The aim of this Editorial is to describe the association between child sexual abuse and psychosis, and to consider potential mechanisms for the association. The association is strongly supported by the literature. Evidence from a variety of sources is triangulated in order to create a plausible model of the link, which can then be used to direct future research. The mechanisms are certainly complex, and there is evidence of interacting contributions at genetic, neurophysiological, behavioural, cognitive and emotional levels. Child sexual abuse is an important antecedent in psychosis, both theoretically and clinically. At the theoretical level, it potentially illuminates mechanisms by which psychotic symptoms are generated, at the clinical level it opens possibilities for improving cognitive-behavioural approaches to treatment.

Declaration of Interest: None.

This editorial reviews the relationship between childhood trauma and the development of psychosis in adulthood. There are numerous studies, including large, prospective studies, which clearly support a link between childhood adversity and experience of psychosis later in life. There is also evidence that there is a dose response relationship, and that childhood trauma is particularly associated with the experience of hallucinations and delusional ideas. It is possible that psychosis is a relatively understandable response to the experience of severe trauma, and recent cognitive models of psychosis can help to explain the underlying mechanisms in such a causal relationship. There are obvious treatment implications, which include the need to assess histories of childhood trauma in people with psychosis, the incorporation of trauma in shared understandings of psychosis with service users, the incorporation of change strategies in cognitive behaviour therapy for psychosis that are derived from evidence-based approaches to the treatment of trauma and PTSD, and the prevention of traumatisation by mental health services.

Declaration of Interest: None.

Mental health services and research have been dominated for several decades by a rather simplistic, reductionistic focus on biological phenomena, with minimal consideration of the social context within which genes and brains inevitably operate. This ‘medical model’ ideology, enthusiastically supported by the pharmaceutical industry, has been particularly powerful in the field of psychosis, where it has led to unjustified and damaging pessimism about recovery. The failure to find robust evidence of a genetic predisposition for psychosis in general, or ‘schizophrenia’ in particular, can be understood in terms of recently developed knowledge about how epigenetic processes turn gene transcription on and off through mechanisms that are highly influenced by the individual's socio-environmental experiences. To understand the emerging evidence of the relationship between adverse childhood events and subsequent psychosis, it is necessary to integrate these epigenetic processes, especially those involving the stress regulating functions of the HPA axis, with research about the psychological mechanisms by which specific types of childhood trauma can lead to specific types of psychotic experiences. The implications, for research, mental health services and primary prevention, are profound.

Declaration of Interest: None of the authors have any conflicts of interest in relation to this paper.

One of the most important critical decision to be taken when designing a randomized controlled trial (RCT) in clinical psychopharmacology is the choice of the comparator. This choice is crucial because it affects many issues related to both internal and external validity. The aim of a RCT may be to establish efficacy in absolute terms, against an inert treatment (usually a placebo), or to establish efficacy with respect to another treatment (also known as comparator), a trial may be designed to demonstrate that the new drug is superior to the control intervention or, by contrast, that the new drug is similar to the control intervention in terms of, say, symptoms' reduction. Three kinds of RCTs may be designed: Superiority trials, Equivalence studies, Non-inferiority studies.

Language disturbances represent a core feature of schizophrenia, affecting social interactions and quality of life. Here we summarize linguistic and pragmatic deficits and illustrate the role of brain imaging studies in delineating the neural substrates of language deficits in patients with schizophrenia.

Aims – To evaluate new generation antidepressants in relation to the placebo response. Methods – I review meta-analyses in which response to antidepressant medication and response to placebo were calculated. Results – All but one of these meta-analyses included unpublished as well as published trials. Most trials failed to show a significant advantage of SSRIs over inert placebo, and the differences between drug and placebo are not clinically significant for most depressed patients. Documents obtained from the U.S. Food and Drug Administration (FDA) revealed an explicit decision to keep this information from the public and from prescribing physicians. Conclusions – Because they do not incur drug risks, exercise and psychotherapy, which show at benefits at least equal to those of antidepressants, may be a better treatment choice for depressed individuals.

Declaration of Interest: The author has not in the last 2 years received any support, including that from drug companies and honoraria for lectures and consultancies, from interests potentially in conflict with this work.

