Pharmacological interventions alone do not provide sufficient benefit for some individuals with bipolar disorder.

To determine the effectiveness of psychosocial interventions for the prevention of relapse in bipolar disorder.

A systematic review and meta-analysis of randomised or quasi-randomised controlled trials were conducted.

Cognitive-behavioural therapy or group psychoeducation may be effective for relapse prevention in stable individuals. Family therapy was no more or less effective than individual psychosocial therapy or crisis management. There is no evidence that care management or integrated group therapy is effective in the prevention of relapse.

Cognitive-behavioural therapy, group psychoeducation and possibly family therapy may be beneficial as adjuncts to pharmacological maintenance treatments.

Depression may increase the risk of mortality among certain subgroups of older people, but the part played by antidepressants in this association has not been thoroughly explored.

To identify the characteristics of older populations who are most at risk of dying, as a function of depressive symptoms, gender and antidepressant use.

Adjusted Cox proportional hazards models were used to determine the association between depression and/or antidepressant use and 4-year survival of 7363 community-dwelling elderly people. Major depressive disorder was evaluated using a standardised psychiatric examination based on DSM-IV criteria and depressive symptoms were assessed using the Center for Epidemiological Studies Depression scale.

Depressed men using antidepressants had the greatest risk of dying, with increasing depression severity corresponding to a higher hazard risk. Among women, only severe depression in the absence of treatment was significantly associated with mortality.

The association between depression and mortality is gender-dependent and varies according to symptom load and antidepressant use.

Lack of social interaction, which is characteristically seen in people with autistic-spectrum disorder, may be caused by malfunctioning of the frontostriatal reward systems. However, no reported invivo brain imaging studies have investigated reward mechanisms in autistic-spectrum disorder.

To investigate functional brain activation during reward feedback in people with autistic-spectrum disorder and control individuals.

We used event-related functional magnetic resonance imaging to examine the neural substrates of monetary reward in individuals with autistic-spectrum disorder and matched controls.

When rewarded, individuals with autism compared with control individuals showed significantly greater brain activation in the left anterior cingulate gyrus. In addition, activation of this region was negatively correlated with social interaction as measured by the Autism Diagnostic Interview.

In people with autistic-spectrum disorder, achieving reward is associated with significant differences in the activation of areas known to be responsible for attention and arousal, and this may partially underpin some deficits in social behaviour.

Obsessive-compulsive disorder (OCD) may be related to a dysfunction in frontostriatal pathways mediating inhibitory control. However, no functional magnetic resonance imaging (fMRI) study has tested this in children.

To test whether adolescents with OCD in partial remission would show abnormal frontostriatal brain activation during tasks of inhibition.

Event-related fMRI was used to compare brain activation in 10 adolescent boys with OCD with that of 9 matched controls during three different tasks of inhibitory control.

During a ‘stop’ task, participants with OCD showed reduced activation in right orbitofrontal cortex, thalamus and basal ganglia; inhibition failure elicited mesial frontal underactivation. Task switching and interference inhibition were associated with attenuated activation in frontal, temporoparietal and cerebellar regions.

These preliminary findings support the hypothesis that paediatric OCD is characterised by a dysregulation of frontostriatothalamic brain regions necessary for motor inhibition, and also demonstrate dysfunction of temporoparietal and frontocerebellar attention networks during more cognitive forms of inhibition.

Alexithymia has been shown to be related to many psychiatric and somatic illnesses. Aberrant emotion processing in the brain may underlie several psychiatric disorders. However, little is known about the neurobiological underpinnings of alexithymia.

To determine the way in which the brain processes emotion in alexithymia.

The participants were 10 healthy women with alexithymia and 11 healthy women without this condition, recruited into the study on the basis of their scores on the 20-item Toronto Alexithymia Scale. Four films were projected on a video screen to induce each of three emotional conditions (neutral, amusement, sadness). The brain areas activated during emotional stimuli in the alexithymia group were compared with those activated in the non-alexithymia group. Scans of the distribution of[15O]H2O were acquired using a positron emission tomography (PET) scanner operated in three-dimensional mode.

In response to emotional stimuli participants with alexithymia activated more parts of their sensory and motor cortices and insula, especially on the left side, and less of their anterior cingulate, compared with the control group.

Women with alexithymia seem to over-activate their ‘bodily’ brain regions, implying a different mode of emotion processing. This may be related to their tendency to experience physical symptoms.

The estimated prevalence of clinically significant psychiatric and somatic symptoms in adults >1 year after the 2004 Asian tsunami is unknown.

