Few published studies address depression outcomes in primary care from a cross-cultural perspective.

To define baseline factors associated with 9-month clinical outcome: across six countries.

Adults meeting criteria for current major depression were recruited from primary care clinics in Australia, Brazil, Israel, Spain, Russia and the USA; 968 patients were assessed at the 9-month follow-up. Predictors of complete remission were examined using logistic regression with a hierarchical model.

Rates of complete remission in the six sites ranged from 25% to 48%. Logistic regression using pooled data showed that education, key life events and the Quality of Life Depression Scale score at baseline were the final predictors of complete remission, adjusting for centres, socio-demographic data, severity of depression, comorbidity and general quality of life. Variation in predictors across sites was not statistically significant.

The two major findings of this study were the low proportion of people achieving complete remission at follow-up across the six sites, and that some baseline characteristics (education, Quality of Life Depression Scale score and key life events) are modest predictors of outcome in depression.

There has been a relative dearth of epidemiological research into bipolar affective disorder. Furthermore, incidence studies of bipolar disorder have been predominantly retrospective and most only included hospital admission cases.

To determine the incidence of operationally defined bipolar disorder in three areas of the UK and to investigate any differences in gender and ethnicity.

All patients who contacted mental health services with first-episode psychosis or non-psychotic mania between September 1997 and August 1999 were identified and diagnosed according to ICD–10 criteria. Incidence rates of bipolar affective disorder were standardised for age and stratified by gender and ethnic group across the three areas.

The incidence rate per 100 000 per year in south-east London was over twice that in Nottingham and Bristol. There was no significant difference in the rates of disorder in men and women. Incidence rates of bipolar disorder in the combined Black and minority ethnic groups in all three areas were significantly higher than those of the comparison White groups.

The incidence of bipolar disorder was higher in south-east London than in the other two areas, and was higher among Black and minority ethnic groups than in the White population.

Organic factors are thought to be important in late-life depressive disorder but there have been few studies specifically of neurological signs.

To compare neurological signs in a group of patients with late-onset depression and in healthy controls.

A case–control study comparing 50 patients with depression and 35 controls on three measures of central nervous system (CNS) signs: a structured CNS examination, the Neurological Evaluation Scale (NES) and the Webster rating scale for parkinsonism.

After adjusting for major depression at the time of evaluation and prescription of tranquillisers, ratings on two of the NES sub-scales (complex motor sequencing and ‘other’ signs) and on the Webster scale were significantly higher (more impaired) in patients compared with controls (P <0.05). With logistic regression, the NES was the main measure predictive of group outcome. There were no differences in scores of vascular risk or white matter but patients had more atrophy.

The findings add to the evidence that late-life depression is associated with organic brain dysfunction, perhaps mediated by neurodegeneration or subtle vascular impairment. The use of the NES in subjects with depression should be replicated.

Two British cohort studies have reported birth weight to be associated with self-reported depression in adulthood, even after adjustment for socio-economic factors.

To examine the relationship between birth dimensions and discharge from a psychiatric ward with a depression diagnosis in adulthood.

A cohort of 10 753 male singletons born in Copenhagen, Denmark in 1953 and for whom birth certificates had been traced in 1965 were followed from 1969 until 2002, with record linkage for date of first admission to a psychiatric ward that led to a discharge diagnosis of depression.

A total of 190 men, corresponding to 1.8% of the cohort, had a discharge diagnosis of depression. The Cox's regression analyses failed to show any association between birth dimensions (birth weight and ponderal index) and risk of psychiatric ward diagnosis of depression in adult life, before or after adjustment for social indicators at birth.

This study does not support the existence of a relation between birth dimensions and psychiatric ward admission for depression in adult men.

The production of grammatically complex sentences is impaired in schizophrenia. It has been suggested that impaired syntax processing reflects a risk for the disorder.

To examine the neural correlates of syntax production in people with schizophrenia using functional magnetic resonance imaging (fMRI).

Six patients with schizophrenia and six healthy volunteers spoke about seven Rorschach inkblots for 3 min each while correlates of brain activation were measured with fMRI. Participants produced varying amounts of syntactically simple and complex sentences during each 3 min run. The number of simple and complex sentences was correlated separately with the BOLD contrast.

In the comparison between the control group and the patient group, the number of complex sentences produced was correlated with activation in the posterior portion of the right middle temporal (Brodmann area 21) and left superior frontal (BA 10) gyri in the control group but not in the patients.

