Cardiac vagal tone, indexed by heart rate variability (HRV), is a proxy for the functional integrity of feedback mechanisms integrating central and peripheral physiology.

To quantify differences in HRV in individuals with schizophrenia compared with healthy controls.

Databases were systematically searched for studies eligible for inclusion. Random effect meta-analyses of standardised mean differences were calculated for vagal activity indicated by high-frequency HRV and the root mean square of successive R–R interval differences (RMSSD).

Thirty-four studies were included. Significant main effects were found for high-frequency HRV (P = 0.0008; Hedges'g =–0.98, 95% CI −1.56 to −0.41, k = 29) and RMSSD (P<0.0001; g =–0.91, 95% CI −1.19 to −0.62, k = 24), indicating lower vagal activity in individuals with schizophrenia than in healthy controls. Considerable heterogeneity was evident but effects were robust in subsequent sensitivity analyses.

Given the association between low HRV, threat processing, emotion regulation and executive functioning, reduced vagal tone may be an endophenotype for the development of psychotic symptoms.

Secure hospitals are a high-cost, low-volume service consuming around a fifth of the overall mental health budget in England and Wales.

A systematic review and meta-analysis of adverse outcomes after discharge along with a comparison with rates in other clinical and forensic groups in order to inform public health and policy.

We searched for primary studies that followed patients discharged from a secure hospital, and reported mortality, readmissions or reconvictions. We determined crude rates for all adverse outcomes.

In total, 35 studies from 10 countries were included, involving 12 056 patients out of which 53% were violent offenders. The crude death rate for all-cause mortality was 1538 per 100 000 person-years (95% CI 1175–1901). For suicide, the crude death rate was 325 per 100 000 person-years (95% CI 235– 415). The readmission rate was 7208 per 100 000 person-years (95% CI 5916–8500). Crude reoffending rates were 4484 per 100 000 person-years (95% CI 3679–5287), with lower rates in more recent studies.

There is some evidence that patients discharged from forensic psychiatric services have lower offending outcomes than many comparative groups. Services could consider improving interventions aimed at reducing premature mortality, particularly suicide, in discharged patients.

The aetiological boundary between obsessive–compulsive related disorders (OCRDs) including obsessive–compulsive disorder (OCD) and anxiety disorders is unclear and continues to generate debate.

To determine the genetic overlap and the pattern of causal relationships among OCRDs and anxiety disorders.

Multivariate twin modelling methods and a new regression analysis to infer causation were used, involving 2495 male and female twins.

The amount of common genetic liability observed for OCD symptoms was higher when considering anxiety disorders and OCRDs in the modelv. modelling OCRD symptoms alone. OCD symptoms emerged as risk factors for the presence of generalised anxiety, panic and hoarding symptoms, whereas social phobia appeared as a risk factor for OCD symptoms.

OCD represents a complex phenotype that includes important shared features with anxiety disorders and OCRDs. The novel patterns of risk identified between OCD and anxiety disorder may help to explain their frequent co-occurrence.

Early-life adversity is a risk for obsessive–compulsive disorder (OCD), but the impact at the neural level is less clear.

To investigate the association between brain volumes and early-life adversity in individuals with a diagnosis of OCD only.

The Childhood Trauma Questionnaire (CTQ-28) was used to assess early-life adversity in 21 participants with OCD and 25 matched healthy controls. The relationship between global and regional brain volume and early-life adversity was measured using voxel-based morphometry (VBM). All data were corrected for multiple comparisons using family-wise error (FWE) atP<0.05.

In the OCD group, correlations with total CTQ scores were positively associated with a larger right orbitofrontal cortex volume. Physical neglect was higher in the OCD group than in controls and was positively associated with larger right cerebellum volume in the OCD group only.

Larger brain volumes may reflect underlying developmental neuropathology in adults with OCD who also have experience of childhood trauma.

The monoamine oxidase A (MAOA) gene has been shown to moderate the impact of maltreatment on antisocial behaviour. Replication efforts have, however, yielded inconsistent results.

To investigate whether the interaction between the MAOA gene and violence is present across the full distribution of violence or emerges at higher levels of exposure.

Participants were 327 male members of the Québec Longitudinal Study of Kindergarten Children. Exposure to violence comprised retrospective reports of mother's and father's maltreatment, sexual and physical abuse. Conduct disorder and antisocial personality symptoms were assessed in semi-structured interviews and partner violence, property-violent crimes and arrest were self-reported.

Non-linear interactions between the MAOA gene and violence were detected, suggesting that the genetic moderation may come about once a certain level of violence is experienced.

Future studies should investigate the mechanisms translating substantial violence exposure, which could, subsequently, trigger the expression of genetically based differences in antisocial behaviour.

The relationship between ethnic density and psychiatric disorder in postnatal women in the UK is unclear.

To examine the effect of own and overall ethnic density on postnatal depression (PND) and personality dysfunction.

Multilevel analysis of ethnically mixed community-level data gathered from a sample of 2262 mothers screened at 6 weeks postpartum for PND and personality dysfunction.

