Background. Full-spectrum fluorescent lighting (FSFL) has been credited with causing dramatic beneficial effects on a wide variety of behaviours, mental health outcomes and physical health effects, as compared to other fluorescent lamp types. These effects are hypothesized to occur because of similarity between FSFL emissions and daylight, which is said to have evolutionary superiority over other light sources.

Method. This review, covering the period 1941–1999, critically considers the evidence for direct effects of FSFL through skin absorption as well as indirect effects on hormonal and neural processes.

Conclusions. Overall, the evidence does not show dramatic effects of fluorescent lamp type on behaviour or health, neither does it support the evolutionary hypothesis.

Background. Research shows that psychopathology, child sexual abuse and other childhood adversities are risk factors for suicide. However, few have investigated their joint and independent roles in the pursuit of a reliable, predictive model of suicidal behaviour.

Methods. Data are from the National Comorbidity Survey (N = 5877), a nationally representative study of prevalence, risk factors, and social consequences of psychiatric disorders in the US. Discrete time survival analysis and population attributable risk methodologies were utilized.

Results. Among those sexually abused as children, odds of suicide attempts were 2–4 times higher among women and 4–11 times higher among men, compared with those not abused, controlling for other adversities. Odds ratios were reduced but most remained statistically significant after adjusting for lifetime psychiatric illnesses preceding suicide attempts. In the same predictive equation, 79% of serious suicide attempts among women could be attributed to psychiatric disorders while 12% was attributable to rape and 7% to molestation. The highest probability of a first attempt was during early adolescence for those who were sexually abused and had a lifetime disorder, but it was 8–12 years older for those sexually abused without any disorders.

Conclusions. In the US, a strong association exists between child sexual abuse and suicidal behaviour, mediated by psychopathology. There is a substantial proportion of suicide risk attributable to child sexual abuse beyond the presence of psychopathology and other adversities. From a clinical standpoint, abuse survivors represent a high-risk population for suicidal behaviour. Further research into this preventable antecedent of suicide attempts is necessary.

Background. Brief problem-solving therapy is regarded as a pragmatic treatment for deliberate self-harm (DSH) patients. A recent meta-analysis of randomized controlled trials (RCTs) evaluating this approach indicated a trend towards reduced repetition of DSH but the pooled odds ratio was not statistically significant. We have now examined other important outcomes using this procedure, namely depression, hopelessness and improvement in problems.

Method. Six trials in which problem-solving therapy was compared with control treatment were identified from an extensive literature review of RCTs of treatments for DSH patients. Data concerning depression, hopelessness and improvement in problems were extracted. Where relevant statistical data (e.g. standard deviations) were missing these were imputed using various statistical methods. Results were pooled using meta-analytical procedures.

Results. At follow-up, patients who were offered problem-solving therapy had significantly greater improvement in scores for depression (standardized mean difference =−0·36; 95% CI −0·61 to −0·11) and hopelessness (weighted mean difference =−3·2; 95% CI −4·0 to −2·41), and significantly more reported improvement in their problems (odds ratio = 2·31; 95% CI 1·29 to 4·13), than patients who were in the control treatment groups.

Conclusions. Problem-solving therapy for DSH patients appears to produce better results than control treatment with regard to improvement in depression, hopelessness and problems. It is desirable that this finding is confirmed in a large trial, which will also allow adequate testing of the impact of this treatment on repetition of DSH.

Background. The risk for panic disorder (PD) is substantially increased in relatives of probands with PD. Prior literature provides only limited information about the degree to which this increase is due to genetic factors or family environment.

Methods. In personal interviews with both members of 3194 twin pairs, we assessed the lifetime history of lifetime panic attacks and PD. Twin resemblance was assessed by tetrachoric correlation and single and multiple threshold biometrical model fitting.

Results. As fully syndromal PD, by DSM-III-R criteria, was too rare to analyse usefully we examined four other dichotomous definitions of increasing stringency: panic probe and very broad, broad and intermediate PD. For all four definitions and for the multiple threshold analyses, the best-fit model indicated that twin resemblance was due solely to genetic factors with a moderate heritability (33–43%). For the broad and intermediate dichotomous definitions of PD, however, a model with twin resemblance due to familial–environmental factors fit nearly as well. No gender effects were seen on the genetic risk factors for these PD-like syndromes.

