Social adversities are accepted as critical factors in the development of psychopathology in young people, but the precise mechanisms of this relationship are unknown.

To explore sources of evidence and suggest future lines of research to clarify the relationship between exposure to negative circumstances and development of psychopathology in young people.

Selective survey of the literature to collect a series of hypotheses that might serve as a framework for future research.

Evidence to date suggests there is no simple relationship between adverse life events and the subsequent emergence of psychopathology. The interplay of acute and chronic stressors over the lifespan with affective temperament; the interrelationship of ‘sensitivity’ and ‘performance’ cognitions in response to life events; and limbic-cortical neural networks are all indicated as important avenues of future research.

Neurological soft signs (NSS) are minor neurological signs indicating non-specific cerebral dysfunction. Their presence has been documented extensively in schizophrenia but not during the first psychotic episode.

To review studies that have specifically investigated NSS at the time of the first psychotic episode.

A review of studies investigating neurological function in first-episode psychosis, using a clinical examination.

Patients with first-episode psychosis show an excess of NSS, particularly in the areas of motor coordination and sequencing, sensory integration and in developmental reflexes. Furthermore, NSS may be associated with a specific laterality pattern.

More studies on first-onset schizophrenia are needed, evaluating both sensory and motor neurological domains (scoring separately for the two sides of the body), integrating this knowledge with neuroimaging findings and clarifying the role of NSS as markers of cognitive dysfunction.

Neurological soft signs preceding adult-onset schizophrenia suggest a neurodevelopmental origin and could reflect physical illness in childhood.

To investigate possible associations of adult-onset psychosis with neurological soft signs and common infectious illnesses in childhood.

Using data from the UK National Child Development Study, a longitudinal general population sample, odds ratios were calculated for clinical diagnoses of common childhood viral illnesses and later adult psychotic illness, childhood epilepsy and a range of neurological soft signs.

The number of illnesses per individual did not relate either to the number of soft signs, or to any particular adult outcome. Schizophrenia, affective psychosis and epilepsy were not associated with common childhood illness but were associated with neurological soft signs and an increased, but small, frequency of previous meningitis and tuberculosis.

Overall the data support the notion of neurological soft signs as markers of disordered neurodevelopment in schizophrenia (but the early neurological abnormalities are not caused by infectious illness) and an association between meningitis or tuberculosis in childhood and a small proportion of cases of epilepsy, affective psychosis and schizophrenia.

Data on the duration of major depressive episodes (MDE) in the general population are sparse.

To assess the duration of MDE and its clinical and socio-demographic determinants in a study group drawn from the general population with newly originated episodes of major depression.

The Netherlands Mental Health Survey and Incidence Study is a prospective epidemiological survey in the adult population (n=7076), using the Composite International Diagnostic Interview. Duration of MDE over 2 years was assessed with a Life Chart Interview.

The median duration of MDE was 3.0 months; 50% of participants recovered within 3 months, 63% within 6 months, 76% within 12 months and nearly 20% had not recovered at 24 months. Determinants of persistence were severity of depression and comorbid dysthymia. A recurrent episode predicted shorter duration.

Although half of those affected with MDE recovered rapidly, the risk of chronicity (duration 24months or more) was considerable. This underlines the necessity of diagnosing and treating those at risk.

Structural brain abnormalities are prevalent in patients with schizophrenia and affective disorders.

To study how regional brain volumes and their ratios differ between patients with schizophrenia, psychotic depression, severe non-psychotic depression and healthy controls.

Magnetic resonance imaging scans of the brain on first-episode patients and on healthy controls.

Patients with schizophrenia had a smaller left frontal grey matter volume than the other three groups. Patients with psychotic depression had larger ventricular and posterior sulcal cerebrospinal fluid (CSF) volumes than controls. Patients with depression had larger white matter volumes than the other patients.

Left frontal lobe, especially its grey matter volume, seems to be specifically reduced in first-episode schizophrenia. Enlarged cerebral ventricles and sulcal CSF volumes are prevalent in psychotic depression. Preserved or expanded white matter is typical of non-psychotic depression.

