In recent years, the Kraepelinian dichotomy has been challenged in light of evidence on shared genetic and environmental factors for schizophrenia and bipolar disorder, but empirical efforts to identify a transdiagnostic phenotype of psychosis remain remarkably limited.

To investigate whether schizophrenia spectrum and bipolar disorder lie on a transdiagnostic spectrum with overlapping non-affective and affective psychotic symptoms.

Multidimensional item-response modelling was conducted on symptom ratings of the OPerational CRITeria (OPCRIT) system in 1168 patients with schizophrenia spectrum and bipolar disorder.

A bifactor model with one general, transdiagnostic psychosis dimension underlying affective and non-affective psychotic symptoms and five specific dimensions of positive, negative, disorganised, manic and depressive symptoms provided the best model fit and diagnostic utility for categorical classification.

Our findings provide support for including dimensional approaches into classification systems and a directly measurable clinical phenotype for cross-disorder investigations into shared genetic and environmental factors of psychosis.

People with a history of self-harm are at a far greater risk of suicide than the general population. However, the relationship between self-harm and suicide is complex.

To undertake the first systematic review and meta-analysis of prospective studies of risk factors and risk assessment scales to predict suicide following self-harm.

We conducted a search for prospective cohort studies of populations who had self-harmed. For the review of risk scales we also included studies examining the risk of suicide in people under specialist mental healthcare, in order to broaden the scope of the review and increase the number of studies considered. Differences in predictive accuracy between populations were examined where applicable.

Twelve studies on risk factors and 7 studies on risk scales were included. Four risk factors emerged from the metaanalysis, with robust effect sizes that showed little change when adjusted for important potential confounders. These included: previous episodes of self-harm (hazard ratio (HR) = 1.68, 95% CI 1.38–2.05, K = 4), suicidal intent (HR = 2.7, 95% CI 1.91–3.81, K = 3), physical health problems (HR = 1.99, 95% CI 1.16–3.43, K = 3) and male gender (HR = 2.05, 95% CI 1.70–2.46, K = 5). The included studies evaluated only three risk scales (Beck Hopelessness Scale (BHS), Suicide Intent Scale (SIS) and Scale for Suicide Ideation). Where meta-analyses were possible (BHS, SIS), the analysis was based on sparse data and a high heterogeneity was observed. The positive predictive values ranged from 1.3 to 16.7%.

The four risk factors that emerged, although of interest, are unlikely to be of much practical use because they are comparatively common in clinical populations. No scales have sufficient evidence to support their use. The use of these scales, or an over-reliance on the identification of risk factors in clinical practice, may provide false reassurance and is, therefore, potentially dangerous. Comprehensive psychosocial assessments of the risks and needs that are specific to the individual should be central to the management of people who have self-harmed.

Recent studies point to overlap between neuropsychiatric disorders in symptomatology and genetic aetiology.

To systematically investigate genomics overlap between childhood and adult attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and major depressive disorder (MDD).

Analysis of whole-genome blood gene expression and genetic risk scores of 318 individuals. Participants included individuals affected with adult ADHD (n = 93), childhood ADHD (n = 17), MDD (n = 63), ASD (n = 51), childhood dual diagnosis of ADHD–ASD (n = 16) and healthy controls (n = 78).

Weighted gene co-expression analysis results reveal disorder-specific signatures for childhood ADHD and MDD, and also highlight two immune-related gene co-expression modules correlating inversely with MDD and adult ADHD disease status. We find no significant relationship between polygenic risk scores and gene expression signatures.

Our results reveal disorder overlap and specificity at the genetic and gene expression level. They suggest new pathways contributing to distinct pathophysiology in psychiatric disorders and shed light on potential shared genomic risk factors.

Common variants in the Vaccinia-related kinase 2 (VRK2) gene have been associated with schizophrenia, but the relevance of its encoded protein VRK2 in the disorder remains unclear.