Conclusion. Even with large epidemiological samples of twins, studying disorders as uncommon as PD is problematical. Despite these difficulties, our results suggest that: (i) narrowly and broadly defined PD are probably on the same continuum of liability; (ii) twin resemblance for these PD-like syndromes is likely due largely to genetic factors with a moderate level of heritability although a contribution of familial–environmental factors cannot be excluded; and, (iii) the same familial risk factors impact, to a similar degree, on the liability to PD in males and females.

Background. In psychiatric surveys of the general population, there has been considerable discrepancy between diagnoses obtained by fully structured interviews and those established by systematic semi-structured clinical evaluation. The Composite International Diagnostic Interview (CIDI) is an example of the first type of interview widely used in general population surveys. We compared its performance in diagnosing current depressive and anxiety disorders with the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), a semi-structured diagnostic interview administered by clinically trained interviewers.

Methods. Household addresses in Leicestershire, UK, were randomly sampled and 860 adults were screened with the Revised Clinical Interview Schedule. Adults with too few symptoms to fulfil diagnostic criteria for study disorders were excluded to increase the proportion re-interviewed who met such criteria. Repeat diagnostic interviews with the CIDI and SCAN, ordered randomly, were sought from eligible screen positive respondents. Recalibrated CIDI prevalence estimates were derived from the SCAN classification using Bayesian statistics.

Results. Concordance ranged between ‘poor’ and ‘fair’ across almost all types of study disorders, and for co-morbidity. Concordance was somewhat better for severity of depression and when lower diagnostic thresholds were used for depression. Interview order effects were suggested with lower concordance when CIDI followed SCAN. Recalibration reduced the prevalence of depressive or anxiety disorder from 9·0 to 6·2%.

Conclusions. Community psychiatric surveys using structured diagnostic interview data must be interpreted cautiously. They should include an element of clinical re-appraisal so findings can be adjusted for estimation differences between fully structured and clinical assessments.

Background. Spiritual beliefs are rarely considered in psychological or medical publications. We recently published the psychometric properties of an interview designed to measure religious and spiritual belief. In this study, we aimed to develop this instrument further as a self-report questionnaire and to make it more comprehensive by including measurement of spiritual experiences in addition to faith or intellectual assent.

Methods. Based on extensive discussion with colleagues, advice from users of the interview and comments from respondents, a self-report format was designed. We then evaluated the final format of the questionnaire in terms of (1) patterns of response and demographic predictors of beliefs; (2) test–retest reliability and internal consistency; (3) criterion and internal validity; and (4) the nature of spiritual experiences and their relationship to beliefs and strength of beliefs.

Results. Two hundred and ninety-seven people took part in the validity and reliability tests of the questionnaire. Criterion validity, predictive validity, internal consistency and test–retest reliability were acceptably high. The instrument consistently differentiated between people with high and low spiritual beliefs.

Conclusions. This instrument is brief and simple to complete. We would recommend that measures of religious and/or spiritual belief like this be more widely applied in health services research as they evaluate aspects of people's lives that go somewhat further than health status or quality of life.

Background. The clinician-administered version of the Liebowitz Social Anxiety Scale (LSAS-CA) is a commonly used assessment device for the evaluation of social anxiety disorder and has been shown to have strong psychometric characteristics. Because of its apparently straightforward rating format and potential savings in time and effort, interest in the use of the LSAS as a self-report (LSAS-SR) measure has increased, and the LSAS-SR has been used in a number of studies. However, the psychometric properties of the LSAS-SR have not been well established.

Methods. This study examined the psychometric properties of the LSAS-SR in comparison to the LSAS-CA in a sample of 99 individuals with a primary diagnosis of social anxiety disorder and 53 individuals with no current psychiatric disorder.

