The duration of untreated psychosis (DUP), the period between the first onset of psychotic symptoms and treatment, has an important influence on the outcome of schizophrenia.

To compare the published studies of DUP in low- and middle-income (LAMI) countries with the DUP of high-income countries, and examine a possible association between DUP and per capita income.

We used six search strategies to locate studies of the DUP from LAMI countries published between January 1975 and January 2008. We then examined the relationship between DUP and measures of economic activity, which was assessed using the LAMI classification of countries and gross domestic product (GDP) purchasing power parity.

The average mean DUP in studies from LAMI countries was 125.0 weeks compared with 63.4 weeks in studies from high-income countries (P=0.012). Within the studies from LAMI countries, mean DUP fell by 6 weeks for every $1000 of GDP purchasing power parity.

There appears to be an inverse relationship between income and DUP in LAMI countries. The cost of treatment is an impediment to care and subsidised antipsychotic medication would improve the access to treatment and the outcome of psychotic illness in LAMI countries.

There are claims that second-generation antipsychotics produce fewer extrapyramidal side-effects (EPS) compared with first-generation drugs.

To compare the incidence of treatment-emergent EPS between second-generation antipsychotics and perphenazine in people with schizophrenia.

Incidence analyses integrated data from standardised rating scales and documented use of concomitant medication or treatment discontinuation for EPS events. Mixed model analyses of change in rating scales from baseline were also conducted.

There were no significant differences in incidence or change in rating scales for parkinsonism, dystonia, akathisia or tardive dyskinesia when comparing second-generation antipsychotics with perphenazine or comparing between second-generation antipsychotics. Secondary analyses revealed greater rates of concomitant antiparkinsonism medication among individuals on risperidone and lower rates among individuals on quetiapine, and lower rates of discontinuation because of parkinsonism among people on quetiapine and ziprasidone. There was a trend for a greater likelihood of concomitant medication for akathisia among individuals on risperidone and perphenazine.

The incidence of treatment-emergent EPS and change in EPS ratings indicated that there are no significant differences between second-generation antipsychotics and perphenazine or between second-generation antipsychotics in people with schizophrenia.

Neurotoxic effects of ecstasy have been reported, although it remains unclear whether effects can be attributed to ecstasy, other recreational drugs or a combination of these.

To assess specific/independent neurotoxic effects of heavy ecstasy use and contributions of amphetamine, cocaine and cannabis as part of The Netherlands XTC Toxicity (NeXT) study.

Effects of ecstasy and other substances were assessed with 1H-magnetic resonance spectroscopy, diffusion tensor imaging, perfusion weighted imaging and [123I]2β-carbomethoxy-3β-(4-iodophenyl)-tropane ([123I]β-CIT) single photon emission computed tomography (serotonin transporters) in a sample (n=71) with broad variation in drug use, using multiple regression analyses.

Ecstasy showed specific effects in the thalamus with decreased [123I]β-CIT binding, suggesting serotonergic axonal damage; decreased fractional anisotropy, suggesting axonal loss; and increased cerebral blood volume probably caused by serotonin depletion. Ecstasy had no effect on brain metabolites and apparent diffusion coefficients.

Converging evidence was found for a specific toxic effect of ecstasy on serotonergic axons in the thalamus.

Outcome from psychotic disorders is heterogeneous with poorer outcomes frequently identified too late to be influenced. Symptomatic ratings at 1 or more years following initiation of treatment have been related to cognition in firstepisode psychosis. However, the relationship between cognition and early outcome remains unclear.

To determine whether specific cognitive domains could identify poor short-term outcome among individuals with first-episode psychosis.

One hundred and fifty-one individuals with first-episode psychosis were divided into two groups based on 6-month clinical data after the initiation of treatment. Six cognitive domains were compared among 78 participants with poor outcomes, 73 with good outcomes and 31 healthy controls.

Lower performance on verbal memory (z-scores: poor outcome=–1.3 (s.d.=1.1); good outcome=–0.8 (s.d.=0.9); P=0.001) and working memory (poor outcome=–1.0 (s.d.=1.2); good outcome=–0.4 (s.d.=0.9); P=0.003) identified individuals with first-episode psychosis with a poor outcome after 6 months of treatment.

The early identification of those individuals with first-episode psychosis with a poor clinical outcome may encourage clinicians to pay special attention to them in the form of alternative pharmacological and psychological treatments for a more favourable outcome in the long term.

A number of studies with conflicting results have examined the familiality of schizophrenia syndromes in Western populations.

The objective of this study was to determine, using clinical data from concordant sibling pairs, whether symptom dimensions and other clinical characteristics of schizophrenia show familial aggregation and are therefore potentially useful traits in genetic studies.

We measured clinical and demographic features, and symptom dimensions of schizophrenia in 137 families from China who had two or more affected members with schizophrenia. Within-sibling pair correlation was assessed with intraclass correlation coefficient and kappa statistics.

Global functioning, positive, disorganisation and dysphoric symptoms, premorbid schizotypal and schizoid traits, premorbid social adjustment, type and age at illness onset all showed significant evidence of familial aggregation. DSM–IV schizophrenia subtypes were also found to be familial.