Certain personality traits may mediate the relationship between familiality and adversity in causing depression.

The high rates of psychiatric morbidity in prisoners vary between ethnic groups.

To compare early environmental risks, stressful daily living experiences and reported use of psychiatric services in prisoners from different ethnic groups.

Cross-sectional survey of 3142 prisoners in all penal establishments in England and Wales in 1997.

Fewer Black and South Asian male prisoners reported childhood traumas and conduct disorder, and fewer Black prisoners experienced stressful prison experiences, than White prisoners. Fewer Black women had received previous psychiatric treatment, and fewer Black men had their psychiatric problems identified in prison. Black prisoners were less likely to have received psychiatric treatment than Whites.

The lower prevalence of psychiatric morbidity observed in Black prisoners corresponds with reduced exposure to risk factors. Higher rates of imprisonment might be explained by higher rates of conduct disorder, adolescent-onset criminality and disadvantage within the criminal justice system.

The highly recurrent nature of major depression in the young and the elderly warrants long-term antidepressant treatment.

To compare the prophylactic efficacy of citalopram and placebo in elderly patients; to evaluate long-term tolerability of citalopram.

Out-patients, ⩾65 years, with unipolar major depression (DSM – IV: 296.2 x or 296.3 x) and Montgomery – Åsberg Depression Rating Scale score ⩾22 were treated with citalopram 20–40 mg for 8 weeks. Responders continued on their final fixed dose of citalopram for 16 weeks before randomisation to double-blind treatment with citalopram or placebo for at least 48 weeks.

Nineteen of the 60 patients using citalopram v. 41 of the 61 patients using placebo had recurrence. Time to recurrence was significantly different between citalopram— and placebo-patients, in favour of citalopram (log-rank test, P < 0.0001). Long-term treatment was well tolerated.

Long-term treatment with citalopram is effective in preventing recurrence of depression in the elderly and is well tolerated.

Impaired intellectual performance is associated with an increased risk of schizophrenia.

To investigate whether this association is due to the influence of prenatal and early childhood exposures on both intellectual development and the risk of schizophrenia.

Cohort of 197 613 Swedish male conscripts with linked birth, census and hospital admission data together with five measures of verbal and non-verbal intellectual performance recorded at conscription. Results 109 643 subjects had complete data; over a mean 5-year follow-up, 60 developed schizophrenia and 92 developed other non-affective psychoses. Poor scores for each of the five tests were associated with 3-to 14-fold increased risk of psychosis, particularly schizophrenia. Controlling for birth-related exposures, including birth weight, and parental education did not attenuate these associations.

109 643 subjects had complete data; over amean 5-year follow-up,60 developed schizophrenia and 92 developed other non-affective psychoses. Poor scores for each of the five testswere associatedwith 3-to 14-foldincreasedrisk of psychosis, particularly schizophrenia. Controlling for birth-related exposures, including birthweight, and parental education didnot attenuate these associations.

Poor intellectual performance at 18 years of age is associated with early-onset psychotic disorder. Associations do not appear to be confounded by prenatal adversity or childhood circumstances, as indexed by parental education.

This is the first report on the epidemiology of psychiatric disorders and needs for psychiatric treatment in the District of Derry, Northern Ireland.

To assess the prevalence of psychiatric disorder and the needs for treatment in the general population of Derry.

The sample was drawn at random with a two-phase design using the General Health Questionnaire (GHQ–28) during the first phase, and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) with the Needs for Care Assessment (NFCAS–C) in the second phase.

The second phase (n=307) gave a weighted 1-month prevalence of hierarchically ordered ICD–10 psychiatric disorders of 7.5% and a 1-year prevalence of 12.2%. The equivalent prevalences for depressive disorders were 2.4% and 6.0%, respectively, and those for anxiety states were 3.5% and 3.7%. Only a quarter of needs for treatment were met, with the situation being better for depression than for anxiety.