The absence of activation in the right posterior temporal and left superior frontal cortex in patients with schizophrenia might contribute to the articulation of grammatically more simple speech in people with this disorder.

Little is known about the psychological health or treatment experiences of those who have left the British armed forces.

To describe the frequency and associations of common mental disorders and help-seeking behaviours in a representative sample of UK veterans at high risk of mental health problems.

A cross-sectional telephone survey of 496 ‘vulnerable’ ex-service personnel selected from an existing epidemiological military cohort.

The response rate was 64%; 44% of these had a psychiatric diagnosis, most commonly depression. Those with a diagnosis were more likely to be of lower rank and divorced or separated. Just over half of those with self-reported mental health problems were currently seeking help, most from their general practitioners. Most help-seekers received treatment, usually medication; 28% were in touch with a service charity and 4% were receiving cognitive-behavioural therapy.

Depression is more common than post-traumatic stress disorder in UK ex-service personnel. Only about half of those who have a diagnosis are seeking help currently, and few see specialists.

We have previously reported that the temporomesial area, including the amygdala, is activated in women when processing unpleasant words concerning body image.

To detect gender differences in brain activation during processing of these words.

Functional magnetic resonance imaging was used to investigate 13 men and 13 women during an emotional decision task consisting of unpleasant words concerning body image and neutral words.

The left medial prefrontal cortex and hippocampus were activated only among men, and the left amygdala was activated only among women during the task; activation in the apical prefrontal region was significantly greater in men than in women.

Our data suggest that the prefrontal region is responsible for the gender differences in the processing of words concerning body image, and may also be responsible for gender differences in susceptibility to eating disorders.

African disaster-affected populations are poorly represented in disaster mental health literature.

To compare systematically assessed mental health in populations directly exposed to terrorist bombing attacks on two continents, North America and Africa.

Structured diagnostic interviews compared citizens exposed to bombings of the US Embassy in Nairobi, Kenya (n=227) and the Oklahoma City Federal Building (n=182).

Prevalence rates of post-traumatic stress disorder (PTSD) and major depression were similar after the bombings. No incident (new since the bombing) alcohol use disorders were observed in either site. Symptom group C was strongly associated with PTSD in both sites. The Nairobi group relied more on religious support and the Oklahoma City group used more medical treatment, drugs and alcohol.

Post-disaster psycho-pathology had many similarities in the two cultures; however, coping responses and treatment were quite different. The findings suggest potential for international generalisability of post-disaster psychopathology, but confirmatory studies are needed.

Smoking may have a beneficial effect on either schizophrenic symptoms or antipsychotic side-effects, but studies are hampered by the lack of control of confounding factors.

To explore the self-medication hypothesis in a large sample of stable out-patients with schizophrenia.

Symptoms, assessed with the Positive and Negative Syndrome Scale (PANSS), and number of hospitalisations were compared in 250 out-patients with DSM–IV schizophrenia classified into three categories: highly dependent smokers, mildly dependent smokers and non-smokers. Log-linear analysis was used to control for potential confounding and interacting variables.

High PANSS total scores and positive symptoms were less frequent in mildly dependent smokers than in non-smokers or highly dependent smokers. The highly dependent smokers had the worst outcome.

The data do not generally support the self-medication hypothesis but rather suggest a complex interaction between nicotine dependence and schizophrenic symptoms.

There are few prospective studies on risk factors for attempted suicide among psychiatric out- and in-patients with major depressive disorder.

To investigate risk factors for attempted suicide among psychiatric out- and in-patients with major depressive disorder inthe city of Vantaa, Finland.

The Vantaa Depression Study included 269 patients with DSM–IV major depressive disorder diagnosed using semi-structured interviews and followed up at 6- and 18-month interviews with a life chart.

During the 18-month follow-up, 8% of the patients attempted suicide. The relative risk of an attempt was 2.50 during partial remission and 7.54 during a major depressive episode, compared with full remission (P<0.001). Numerous factors were associated with this risk, but lacking a partner, previous suicide attempts and total time spent in major depressive episodes were the most robust predictors.

Suicide attempts among patients with major depressive disorder are strongly associated with the presence and severity of depressive symptoms and predicted by lack of partner, previous suicide attempts and time spent in depression. Reducing the time spent depressed is a credible preventive measure.

Many people with depression in residential care homes for the elderly do not receive treatment because their depression remains undetected.

To determine the effects of staff training on the detection, treatment and outcome of depression in residents often homes.