This is the first study in a large non-European population to confirm that schizophrenia dimensions and clinical characteristics show significant familiality, implying possible heritability. This supports their use in the delineation of homogeneous subsets for future genetic studies.

Women with schizophrenia are at increased risk for adverse pregnancy outcomes. It is not known whether offspring born to fathers with schizophrenia also have an increased risk.

To evaluate paternal and maternal influences on the association between schizophrenia and pregnancy outcomes.

A record linkage including 2 million births was made using Swedish population-based registers. The risk for adverse pregnancy outcomes was evaluated through logistic regression.

Offspring with a mother or father with schizophrenia faced a doubled risk of infant mortality, which could not be explained by maternal behaviour alone during pregnancy. Excess infant death risk was largely attributable to post-neonatal death. Maternal factors (e.g. smoking) explained most of the other risks of adverse pregnancy outcomes among both mothers and fathers with schizophrenia.

The risks to offspring whose fathers had schizophrenia suggest that, in addition to maternal risk behaviour, nonoptimal social and/or parenting circumstances are of importance.

Previous studies have reported the association between advanced paternal age at birth and the risk of autistic-spectrum disorder in offspring, including offspring with intellectual disability.

To test whether an association between advanced paternal age at birth is found in offspring with high-functioning autistic-spectrum disorder (i.e. offspring without intellectual disability).

A case–control study was conducted in Japan. The participants consisted of individuals with full-scale IQ ⩾ 70, with a DSM–IV autistic disorder or related diagnosis. Unrelated healthy volunteers were recruited as controls. Parental ages were divided into tertiles (i.e. three age classes). Odds ratios and 95% confidence intervals were estimated using logistic regression analyses, with an adjustment for age, gender and birth order.

Eighty-four individuals with autistic-spectrum disorder but without intellectual disability and 208 healthy controls were enrolled. Increased paternal, but not maternal, age was associated with an elevated risk of high-functioning autistic-spectrum disorder. A one-level advance in paternal age class corresponded to a 1.8-fold increase in risk, after adjustment for covariates.

Advanced paternal age is associated with an increased risk for high-functioning autistic-spectrum disorder.

Smoking is disproportionately prevalent among people with psychiatric illness.

To investigate smoking as a risk factor for major depressive disorder.

A population-based sample of women was studied using case–control and retrospective cohort study designs. Exposure to smoking was self-reported, and major depressive disorder diagnosed using the Structured Clinical Interview for DSM–IV–TR (SCID–I/NP).

Among 165 people with major depressive disorder and 806 controls, smoking was associated with increased odds for major depressive disorder (age-adjusted odds ratio (OR)=1.46, 95% CI 1.03–2.07). Compared with non-smokers, odds for major depressive disorder more than doubled for heavy smokers (>20 cigarettes/day). Among 671 women with no history of major depressive disorder at baseline, 13 of 87 smokers and 38 of 584 non-smokers developed de novo major depressive disorder during a decade of follow-up. Smoking increased major depressive disorder risk by 93% (hazard ratio (HR)=1.93, 95% CI 1.02–3.69); this was not explained by physical activity or alcohol consumption.

Evidence from cross-sectional and longitudinal data suggests that smoking increases the risk of major depressive disorder in women.

Antidepressants and anxiolytics have demonstrated short-term efficacy; however, little is known about the long-term effectiveness of these drugs.

To investigate long-term psychiatric outcomes following antidepressant and/or anxiolytic use during an episode of mental disorder in mid-life.

Members of the 1946 British birth cohort were assessed for symptoms of depression and anxiety at age 43. Among 157 with mental disorder, those using antidepressants and/or anxiolytics were compared with those not using medications on psychiatric outcomes at age 53.

Use of antidepressants or anxiolytics was associated with a lower prevalence of mental disorder at age 53 (odds ratio (OR)=0.3, 95% CI 0.1–1.0) after adjustment for eight variables in a propensity-for-treatment analysis. Only 24% of those being treated with medications at age 43 were still using them at 53.

Use of antidepressants or anxiolytics during an episode of mental disorder may have long-term beneficial effects on mental health. This may be because of a demonstrated willingness to seek help rather than long-term maintenance therapy.

Little is known about the management of health anxiety and hypochondriasis in secondary care settings.

To determine whether cognitive–behavioural therapy (CBT) along with a supplementary manual was effective in reducing symptoms and health consultations in patients with high health anxiety in a genitourinary medicine clinic.

Patients with high health anxiety were randomly assigned to brief CBT and compared with a control group.

Greater improvement was seen in Health Anxiety Inventory (HAI) scores (primary outcome) in patients treated with CBT (n=23) than in the control group (n=26) (P=0.001). Similar but less marked differences were found for secondary outcomes of generalised anxiety, depression and social function, and there were fewer health service consultations. The CBT intervention resulted in improvements in outcomes alongside higher costs, with an incremental cost of £33 per unit reduction in HAI score.

Cognitive–behavioural therapy for health anxiety within a genitourinary medicine clinic is effective and suggests wider use of this intervention in medical settings.