Susan Sontag has observed that every society seems to need one illness that attaches stigma and blame to its ‘victims’ – mental illness, particularly schizophrenia, appears to have taken this mantle over from AIDS. A review paper by Haghighat (pp. 207–215) proposes that stigmatisation is a fundamental human tendency – a vestige of our animal evolutionary heritage – and, consequently, anti-stigma campaigns must work on many different levels in order to be successful. The power of the mass media has greatly increased the impact of stigma. If every time we hear the word ‘schizophrenic’ on television there is news of another murder, a form of classical conditioning occurs. Cognitive, affective and cultural strategies are therefore needed to ‘desensitise’ the public's fear and anxiety. Crisp (pp. 197–199), in an accompanying editorial, favours legislative and political interventions and feels that people with mental illnesses, like those with physical disabilities, should be empowered to ‘fight their corner’ and test out the relevance of human rights and disability discrimination legislation for their own ends.

While depression is known to involve a disturbance of mood, movement and cognition, its associated cognitive deficits are frequently viewed as simple epiphenomena of the disorder.

To review the status of cognitive deficits in depression and their putative neurobiological underpinnings.

Selective computerised review of the literature examining cognitive deficits in depression and their brain correlates.

Recent studies report both mnemonic deficits and the presence of executive impairment – possibly selective for set-shifting tasks – in depression. Many studies suggest that these occur independent of age, depression severity and subtype, task ‘difficulty’, motivation and response bias: some persist upon clinical ‘recovery’.

M nemonic and executive deficits do not appear to be epiphenomena of depressive disorder. A focus on the interactions between motivation, affect and cognitive function may allow greater understanding of the interplay between key aspects of the dorsal and ventral aspects of the prefrontal cortex in depression.

Stigmatisation is of increasing importance in relation to racism, ageism and sexism but also as an impediment to treating patients.

To develop a theoretical foundation to help comprehend the core meaning of stigmatisation and to guide practical anti-stigmatisation measures.

Personal reflection; re-interpretation of stigmatisation and reformulation of the relevant concepts.

Emergence of a unitary theory of stigmatisation.

Based on the structure of stigmatisation one could explore six levels of intervention in anti-stigmatisation campaigns: the cognitive level – educational intervention; the affective level – psychological intervention; the discrimination level – legislative intervention; the denial level – linguistic intervention; the economic origin – political intervention; the evolutionary origin – intellectual and cultural intervention. As destigmatisation has to challenge fundamental human tendencies, anti-stigmatisation campaigns have to be continuous, non-stop, open-ended projects aiming at keeping alive thought processes that moderate and humanise the pursuit of self-interest and the urge to survive in a competitive world.

Currently, without systematic evidence, psychotherapy for anorexia nervosa in adults draws on psychodynamic, cognitive and systemic theories.

To assess effectiveness of specific psychotherapies in out-patient management of adult patients with anorexia nervosa.

Eighty-four patients were randomised to four treatments: three specific psychotherapies – (a) a year of focal psychoanalytic psychotherapy; (b) 7 months of cognitive-analytic therapy (CAT); (c) family therapy for 1 year – and (d) low contact, ‘routine’ treatment for 1 year (control).

At 1 year, there was symptomatic improvement in the whole group of patients. This improvement was modest, several patients being significantly undernourished at follow-up. Psychoanalytic psychotherapy and family therapy were significantly superior to the control treatment; CAT tended to show benefits.

Psychoanalytic and family therapy are of specific value in the out-patient treatment of adult patients with anorexia.

It has been hypothesised that the association between greater income inequality and increased mortality is mediated by poor psychosocial health.

To test the hypothesis that individuals in regions of Britain with the highest income inequality have a higher prevalence of the common mental disorders, after adjusting for individual income.

Cross-sectional survey of 8191 adults aged 16–75 in private households in England, Wales and Scotland. The prevalence of common mental disorders was assessed using the General Health Questionnaire.

The association between income inequality and prevalence of the common mental disorders varied with individual income level. Among persons with the highest incomes, common mental disorders were more frequent in regions with greater income inequality (as indicated by high Gini coefficient) (adjusted OR 1.31, 95% CI 1.05–1.65; P=0.02). The opposite was true for those with the lowest incomes.

Income inequality was associated with worse mental health among the most affluent individuals.

There have been relatively few surveys in Latin America that have attempted to estimate the prevalence of psychiatric morbidity in private households.

To determine the prevalence of common mental disorders and socio-demographic correlates among adults from Santiago, Chile.

Cross-sectional survey of private households with a probabilistic sampling design was used. Common mental disorders were measured using the Clinical Interview Schedule–Revised (CIS–R).

Three thousand eight hundred and seventy adults were interviewed. Twenty-five per cent were CIS–R cases and 13% met criteria for an ICD–10 diagnosis. Low education, female gender, unemployment, separation, low social status and lone parenthood were associated with a higher prevalence.

Prevalence rates were higher than those found in urban areas of Great Britain, both for ICD–10 diagnoses and ‘non-specific neurotic disorders’. Similar socio-demographic factors were associated with an increased prevalence of common mental disorders in Chile as in the UK. There is a need to unify methodologies to be able to compare results internationally.

