Reducing the global treatment gap for mental disorders requires treatments that are economical, effective and culturally appropriate.

To describe a systematic approach to the development of a brief psychological treatment for patients with severe depression delivered by lay counsellors in primary healthcare.

The treatment was developed in three stages using a variety of methods: (a) identifying potential strategies; (b) developing a theoretical framework; and (c) evaluating the acceptability, feasibility and effectiveness of the psychological treatment.

The Healthy Activity Program (HAP) is delivered over 6–8 sessions and consists of behavioral activation as the core psychological framework with added emphasis on strategies such as problem-solving and activation of social networks. Key elements to improve acceptability and feasibility are also included. In an intention-to-treat analysis of a pilot randomised controlled trial (55 participants), the prevalence of depression (Beck Depression Inventory II ⩾19) after 2 months was lower in the HAP than the control arm (adjusted risk ratio = 0.55, 95% CI 0.32–0.94, P = 0.01).

Our systematic approach to the development of psychological treatments could be extended to other mental disorders. HAP is an acceptable and effective brief psychological treatment for severe depression delivered by lay counsellors in primary care.

Despite current interest in attachment disorder, there is concern about its discrimination from other disorders and an unproven assumption of an environmental aetiology.

To test whether behaviours suggestive of attachment disorder are distinct from other childhood behavioural and emotional problems and are solely environmentally determined.

In a community sample of 13472 twins, we carried out factor analysis of questionnaire items encompassing behaviours indicative of attachment disorder, conduct problems, hyperactivity and emotional difficulties. We used behavioural genetic model-fitting analysis to explore the contribution of genes and environment.

Factor analysis showed clear discrimination between behaviours suggestive of attachment disorder, conduct problems, hyperactivity and emotional problems. Behavioural genetics analysis suggested a strong genetic influence to attachment disorder behaviour, with males showing higher heritability.

Behaviours suggestive of attachment disorder can be differentiated from common childhood emotional and behavioural problems and appear to be strongly genetically influenced, particularly in boys.

Insecure attachment style relates to major depression in women, but its relationship to depression associated with childbirth is largely unknown. A new UK-designed measure, the Attachment Style Interview (ASI), has potential for cross-cultural use as a risk marker for maternal disorder.

To establish the reliability of the ASI across centres, its stability over a 9-month period, and its associations with social context and majoror minor depression.

The ASI was used by nine centres antenatally on 204 women, with 174 followed up 6 months postnatally. Interrater reliability was tested and the ASI was repeated on a subset of 96 women. Affective disorder was assessed by means of the Structured Clinical Interview for DSM–IV.

Satisfactory interrater reliability was achieved with relatively high stability rates at follow-up. Insecure attachment related to lower social class position and more negative social context. Specific associations of avoidant attachment style (angry–dismissive or withdrawn) with antenatal disorder, and anxious style (enmeshed or fearful) with postnatal disorder were found.

The ASI can be used reliably in European and US centres as a measure for risk associated with childbirth. Its use will contribute to theoretically underpinned preventive action for disorders associated with childbirth.

There is a higher mortality rate due to cancer in people with mental illness and previous work suggests suboptimal medical care in this population. It remains unclear if this extends to breast cancer population screening.

To conduct a systematic review and meta-analysis to establish if women with a mental health condition are less likely to receive mammography screening compared with those without mental ill health.

Major electronic databases were searched from inception until February 2014. We calculated odds ratios (OR) with a random effects meta-analysis comparing mammography screening rates among women with and without a mental illness. Results were stratified according to primary diagnosis including any mental illness, mood disorders, depression, severe mental illness (SMI), distress and anxiety.

We identified 24 publications reporting breast cancer screening practices in women with mental illness (n = 715 705). An additional 5 studies investigating screening for those with distress (n = 21 491) but no diagnosis of mental disorder were identified. The pooled meta-analysis showed significantly reduced rates of mammography screening in women with mental illness (OR = 0.71, 95% CI 0.66–0.77), mood disorders (OR = 0.83, 95% CI 0.76–0.90) and particularly SMI (OR = 0.54, 95% CI 0.45–0.65). No disparity was evident among women with distress alone.

Rates of mammography screening are lower in women with mental illness, particularly women with SMI, and this is not explained by the presence of emotional distress. Disparities in medical care due to mental illness clearly extend into preventive population screening.

