History of prior mental disorder, particularly post-traumatic stress disorder (PTSD), increases risk for PTSD following subsequent trauma exposure. However, limited research has examined differences associated with specific prior mental disorders among people with PTSD.

The current study examined whether different prior mental disorders were associated with meaningful differences among individuals presenting to a specialist service for severe earthquake-related distress following the Canterbury earthquakes (N = 177).

Two sets of comparisons were made: between participants with no history of prior disorder and participants with history of any prior disorder; and between participants with history of prior PTSD and those with history of other prior disorders. Comparisons were made in relation to sociodemographic factors, earthquake exposure, peri-traumatic distress, life events and current psychological functioning.

Participants with any prior mental disorder had more current disorders than those with no prior disorder. Among participants with history of any prior disorder, those with prior PTSD reported more life events in the past 5 years than those with other prior disorders.

Findings suggest a history of any prior mental disorder contributes to increased clinical complexity, but not increased PTSD severity, among people with PTSD seeking treatment. Although post-disaster screening efforts should include those with prior mental disorders, it should also be recognised that those with no prior disorders are also at risk of developing equally severe PTSD.

Natural disasters are increasing in frequency and impact; they cause widespread disruption and adversity throughout the world. The Canterbury earthquakes of 2010–2011 were devastating for the people of Christchurch, New Zealand. It is important to understand the impact of this disaster on the mental health of children and adolescents.

To report psychiatric medication use for children and adolescents following the Canterbury earthquakes.

Dispensing data from community pharmacies for the medication classes antidepressants, antipsychotics, anxiolytics, sedatives/hypnotics and methylphenidate are routinely recorded in a national database. Longitudinal data are available for residents of the Canterbury District Health Board (DHB) and nationally. We compared dispensing data for children and adolescents residing in Canterbury DHB with national dispensing data to assess the impact of the Canterbury earthquakes on psychotropic prescribing for children and adolescents.

After longer-term trends and population adjustments are considered, a subtle adverse effect of the Canterbury earthquakes on dispensing of antidepressants was detected. However, the Canterbury earthquakes were not associated with higher dispensing rates for antipsychotics, anxiolytics, sedatives/hypnotics or methylphenidate.

Mental disorders or psychological distress of a sufficient severity to result in treatment of children and adolescents with psychiatric medication were not substantially affected by the Canterbury earthquakes.

Natural disasters are increasing in frequency and severity. They cause widespread hardship and are associated with detrimental effects on mental health.

Our aim is to provide the best estimate of the effects of natural disasters on mental health through a systematic review and meta-analysis of the rates of psychological distress and psychiatric disorder after natural disasters.

This systematic review and meta-analysis is limited to studies that met predetermined quality criteria. We required included studies to make comparisons with pre-disaster or non-disaster exposed controls, and sample representative populations. Key studies were identified through a comprehensive search of PubMed, EMBASE and PsycINFO from 1980 to 3 March 2017. Random effects meta-analyses were performed for studies that reported key outcomes with appropriate statistics.

Forty-one studies were identified by the literature search, of which 27 contributed to the meta-analyses. Continuous measures of psychological distress were increased after natural disasters (combined standardised mean difference 0.63, 95% CI 0.27–0.98, P = 0.005). Psychiatric disorders were also increased (combined odds ratio 1.84, 95% CI 1.43–2.38, P < 0.001). Rates of post-traumatic stress disorder and depression were significantly increased after disasters. Findings for anxiety and alcohol misuse/dependence were not significant. High rates of heterogeneity suggest that disaster-specific factors and, to a lesser degree, methodological factors contribute to the variance between studies.

Increased rates of psychological distress and psychiatric disorders follow natural disasters. High levels of heterogeneity between studies suggest that disaster variables and post-disaster response have the potential to mitigate adverse effects.

None.

Impaired neuropsychological functioning is a feature of major depression. Previous studies have suggested that at least some aspects of neuropsychological functioning improve with successful treatment of major depression. The extent to which medications may affect the degree of normalization of these functions is unclear. The aim of the current study was to examine the course of neuropsychological functioning during treatment of major depression with cognitive–behaviour therapy (CBT) or schema therapy (ST).

A total of 69 out-patients with a primary diagnosis of major depression and 58 healthy controls completed mood ratings, neuropsychological measures, and measures of emotional processing at baseline and after 16 weeks. Participants were randomized after baseline assessment to a year-long course of CBT or ST. Patients reassessed at 16 weeks were medication-free throughout the study.

Significant neuropsychological impairment was evident at baseline in depressed participants compared with healthy controls. After 16 weeks of psychotherapy, mean depression rating scores fell more than 50%. However, no neuropsychological measures showed convincing evidence of significant improvement and emotional processing did not change.

Persisting impairment in neuropsychological functioning after the first 16 weeks of CBT or ST suggests a need to modify psychological treatments to include components targeting cognitive functioning.

The role of nutrition in the treatment of attention-deficit hyperactivity disorder (ADHD) is gaining international attention; however, treatments have generally focused only on diet restriction or supplementing with one nutrient at a time.

To investigate the efficacy and safety of a broad-based micronutrient formula consisting mainly of vitamins and minerals, without omega fatty acids, in the treatment of ADHD in adults.

This double-blind randomised controlled trial assigned 80 adults with ADHD in a 1:1 ratio to either micronutrients (n = 42) or placebo (n = 38) for 8 weeks (trial registered with the Australian New Zealand Clinical Trials Registry: ACTRN12609000308291).