We conducted a randomised controlled trial in ten residential homes. The intervention consisted of a training programme for staff and collaborative evaluation by staff and a mental health specialist of residents with possible depression.

Recognition of depression increased more in homes where staff received the training than in the control homes. Treatment rates also increased compared with control homes, but the increase was not significant. Residents with depressive symptoms had a more favourable course when staff had received training. Moreover, the prevalence of depressive symptoms decreased, but the decrease was not significant.

Training of care staff results in the increased detection of depression in the elderly, a trend towards more treatment and better outcomes.

During the years 1988–1993 the primary care incidence of anorexia nervosa in the UK remained stable, but the incidence of bulimia nervosa increased threefold.

To determine whether the incidence of anorexia nervosa remained stable, and that of bulimia nervosa continued to increase, in the years 1994–2000.

The General Practice Research Database was screened for new cases of anorexia and bulimia nervosa between 1994 and 2000. Annual incidence rates were calculated for females aged 10–39 years and compared with rates from the previous 5 years.

In 2000 primary care incidence rates were 4. 7 and 6. 6 per 100 000 population for anorexia and bulimia nervosa, respectively. The incidence of anorexia nervosa remained remarkably consistent over the period studied. Overall there was an increase in the incidence of bulimia, but rates declined after a peak in 1996.

This study provides further evidence for the stability of anorexia nervosa incidence rates. Decreased symptom recognition and changes in service use might have contributed to observed changes in the incidence of bulimia nervosa.

Post-traumatic stress disorder (PTSD) is the only psychiatric condition that requires a specific event to have occurred for its diagnosis.

To gather evidence from the adult general population on whether life events (e. g. divorce, unemployment) generate as many symptoms of post-traumatic stress as traumatic events (e. g. accidents, abuse).

Data on demographic characteristics and history of stressful events were collected through a written questionnaire sent to a random sample of 2997 adults. Respondents also filled out a PTSD symptom checklist, keeping in mind their worst event. Mean PTSD scores were compared, controlling for differences between the two groups. Differences in item scores and in the distribution of the total PTSD scores were analysed.

Of the 1498 respondents, 832 were eligible for inclusion in our analysis. For events from the past 30 years the PTSD scores were higher after life events than after traumatic events; for earlier events the scores were the same for both types of events. These findings could not be explained by differences in demographics, history of stressful events, individual item scores, or the distribution of the total PTSD scores.

Life events can generate at least as many PTSD symptoms as traumatic events. Our findings call for further studies on the specificity of traumatic events as a cause of PTSD.

Selective serotonin reuptake inhibitors are effective in the treatment of social anxiety disorder and are currently regarded as the pharmacotherapy of choice.

To investigate the efficacy and tolerability of escitalopram in the treatment of generalised social anxiety disorder.

Patients with generalised social anxiety disorder were randomised to receive placebo (n=177) or 10–20 mg escitalopram (n=181) in a 12-week, double-blind trial. The primary outcome measure was the mean change from baseline to last assessment in the Liebowitz Social Anxiety Scale (LSAS) total score.

The study showed a statistically superior therapeutic effect for escitalopram compared with placebo on the LSAS total score (P=0.005). There were significantly more responders to treatment for escitalopram than for placebo (54% v. 39%; P < 0.0 1). The clinical relevance of these findings was supported by significant reduction in the work and social components of the Sheehan Disability Scale and by the good tolerability of escitalopram treatment.

Escitalopram was efficacious and well tolerated in the treatment of generalised social anxiety disorder.

Dementia is emerging as an important health problem of elderly people in India.

To investigate the prevalence, psychosocial correlates and risk factors of various dementing disorders in an urban population in Kerala, southern India.

A door-to-door survey was conducted in the city of Kochi (Cochin) to identify residents aged ?65 years using cluster sampling. Of 1934 people screened with a vernacular adaptation of the Mini-Mental State Examination, all those scoring at or below the cut-off of 23 were evaluated further and those with confirmed cognitive and functional impairment were assigned diagnoses according to DSM–IV criteria. Identified cases were categorised by ICD–10 criteria. Ten percent of those screened as negative were evaluated at each stage.

Prevalence of dementia was 33. 6 per 1000 (95% Cl 27.3–40.7). Alzheimer's disease was the most common type (54%) followed by vascular dementia (39%), and 7% of cases were due to causes such as infection, tumour and trauma. Family history of dementia was a risk factor for Alzheimer's disease and history of hypertension was a risk factor for vascular dementia.