Brain-derived neurotrophic factor (BDNF) influences neuronal survival, proliferation and plasticity Three family-based studies have shown association of the common Valine (Val) allele of the Val66Met polymorphism of the BDNF gene with susceptibility to bipolar disorder.

To replicate this finding.

We genotyped the Val66Met polymorphism in our UK White bipolar case-control sample (n=3062).

We found no overall evidence of allele or genotype association. However, we found association with disease status in the subset of 131 individuals that had experienced rapid cycling at some time (P=0.004). We found a similar association on re-analysis of our previously reported family-based association sample (P<0.03, one-tailed test).

Variation at the Val66Met polymorphism of BDNF does not play a major role in influencing susceptibility to bipolar disorder as a whole, but is associated with susceptibility to the rapid-cycling subset of the disorder.

This paper describes the 13-year outcome of an epidemiologically defined and representative cohort of patients selected when they were experiencing their first episode of schizophrenia.

In a 13-year follow-up study of a cohort identified in Nottingham in 1978–80, the outcome (symptoms, disability, residence and treatment) was assessed using standardised instruments.

Four of the original 67 patients with ICD–9 schizophrenia were lost to follow-up and five were dead: 52% were without psychotic symptoms in the last two years of follow-up, 52% were without negative symptoms and 55% showed good/fair social functioning. However, only 17% were alive at follow-up, without symptoms and disability, and receiving no treatment.

The findings reported are similar to those of other long-term follow-up studies of schizophrenia and also to 5-year follow-up studies. Kraepelin's emphasis on the longitudinal implications of a diagnosis of schizophrenia are supported, but may be over-pessimistic.

Information about the cost-effectiveness of early intervention programmes for first-episode psychosis is limited.

To evaluate the cost-effectiveness of an intensive early-intervention programme (called OPUS) (trial registration NCT00157313) consisting of enriched assertive community treatment, psychoeducational family treatment and social skills training for individuals with first-episode psychosis compared with standard treatment.

An incremental cost-effectiveness analysis of a randomised controlled trial, adopting a public sector perspective was undertaken.

The mean total costs of OPUS over 5 years (€123683, s.e. = 8970) were not significantly different from that of standard treatment (€148751, s.e. = 13073). At 2-year follow-up the mean Global Assessment of Functioning (GAF) score in the OPUS group (55.16, s.d. = 15.15) was significantly higher than in standard treatment group (51.13, s.d. = 15.92). However, the mean GAF did not differ significantly between the groups at 5-year follow-up (55.35 (s.d. = 18.28) and 54.16 (s.d. = 18.41), respectively). Cost-effectiveness planes based on non-parametric bootstrapping showed that OPUS was less costly and more effective in 70% of the replications. For a willingness-to-pay up to €50000 the probability that OPUS was cost-effective was more than 80%.

The incremental cost-effectiveness analysis showed that there was a high probability of OPUS being cost-effective compared with standard treatment.

Antipsychotic medications cause a wide range of adverse effects and have been associated with sudden death in psychiatric patients.

To supply power spectral analysis of heart rate variability as a tool to examine the arrythmogenic effects of neuroleptics.

Heart rate analysis was carried out in patients with schizophrenia on standard doses of neuroleptic monotherapy − 21 were on clozapine, 18 on haloperidol and 17 on olanzapine – and in 53 healthy subjects.

Patients with schizophrenia on clozapine had significantly higher heart rate, lower heart rate variability and lower high-frequency and higher low-frequency components compared with patients on haloperidol or olanzapine and matched control subjects. Prolonged QTc intervals were more common in patients than controls.

Patients treated with neuroleptic medications, especially clozapine, showed autonomic dysregulation and cardiac repolarisation changes. Physicians should be aware of this adverse reaction.

Predicting transitions to psychosis is difficult. Neuropsychology might facilitate predictions.

To report preliminary data on self-perceived and objectively measurable neurocognition in prodromal patients of the first German early recognition centre.

Subjective neuropsychological disturbances were assessed in 51 patients with potentially prodromal symptoms of schizophrenia. Initial neurocognitive functioning was compared with matched normals and patients with schizophrenia.

Self-perceived deficits mostly concerned perception, cognition and stress reactivity. Five transitions happened during the 15-month follow-up. Recently emerging or intensifying deficits were to some extent predictive of transition. Persons at risk performed worse than controls on objectively measured verbal capacity, attention and memory functions.