The rates of psychiatric disorder in Derry were even higher than those reported by a similar survey in inner London. This almost certainly reflects the very high levels of social deprivation in the District. Needs for treatment were often unmet.

The links between drug use and psychosis are of major aetiological and prognostic significance. Psychosis and drug dependence frequently co-occur within the prison population, providing the opportunity to study this link more closely.

To explore the relationship between psychosis and drug dependence in a sample of prisoners.

A total of 3142 prisoners were surveyed nationally and structured clinical data were obtained from a subsample of 503 respondents. Psychiatric assessment was based on the Schedules for Clinical Assessment in Neuropsychiatry (version 1.0). Measures of amphetamine, cannabis, cocaine and heroin use and dependence were obtained through self-report.

Logistic regression analyses indicated that first use of amphetamines or cocaine before the age of 16 years and severe cannabis or cocaine dependence were related to an increased risk of psychosis. In contrast, severe dependence on heroin was associated with a reduced risk of this classification.

Severe dependence on cannabis and psychostimulants is associated with a higher risk of psychosis and is in contrast to severe dependence on heroin, which has a negative relationship with psychosis.

The most damaging effect of stigma is the internalisation of others' negative valuations.

To explore the factors that mediate patients' emotional and cognitive responses to stigma.

Based on responses to 10 open-ended questions about stigma appended to the Chinese version of the Camberwell Family Interview, trained coders rated the effect of stigma on both patients and family members in 1491 interviews conducted with 952 family members of 608 patients with schizophrenia at 5 sites around China from 1990 to 2000.

Family members reported that stigma had had a moderate to severe effect on the lives of patients over the previous 3 months in 60% of the interviews, and on the lives of other family members in 26% of the interviews. The effect of stigma on patients and family members was significantly greater if the respondent had a high level of expressed emotion, if the patient had more severe positive symptoms, if the respondent was highly educated and if the family lived in a highly urbanised area.

Clinicians should assess the effect of stigma as part of the standard work-up for patients with mental illness, and help patients and family members reduce the effect of stigma on their lives.

It is not clear whether the increased mortality associated with depression can be explained by the effects of potential confounding variables.

To measure the effect of depression on mortality after controlling for cognitive decline, cardiovascular risk factors and antidepressant use.

A prospective cohort study derived from data from a multi-centre randomised controlled trial of moderate hypertension. Atotal of2584 participants, aged 65–75 years at study entry, were followed up for 11 years.

Depression on the SelfCARE-D scale was associated with mortality after controlling for gender. After controling for cardiovascular risk factors, cognitive decline and anti-depressant use, depression continued to have a modest effect (hazard ratio⩵l.43; 95% CI 1.03–1.98). Depression in males and in people aged under 70 years significantly increased the risk of death.

Depression was associated with mortality only after controlling for gender. There was a modest but robust association between depression and mortality that was not explained by confounding by cardiovascular risk factors, cognitive decline or history of antidepressant use.

Previous studies have shown a positive relationship between disease severity and cost.

To explore the factors affecting time to institutionalisation and estimate the relationship between the costs of care and disease progression.

Retrospective analysis of a longitudinal data-set for a cohort of 100 patients diagnosed with Alzheimer's disease or vascular dementia.

Changes in both Mini-Mental State Examination (MMSE) and Barthel scores have independent and significant marginal effects on costs. Each one-point decline in the MMSE score is associated with a £56 increase in the four-monthly costs, whereas each one-point fall in the Barthel index is associated with a £586 increase in costs.

It may be inappropriate for economic models of disease progression in dementia to be based solely on measures of cognitive change. MMSE and the Barthel index are independent significant predictors of time to institutionalisation and cost of care, but changes in the Barthel index are particularly important in predicting costs outside institutional care.

Comorbidity in epidemiological surveys of mental disorders is common and of uncertain importance.

To explore the correlates of current comorbidity.

Data from the Australian National Survey of Mental Health and Well-Being were used to evaluate the relationships between comorbidity, disability and service utilisation associated with particular mental disorders.

