severity of Alcohol Dependence Questionnaire (SADQ), alcohol consumption and alcohol-related problems), socio-demographic variables and treatment for depression were assessed.

For the episode of drinking which led to admission, a diagnosis of major depression was found in the majority of patients (67%). Once detoxification from alcohol took place, only the minority (13%) met criteria for major depression.

It is suggested that depression is largely associated with the episode of drinking which led to admission in patients who are dependent on alcohol and may be due to the effect of chronic alcohol intoxication. Socio-demographic and alcohol-related characteristics appear to bear little relation to the presence of depression. Clinicians exercise appropriate judgement in not prescribing antidepressant treatments to patients whose depression may remit with abstinence from alcohol.

There is an ongoing debate about the use of atypical antipsychotics as a first-line treatment for first-episode psychosis.

To examine the evidence base for this recommendation.

Meta-analyses of randomised controlled trials in the early phase of psychosis, looking at long-term discontinuation rates, short-term symptom changes, weight gain and extrapyramidal side-effects. Trials were identified using a combination of electronic (Cochrane Central, EMBASE, MEDLINE and PsycINFO) and manual searches.

Fifteen randomised controlled trials with a total of 2522 participants were included. No significant differences between atypical and typical drugs were found for discontinuation rates (odds ratio (OR) = 0.7, 95% CI 0.4 to 1.2) or effect on symptoms (standardised mean difference (SMD) = –0.1, 95% CI –0.2 to 0.02). Participants on atypical antipsychotics gained 2.1 kg (95% CI 0.1 to 4.1) more weight than those on typicals, whereas those on typicals experienced more extrapyramidal side-effects (SMD = –0.4, 95% CI –0.5 to –0.2).

There was no evidence for differences in efficacy between atypical and typical antipsychotics, but there was a clear difference in the side-effect profile.

Although hypochondriasis is currently classified as a somatoform disorder, the underlying cognitive processes may be more consistent with an anxiety disorder. This observation has important implications for treatment and subsequent revisions of the diagnostic classification of hypochondriasis.

The use of benzodiazepines has been advised against in older people, but prevalence rates remain high.

To review the evidence for interventions aimed at reducing benzodiazepine use in older people.

We conducted a systematic review, assessment of risk of bias and meta-analyses of randomised controlled trials of benzodiazepine withdrawal and prescribing interventions.

Ten withdrawal and eight prescribing studies met the inclusion criteria. At post-intervention, significantly higher odds of not using benzodiazepines were found with supervised withdrawal with psychotherapy (odds ratio (OR) = 5.06, 95% CI 2.68–9.57, P<0.00001) and withdrawal with prescribing interventions (OR = 1.43, 95% CI 1.02–2.02, P=0.04) in comparison with the control interventions treatment as usual (TAU), education placebo, withdrawal with or without drug placebo, or psychotherapy alone. Significantly higher odds of not using benzodiazepines were also found for multifaceted prescribing interventions (OR = 1.37, 95% CI 1.10–1.72, P = 0.006) in comparison with control interventions (TAU and prescribing placebo).

Supervised benzodiazepine withdrawal augmented with psychotherapy should be considered in older people, although pragmatic reasons may necessitate consideration of other strategies such as medication review.

Internationally, intimate partner violence (IPV) cohorts have demonstrated associations with depression and anxiety. However, this association has not yet been described in a UK population, nor has the association with serious mental illness (SMI).

To explore the relationship between IPV exposure and mental illness in a UK population.

We designed a retrospective cohort study whereby we matched 18 547 women exposed to IPV to 74 188 unexposed women. Outcomes of interest (anxiety, depression and SMI) were identified through clinical codes.

At baseline, 9174 (49.5%) women in the exposed group had some form of mental illness compared with 17 768 (24.0%) in the unexposed group, described as an adjusted odds ratio of 2.62 (95% CI 2.52–2.72). Excluding those with mental illness at baseline, 1254 exposed women (incidence rate 46.62 per 1000 person-years) went on to present with any type of mental illness compared with 3119 unexposed women (incidence rate 14.93 per 1000 person-years), with an aIRR of 2.77 (95% CI 2.58–2.97). Anxiety (aIRR 1.99, 95% CI 1.80–2.20), depression (aIRR 3.05, 95% CI 2.81–3.31) and SMI (aIRR 3.08, 95% CI 2.19–4.32) were all associated with exposure to IPV.

IPV remains a significant public health issue in the UK. We have demonstrated the significant recorded mental health burden associated with IPV in primary care, at both baseline and following exposure. Clinicians must be aware of this association to reduce mental illness diagnostic delay and improve management of psychological outcomes in this group of patients.

Studies conducted in the USA have found the individual placement and support model of supported employment to be more effective than traditional vocational rehabilitation at helping people with severe mental illness to find and maintain competitive employment.

To determine the effectiveness of the individual placement and support (supported employment) model in a Canadian setting.

A total of 150 adults with severe mental illness, who were not currently employed and who desired competitive employment, were randomly assigned to receive either supported employment (n=75) or traditional vocational services (n=75).

Over the 12 months of follow-up, 47% of clients in the supported employment group obtained at least some competitive employment, v. 18% of the control group (P<0.001). They averaged 126 h of competitive work, v. 72 inthe control group (P<0.001).

Supported employment proved more effective than traditional vocational services in a setting significantly different from settings in the USA, and may therefore be generalised to settings in other countries.

Hospital-treated self-poisoning is common, with limited effective interventions for reducing subsequent suicidal behaviour.

To test the efficacy of a postcard intervention to reduce suicidal behaviour.

Randomised controlled trial of individuals who self-poisoned (n = 2300), the intervention consisted of nine postcards sent over 12 months versus usual treatment. Outcomes assessed at 12 months (n = 2113) were suicidal ideation, suicide attempts and self-cutting (proportion and event rates).

There was a significant reduction in any suicidal ideation (relative risk reduction (RRR) = 0.31, 95% CI 0.22–0.38), any suicide attempt (RRR = 0.42, 95% CI 0.11–0.63) and number of attempts (incidence rate ratios (IRR) = 0.64, 95% CI 0.42–0.97). There was no significant reduction in any self-cutting (RRR = 0.14, 95% CI −-0.29 to 0.42) or self-cutting events (IRR = 1.03 95% CI 0.76–1.39).

A postcard intervention reduced suicidal ideation and suicide attempts in a non-Western population. Sustained, brief contact by mail may reduce suicidal ideation and suicide attempts in individuals who self-poison.