It had been suggested that the antidepressant venlafaxine, which inhibits reuptake of both serotonin and (at higher doses) noradrenaline, may result in better outcomes than treatment with selective serotonin reuptake inhibitors (SSRIs).

To compare remission rates during treatment with SSRIs or venlafaxine.

Data from eight comparable randomised, double-blind studies of major depressive disorder were pooled to compare remission rates (Hamilton Rating Scale for Depression score ≤ 7) during treatment with venlafaxine (n=851), SSRIs (fluoxetine, paroxetine, fluvoxamine; n=748) or placebo (four studies; n=446).

Remission rates were: venlafaxine, 45% (382/851); SSRIs, 35% (260/748); placebo, 25% (110/446) (P < 0.001; odds ratio for remission is 1.50 (1.3–1.9), favouring venlafaxine v. SSRIs). The difference between venlafaxine and the SSRIs was significant at week 2, whereas the difference between SSRIs and placebo reached significance at week 4. Results were not dependent on any one study or the definition of remission.

Remission rates were significantly higher with venlafaxine than with an SSRI.

Psychiatric casualties are recognised as an important and inevitable feature of modern warfare. At the beginning of the 20th century they were scarcely acknowledged and still less treated. Today, as a result of lessons learned in the First and Second World Wars, numbers can be predicted on the basis of battle intensity and effective clinical interventions applied.

To discover more about the factors that cause psychiatric casualties and their relationship to total battle casualties.

A survey of historical War Office reports and the papers of Royal Army Medical Corps psychiatrists has provided both statistics and treatment strategies.

Reported psychiatric casualties were low in the Boer War, influenced, in part, by the misdiagnosis of psychosomatic disorders. Their incidence rose appreciably in the First World War with the identification of shell-shock and neurasthenia. The Second World War saw the collection of accurate data, and combat stress was treated efficiently, although few soldiers returned to fighting units.

A constant relationship exists between the incidence of the total killed and wounded and the number of psychiatric casualties, mediated by the nature of the fighting and quality of the troops involved.

The isolation experienced by many patients with severe psychotic disorders is generally assumed to be due to their social withdrawal. An alternative possibility is that relatives avoid frequent contact with patients because they find the situation distressing.

To examine the predictors of frequent patient-relative contact, in particular the role of relatives' experience.

UK700 trial data were used to determine baseline predictors of frequent contact and establish whether relatives' experience at baseline predicted continued frequent contact 2 years later.

Neither characteristics associated in the literature with relatives' ‘burden’ nor relatives' experience predicted patient-relative contact frequency. Instead, the predictors were mainly demographic.

Many relatives experience considerable distress, but the evidence does not suggest that they avoid frequent contact with the patient as a consequence.

It is unclear whether intensive case management influences the prevalence of suicidal behaviour in patients with psychosis.

To compare the effect of intensive case management and standard care on prevalence of suicidal behaviour in patients with chronic psychosis.

Patients with established psychosis (n=708) were randomised either to intensive case management or to standard care. The prevalence of suicidal behaviour was estimated at 2-year follow-up and compared between treatment groups. Suicide attempters and non-attempters were compared on multiple socio-demographic and clinical variables to identify predictors of suicidal behaviour.

There was no significant difference in prevalence of suicidal behaviour between treatment groups. Recent attempts at suicide and multiple recent hospital admissions best predicted future attempts.

Intensive case management does not appear to influence the prevalence of suicidal behaviour in chronic psychosis. Predictors identified in this study confirm some previous findings.

The study arises from the need for good quality of life (QOL) assessment and a new comprehensive generic QOL profile for cross-cultural use.

To examine changes in the QOL of patients receiving antidepressants from a general practitioner, and to assess the validity and sensitivity of a new QOL measure, the World Health Organization Quality of Life Assessment (100-item version) (WHOQOL–100).

Patients with moderate depression (n=106) completed the WHOQOL–100 and Beck Depression Inventory at the start of treatment and again after 6 weeks.

Depression decreased significantly over 2 months and 74% reported feeling better. WHOQOL–100 scores increased in 24 of the 25 facets, demonstrating that QOL improves significantly in the 8 weeks following the start of antidepressant treatment. It also shows the instrument's validity and sensitivity to changes in clinical condition.

The UK WHOQOL–100 is confirmed as excellent to good. Antidepressants significantly and comprehensively improve QOL.

Both subjective and objective information is necessary to assess quality of life (QOL).

To explore the role of subjective and objective QOL dimensions and their cross-sectional and longitudinal predictors.

The relationship between QOL, as measured by the Lancashire Quality of Life Profile (LQL), and demographic variables, diagnosis, psychopathology, disability, functioning, affect balance, self-esteem, service use and service satisfaction was investigated at two points in time, using factor analysis and multiple regression techniques.

One subjective and two objective LQL factors with strong face validity were identified. Cross-sectional predictors of the subjective factor were primarily subjective measures; longitudinally, few predictors of this factor were identified. The cross-sectional and longitudinal predictors of the objective factors were primarily demographic and observer-rated measures.

Subjective and objective data are distinct types of information. Objective measures may be more suitable in detecting treatment effects. Subjective information is necessary to complete the QOL picture and to enhance the interpretation of objective data.