Psychological interventions may be beneficial in bipolar disorder.

To evaluate the efficacy of psychological interventions for adults with bipolar disorder.

A systematic review of randomised controlled trials was conducted. Outcomes were meta-analysed using RevMan and confidence assessed using the GRADE method.

We included 55 trials with 6010 participants. Moderate-quality evidence associated individual psychological interventions with reduced relapses at post-treatment (risk ratio (RR) = 0.66, 95% CI 0.48–0.92) and follow-up (RR = 0.74, 95% CI 0.63–0.87), and collaborative care with a reduction in hospital admissions (RR =0.68, 95% CI 0.49–0.94). Low-quality evidence associated group interventions with fewer depression relapses at post-treatment and follow-up, and family psychoeducation with reduced symptoms of depression and mania.

There is evidence that psychological interventions are effective for people with bipolar disorder. Much of the evidence was of low or very low quality thereby limiting our conclusions. Further research should identify the most effective (and cost-effective) interventions for each phase of this disorder.

Better methods of assessing patients' and family members' causal models of illness are needed to improve adherence with biomedical interventions and to design services that meet the needs of consumers.

To develop a quantitative measure suitable for assessing the relationship of causal beliefs to expressed emotion, stigma, care-seeking and adherence.

The Causal Models Questionnaire for Schizophrenia, which includes 45 causes identified during in-depth interviews with family members, was administered to 245 family members of 135 patients with DSM–III–R schizophrenia in Suzhou and Siping, China at the time of admission to hospital.

Respondents, who identified a mean of 2.5 causes (range 1–10, mode 2), attributed 84% of the cause of schizophrenia to social, interpersonal and psychological problems. Hence, their beliefs do not concur with Chinese professionals' ideas about the biomedical causes of schizophrenia. Multivariate analyses identified the socio-economic factors that influence family members' causal beliefs.

Despite the complexity of causal models, measures can be developed that will help improve clinicians' communication with patients and understanding of help-seeking behaviours.

We consider how well the psychosocial and clinical factors found to predict a chronic course for depressive episodes in the community, held for female psychiatric patients.

A consecutive series of depressed patients, aged 18 to 60, treated as in-patients, out-patients or day-patients at psychiatric departments of two London hospitals, were interviewed initially and at follow-up two years later.

Indices of childhood adversity and current interpersonal difficulties predicted episodes taking a chronic course (of more than 12 months' duration). Half of the episodes associated with one or the other factor were chronic, compared with 22% of those with neither. The patients were at higher risk than the community series (75% v. 34%) and this explains their much greater rate of chronicity. There was also some evidence that social support reduced risk. Clinical features and the presence of a personality disorder were unrelated to chronicity.

Similar psychosocial factors are important for predicting chronicity in both community and patient series.

Although the incidence of suicide among women who have given birth during the past 12 months is lower than that of women who have not given birth, suicide remains one of the most common causes of death during the year following delivery in high-income countries, such as Sweden.

To characterise women who died by suicide during pregnancy and postpartum from a maternal care perspective.

We traced deaths (n = 103) through linkage of the Swedish Cause of Death Register with the Medical Birth and National Patient Registers. We analysed register data and obstetric medical records.

The maternal suicide ratio was 3.7 per 100 000 live births for the period 1980–2007, with small magnitude variation over time. The suicide ratio was higher in women born in low-income countries (odds ratio 3.1 (95% CI 1.3–7.7)). Violent suicide methods were common, especially during the first 6 months postpartum. In all, 77 women had received psychiatric care at some point, but 26 women had no documented psychiatric care. Antenatal documentation of psychiatric history was inconsistent. At postpartum discharge, only 20 women had a plan for psychiatric follow-up.

Suicide prevention calls for increased clinical awareness and cross-disciplinary maternal care approaches to identify and support women at risk.

Evidence suggests a reversal of the normal left-lateralised response to speech in schizophrenia.

To test the brain's response to emotional prosody in schizophrenia and bipolar disorder.

BOLD contrast functional magnetic resonance imaging of subjects while they passively listened or attended to sentences that differed in emotional prosody.

Patients with schizophrenia exhibited normal right-lateralisation of the passive response to ‘pure’ emotional prosody and relative left-lateralisation of the response to unfiltered emotional prosody. When attending to emotional prosody, patients with schizophrenia activated the left insula more than healthy controls. When listening passively, patients with bipolar disorder demonstrated less activation of the bilateral superior temporal gyri in response to pure emotional prosody, and greater activation of the left superior temporal gyrus in response to unfiltered emotional prosody. In both passive experiments, the patient groups activated different lateral temporal lobe regions.

Patients with schizophrenia and bipolar disorder may display some left-lateralisation of the normal right-lateralised temporal lobe response to emotional prosody.

Citalopram is a serotonin reuptake inhibitor which has been demonstrated to be highly selective and with a superior tolerability profile to the classical tricyclic antidepressants. This study was designed to test whether there was any difference in eff icacy in the management of panic disorder (PD) between Citalopram and placebo.

This was a double-blind, placebo and clomipramine controlled, parallel group eight-week study. A total of 475 patients with PD, with or without agoraphobia, were randomised to treatment with either placebo, clomipramine 60 or 90 mg/day, or Citalopram 10 or 15 mg/day, 20 or 30 mg/day, or 40 or 60 mg/day. Doses were increased over the first three weeks, stabilised during the fourth week and fixed between weeks five and eight.