Neuropsychological deficits, either self-perceived or objectively measured, characterise persons at risk for schizophrenia and may contribute to predicting transitions.

The source of variability in people's response to stressful life events is poorly understood.

We examine the genetic and environmental underpinning of resilience (i.e. the difference between the twins' internalising symptoms and their predicted symptoms based on cumulative stressful life events).

Stressful life event exposure and internalising symptoms were assessed at two time points in 7500 adult twins. Using the residual between actual and predicted internalising symptom total score, twin modelling was conducted for each wave separately and longitudinally.

Resilience was found to have a moderate genetic heritability at each wave (~31%). Qualitative gender effects were found. Incorporating error of measurement into the model increased the estimated heritability for the latent construct of resilience (~50%). When measurement error and occasion-specific effects were removed, environmental influences contributed roughly equally to level of resilience.

Both genes and environment influence level of psychiatric resilience, and are largely stable over time. Environmental influences can have an enduring effect on resilience.

People with schizophrenia show impaired attention. This could result from reduced latent inhibition (a measure of ability to filter out irrelevant stimuli). Previous studies have found reduced auditory latent inhibition in people with acute schizophrenia: we tested whether this results from psychosis or from drug treatment.

We measured auditory latent inhibition in two studies. One compared antipsychotic-naive people with acute schizophrenia with patients within two weeks of starting antipsychotic treatment. The second compared healthy volunteers given either saline or 1.0 mg haloperidol, intravenously.

Latent inhibition was absent in treated patients, but was clearly present in patients who were naive to antipsychotics. Latent inhibition was absent in volunteers given haloperidol, but was clearly present in those given saline.

The reduced auditory latent inhibition seen in acute schizophrenia is more plausibly due to antipsychotic treatment than to the disorder. Unless neuropsychological models of schizophrenia incorporate evidence from drug-free patients and drug-treated healthy controls, they may be invalid.

The neurocognitive basis of auditory verbal hallucinations is unclear.

To investigate whether people with a history of such hallucinations would misattribute their own speech as external and show differential activation in brain areas implicated in hallucinations compared with people without such hallucinations.

Participants underwent functional magnetic resonance imaging (fMRI) while listening to pre-recorded words. The source (self/non-self) and acoustic quality (undistorted/distorted) were varied across trials. Participants indicated whether the speech they heard was their own or that of another person. Twenty people with schizophrenia (auditory verbal hallucinations n=10, no hallucinations n=10) and healthy controls (n=11) were tested.

The hallucinator group made more external misattributions and showed altered activation in the superior temporal gyrus and anterior cingulate compared with both other groups.

The misidentification of self-generated speech in patients with auditory verbal hallucinations is associated with functional abnormalities in the anterior cingulate and left temporal cortex. This may be related to impairment in the explicit evaluation of ambiguous auditory verbal stimuli.

The long-term effect of anxiety and depression on blood pressure is unclear.

To examine the prospective association of anxiety and depression with change in blood pressure in a general population.

Data on 36530 men and women aged 20–78 years participating in the Nord-Tr⊘ndelag Health Study (HUNT) in Norway in 1984–86 were re-examined 11 years later.

A high symptom level of anxiety and depression at baseline predicted low systolic blood pressure (< 10th percentile) at follow-up (OR=1.30, 95% CI 1.08–1.57) when those with low systolic blood pressure at baseline were excluded. Change in symptom level of anxiety and depression between baseline and follow-up was inversely associated with change in systolic blood pressure. For diastolic blood pressure, the findings were weaker or non-significant.

Symptoms of anxiety and depression predicted lower blood pressure 11 years later.

Migration is a risk factor for the development of schizophrenia.

To examine whether migration is also a risk factor for bipolar affective disorder, unipolar depressive disorder and mood disorders in general.

Medline was searched for population-based incidence studies concerning mood disorders among migrants and mean relative risks were computed using a mixed-effects statistical model.

Only a few studies of unipolar depressive disorder were retrieved. The mean relative risk of developing bipolar affective disorder among migrants was 2.47 (95% C11.33–4.59). However, after excluding people of African-Caribbean origin in the UK this risk was no longer significantly increased. The mean relative risk of mood disorders of unspecified polarity was 1.25 (95% CI 1.04–1.49) and that of any mood disorder was 1.38 (95% CI 1.17–1.62).

There is no conclusive evidence for a large increase in the risk of mood disorders associated with migration.