Orbitofrontal cortex dysfunctions have been frequently documented in people with substance use disorders. The exact role of this cortical region, however, remains unspecified.

To assess the functionality of the orbitofrontal cortex in people with substance use disorders.

Reports of studies using behavioural decision-making tasks and/or neuroimaging techniques to investigate orbitofrontal cortex functioning in cases of substance misuse were reviewed. Studies focusing exclusively on tobacco-smoking and gambling were excluded.

Fifty-two research articles were evaluated. Most studies showed significant deficits in decision-making in people with substance use disorders. A consistent finding in the neuroimaging studies was hypoactivity of the orbitofrontal cortex after detoxification. The association between hyperactivity of this region and craving or cue reactivity was not consistent across studies.

The orbitofrontal cortex has an important role in addictive behaviours. Further studies are needed to elucidate the underlying neuronal substrates of cue reactivity, craving and decision-making, and the implications for treatment and relapse prevention.

When planning and delivering a liaison psychiatry service it is important to have an understanding of the research evidence supporting the use of interventions likely to be delivered by the service.

To identify high-quality systematic reviews for all interventions in three defined areas of liaison psychiatry, to summarise their clinical implications and to highlight areas where more research is needed. The three areas were the psychological effects of physical illness or treatment, somatoform disorders and self-harming behaviour.

Computerised database searching, secondary reference searching, hand-searching and expert consultation were used to identify relevant systematic reviews. Studies were reliably selected, and quality-assessed, and data were extracted and interpreted by two reviewers.

We found 64 high-quality systematic reviews. Only 14 reviews included meta-analyses.

Many areas of liaison psychiatry practice are not based on high-quality evidence. More research in this area would help inform development and planning of liaison psychiatry services.

Various behavioural indices of brain lateralisation significantly intercorrelate, but current research in this area still focuses on single behavioural asymmetries, such as handedness.

To describe a novel approach, which simultaneously integrates various laterality indices and delineates complex phenotypes.

Grade of membership analysis was used to describe latent, complex lateralisation phenotypes in patients with schizophrenia (n=157), their siblings (n=74) and controls (n=77). The indices used were asymmetries of eye, foot and hand; hand motor proficiency; and handedness of patient's first-degree relatives.

Three distinct pure types of lateralisation (‘right’, ‘left’ and ‘mixed’) were evident in patients compared with two (‘right’ and ‘left’) in siblings and controls. The ‘mixed’ type in patients featured absence of eye and foot lateralisation and presence of familial sinistrality, despite a right-hand dominance for writing. Patients with schizophrenia expressing the ‘left’ phenotype had a more severe course of illness, significantly increased scores on two schizotypy factors and poorer neurocognitive performance. The pure types in the siblings were similar to those in healthy controls.

The findings suggest that a leftward reversal, rather than a reduction in lateralisation, is associated with clinical severity and neurocognitive deficits in patients with schizophrenia.

Suicide risk is greatly increased in schizophrenia. Detection of those at risk is clinically important.

To identify risk factors for suicide in schizophrenia.

The international literature on case-control and cohort studies of patients with schizophrenia or related conditions in which suicide was reported as an outcome was systematically reviewed. Studies were identified through searching electronic databases and reference lists, and by consulting experts.

Twenty-nine eligible studies were identified. Factors with robust evidence of increased risk of suicide were previous depressive disorders (OR=3.03, 95% CI 2.06–4.46), previous suicide attempts (OR=4.09, 95% CI 2.79–6.01), drug misuse (OR=3.21, 95% CI 1.99–5.17), agitation or motor restlessness (OR=2.61, 95% CI 1.54–4.41), fear of mental disintegration (OR=12.1, 95% CI 1.89–81.3), poor adherence to treatment (OR=3.75, 95% CI 2.20–6.37) and recent loss (OR=4.03, 95% CI 1.37–11.8). Reduced risk was associated with hallucinations (OR=0.50, 95% CI 0.35–0.71).

Prevention of suicide in schizophrenia is likely to result from treatment of affective symptoms, improving adherence to treatment, and maintaining special vigilance in patients with risk factors, especially after losses.

