One factor contributing to impaired awareness of illness (poor insight) in psychotic disorders may be neurocognitive deficits.

A systematic review and meta-analysis were conducted after data extraction. Following an overall analysis, in which measures of different cognitive domains were taken together, more finegrained analyses investigated whether there was a specific relation with frontal executive functioning, and whether this was influenced by diagnosis or the insight scales used.

There was a significant mean correlation between insight ratings and neurocognitive performance (mean weighted r=0.17, 95% CI 0.13–0.21, z=8.3, P < 0.0001), based on 35 studies with a total of 2354 individuals. Further analyses revealed that the effect of general intellectual impairment was smaller than the specific association with executive function. This was only the case for psychosis in general, and not in an analysis limited to schizophrenia, where all cognitive domains were associated with impaired insight to a similar degree.

Neuropsychological dysfunction, specifically impairment of set-shifting and error monitoring, contributes to poor insight in psychosis. Specific relations with different dimensions of insight and the putative role of metacognitive functions require further study.

The prevalence of benzodiazepine consumption in European countries remains at 2–3% of the general population despite the well-documented disadvantages of long-term use.

To review systematically the success rates of different benzodiazepine discontinuation strategies.

Meta-analysis of comparable intervention studies.

Twenty-nine articles met inclusion criteria. Two groups of interventions were identified; minimal intervention (e.g. giving simple advice in the form of a letter or meeting to a large group of people; n=3), and systematic discontinuation (defined as treatment programmes led by a physician or psychologist; n=26). Both were found to be significantly more effective than treatment as usual: minimal interventions (pooled OR=2.8, 95% CI 1.6–5.1); systematic discontinuation alone (one study, OR=6.1, 95% CI 2.0–18.6). Augmentation of systematic discontinuation with imipramine (two studies, OR=3.1, 95% CI 1.1–9.4) or group cognitive-behavioural therapy for patients with insomnia (two studies, OR=5.5, 95% CI 2.3–14.2) was superior to systematic discontinuation alone.

Evidence was found for the efficacy of stepped care (minimal intervention followed by systematic discontinuation alone) in discontinuing long-term benzodiazepine use.

Minor physical anomalies are more prevalent among people with psychosis. This supports a neurodevelopmental aetiology for psychotic disorders, since these anomalies and the brain are both ectodermally derived. However, little is understood about the brain regions implicated in this association.

To examine the relationship between minor physical anomalies and grey matter structure in a sample of patients with first-episode psychosis.

Sixty patients underwent assessment of minor physical anomalies with the Lane scale. High-resolution magnetic resonance images and voxel-based methods of image analysis were used to investigate brain structure in these patients.

The total anomalies score was associated with a grey matter reduction in the prefrontal cortex and precuneus and with a grey matter excess in the basal ganglia, thalamus and lingual gyrus.

Minor physical anomalies in a sample of patients with first-episode psychosis are associated with regional grey matter changes. These regional changes may be important in the pathogenesis of psychotic disorder.

Well-designed prospective studies of substance misuse in first-episode psychosis can improve our understanding of the risks associated with comorbid substance misuse and psychosis.

To examine the potential effects of substance misuse on in-patient admission and remission and relapse of positive symptoms in first-episode psychosis.

The study was a prospective 15-month follow-up investigation of 103 patients with first-episode psychosis recruited from three mental health services.

Substance misuse was independently associated with increased risk of in-patient admission, relapse of positive symptoms and shorter time to relapse of positive symptoms after controlling for potential confounding factors. Substance misuse was not associated with remission or time to remission of positive symptoms. Heavy substance misuse was associated with increased risk of in-patient admission, relapse and shorter time to relapse.

Substance misuse is an independent risk factor for a problematic recovery from first-episode psychosis.

There has been controversy as to whether early intervention in psychosis can improve the outcome of the disorder.

To establish if there is an association between duration of untreated psychosis and the 4-year outcome of persons with a first episode of psychosis.

Prospective naturalistic follow-up study of the outcome of consecutive first presentations with DSM–IV psychosis attending a community-based psychiatric service.

A longer duration of untreated psychosis was associated with a significantly poorer functional and symptomatic outcome 4 years later. For schizophrenia and schizophreniform disorder, each increment in duration of untreated psychosis was associated with a 7.8 point decrease in global functioning and an increase in positive symptoms scores by 1.9 points.

This study extends the findings of short-term follow-up studies by confirming an association between duration of untreated psychosis and ‘midterm’ outcome.

The outcome and impact of major depression in developing countries are not clear.

To describe the outcome of major depression and compare the disability and patterns of service use among different outcome groups.

In a case cohort study, nested within a population-based survey of 68 000 participants using the Composite International Diagnostic Interview (CIDI), 300 participants were randomly selected from those with current major depression and 300 from those with no lifetime history. Participants were re-interviewed after 18–62 months to ascertain current diagnosis, psychological symptoms, disability and use of health services.

