Previous work on the reliability of mental capacity assessments in patients with psychiatric illness has been limited.

To describe the interrater reliability of two independent assessments of capacity to consent to treatment, as well as assessments made by a panel of clinicians based on the same interview.

Fifty-five patients were interviewed by two interviewers 1–7 days apart and a binary (yes/no) capacity judgement was made, guided by the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). Four senior clinicians used transcripts of the interviews to judge capacity.

There was excellent agreement between the two interviewers for capacity judgements made at separate interviews (kappa=0.82). A high level of agreement was seen between senior clinicians for capacity judgements of the same interview (mean kappa=0.84)

In combination with a clinical interview, the MacCAT–T can be used to produce highly reliable judgements of capacity.

There are inconsistent reports as to whether people with anxiety disorders have a higher mortality risk.

To determine whether anxiety disorders predict mortality in older men and women in the community Method Longitudinal data were used from a large, community-based random sample (n=3107) of older men and women (55–85 years) in The Netherlands, with a follow-up period of 7.5 years. Anxiety disorders were assessed according to DSM–III criteria in a two-stage screening design.

In men, the adjusted mortality risk was 1.78 (95% Cl 1.01–3.13) in cases with diagnosed anxiety disorders at baseline. In women, no significant association was found with mortality.

The study revealed a gender difference in the association between anxiety and mortality. For men, but not for women, an increased mortality risk was found for anxiety disorders.

It remains unclear how much various factors contribute to the placebo response.

To estimate the therapeutic impact of follow-up assessments on placebo response in antidepressant trials.

Double-blind, placebo-controlled antidepressant trials that reported weekly changes in Hamilton Rating Scale for Depression (HRSD) scores over 6 weeks were selected. Included studies (n=41) were divided into those that conducted four, five or six follow-up assessments. Reductions in HRSD scores as a function of the different follow-up schedules were compared.

An extra follow-up visit at week 3 was associated with a 0.86 further reduction in HRSD score; an extra visit at week 5 was associated with a 0.67 further reduction. These effects represented approximately 34–44% of the placebo response that occurred over these time frames. Two additional visits were associated with twice the reduction in HRSD score than one, suggesting that the therapeutic impact of assessment visits is cumulative and proportional. A comparable therapeutic effect was also found in participants receiving active medication.

Follow-up assessments in antidepressant treatment trials incur a significant therapeutic effect for participants on placebo, and this represents about 40% of the placebo response.

A propensity to attend to other people's emotions is a necessary condition for human empathy.

To test our hypothesis that psychopathic disorder begins as a failure to attend to the eyes of attachment figures, using a ‘love’ scenario in young children.

Children with oppositional defiant disorder, assessed for callous–unemotional traits, and a control group were observed in a love interaction with mothers. Eye contact and affection were measured for each dyad.

There was no group difference in affection and eye contact expressed by the mothers. Compared with controls, children with oppositional defiant disorder expressed lower levels of affection back towards their mothers; those with high levels of callous–unemotional traits showed significantly lower levels of affection than the children lacking these traits. As predicted, the former group showed low levels of eye contact toward their mothers. Low eye contact was not correlated with maternal coercive parenting or feelings toward the child, but was correlated with psychopathic fearlessness in their fathers.

Impairments in eye contact are characteristic of children with callous–unemotional traits, and these impairments are independent of maternal behaviour.

People in a putatively late prodromal state not only have an enhanced risk for psychosis but already suffer from mental and functional disturbances

To evaluate the acute effects of a combined supportive and antipsychotic treatment on prodromal symptoms

Putatively prodromal individuals were randomly assigned to a needs-focused intervention without (n=59) or with amisulpride (n=65). Outcome measures at 12-weeks effects were prodromal symptoms, global functioning and extrapyramidal side-effects

Amisulpride plus the needs-focused intervention produced superior effects on attenuated and full-blown psychotic symptoms, basic, depressive and negative symptoms, and global functioning. Main side-effects were prolactin associated

Coadministration of amisulpride yielded a marked symptomatic benefit. Effects require confirmation by a placebo-controlled study

Although evidence exists for abnormal brain function across various anxiety disorders, direct comparison of neural function across diagnoses is needed to elicit abnormalities common across disorders and those distinct to a particular diagnosis.

To delineate common and distinct abnormalities within generalised anxiety (GAD), panic and social anxiety disorder (SAD) during affective processing.

Fifty-nine adults (15 with GAD, 15 with panic disorder, 14 with SAD, and 15 healthy controls) underwent functional magnetic resonance imaging while completing a facial emotion matching task with fearful, angry and happy faces.

Greater differential right amygdala activation to matching fearful v. happy facial expressions related to greater negative affectivity (i.e. trait anxiety) and was heightened across all anxiety disorder groups compared with controls. Collapsing across emotional face types, participants with panic disorder uniquely displayed greater posterior insula activation.

These preliminary results highlight a common neural basis for clinical anxiety in these diagnoses and also suggest the presence of disorder-specific dysfunction.

Self-harm is a major public health concern. Increasing ageing populations and high risk of suicide in later life highlight the importance of identification of the particular characteristics of self-harm in older adults.

To systematically review characteristics of self-harm in older adults.

A comprehensive search for primary studies on self-harm in older adults was conducted in e-databases (AgeLine, CINAHL, PsycINFO, MEDLINE, Web of Science) from their inception to February 2018. Using predefined criteria, articles were independently screened and assessed for methodological quality. Data were synthesised following a narrative approach. A patient advisory group advised on the design, conduct and interpretation of findings.

A total of 40 articles (n = 62 755 older adults) were included. Yearly self-harm rates were 19 to 65 per 100 000 people. Self-poisoning was the most commonly reported method. Comorbid physical problems were common. Increased risk repetition was reported among older adults with self-harm history and previous and current psychiatric treatment. Loss of control, increased loneliness and perceived burdensome ageing were reported self-harm motivations.

Self-harm in older adults has distinct characteristics that should be explored to improve management and care. Although risk of further self-harm and suicide is high in all age cohorts, risk of suicide is higher in older adults. Given the frequent contact with health services, an opportunity exists for detection and prevention of self-harm and suicide in this population. These results are limited to research in hospital-based settings and community-based studies are needed to fully understand self-harm among older adults.

None.

In a follow-up survey from Oslo, 503 persons were re-interviewed using the same questionnaire after 10 years.

The questionnaire includes questions about social support, social characteristics of the neighbourhood and mental health. Information about the neighbourhood was also gathered from key informants.

Of the five types of neighbourhoods surveyed, only one showed marked change over time with respect to social characteristics. This was an initially poorly functioning neighbourhood with poor mental health among the residents, where substantial improvement took place as part of the further development of the area. Parallel with the improvement in social environment there was a significant improvement in mental health among those who continued to live in the same area, as opposed to those who continued to live in the other areas. Selective migration could not explain this finding.

The findings support the environment stress hypothesis, implying that the quality of a neighbourhood has an impact on mental health. The implications for psychiatric prevention are discussed.