Obsessions and compulsions may occur in the post-streptococcal disorders Sydenham's chorea and paediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS). The proposed mediators are anti-basal ganglia antibodies (ABGA)

We tested the hypothesis that post-streptococcal autoimmunity may have a role in ‘idiopathic’ obsessive–compulsive disorder (OCD)

We examined 50 children with OCD for ABGA using enzyme-linked immunosorbent assay (ELISA) and western immunoblotting. The findings were compared with paediatric autoimmune (n=50), neurological (n=100) and streptococcal (n=40) controls.

The mean ABGA binding on ELISA was elevated in the patient cohort compared with all control groups (P<0.005 in all comparisons). Western immunoblotting revealed positive antibody binding (as seen in Sydenham's chorea) in 42% of the patient cohort compared with 2–10% of control groups (P<0.001 in all comparisons)

Our findings support the hypothesis that central nervous system autoimmunity may have a role in a significant subgroup of cases of OCD. Further study is required to examine whether the antibodies concerned are pathogenic.

Most research investigating the relationship between IQ and risk of mental disorder has focused on schizophrenia.

To illuminate the relationship between IQ test scores in early adulthood and various mental disorders.

For 3289 men from the Copenhagen Perinatal Cohort, military IQ test scores and information on psychiatric hospitalisation were available. We identified 350 men in the Danish Psychiatric Central Register, and compared the mean IQ test scores of nine diagnostic categories with the mean scores of 2939 unregistered cohort controls.

Schizophrenia and related disorders, other psychotic disorders, adjustment, personality, alcohol and substance-use-related disorders were significantly associated with low IQ scores, but this association remained significant for the four non-psychotic disorders only when adjusting for comorbid diagnoses. For most diagnostic categories, test scores were positively associated with the length of the interval between testing and first admission. ICD mood disorders as well as neuroses and related disorders were not significantly associated with low IQ scores.

Low IQ may be a consequence of mental disease or a causal factor in psychotic and non-psychotic disorders.

Few studies have examined samples of people with cannabis-induced psychotic symptoms.

To establish whether cannabis-induced psychotic disorders are followed by development of persistent psychotic conditions, and the timing of their onset.

Data on patients treated for cannabis-induced psychotic symptoms between 1994 and 1999 were extracted from the Danish Psychiatric Central Register. Those previously treated for any psychotic symptoms were excluded. The remaining 535 patients were followed for at least 3 years. In a separate analysis, the sample was compared with people referred for schizophrenia-spectrum disorders for the first time, but who had no history of cannabis-induced psychosis.

Schizophrenia-spectrum disorders were diagnosed in 44.5% of the sample. New psychotic episodes of any type were diagnosed in 77.2%. Male gender and young age were associated with increased risk. Development of schizophrenia-spectrum disorders was often delayed, and 47.1% of patients received a diagnosis more than a year after seeking treatment for a cannabis-induced psychosis. The patients developed schizophrenia at an earlier age than people in the comparison group (males, 24.6 v. 30.7 years, females, 28.9 v. 33.1 years).

Cannabis-induced psychotic disorders are of great clinical and prognostic importance.

Clinical and research focus has recently shifted from established psychotic disorders to first-episode psychosis and the prepsychotic phase of illness.

To describe the principles, progress and dilemmas associated with the prospective detection, engagement and treatment of young people at risk of developing a psychotic disorder.

Strategies to identify young people at heightened risk of a psychotic disorder are described. Preventive interventions and results of their evaluation are provided.

Well-validated criteria for identifying young people at heightened risk of psychosis have been developed, evidence of the efficacy of various psychological and pharmacological interventions in preventing progression has accumulated and progress towards the identification of clinical and neurobiological predictors of transition to acute psychosis has been made.

The detection, monitoring and treatment of young people in the prepsychotic phase is a growth area in psychiatry. The ethical considerations about treatment options, treatment of minors and provision of information about risk status must be treated with sensitivity if the potential benefit to many young people and their families is to be realised.

The Early Detection and Intervention Programme of the German Research Network on Schizophrenia (GRNS) investigates the initial prodromal phase of psychosis in a multidimensional approach. Two intervention strategies are being studied by two large-scale multicentre projects.

To present the concept of the intervention studies, and to provide an interim report of the recruitment procedure.