Dementia is an important health problem of the elderly population. Identification of risk factors points towards the possibility of prevention.

Studies have compared electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) with regard to clinical efficacy in the treatment of depression, but no study has yet addressed the differential impact on cognition.

To compare the neurocognitive effects of unilateral ECT and rTMS.

Thirty patients with treatment-refractory non-psychotic major depression received an average of ten treatments with either unilateral ECT or left prefrontal rTMS and were assessed for objective and subjective cognitive impairments before and about a week after treatment.

Treatment response was comparable (46% of the ECT group and 44% of the rTMS group showed a reduction of 50% or more in Hamilton Rating Scale for Depression scores). In patients treated with rTMS, cognitive performance remained constant or improved and memory complaints alleviated, whereas in the ECT group memory recall deficits emerged and memory complaints remained.

In contrastto unilateral ECT, rTMS has no adverse memory effects.

The development of reliable, valid measures of psychopathology in people with intellectual disabilities is an important task. However, independent replication studies are rarely reported.

To report data on the psychometric properties of the Psychiatric Assessment Schedule for Adults with Developmental Disabilities (PAS–ADD) Checklist.

The PAS–ADD Checklist was completed for 226 adults as part of the assessment process for a specialist mental health service for people with intellectual disabilities.

Internal consistency was acceptable. Factor analysis revealed one main factor that was characterised by items related to mood. The Checklist was sensitive to differences between diagnostic groups and had an overall sensitivity of 66%; its specificity was 70%.

The PAS–ADD Checklist is a quick and easy to use screening tool. Although at present it is the best measure available, it should not be the only method used to identify psychiatric disorders in people with intellectual disabilities.

Electroconvulsive therapy (ECT) is a procedure that attracts special safeguards under common law for voluntary patients and under both current and proposed mental health legislation, for those receiving compulsory treatment.

To review patients' views on issues of information, consent and perceived coercion.

Seventeen papers and reports were identified that dealt with patients' views on information and consent in relation to ECT; 134 ‘testimonies' or first-hand accounts were identified. The papers and reports were subjected to a descriptive systematic review. The testimony data were analysed qualitatively.

Approximately half the patients reported that they had received sufficient information about ECT and side-effects. Approximately a third did not feel they had freely consented to ECTeven when they had signed a consent form. Clinician-led research evaluates these findings to mean that patients trust their doctors, whereas user-led work evaluates similar findings as showing inadequacies in informed consent.

Neither current nor proposed safeguards for patients are sufficient to ensure informed consent with respect to ECT, at least in England and Wales.

There is increasing evidence that cognitive–behavioural therapy can be an effective intervention for patients experiencing drug-refractory positive symptoms of schizophrenia.

To investigate the effects of cognitive–behavioural therapy on in-patients with treatment-refractory psychotic symptoms.

Manualised therapy was compared with supportive counselling in a randomised controlled study. Both interventions were delivered by experienced psychologists over 16 sessions of treatment. Therapy fidelity was assessed by two independent raters. Participants underwent masked assessment at baseline, after treatment and at 6 months' follow-up. Main outcome measures were the Positive and Negative Syndrome Scale and the Psychotic Symptoms Rating Scale. The analysis was by intention to treat.

Participants receiving cognitive–behavioural therapy had improved with regard to auditory hallucinations and illness insight at the post-treatment assessment, but these findings were not maintained at follow-up.

Cognitive–behavioural therapy showed modest short-term benefits over supportive counselling for treatment-refractory positive symptoms of schizophrenia.

Self-harm is associated with a high risk of suicide. It is unclear whether suicidal intent at the time of self-harm is a risk factor for future suicidal behaviour.

To investigate the relationship between suicidal intent and patient characteristics, repetition of self-harm, and suicide.

Clinical and demographic data on 4415 patients presenting to hospital following self-harm between 1993 and 2000 were analysed. Suicidal intent was measured using the Beck Suicide Intent Scale (SIS). Follow-up information on repetition of self-harm and suicide was investigated for 2489 patients presenting between 1993 and 1997.

Suicidal intent at the time of self-harm was associated with risk of subsequent suicide, especially within the first year and among female patients. Suicide was more strongly associated with scores on the circumstances section of the SIS than the self-report section. The association between repetition of self-harm and SIS scores was different for male and female patients.

The measurement of suicidal intent in the assessment of self-harm patients is beneficial for the evaluation of future suicide risk. A shortened measuring scale might be useful in clinical practice.