Results. There was little difference between the two versions of the LSAS on any scale or subscale score. Both forms were internally consistent and the subscale intercorrelations for the two forms were essentially identical. Correlations of each LSAS-SR index with its LSAS-CA counterpart were all highly significant. Finally, the convergent and discriminant validity of the two forms of the LSAS was shown to be strong.

Conclusion. Results of this study suggest that the self-report version of the LSAS compares well to the clinician-administered version and may be validly employed in the assessment of social anxiety disorder.

Background. Fatigue is a common, non-specific, subjective symptom associated with several medical and psychiatric illnesses. The purpose of this investigation was to explore further the epidemiology of unexplained fatigue in the general population and the relationship between fatigue and depression.

Methods. The design was a prospective population-based study. Subjects included community-dwelling adults who were participants of the Baltimore sample of the Epidemiologic Catchment Area Program in 1981 and who were reinterviewed 13 years later. Lay interviewers using the Diagnostic Interview Schedule interviewed subjects.

Results. Number of somatization symptoms and history of a dysphoric episode at baseline were the two strongest predictors of both new onset of fatigue as well as recurrent/chronic fatigue over the 13-year follow-up interval. In addition, individuals who reported a history of unexplained fatigue at baseline as well as during the follow-up, were at markedly increased risk for new onset major depression as compared to those who never reported such fatigue, (RR = 28·4, 95% CI) (11·7, 68·0). Similarly, respondents who developed new fatigue or had remitted fatigue after 1981 were also at increased risk for developing major depression.

Conclusions. Somatization was the strongest predictor of both new and chronic fatigue with unknown cause. In addition, fatigue was both predictive and a consequence of the depression syndrome.

Background. We investigated whether there is regional variation in the incidence of schizophrenia and if so, whether it is caused by urban–rural differences, larger spatial clustering, or both. To control for the effect of migration, we examined regional variation in the incidence according to place of birth.

Methods. Finnish birth cohorts born from 1950 to 1969 were followed in the National Hospital Discharge Register from 1969 until 1991, and all cases of schizophrenia (ICD-8 or ICD-9 295) were identified (N = 14828). Forty-eight of the 559 municipalities were classified as urban and 25% of the Finnish population lived in these municipalities in 1960. For the analysis of spatial clustering, municipalities were grouped into 57 functional small-areas. We used Poisson regression model with the number of births of individuals who later developed schizophrenia as a response variable, and place of birth (urban/rural), birth cohort (1950–54, 1955–9, 1960–64, and 1965–9), functional small-area units, and sex as response variables.

Results. The incidence was slightly higher among the rural-born in the oldest birth cohort. In the other cohorts, it was higher among the urban-born, and the difference between urban and rural born increased in the youngest cohorts. Significant spatial clustering of schizophrenia was observed in eastern Finland.

Conclusions. Urban birth is a risk factor for schizophrenia in Finland in cohorts born since 1955. However, genuine spatial clustering of schizophrenia in eastern Finland was also observed, possibly caused by genetic isolation.

Background. It is not known why the most common mental disorders (CMD), anxiety and depression, are more prevalent among women. This gradient has not been explained by differences in the number or type of social roles occupied by men and women. Given the dearth of longitudinal studies, these negative findings could reflect reverse causality, if men with CMD relinquish social roles more readily than women.

Methods. Cohort study using data from the first seven (annual) waves of the British Household Panel Survey. The prevalence of CMD was assessed using the General Health Questionnaire (GHQ), 12 months after ascertaining occupancy of five social roles. Of 12379 participants aged 16–70, 9947 completed the GHQ on at least two consecutive occasions, resulting in 44139 paired observations. Random effects models adjusted for the correlation of repeated measures and for baseline GHQ score.

Results. The odds ratio for the gender difference in the future prevalence of CMD (adjusted for baseline GHQ score) was 1·92 (95% CI 1·75–2·10). Neither the number or type of social roles occupied, nor socio-economic status explained the gender difference in these conditions (adjusted OR 1·82, 95% CI 1·66–1·99). While CMD at baseline was associated with a subsequent reduction in social role occupancy, this did not vary between men and women.

