There is an ongoing debate about the use of atypical antipsychotics as a first-line treatment for first-episode psychosis.

To examine the evidence base for this recommendation.

Meta-analyses of randomised controlled trials in the early phase of psychosis, looking at long-term discontinuation rates, short-term symptom changes, weight gain and extrapyramidal side-effects. Trials were identified using a combination of electronic (Cochrane Central, EMBASE, MEDLINE and PsycINFO) and manual searches.

Fifteen randomised controlled trials with a total of 2522 participants were included. No significant differences between atypical and typical drugs were found for discontinuation rates (odds ratio (OR) = 0.7, 95% CI 0.4 to 1.2) or effect on symptoms (standardised mean difference (SMD) = –0.1, 95% CI –0.2 to 0.02). Participants on atypical antipsychotics gained 2.1 kg (95% CI 0.1 to 4.1) more weight than those on typicals, whereas those on typicals experienced more extrapyramidal side-effects (SMD = –0.4, 95% CI –0.5 to –0.2).

There was no evidence for differences in efficacy between atypical and typical antipsychotics, but there was a clear difference in the side-effect profile.

Research on the comorbidity between cigarette smoking and major depression has not elucidated the pathways by which smoking is associated with depression.

To examine the causal relationships between smoking and depression via fixed-effects regression and structural equation modelling.

Data were gathered on nicotine-dependence symptoms and depressive symptoms in early adulthood using a birth cohort of over 1000 individuals.

Adjustment for confounding factors revealed persistent significant (P<0.05) associations between nicotine-dependence symptoms and depressive symptoms. Structural equation modelling suggested that the best-fitting causal model was one in which nicotine dependence led to increased risk of depression. The findings suggest that the comorbidity between smoking and depression arises from two routes; the first involving common or correlated risk factors and the second a direct path in which smoking increases the risk of depression.

This evidence is consistent with the conclusion that there is a cause and effect relationship between smoking and depression in which cigarette smoking increases the risk of symptoms of depression.

Little is known about the experiential dynamics of the interaction between cannabis and vulnerability to psychosis.

To examine the effects of cannabis on psychotic symptoms and mood in patients with psychosis and healthy controls.

Patients with a psychotic disorder (η = 42) and healthy controls (η = 38) were followed in their daily lives using a structured time-sampling technique.

Daily life cannabis use predicted subsequent increases in positive affect and in patients, but not in controls, decreases in negative affect. In patients, but not in controls, cannabis use predicted increased levels of hallucinatory experiences. Mood-enhancing properties of cannabis were acute, whereas psychosis-inducing effects were sub-acute. There was no direct evidence for self-medication effects in daily life.

Patients with psychosis are more sensitive to both the psychosis-inducing and mood-enhancing effects of cannabis. The temporal dissociation between acute rewarding effects and sub-acute toxic influences may be instrumental in explaining the vicious circle of deleterious use in these patients.

Transcultural studies have found lack of insight to be an almost invariable feature of acute and chronic schizophrenia, but its influence on prognosis is unclear.

To investigate the relationship between insight, psychopathology and outcome of first-episode schizophrenia in Vellore, India.

Patients with a DSM–IV diagnosis of schizophrenia (η = 131) were assessed prospectively at baseline and at 6-month and 12-month follow-up. Demographic and clinical measures included insight, psychopathology, duration of untreated psychosis (DUP) and social functioning. Linear and logistic regression was used to measure predictors of outcome.

Follow-up data were available for 115 patients at 1 year. All achieved remission, half of them with and half without residual symptoms. Changes in psychopathology and insight during the first 6 months and DUP strongly predicted outcome (relapse or functional impairment), controlling for baseline measures.

Outcome of schizophrenia in this setting is driven by early symptomatic improvement and is relatively favourable, in line with other studies from low- and middle-income countries. Early improvement in insight might be a useful clinical guide to future outcome. Reduction of DUP should be a target for intervention.

Early improvement with treatment is thought to be important in patients with first-episode schizophrenia, yet a valid definition is still outstanding.

To develop a valid definition of early improvement and test its predictive validity regarding response and remission.

We examined 188 in-patients with first-episode schizophrenia. Early improvement was defined as improvement in Positive and Negative Syndrome Scale (PANSS) total score at week 2, response as a 40% PANSS total score improvement at end-point, and remission according to consensus criteria.

Reasonable predictive validity of early improvement was found for a 46% PANSS total score improvement at week 2 and a 50% improvement for remission (area under the curve: response 0.707, remission 0.692). Estimated confidence intervals ranged from 26 to 62% PANSS reduction for response and remission.

Patients with a first episode of schizophrenia should improve by at least 30% in PANSS total score at week 2 to achieve response and remission.