Aims – ‘difficult patients’ may evoke strong feelings in health professionals. The ambivalent attitude of, especially, non-psychotic chronic patients towards psychiatric care may be frustrating and burdensome to professionals. Many of these patients are cared for in non-specialized services, where professionals are often more used to working with psychotic patients. Specific problems with ‘difficult’ non-psychotic patients may occur, and hamper the quality of care offered. The aim of this research is to determine precisely what problems psychiatric professionals perceive in contact with non-psychotic chronic patients in order to identify starting points for alternative or improved care in non-specialized services. Methods – a modified five-phase Delphi study with three groups of eight participants from was used to identify and prioritize experts' judgments. Results – 46 problems were identified of which some were relevant to one or two subgroups and some were relevant to the entire group. Conclusions – a program that combines a coherent view at services level, with support and increased communication at the interprofessional level (e.g. through regular supervision, sharing of case-loads) may be highly beneficial to non-specialized services.

Declaration of Interest: None for any author. Funding for this study was provided by ZonMW ‘Geestkracht’ (Grant 100–002–031), Altrecht Mental Health Care and Gelderse Roos Mental Health Care.

Aim – The association between sporting activities, or lack there of, and suicidal behaviour has not yet been clarified. The objective of this study was to determine, if sports participation has an impact on risk for completed suicide. Methods – Axis I and Axis II disorders, sociodemographic factors, and current and former sports activities, including various sports disciplines, were assessed by a semi-structured interview by psychological autopsy method in 163 suicides and by personal interview in 396 living population-based control persons. Results – Current sports activities (OR = 0.24, 95%CI, 0.15 to 0.39; OR = 0.27, 95%CI, 0.16 to 0.45) and sports activities at some point in life (OR = 0.33, 95%CI, 0.18 to 0.62; OR = 0.40, 95%CI, 0.23 to 0.68, after adjustment for axis I and II disorders or educational level, each) were associated with decreased suicide risk. Conclusions – Current sports activities and sports activities at some point in life may reduce suicide risk.

Declaration of Interest: Barbara Schneider got research funding as young scientist for the project “Psychopathological, sociodemographic, psychosocial, and work-related risk factors for suicide” from the faculty representative committee of the Faculty of Medicine, Johann Wolfgang Goethe-University of Frankfurt/Main. Furthermore, “Nachlaβ Martha Schmelz”, part of the university foundation of Frankfurt am Main, supported the research project. There was no support from drug companies related to the present paper. Barbara Schneider, Klaus Georgi, and Axel Schnabel are employed at the Goethe-University Hospital and Faculty of Medicine. Bettina Müller is employed at the Markus Hospital, Frankfurt /Main.

Aim – Since the importance of latitude of living for the prevalence of Seasonal Affective Disorder (SAD) is unclear, the study aims to test the latitude hypothesis by comparing SAD in two rather similar groups of students living at latitudes far apart. Methods – Two groups of students, 199 in Tromsø, Norway (690 N) and 188 in Ferrara, Italy (440 N) were asked to fill in the Seasonal Pattern Assessment Questionnaire. Results – Global Seasonality score (GS-score) was significantly higher in Italian than in Norwegian students, in females and in students with sleeping-problems. Norwegian students had significantly higher SAD prevalence in winter and in spring. Most people in both countries felt worst in October and November, and the prevalence of Autumn SAD was not significantly different between the two countries. Conclusions – The hypothesis that SAD is linked to amount of environmental light and latitude of living was not supported.

Declaration of Interest: The study was fully financed by the University of Tromsø and the University Hospital North Norway, and there are no conflicts of interests.

Aim – To examine the associations of job acquisition and loss in a representative, prospective community sample of people with schizophrenia living in the UK, France and Germany. Method – A representative sample of twelve hundred and eight people with schizophrenia were recruited from selected secondary mental health services in the U.K, France and Germany and followed up for 2 years. Information on demographic details, psychotic symptoms and work status was collected. Results – The odds of getting jobs were increased by being resident in Marseille, Leipzig, Hemer and Heilbronn and by a higher regional general population employment rate. The odds were reduced by living in Lyon, a later illness onset, a longer length of illness, a continuous illness course and more severe negative psychotic symptoms. Previous vocational training reduced the odds of losing employment, whilst living in Lyon or Leipzig, harmful use of alcohol and more positive psychotic symptoms at baseline all increased the odds. Conclusions – In addition to illness related factors, area of residence and local labour market conditions appear to be important in explaining employment status change in people with schizophrenia.

Declaration of Interest: All authors declare there are no conflicts of interest. This study was funded by grants from Lundbeck A/S and from the German Federal Ministry of Education and Research.

Desideriamo segnalare ai lettori che nel numero 3 del 2009 la Tabella I dell'articolo “Is the exposure to antidepressant drugs in early pregnancy…” (18(3): 240–247) è stata involontariamente sbagliata.

Riportiamo di seguito i passaggi di interesse evidenziati in neretto