Episodes of mass sociogenic illness are becoming increasingly recognised as a significant health and social problem that is more common than is presently reported.

To provide historical continuity with contemporary episodes of mass sociogenic illness in order to gain a broader transcultural and transhistorical understanding of this complex, protean phenomenon.

Literature survey to identify historical trends.

Mass sociogenic illness mirrors prominent social concerns, changing in relation to context and circumstance. Prior to 1900, reports are dominated by episodes of motor symptoms typified by dissociation, histrionics and psychomotor agitation incubated in an environment of preexisting tension. Twentieth-century reports feature anxiety symptoms that are triggered by sudden exposure to an anxiety-generating agent, most commonly an innocuous odour or food poisoning rumours. From the early 1980s to the present there has been an increasing presence of chemical and biological terrorism themes, climaxing in a sudden shift since the 11 September 2001 terrorist attacks in the USA.

A broad understanding of the history of mass sociogenic illness and a knowledge of episode characteristics are useful in the more rapid recognition and treatment of outbreaks.

Despite improvements in psychiatric teaching, British medical schools have never produced enough graduands aiming for psychiatry.

To inform the strategy for improving recruitment.

A literature review.

The number of psychiatrists required depends on the role of psychiatry, which is constantly changing. The present requirement is about 250–300 per year, including replacements and new posts. The number of psychiatric trainees has always been higher than expected from the career plans of newly qualified doctors, but the number of British graduates passing the Royal College of Psychiatrists' Membership examination has still fallen short, requiring a supplement of foreign medical graduates. The recent 50% expansion in medical students may make this country self-sufficient.

To improve recruitment, the College should focus on influences before and after undergraduate training – the kind of student entering medical school and the factors favouring sustained psychiatric practice after graduation.

Recovery in bipolar disorder is central to its definition but is rarely complete. Previous work has suggested that neuropsychological impairment persists during the euthymic state but has been confounded partly by mild affective symptoms in remitted patients.

To characterise neuropsychological functioning in the euthymic phase of bipolar disorder with an emphasis on tasks of executive functioning.

Thirty euthymic patients with bipolar disorder were compared with thirty healthy controls on neuropsychological tasks differentially sensitive to damage within prefrontal cortex.

Bipolar I patients were impaired on tasks of attentional set shifting, verbal memory and sustained attention. Only sustained attention deficit survived controlling for mild affective symptoms. This deficit was related to progression of illness, but was none the less present in a subgroup of patients near illness onset.

Sustained attention deficit may represent a neuropsychological vulnerability marker for bipolar disorder, providing a focus for further understanding of the phenotype and analysis of the neuronal networks involved.

In individual studies and limited meta-analyses venlafaxine has been reported to be more effective than comparator antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs).

To perform a systematic review of all such studies.

We conducted a systematic review of double-blind, randomised trials comparing venlafaxine with alternative antidepressants in the treatment of depression. The primary outcome was the difference in final depression rating scale value, expressed as a standardised effect size. Secondary outcomes were response rate, remission rate and tolerability.

A total of 32 randomised trials were included. Venlafaxine was more effective than other antidepressants (standardised effect size was −0.14, 95% Cl −0.07 to −0.22). A similar significant advantage was found against SSRIs (20 studies) but nottricyclic antidepressants (7 studies).

Venlafaxine has greater efficacy than SSRIs although there is uncertainty in comparison with other antidepressants. Further studies are required to determine the clinical importance of this finding.

Neurocognitive impairments in euthymic patients with bipolar disorder may represent trait rather than state variables.

To test the hypothesis that euthymic patients with bipolar disorder would exhibit impairment in verbal learning and memory and executive function compared with healthy controls matched for age, gender and premorbid IQ.

Twenty euthymic patients with bipolar disorder were matched, on a case-by-case basis, to twenty healthy community controls. Cases and controls were tested with a battery of neuropsychological tests.

Impairments were found in cases compared with controls in tests of verbal learning and memory. Verbal learning and memory correlated negatively with the number of manic episodes.

Impaired verbal learning and memory may be a trait variable in bipolar disease. There are implications for adherence to medication and relapse and for the role of early treatment interventions. Prospective designs and targeting first-episode groups may help to differentiate trait v. disease process effects.

Non-adherence with antidepressant treatment is very common. Increasing adherence to pharmacological treatment may affect response rate.

To review and summarise quantitative evidence on factors associated with adherence and of adherence-enhancing interventions.

A systematic review of computerised databases was carried out to identify quantitative studies of adherence in depression. Papers retained addressed unipolar depression and considered adherence as the primary end-point.

Of studies published between 1973 and 1999, 32 met the review criteria: epidemiological descriptive studies (n=14): non-random comparisons of control and intervention groups (n=3); randomised interventions (n=14); and meta-analysis (n=1). Patient education and medication clinics were the interventions most commonly tested, combined with a variety of other interventions.

The studies did not give consistent indications of which interventions may be effective. Carefully designed clinical trials are needed to clarify the effect of single and combined interventions.