To identify potential differences in VRK2 gene expression levels between schizophrenia, bipolar disorder, psychosis not otherwise specified (PNOS) and healthy controls.

VRK2 mRNA level was measured in whole blood in 652 individuals (schizophrenia, n = 201; bipolar disorder, n = 167; PNOS, n = 61; healthy controls, n = 223), and compared across diagnostic categories and subcategories. Additionally, we analysed for association between 1566 VRK2 single nucleotide polymorphisms and mRNA levels.

We found lower VRK2 mRNA levels in schizophrenia compared with healthy controls (P<10–12), bipolar disorder (P<10–12) and PNOS (P = 0.0011), and lower levels in PNOS than in healthy controls (P = 0.0042) and bipolar disorder (P = 0.00026). Expression quantitative trait loci in close proximity to the transcription start site of the short isoforms of the VRK2 gene were identified.

Altered VRK2 gene expression seems specific for schizophrenia and PNOS, which is in accordance with findings from genome-wide association studies. These results suggest that reduced VRK2 mRNA levels are involved in the underlying mechanisms in schizophrenia spectrum disorders.

Radicalisation is proposed to explain why some individuals begin to support and take part in violent extremism. However, there is little empirical population research to inform prevention, and insufficient attention to the role of psychiatric vulnerabilities.

To test the impact of depressive symptoms, adverse life events and political engagement on sympathies for violent protest and terrorism (SVPT).

A cross-sectional survey of a representative sample of Pakistani and Bangladeshi men and women from two English cities. Weighted, multivariable, logistic regression yielded population estimates of association (odds ratio (OR) and 95% confidence intervals) against a binary outcome of SVPT derived from a three-group solution following cluster analysis.

Depressive symptoms were associated with a higher risk of SVPT (OR = 2.59, 95% CI 1.59–4.23, P<0.001), but mediated little of the overall effects of life events and political engagement, which were associated with a lower risk of SVPT (death of a close friend: OR = 0.24, 95% CI 0.07–0.74; donating money to a charity: OR = 0.52, 95% CI 0.3–0.9).

Independent of SVPT associations with depressive symptoms, some expressions of social connectedness (measured as life events and political engagement) are associated with a lower risk of SVPT.

Numerous studies report an association between social support and protection from depression, but no systematic review or meta-analysis exists on this topic.

To review systematically the characteristics of social support (types and source) associated with protection from depression across life periods (childhood and adolescence; adulthood; older age) and by study design (cross-sectional v. cohort studies).

A systematic literature search conducted in February 2015 yielded 100 eligible studies. Study quality was assessed using a critical appraisal checklist, followed by meta-analyses.

Sources of support varied across life periods, with parental support being most important among children and adolescents, whereas adults and older adults relied more on spouses, followed by family and then friends. Significant heterogeneity in social support measurement was noted. Effects were weaker in both magnitude and significance in cohort studies.

Knowledge gaps remain due to social support measurement heterogeneity and to evidence of reverse causality bias.

Criminal offending is strongly transmitted across generations.

To clarify the contribution of rearing environment to cross-generational transmission of crime.

Using Swedish national registries, we identified 1176 full-sibling and 3085 half-sibling sets from high-risk families where at least one sibling was adopted and the other raised by the biological parents.

Risk for criminal conviction was substantially lower in the full- and half-siblings who were adopted v. home-reared (hazard ratios (HR) = 0.56, 95% CI 0.50–0.64 and 0.60, 95% CI 0.56–0.65, respectively). The protective effect of adoption was significantly stronger in sibships with two v. one high-risk parent.

Using matched high-risk full- and half-siblings, we found replicated evidence that (a) rearing environment has a strong impact on risk for criminal conviction, (b) high-quality rearing environments have especially strong effects in those at high familial risk for criminal offending and (c) the protective effects of adoption are stronger for more severe crimes and for repeated offending.