Of participants with major depression at baseline 26% also met criteria for major depression at follow up. Mortality ratio standardised for age and gender was 3.55 (95% CI 1.97 to 6.39). All indices of measure of disability were significantly higher in the persistently depressed group compared with the completely recovered group. Participants who had recovered partially resembled participants with persistent depression. Two-thirds of those with persistent depression had not sought any help.

Major depression was associated with mortality and disability Those with residual symptoms remained disabled. Help-seeking was unusual.

Medically unexplained disabling fatigue in young people is familial and frequently associated with depressed mood.

To examine the degree of sharing of genetic and environmental influences on the symptoms of depression and fatigue in this age group.

The parents of twins aged 8–17 years, derived from a population-based register, completed a questionnaire regarding lifetime-ever disabling fatigue in both twins. Twins aged 11 years or over completed the Mood and Feelings Questionnaire. The genetic and environmental influences on fatigue and the relationship with depression were examined using bivariate genetic analysis.

Parent-rated data were obtained for 1468 twin pairs (65%) and self-rated data from 930 older twin pairs (58%). Bivariate analysis of fatigue and depression suggested that genetic and environmental influences on disabling fatigue were mainly specific to fatigue.

Unexplained disabling fatigue in childhood is substantially familial and has mainly an independent aetiology from depression.

Persistent impairments in neurocognitive function have been described in bipolar disorder.

To compare the cognitive performance of patients with bipolar II disorder with that of patients with bipolar I disorder and a healthy control group.

The study included 71 euthymic patients with bipolar disorder (38 bipolar I, 33 bipolar II), who were compared on clinical and neuropsychological variables (e.g. executive function, attention, verbal and visual memory) and contrasted with 35 healthy controls on cognitive performance.

Compared with controls, both bipolar groups showed significant deficits in most cognitive tasks including working memory (Digit Span Backwards, P=0.002) and attention (Digit Span Forwards, P=0.005; Trail Making Test, P=0.001). Those with type II disorders had an intermediate level of performance between the bipolar I group and the control group in verbal memory (P < 0.005) and executive functions (Stroop interference task, P=0.020).

Cognitive impairment exists in both subtypes of bipolar disorder, although more so in the bipolar I group. The best predictors of poor psychosocial functioning in bipolar II disorder were subclinical depressive symptoms, early onset of illness and poor performance on a measure related to executive function.

The vascular depression hypothesis and our recent findings of increased frequency of spontaneous cerebral emboli in dementia suggest that such emboli may be involved in the causation of depressive symptoms in dementia.

To evaluate the association between spontaneous cerebral emboli and depressive symptoms in Alzheimer's disease and vascular dementia.

In a cohort of 142 patients with dementia (72 with Alzheimer's disease and 70 with vascular dementia), the association between spontaneous cerebral emboli and clinically relevant depressive symptoms was examined using multiple logistic regression analyses.

Spontaneous cerebral emboli were significantly more frequent in the patients with clinically relevant depressive symptoms (66 v. 37%, P=0.03). After adjustment for age, gender, Mini-Mental State Examination score, type of dementia and significant cardiovascular risk factors, the relationship remained significant (OR=3.47, 95% CI 1.10–10.97).

Spontaneous cerebral emboli are associated with clinically relevant depressive symptoms in dementia, and further research is needed to explore the nature of this relationship.

It is uncertain whether higher doses of selective serotonin reuptake inhibitors have greater efficacy in generalised anxiety disorder.

To assess the efficacy of different doses of escitalopram in generalised anxiety disorder.

Randomised, double-blind, placebo-controlled, fixed-dose, parallel-group, 12-week study, with 681 patients: placebo (n=139); escitalopram, 5 mg/day, (n=134); 10 mg/day (n=136); 20 mg/day (n=133); paroxetine, 20 mg/day (n=139).

Mean change in the primary efficacy measure was greater with escitalopram 10 and 20 mg than with placebo; 10 mg was more efficacious than paroxetine. Paroxetine was superior to placebo on some secondary measures, at sometime points. Compared with placebo, more patients withdrew because of adverse events with escitalopram 20 mg and paroxetine.

Escitalopram was efficacious in generalised anxiety disorder, 20 was not significantly superior to 10 mg/day Escitalopram 10 mg was more efficacious than paroxetine.

A major use of the internet is for health information-seeking. There has been little research into its use in relation to mental health.

To investigate the prevalence of internet use for mental health information-seeking and its relative importance as a mental health information source.

General population survey. Questions covered internet use, past psychiatric history and the 12-item General Health Questionnaire.

Eighteen per cent of all internet users had used the internet for information related to mental health. The prevalence was higher among those with a past history of mental health problems and those with current psychological distress. Only 12% of respondents selected the internet as one of the three most accurate sources of information, compared with 24% who responded that it was one of the three sources they would use.

The internet has a significant role in mental health information-seeking. The internet is used more than it is trusted.