Comprehensive cognitive-behavioural therapy has been developed for patients in the ‘early initial prodromal state’. For patients in the ‘late initial prodromal state’ the atypical neuroleptic amisulpride is explored. Both interventions are evaluated in randomised controlled trials using clinical management as the control condition.

Between January 2001 and March 2003, 1212 individuals seeking help for mental health problems were screened for putative prodromal symptoms at four university centres. More than 388 individuals fulfilled criteria for both interventions and 188 (48. 5%) gave informed consent to participate in the trials.

The screening procedure appears to be feasible and trial participation seems to be acceptable to a relevant proportion of people at increased risk of developing psychosis.

Studies of chronic schizophrenia suggest that there are subgroups with different profiles of cognitive impairment.

To determine whether such heterogeneity is present at illness onset and any relationship to clinical variables.

Ninety-three community patients with first-episode schizophrenia and 50 healthy volunteers were assessed for premorbid (Revised National Adult Reading Test) and current IQ, memory and executive function.

Half of those with schizophrenia had preserved IQ in the normal range but there was evidence of a specific impairment in spatial working memory even in those with high/average IQ; 37 out of 93 (40%) had generalised cognitive decline. Those with low premorbid IQ were significantly younger at illness onset. For the entire group, age at onset correlated positively with premorbid but not current IQ.

At illness onset, cognitive heterogeneity is present in people with schizophrenia, with a high proportion having undergone general cognitive decline. However, working memory impairment may be a common feature. Lower premorbid IQ is a risk factor for an earlier onset.

Studies have shown increased bilateral activation in the prefrontal cortex when normal individuals lie, but there have been no structural imaging studies of deceitful individuals.

To assess whether deceitful individuals show structural abnormalities in prefrontal grey and white matter volume.

Prefrontal grey and white matter volumes were assessed using structural magnetic resonance imaging in 12 individuals who pathologically lie, cheat and deceive (‘liars’), 16 antisocial controls and 21 normal controls.

Liars showed a 22–26% increase in prefrontal white matter and a 36–42% reduction in prefrontal grey/white ratios compared with both antisocial controls and normal controls.

These findings provide the first evidence of a structural brain deficit in liars, they implicate the prefrontal cortex as an important (but not sole) component in the neural circuitry underlying lying and provide an initial neurobiological correlate of a deceitful personality.

Severe mania is life-threatening, carries an increased risk of suicide and has a serious impact on patients and their families. Efficient and rapid control of episodes of acute mania is needed.

To evaluate the safety and efficacy of risperidone monotherapy for acute mania.

In a 3-week, randomised, double-blind trial, 290 in-patients with bipolar l disorder with current manic or mixed episode and a baseline Young Mania Rating Scale (YMRS) score of 20 or more received flexible doses of risperidone (1–6 mg per day) or placebo.

Risperidone was received by 146 patients and placebo by 144. Their mean baselineYMRS score was 37. 2 (s. e. =0. 5). Significantly greater improvements were observed with risperidone than with placebo at weeks l and 2 and at end-point (total YMRS: P<0. 01). Extrapyramidal symptoms were the most frequently reported adverse events in the risperidone group.

In patients with severe manic symptoms, risperidone produced significant improvements in YMRS scores as early as week 1 and substantial changes at end-point. Treatment was well tolerated.

It is unclear whether the effect of low birth weight on common affective disorders in later life is director mediated through childhood factors.

To determine whether birth weight has a direct effect on psychological distress in adulthood not mediated by childhood IQ or behavioural problems.

Participants (n=5572) of the Aberdeen Children of the 1950s study had data on birth weight for gestational age and adult psychological distress. Logistic regression was used to examine the association between these factors, with adjustment for confounders and potential childhood mediators.

Children born full term but weighing less than 5.5 lb had increased odds of psychological distress in later life after adjustment for potential confounders (OR=1.49, 95% CI 1.01–2.20). Further adjustment for childhood IQ and behaviour did not attenuate the association. A 1 s.d. decrease in birth weight for gestational age was associated with a 4% increased odds of psychological distress in adulthood (OR=1.04, 95% CI 0.97–1.12).

Low birth weight for gestational age, particularly atterm, was associated with adult psychological distress. This was not mediated by childhood factors, suggesting a direct effect of early life factors on adult mental health. A neurodevelopmental pathway may therefore be implicated.