Intent-to-treat analyses showed significant between-group differences favouring active treatment on self- and observer- but not clinician-ADHD rating scales. However, clinicians rated those receiving micronutrients as more improved than those on placebo both globally and on ADHD symptoms. Post hoc analyses showed that for those with moderate/severe depression at baseline, there was a greater change in mood favouring active treatment over placebo. There were no group differences in adverse events.

This study provides preliminary evidence of efficacy for micronutrients in the treatment of ADHD symptoms in adults, with a reassuring safety profile.

This trial aimed to compare the guillotine technique of tonsillectomy with ‘cold steel’ dissection, the current ‘gold standard’.

A single centre, randomised, controlled trial.

One hundred children aged 3 to 11 years who were listed for bilateral tonsillectomy were recruited. Patients had one tonsil removed by each technique, and were blinded to the side. The operative time, intra-operative blood loss, haemostasis requirement and post-operative pain scores were recorded and compared.

Operative time and intra-operative blood loss were both significantly less for the guillotine technique (p < 0.001) and there was a significantly reduced haemostasis requirement (p < 0.001). Pain was also less on the guillotine side (p < 0.001). There were no tonsillar remnants or palatal trauma for either technique. There was no significant difference between techniques in the frequency of secondary haemorrhage.

This study provides level Ib evidence that guillotine tonsillectomy in children with mobile tonsils is an effective and time-efficient procedure which produces less intra-operative blood loss and post-operative pain than cold steel dissection.

Post-auricular incisions are performed for a range of otological procedures. Anecdotally, many patients suffer some numbness of the pinna or post-auricular skin post-operatively, but for most this appears to reduce with time. This study aimed to investigate this phenomenon.

A single centre, questionnaire-based study was undertaken, assessing the presence of numbness beyond eight months post-surgery, its location, how it changed, and its impact on the patient. Patients whose numbness had resolved provided details of any temporary deficit. Data were acquired for 35 primary and 16 revision procedures.

Sixty-nine per cent of patients undergoing primary surgery experienced post-operative numbness. Twenty-six per cent had continued numbness after at least eight months' recovery, but only 3 per cent were constantly aware of the deficit. Of those with an ongoing deficit, 78 per cent felt there had been a reduction in the severity, and 67 per cent in the area size, over time. Recovery appeared to be slightly worse in revision cases.

Few data exist examining the longer-term outcome of bulimia nervosa (BN) following treatment with cognitive behavioral therapy (CBT) and exposure with response prevention (ERP).

One hundred and thirty-five women with purging BN received eight sessions of individual CBT and were then randomly assigned to either relaxation training (RELAX) or one of two ERP treatments, pre-binge (B-ERP) or pre-purge cues (P-ERP). Participants were assessed yearly following treatment and follow-up data were recorded.

Eighty-one per cent of the total sample attended long-term follow-up. At 5 years, abstinence rates from binging were significantly higher for the two exposure treatments (43% and 54%) than for relaxation (27%), with no difference between the two forms of exposure. Over 5 years, the frequency of purging was lower for the exposure treatments than for relaxation training. Rates of recovery varied according to definition of recovery. Recovery continued to increase to 5 years. At 5 years, 83% no longer met DSM-III-R criteria for BN, 65% received no eating disorder diagnosis, but only 36% had been abstinent from bulimic behaviors for the past year.

This study provides possible evidence of a conditioned inoculation from exposure treatment compared with relaxation training in long-term abstinence from binge eating at 5 years, and the frequency of purging over 5 years, but not for other features of BN. Differences among the groups were not found prior to 5 years. CBT is effective for BN, yet a substantial group remains unwell in the long term. Definition of recovery impacts markedly on recovery rates.

Interpersonal psychotherapy and cognitive–behavioural therapy (CBT) are established as effective treatments for major depression. Controversy remains regarding their effectiveness for severe and melancholic depression.

To compare the efficacy of interpersonal psychotherapy and CBT in people receiving out-patient treatment for depression and to explore response in severe depression (Montgomery–Åsberg Depression Rating Scale (MADRS) score above 30), and in melancholic depression.

Randomised clinical trial of 177 patients with a principal Axis I diagnosis of major depressive disorder receiving 16 weeks of therapy comprising 8–19 sessions. Primary outcome was improvement in MADRS score from baseline to end of treatment.

There was no difference between the two psychotherapies in the sample as a whole, but CBT was more effective than interpersonal psychotherapy in severe depression, and the response was comparable with that for mild and moder-ate depression. Melancholia did not predict poor response to either psychotherapy.

Both therapies are equally effective for depression but CBT maybe preferred in severe depression.

Interpersonal psychotherapy and cognitive–behavioural therapy are widely accepted as effective treatments for major depression. There is little evidence on how personality disorder or personality traits affect treatment response.

To determine whether personality disorder or traits have an adverse impact on treatment response to interpersonal psychotherapy or cognitive–behavioural therapy in people receiving out-patient treatment for depression.

The study was a randomised trial in a university-based clinical research unit for out-patients with depression.

Personality disorder did not adversely affect treatment response for patients with depression randomised to cognitive–behavioural therapy Conversely, personality disorder did adversely affect treatment response for patients randomised to interpersonal psychotherapy.

Despite the two therapies having comparable efficacy in patients with depression, response to interpersonal psychotherapy (but not cognitive–behavioural therapy) is affected by personality traits. This could suggest the two therapies are indicated for different patients or that they work by different mechanisms.