The effect of gender, age, and urban versus rural residence on suicide risk among people with different mental disorders is unknown.

To estimate cohort-specific risk of suicide among people with different types of mental disorders using data from China's National Psychological Autopsy Study.

Logistic regression models estimated adjusted odd ratios (OR) in 895 suicides and 701 injury deaths.

The adjusted risk of suicide for mood disorders was highest (OR = 44.2) followed by that for other mental disorders (OR = 10.7), anxiety disorders (OR = 10.2), psychotic disorders (OR = 7.4), substance use disorders (2.7) and organic mental disorders (OR = 1.2). Risk of suicide among urban residents with any mental disorder was more than double that of rural residents (OR = 15.5 v. 7.6, P = 0.008).

The suicide risk associated with mental illness varies by type of illness and by demographic cohort. Lower risk of suicide among rural residents with mental disorders highlights the importance of non-mental health approaches to the prevention and management of suicidal behaviour in rural areas of low- and middle-income countries.

Brain serotonin2 (5-hydroxytryptamine2; 5-HT2) receptors were considered potential targets for therapeutic efficacy of electroconvulsive therapy (ECT), but pre-clinical studies showed that electroconvulsive shock up-regulates 5-HT2 receptors in contrast to antidepressant medications, which down-regulate brain 5-HT2 receptors. Positron emission tomography (PET) studies in individuals with depression confirmed that antidepressant medications reduce brain 5-HT2 receptors, but the effects of ECT on these receptors in individuals with depression are unknown.

To determine if a course of ECT alters brain 5-HT2 receptors in individuals with depression and whether such changes correlate with improvement in symptoms.

Fifteen people with major depression, refractory to antidepressant therapy and referred for a course of ECT, had an [18F]setoperone scan during baseline drug-free washout period and another after a course of ECT. We assessed changes in brain 5-HT2 receptors with ECT and their relationship to therapeutic outcome.

Widespread reduction in brain 5-HT2 receptors was observed in all cortical areas with changes slightly more prominent in the right hemisphere. There was a trend for correlation between reduction in brain 5-HT2 receptors in right parahippocampal gyrus, right lingual gyrus and right medial frontal gyrus, and improvement in depressive symptoms.

Unlike in rodents, and similar to antidepressants, ECT reduces brain 5-HT2 receptors in individuals with depression. The ability of ECT to further down-regulate brain 5-HT2 receptors in antidepressant non-responsive individuals may explain its efficacy in those people with antidepressant refractory depression.

A third of family carers of people with dementia report abusive behaviour towards the person for whom they are caring. This is the first longitudinal study to investigate such behaviour.

To test our hypotheses that carers' reports of abusive behaviour would increase over time, and that change in abuse scores would be predicted by change in anxiety and depression scores.

In total, 131 (71.6%) of the family/friend dementia carers consecutively recruited from new referrals to Essex and London community mental health teams who were interviewed at baseline, completed the revised Modified Conflict Tactics Scale to measure abuse 1 year later.

Sixty-three (48.1%) of the carers reported any abusive behaviour at baseline compared with 81 (61.8%) a year later (χ2 = 6.9, P = 0.009). An increase in abuse scores was predicted by an increase in anxiety and depressive symptoms (respectively ß = 0.32, t = 3.9, P<0.001 and ß = 0.24, t = 2.9, P = 0.005), and by less domiciliary care at baseline (ß = –0.18, t =–2.2, P = 0.031).

Most abusive behaviour reported by carers at baseline persisted or worsened in the following year, despite contact with specialist services. We suggest that trials of psychological interventions shown to reduce anxiety and depression in the carers of people with dementia are needed to determine whether they also reduce elder abuse, and can be delivered cost-effectively within the National Health Service (NHS).

Despite increasing concern over the potential adverse effects of excessive internet use, especially in young people, there is some debate over its definition, magnitude and discriminant validity.

To examine the prevalence of adolescents' internet addiction in Hong Kong, China; to test its differentiation from other correlates; and to examine its relationships with correlates in a representative community sample of adolescents.

A two-wave panel household survey with 208 adolescents (aged 15–19 years) was conducted. Participants were asked to self-report their patterns of internet usage, symptoms of internet addiction, suicidal ideation, psychiatric symptoms and psychosocial conditions during the study period.

The prevalence rate for having five or more symptoms of internet addiction was estimated to be 6.7% (95% CI 3.3–10.2). The discriminatory characteristic of internet addiction was marginally demonstrated. Positive dose–response relationships were found between the number of symptoms of internet addiction and 1-year changes in scores for suicidal ideation and depressive symptoms.

Evidence supports the specificity of internet addiction and its symptoms seem to co-occur with individuals' suicidal ideation and depressive symptoms.