To estimate the prevalence of psychiatric and somatic symptoms and impairment in Sri Lanka 20–21 months after the 2004 Asian tsunami, and to assess coping strategies used by tsunami-affected individuals that contribute to post-tsunami adjustment.

Homes from one severely affected area were randomly selected, and adult respondents were sampled utilising a modified Kish method. Instruments were administered in Sinhala to assess exposure, post-traumatic stress disorder (PTSD), depression, anxiety, somatic distress and impairment. Demographic variables and culturally-relevant coping activities were assessed.

The prevalence of clinically significant PTSD, depression and anxiety was 21%, 16% and 30% respectively. Respondents reported a mean of eight persistent and bothersome somatic complaints, which were associated with psychiatric symptoms and impairment. Thinking that one's life was in danger was the exposure item most strongly associated with symptoms and impairment. The majority of respondents found their own strength, family and friends, a Western-style hospital and their religious practice to be the most helpful coping aids.

A large minority of adults in one area of Sri Lanka reported significant psychiatric and somatic symptoms and impairment 20–21 months after the tsunami. Accurate data about risk for and resilience to impairing symptoms > 1 year after disasters are necessary in order to develop rational surveillance and interventions.

Adolescents comprise a fifth of the population of India, but there is little research on their mental health. We conducted an epidemiological study in the state of Goa to describe the current prevalence of mental disorders and its correlates among adolescents aged between 12 and 16 years.

To estimate the prevalence and correlates of mental disorders in adolescents.

Population-based survey of all eligible adolescents from six urban wards and four rural communities which were randomly selected. We used a Konkani translation of the Development and Well-Being Assessment to diagnose current DSM-IV emotional and behavioural disorders. All adolescents were also interviewed on socio-economic factors, education, neighbourhood, parental relations, peer and sexual relationships, violence and substance use.

Out of 2684 eligible adolescents, 2048 completed the study. The current prevalence of any DSM-IV diagnosis was 1.81%; 95% CI 1.27–2.48. The most common diagnoses were anxiety disorders (1.0%), depressive disorder (0.5%), behavioural disorder (0.4%) and attention-deficit hyperactivity disorder (0.2%). Adolescents from urban areas and girls who faced gender discrimination had higher prevalence. The final multivariate model found an independent association of mental disorders with an outgoing ‘non-traditional’ lifestyle (frequent partying, going to the cinema, shopping for fun and having a boyfriend or girlfriend), difficulties with studies, lack of safety in the neighbourhood, a history of physical or verbal abuse and tobacco use. Having one's family as the primary source of social support was associated with lower prevalence of mental disorders.

The current prevalence of mental disorders in adolescents in our study was very low compared with studies in other countries. Strong family support was a critical factor associated with low prevalence of mental disorders, while factors indicative of adoption of a non-traditional lifestyle were associated with an increased prevalence.

The Montgomery-Åsberg Depression Rating Scale (MADRS) is often used in clinical trials to select patients and to assess treatment efficacy. The scale was originally published without suggested questions for clinicians to use in gathering the information necessary to rate the items. Structured and semi-structured interview guides have been found to improve reliability with other scales.

To describe the development and test-retest reliability of a structured interview guide for the MADRS (SIGMA).

A total of 162 test-retest interviews were conducted by 81 rater pairs. Each patient was interviewed twice, once by each rater conducting an independent interview.

The intraclass correlation for total score between raters using the SIGMA was r = 0.93, P < 0.0001. All ten items had good to excellent interrater reliability.

Use of the SIGMA can result in high reliability of MADRS scores in evaluating patients with depression.

There is current interest in exploring the different subtypes of mild cognitive impairment (MCI), in terms of both their epidemiology and their cognitive profile.

To examine the frequency of MCI subtypes presenting to a memory clinic and to document detailed neuropsychological profiles of patients with the amnestic subtype.

Consecutive tertiary referrals (n = 187) were psychiatrically evaluated; 45 patients met criteria for amnestic mild cognitive impairment (aMCI). A subgroup of 33 patients with aMCI as well as 21 healthy controls took part in a thorough neuropsychological examination.

Of the patients who were examined in greater neuropsychological detail, ten had pure aMCI (none with visual memory impairment only). Fifteen met criteria for non-amnestic MCI. Fifteen had normal neuropsychological profiles. Using more than one test increased sensitivity to detect episodic memory impairment.

Amnestic MCI is an important diagnosis in secondary and tertiary memory clinics. There is scope to improve the efficacy and sensitivity of the clinical assessment of this impairment.