Living in areas of higher own ethnic density was protective against screening positive for PND in White women (z =–3.18,P = 0.001), even after adjusting for area level deprivation, maternal age, relationship status, screening positive for personality dysfunction, parity and geographical clustering (odds ratio (OR) 0.98 (95% CI 0.96–0.99); P = 0.002), whereas the effect on personality dysfunction (z =–2.42,P = 0.016) was no longer present once the effect of PND was taken into account (OR = 0.99 (95% CI 0.90–1.0);P = 0.13). No overall ethnic density effect was found for women screening positive for PND or personality dysfunction.

In White women, living in areas of higher own ethnic density was protective against developing PND.

Light severely affects the occurrence of seasonal affective disorder (SAD).

To compare the prevalence of SAD in persons with severe visual impairment and persons with full sight, and in persons with severe visual impairment with or without light perception.

This cross-sectional study assessed the Global Seasonality Score (GSS) and the prevalence of SAD among 2781 persons with visual impairment and 4099 persons with full sight using the Seasonal Pattern Assessment Questionnaire (SPAQ).

Respondents with visual impairment had significantly higher GSS and prevalence of SAD compared with full sight controls, P<0.001. Light perception respondents were more vulnerable to seasonal change than both full sight and no light perception respondents.

The study showed a highly significant association between visual impairment and SPAQ-defined SAD parameters, supporting the hypothesis that decreased retinal light input plays a role in the pathogenesis of SAD.

Clinical and aetiological heterogeneity have impeded our understanding of depression.

To evaluate differences in psychiatric and somatic course between people with depression subtypes that differed clinically (severity) and aetiologically (melancholic v. atypical).

Data from baseline, 2-, 4- and 6-year follow-up of The Netherlands Study of Depression and Anxiety were used, and included 600 controls and 648 people with major depressive disorder (subtypes: severe melancholicn = 308; severe atypical n = 167; moderate n = 173, established using latent class analysis).

Those with the moderate subtype had a significantly better psychiatric clinical course than the severe melancholic and atypical subtype groups. Suicidal thoughts and anxiety persisted longer in those with the melancholic subtype. The atypical subtype group continued to have the highest body mass index and highest prevalence of metabolic syndrome during follow-up, although differences between groups became less pronounced over time.

Course trajectories of depressive subtypes mostly ran parallel to each other, with baseline severity being the most important differentiator in course between groups.

Depression is a highly prevalent disorder, causing a large burden of disease and substantial economic costs. Web-based self-help interventions seem promising in promoting mental health.

To compare the efficacy of a guided web-based intervention based on acceptance and commitment therapy (ACT) with an active control (expressive writing) and a waiting-list control condition (Netherlands Trial Register NTR1296).

Adults with depressive symptoms from the general population were randomised to ACT (n = 82), expressive writing(n = 67) or waiting-list control (n = 87). The main outcome was reduction in depressive symptoms assessed with the Center for Epidemiological Studies – Depression scale.

Significant reductions in depressive symptoms were found following the ACT intervention, compared with the control group (Cohen'sd = 0.56) and the expressive writing intervention(d = 0.36). The effects were sustained at 6-month and 12-month follow-up.

Acceptance and commitment therapy as a web-based public mental health intervention for adults with depressive symptoms can be effective and applicable.

Adjunctive antidepressant therapy is commonly used to treat acute bipolar depression but few studies have examined this strategy.

To examine the efficacy of agomelatine v. placebo as adjuncts to lithium or valproate in bipolar depression.

Patients who were currently depressed despite taking lithium or valproate for at least 6 weeks were randomised to treatment with agomelatine(n = 172) or placebo (n = 172) for 8 weeks of acute therapy and 44 weeks of continuation therapy (trial registration: ISRCTN28588282).

No significant differences in improvement of depressive symptoms were observed between the two groups either at 8 weeks or 52 weeks on the primary efficacy measure of change in Montgomery–Åsberg Depression Rating Scale scores from baseline to end-point. Adverse events including switches into mania/hypomania were low and similar in both groups.

Agomelatine adjunctive therapy was not superior to placebo adjunctive therapy for acute bipolar depression.

Few randomised clinical trials have examined the efficacy of an intervention aimed at improving psychosocial functioning in bipolar disorder.

To examine changes in psychosocial functioning in a group that has been enrolled in a functional remediation programme 1 year after baseline.

This was a multicentre, randomised, rater-masked clinical trial comparing three patient groups: functional remediation, psychoeducation and treatment as usual over 1-year follow-up. The primary outcome was change in psychosocial functioning measured by means of the Functioning Assessment Short Test (FAST). Group×time effects for overall psychosocial functioning were examined using repeated-measures ANOVA (trial registration NCT01370668).

There was a significant group×time interaction for overall psychosocial functioning, favouring patients in the functional remediation group(F = 3.071, d.f. = 2, P = 0.049).

Improvement in psychosocial functioning is maintained after 1-year follow-up in patients with bipolar disorder receiving functional remediation.