In the UK almost 60% of people with a diagnosis of schizophrenia who use mental health services say they are not involved in decisions about their treatment. Guidelines and policy documents recommend that shared decision-making should be implemented, yet whether it leads to greater treatment-related empowerment for this group has not been systematically assessed.

To examine the effects of shared decision-making on indices of treatment-related empowerment of people with psychosis.

We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of shared decision-making concerning current or future treatment for psychosis (PROSPERO registration CRD42013006161). Primary outcomes were indices of treatment-related empowerment and objective coercion (compulsory treatment). Secondary outcomes were treatment decision-making ability and the quality of the therapeutic relationship.

We identified 11 RCTs. Small beneficial effects of increased shared decision-making were found on indices of treatment-related empowerment (6 RCTs; g = 0.30, 95% CI 0.09–0.51), although the effect was smaller if trials with >25% missing data were excluded. There was a trend towards shared decision-making for future care leading to reduced use of compulsory treatment over 15–18 months (3 RCTs; RR = 0.59, 95% CI 0.35–1.02), with a number needed to treat of approximately 10 (95% CI 5–∞). No clear effect on treatment decision-making ability (3 RCTs) or the quality of the therapeutic relationship (8 RCTs) was found, but data were heterogeneous.

For people with psychosis the implementation of shared treatment decision-making appears to have small beneficial effects on indices of treatment-related empowerment, but more direct evidence is required.

Lithium inhibits glycogen synthase kinase-3, which is an enzyme involved in the pathogenesis of cancer.

To investigate the association between lithium and cancer risk in patients with bipolar disorder.

A retrospective cohort study was designed using the National Health Insurance Research Database (NHIRD) in Taiwan. Patients using lithium comprised the index drug group and patients using anticonvulsants only comprised the control group. Time-dependent Cox regression was used to evaluate the hazard ratios (HRs) for risk of cancer.

Compared with anticonvulsant-only exposure, lithium exposure was associated with significantly lower cancer risk (HR = 0.735, 95% CI 0.554–0.974). The hazard ratios for the first, second and third tertiles of the cumulative defined daily dose were 0.762 (95% CI 0.516–1.125), 0.919 (95% CI 0.640–1.318) and 0.552 (95% CI 0.367–0.831), respectively.

Lithium is associated with reduced overall cancer risk in patients with bipolar disorder. A dose–response relationship for cancer risk reduction was observed.

There is growing risk from terrorism following radicalisation of young men. It is unclear whether psychopathology is associated.

To investigate the population distribution of extremist views among UK men.

Cross-sectional study of 3679 men, 18–34 years, in Great Britain. Multivariate analyses of attitudes, psychiatric morbidity, ethnicity and religion.

Pro-British men were more likely to be White, UK born, not religious; anti-British were Muslim, religious, of Pakistani origin, from deprived areas. Pro- and anti-British views were linearly associated with violence (adjusted odds ratio (OR) = 1.51, 95% CI 1.38–1.64, P<0.001, adjusted OR = 1.33, 95% CI 1.13–1.58, P<0.001, respectively) and negatively with depression (adjusted OR = 0.72, 95% CI 0.61–0.85, P<0.001, adjusted OR = 0.64, 95% CI 0.48–0.86, P = 0.003, respectively).

Men at risk of depression may experience protection from strong cultural or religious identity. Antisocial behaviour increases with extremism. Religion is protective but may determine targets of violence following radicalisation.

The status and differentiation of comorbid borderline personality disorder and bipolar disorder is worthy of clarification.

To determine whether comorbid borderline personality disorder and bipolar disorder are interdependent or independent conditions.

We interviewed patients diagnosed with either a borderline personality disorder and/or a bipolar condition.

Analyses of participants grouped by DSM diagnoses established that those with comorbid conditions scored similarly to those with a borderline personality disorder alone on all key variables (i.e. gender, severity of borderline personality scores, developmental stressors, illness correlates, self-injurious behaviour rates) and differed from those with a bipolar disorder alone on nearly all non-bipolar item variables. Similar findings were returned for groups defined by clinical diagnoses.