Treatment with Citalopram at 20 or 30 mg, 40 or 60 mg and clomipramine were significantly superior to placebo, judged by the number of patients free of panic attacks in the week prior to the final assessment. All rating scales examined suggested that Citalopram 20 or 30 mg was more effective than Citalopram 40 or 60 mg.

The most advantageous benefit/risk ratio for the treatment of PD was associated with citalopram 20 or 30 mg/day.

Health of the Nation Outcome Scales (HoNOS) have been developed to measure outcomes in people with mental health problems.

The particular physical and cognitive problems affecting older people requires a specific scale for their measurement. We describe the development of such a scale, named HoNOS 65+.

Pilot, validity and reliability studies were carried out on an amended scale. Validity was assessed by comparison with existing scales reflecting depression, cognitive function, psychiatric symptomatology, activities of daily living and functional abilities. Reliability was measured in two centres.

HoNOS 65+ was successfully amended to include specific aspects of mental health problems in older people including the phenomenology of depression, delusions occurring in the presence of dementia, incontinence and agitation/restlessness. HoNOS 65+ was able to discriminate between people suffering from organic and functional illnesses. Correlations with other scales indicated reasonable validity. Reliability was satisfactory.

Aversion of HoNOS 65+ is presented (see pp. 435–438, this issue) which is appropriate for use in elderly people with mental health problems.

Physical symptoms and psychiatric disorder are associated. We aimed to investigate which comes first.

Data from the Medical Research Council National Survey of Health and Development, a population-based birth cohort study were used at two time points: 36 and 43 years. Six physical symptoms were reported at both time points. The Present State Examination and Psychiatric Symptom Frequency interviews were administered at 36 and 43 years respectively. Odds ratios corrected for a variety of confounders were used to describe the associations between physical symptoms and psychiatric disorder across these two time points.

Psychiatric disorder increased the odds of reporting symptoms 3–7-fold. The relationship strengthened when the outcome was defined as suffering from multiple symptoms. Population attributable risk of psychiatric disorder and subsyndromal disorder in causing multiple somatic symptoms was 40.3%. Prospectively, psychiatric disorder at 36 years was a predictor for five of the six physical symptoms. Three physical symptoms at 36 years predicted new onset of psychiatric symptoms at 43 years.

Psychiatric disorder is strongly related to physical symptoms. The direction of causality may operate in both directions. Assuming a causal relationship, psychiatric disorder (including subthreshold disorders) could account for at most 40% of cases of multiple physical symptoms.

Daily-life stress sensitivity is associated with depression, but prospective data are lacking.

To examine associations between baseline ecological daily-life stress sensitivity and later depression, and to identify genetic and non-genetic factors moderating the transition from stress sensitivity to depression.

Daily-life stress sensitivity was assessed at baseline in twins (n = 502). One baseline and four follow-up measurements of depressive symptoms and negative life events were collected, as well as interview-based diagnoses at baseline and last follow-up. Hypothesised genetic markers were determined.

Baseline stress sensitivity was associated with increased depressive symptoms at follow-up and risk of major depressive disorder. Both genetic liability and major life events moderated the probability of transition from stress sensitivity to depression.

Onset of depression is attributable to pre-onset ecological measurements of stress sensitivity, particularly where genetic liability is high and individuals have reached a stage where the influence of competing environmental causes is low.

Abusive experiences in childhood and adulthood increase risks of psychiatric morbidity in women and independently increase risks of further abuse over the lifetime. It is unclear which experiences are most damaging.

To measure lifetime prevalence of abusive experiences and psychiatric morbidity, and to analyse associations in women primary care attenders.

A cross-sectional, self-report survey of 1207 women attending 13 surgeries in the London borough of Hackney, UK. Independent associations between demographic measures, abusive experiences and psychiatric outcome were established using logistic regression.

Childhood sexual abuse had few associations with adult mental health measures, in contrast to physical abuse. Sexual assault in adulthood was associated with substance misuse; rape with anxiety, depression and post-traumatic stress disorder but not substance misuse. Domestic violence showed strongest associations with most mental health measures, increased for experiences in the past year.

Abuse in childhood and adulthood have differential effects on mental health; effects are increased by recency and severity. Women should be routinely questioned about ongoing and recent experiences as well as childhood.

There is little evidence of the feasibility, acceptability and impact of services for the care of people with psychotic disorders in low- and middle-income countries.

To describe the scaling up and impact of a community-based rehabilitation programme for people with psychotic disorders in a very-low-resource setting.

Longitudinal study of people with psychotic disorders who had been ill for an average of 8 years in a rural Indian community. All individuals received a community-based intervention package comprising psychotropic medications, psychoeducation, adherence management, psychosocial rehabilitation and support for livelihoods. The primary outcome was change in disability scores.

The cohort consisted of 256 people with psychotic disorders (schizophrenia, bipolar affective disorder and other psychosis) of whom 236 people completed the end-point assessments (92%), with a median follow-up of 46 months. There were significant reductions (P<0.05) in the levels of disability for the cohort, the vast majority (83.5%) of whom engaged with the programme. On multivariate analyses, lower baseline disability scores, family engagement with the programme, medication adherence and being a member of a self-help group were independent determinants of good outcomes. Lack of formal education, a diagnosis of schizophrenia and dropping out of the programme were independent determinants of poor outcomes.

Community-based rehabilitation is a feasible and acceptable intervention with a beneficial impact on disability for the majority of people with psychotic disorders in low-resource settings. The impact on disability is influenced by a combination of clinical, programme and social determinants.