The number of current comorbid disorders predicted disability, distress, neuroticism score and service utilisation. Comorbidity is more frequent than expected, which might be due to the effect of one disorder on the symptom level of another, or to the action of common causes on both. The combination of affective and anxiety disorders was more predictive of disability and service utilisation than any other two or three group combinations. When people nominated their principal disorder as the set of symptoms that troubled them the most, the affective and anxiety disorders together were associated with four-fifths of the disability and service utilisation.

To make clinical interventions more practical, current comorbidity is best reduced to a principal disorder and subsidiary disorders.

Although brain volume changes are found in schizophrenia, only a limited number of structural magnetic resonance imaging studies have exclusively examined antipsychotic-naïve patients.

To comprehensively investigate multiple brain structures in a single sample of patients who were antipsychotic-naïve.

Twenty antipsychotic-naïve patients with first-episode schizophrenia and 20 healthy comparison subjects were included. Intracranial, total brain, frontal lobe, grey and white matter, cerebellar, hippocampal, parahippocampal, thalamic, caudate nucleus and lateral and third ventricular volumes were measured. Repeated-measures analyses of (co)variance were conducted with intracranial volume as covariate.

Third ventricle volume enlargement was found in patients compared with the healthy subjects. No differences were found in other brain regions.

These findings suggest that some brain abnormalities are present in the early stages of schizophrenia. Moreover, it suggests that brain abnormalities reported in patients with chronic schizophrenia develop in a later stage of the disease and/or are medication induced.

Neuroimaging studies have demonstrated changes in the dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC) in major depression.

We investigated the expression of cell adhesion molecules (CAMs) in the prefrontal cortex in depression.

Immunohistochemistry to localise CAMs in post-mortem tissue from 20 subjects with major depression and 20 controls, and image analysis to quantify their expression.

We found significant increases in CAMs in the grey matter ofthe DLPFC in the depression group but no comparable differences in the ACC or occipital cortex. In the white matter there was a non-significant increase in intercellular adhesion molecule-1 in the DLPFC in the depression group but no increase in the other areas or for vascular cell adhesion molecule-1 in any area. Paired tests showed specificity for the DLPFC in the depression group only.

Theincreasein CAM expression in the DLPFC suggests an inflammatory reaction and is consistent with ischaemia.

Stigma affects not only people with mental illnesses, but their families as well. Understanding how stigma affects family members in terms of both their psychological response to the ill person and their contacts with psychiatric services will improve interactions with the family.

To investigate factors of psychological significance related to stigma of the relatives.

In a Swedish multi-centre study, 162 relatives of patients in acute psychiatric wards following both voluntary and compulsory admissions were interviewed concerning psychological factors related to stigma.

A majority of relatives experienced psychological factors of stigma by association. Eighteen per cent of the relatives had at times thought that the patient would be better off dead, and 10% had experienced suicidal thoughts. Stigma by association was greater in relatives experiencing mental health problems of their own, and was unaffected by patient background characteristics.

Interventions are needed to reduce the negative effects of psychological factors related to stigma by association in relatives of people with mental illness.

In the UK, people with mental disorder thought to pose a high risk of harm to others are usually put in a high-security (special) hospital. Little is known about what happens after that.

To test a hypothesis that, under current services and laws (from the mid-1980s), no one leaving high-security hospitals remains indefinitely institutionalised.

The special hospitals' case register was used for case ascertainment and admission data; post-discharge data were collected from multiple sources on patients discharged in 1984 (census date 31.12.1995).

In this discharge cohort (n=223), 36 (17%) did not return to the community: 17 died in special hospital and 19 continuously lived in other institutions until death or the census date. Over two-thirds of these had mental illness, were older on admission and had lived longer in special hospital than their better-rehabilitated peers. Offending history was irrelevant to this. Most post-discharge institution time was in open psychiatric hospital, or back in special hospital, not in medium secure units or prison.

The hypothesis was not sustained, but fewer people never reached the community than before the mid-1980s. Atypical antipsychotics might reduce this number. We found no justification for a new tier of long-term medium secure units.