Comorbid bipolar disorder and borderline personality disorder is consistent with the formal definition of comorbidity in that, while coterminous, individuals meeting such criteria have features of two independent conditions.

Studies indicate that risk of mortality is higher for patients admitted to acute hospitals at the weekend. However, less is known about clinical outcomes among patients admitted to psychiatric hospitals.

To investigate whether weekend admission to a psychiatric hospital is associated with worse clinical outcomes.

Data were obtained from 45 264 consecutive psychiatric hospital admissions. The association of weekend admission with in-patient mortality, duration of hospital admission and risk of readmission was investigated using multivariable regression analyses. Secondary analyses were performed to investigate the distribution of admissions, discharges, in-patient mortality, episodes of seclusion and violent incidents on different days of the week.

There were 7303 weekend admissions (16.1%). Patients who were aged between 26 and 35 years, female or from a minority ethnic group were more likely to be admitted at the weekend. Patients admitted at the weekend were more likely to present via acute hospital services, other psychiatric hospitals and the criminal justice system than to be admitted directly from their own home. Weekend admission was associated with a shorter duration of admission (B coefficient –21.1 days, 95% CI –24.6 to –17.6, P<0.001) and an increased risk of readmission in the 12 months following index admission (incidence rate ratio 1.13, 95% CI 1.08 to 1.18, P<0.001), but in-patient mortality (odds ratio (OR) = 0.79, 95% CI 0.51 to 1.23, P = 0.30) was not greater than for weekday admission. Fewer episodes of seclusion occurred at the weekend but there was no significant variation in deaths during hospital admission or violent incidents on different days of the week.

Being admitted at the weekend was not associated with an increased risk of in-patient mortality. However, patients admitted at the weekend had shorter admissions and were more likely to be readmitted, suggesting that they may represent a different clinical population to those admitted during the week. This is an important consideration if mental healthcare services are to be implemented across a 7-day week.

Determinants of cross-national differences in the prevalence of mental illness are poorly understood.

To test whether national post-traumatic stress disorder (PTSD) rates can be explained by (a) rates of exposure to trauma and (b) countries' overall cultural and socioeconomic vulnerability to adversity.

We collected general population studies on lifetime PTSD and trauma exposure, measured using the WHO Composite International Diagnostic Interview (DSM-IV). PTSD prevalence was identified for 24 countries (86 687 respondents) and exposure for 16 countries (53 038 respondents). PTSD was predicted using exposure and vulnerability data.

PTSD is related positively to exposure but negatively to country vulnerability. Together, exposure, vulnerability and their interaction explain approximately 75% of variance in the national prevalence of PTSD.

Contrary to expectations based on individual risk factors, we identified a paradox whereby greater country vulnerability is associated with a decreased, rather than increased, risk of PTSD for its citizens.

Bipolar disorder has been associated with cognitive decline, but confirmatory evidence from a community-derived sample of older people is lacking.

To investigate the 13-year risk of dementia and death in older adults with bipolar disorder.

Cohort study of 37 768 men aged 65–85 years. Dementia (primary) and death (secondary), as recorded by electronic record linkage, were the outcomes of interest.

Bipolar disorder was associated with increased adjusted hazard ratio (HR) of dementia (HR = 2.30, 95% CI 1.80–2.94). The risk of dementia was greatest among those with <5 years of history of bipolar disorder or who had had illness onset after 70 years of age. Bipolar disorder was also associated with increased mortality (HR = 1.51, 95% CI 1.28–1.77). Competing risk regression showed that bipolar disorder was associated with increased hazard of death by suicide, accidents, pneumonia or influenza, and diseases of the liver and digestive system.

Bipolar disorder in later life is associated with increased risk of dementia and premature death.