There is little knowledge of the predictors of objective and subjective quality of life.

To describe changes at 2 and 6 years in objective and subjective quality of life in 261 individuals attending a community mental health service and to identify predictors of change in each life domain.

Prospective study of demographic, diagnostic and service utilisation characteristics, psychopathology, functioning, disability, self-esteem, affect balance and service satisfaction.

Female gender, unmarried status, older age, less education and greater disability predicted a worsening of objective quality of life over time, but explain a small amount of variance. The variance in subjective quality of life was higher (>40%). Greater clinician-rated anxiety and depressive symptoms had a negative effect on satisfaction with health and general well-being. Psychological status, self-esteem and satisfaction with service were the most important predictors in almost all subjective domains; these variables should be important targets for treatment.

This study is the first to provide information to enable clinicians to make prognostic judgements about quality of life and plan effective therapeutic strategies to improve quality of life.

No studies have assessed psychopathology among victims of stalking who have not sought specialist help.

To examine the associations between stalking victimisation and psychiatric morbidity in a representative community sample.

A random community sample (n = 1844) completed surveys examining the experience of harassment and current mental health. The 28-item General Health Questionnaire (GHQ–28) and the Impact of Event Scale were used to assess symptomatology in those reporting brief harassment (n = 196) or protracted stalking (n = 236) and a matched control group reporting no harassment (n = 432)

Rates of caseness on the GHQ–28 were higher among stalking victims (36.4%) than among controls (19.3%) and victims of brief harassment (21.9%). Psychiatric morbidity did not differ according to the recency of victimisation, with 34.1% of victims meeting caseness criteria 1 year after stalking had ended.

In a significant minority of victims, stalking victimisation is associated with psychiatric morbidity that may persist long after it has ceased. Recognition of the immediate and long-term impacts of stalking is necessary to assist victims and help alleviate distress and long-term disability.

There has been no long-term study of people addicted to injected heroin who have been treated without the prescribing of substitute opioids.

To investigate the outcome for patients treated for injected heroin addiction 33 years after they were first seen, and 26 years after they were first followed up, in terms of sustained abstinence, continuing maintenance on methadone and deaths.

Eighty-six people with heroin addiction first seen in 1966–1967 in a small town in the south-east of England were located and their clinical state assessed using multiple sources, including personal interviews with a proportion of the cohort.

Forty-two per cent of the cohort had been abstinent for at least 10 years; 10% were taking methadone and were classified as addicted; and 22% had died. Eight per cent of the cohort could not be located.

Results proved favourable in the above three parameters compared with other long-term studies.

There is little geographical variation in the prevalence of the common mental disorders. However, there is little longitudinal research.

To estimate variance in rates of common mental disorders at individual, household and electoral ward levels prospectively.

A 12-month cohort study of 7659 adults aged 16–74 years in 4338 private households, in 626 electoral wards. Data were collected as part of the British Household Panel Survey. Common mental disorders were assessed using the 12-item General Health Questionnaire (GHQ). Ward-level socio-economic deprivation was measured using the Carstairs index.

Less than 1% of total variance, in onset and maintenance of common mental disorders and change in GHQ score between waves, occurred at ward level. However, 12% of variance, which is a statistically significant difference, was found at household level (a much smaller geographical unit) and this difference remained after further analyses.

Ward level socio-economic deprivation does not influence the onset and maintenance of common mental disorders in Britain but local factors at the household level do. Reasons for this remain unclear.

The extent to which antipsychotics improve patients' well-being is uncertain.

To examine psychopathology and patient-rated functioning and well-being in patients treated with risperidone.

In a 1-year, open-label, international multicentre trial of long-acting risperidone in 615 stable adult patients with schizophrenia, self-rated functioning and well-being were measured every 3 months using the Short Form 36-item questionnaire (SF–36). Psychopathology was quantified using the Positive and Negative Syndrome Scale (PANSS).

Significant improvements were found on the SF–36 mental component summary score and vitality and social functioning scales. PANSS and mental component summary scores were moderately correlated.

Patient-reported functioning and well-being appear to differ from investigator-rated psychotic symptoms. Patient-rated well-being should be assessed with symptoms to help measure treatment outcomes.