Conclusions. Gender differences in CMD were not explained by differences in the number or type of social roles occupied by men and women, or by reverse causality. Future studies should consider characteristics of social roles, such as demand, control and reward.

Background. According to current theories, schizophrenia results from altered connectivity in brain circuits for fundamental cognitive operations. Consequently, the poorly understood mechanisms of neuroleptic treatment may be explainable by altered functional interactions within such networks. The ‘cognitive dysmetria’ model hypothesizes that one key structure in these circuits is the cerebellum. To investigate the effects of olanzapine on cerebellar functional connectivity (CFC), a seed-voxel correlation analysis (SVCA) was used in a functional magnetic resonance imaging (fMRI) study of a simple finger-tapping task.

Methods. fMRI scans were obtained from six schizophrenic patients under both drug-free and olanzapine-treated conditions and from a matched control group of six healthy subjects at corresponding time points. SVCAs were performed for anatomically and functionally standardized seed voxels in the anterior cerebellum. SVCA results were then processed by three different randomization analyses.

Results. The analyses revealed that olanzapine caused widespread changes of CFC, including prominent changes in prefrontal cortex and mediodorsal thalamus. Significant changes in motor structures were found after subtractions within both groups and may thus indicate repetition effects rather than drug effects. Olanzapine ‘normalized’ the patients' CFC patterns for the right, but not for the left cerebellum.

Conclusion. Even for a simple motor task, olanzapine affects functional interactions between the cerebellum and many non-motor brain regions, including elements of the ‘cognitive dysmetria’ circuit. Altogether, our findings suggest that olanzapine has a stronger differential effect on neural activity in prefrontal cortex and thalamus than in motor structures.

Background. Motor skill learning may be impaired in schizophrenia. While functional brain imaging studies have shown reduced activation during motor task performance in schizophrenic patients, brain activity changes with motor skill learning in these patients have not been studied by functional imaging.

Methods. A sequential complex motor task involving the right hand was performed by nine medicated schizophrenic patients and 10 age-matched healthy controls. Functional magnetic resonance images were obtained using a gradient echo, echoplanar imaging (EPI) pulse sequence before and after 1 week of training in performing the task.

Results. Bilaterally, patients showed significantly less blood oxygenation level-dependent (BOLD) signal response in the premotor area (PMA) before beginning motor training than controls. BOLD signal response increased in the left PMA of schizophrenic patients after 1 week of motor training; in contrast, the signal decreased in the left PMA of control subjects. Training effects concerning the number of finger movement sequences achieved did not differ between groups. Daily neuroleptic dose did not significantly affect changes with training in BOLD signal response in the PMA.

Conclusions. These preliminary results suggest that schizophrenic patients have dysfunction of neural networks in areas including the PMA that are involved in executing a complex motor task. In terms of brain activity, motor learning may be less efficient or slower in the patients than in healthy subjects.

Background. Patients with obsessive–compulsive disorder (OCD) exhibit recall deficits on word learning tasks, mediated by their failure to detect semantic connections among the words.

Methods. In the present experiment, using methods devised by Bransford & Franks (1971), we tested whether this encoding problem impairs their extraction of gist from complex linguistic material.

Results. Consistent with our hypothesis, OCD patients extracted less gist from related sentences than did healthy participants. The groups did not differ in recognition memory for individual sentences or in criterion for affirming previously encountered sentences as ‘old’, as evinced by signal detection indices of memory sensitivity (d′) and response bias (β), or in recognition memory confidence.

Conclusions. These data provide further evidence that OCD patients exhibit less reliance on organizational strategies than do healthy control participants. These data are consistent with neuropsychological research suggestive of prefrontal executive problems in OCD.

Background. Recent brain imaging studies suggest that proneness to violence and antisocial behaviour may be associated with dysfunction of the prefrontal cortex. The present study, therefore, examined aspects of prefrontally guided executive functions in a group of criminal violent men.

Methods. Violent offenders undergoing forensic psychiatric examination by court order undertook computerized tasks for planning, visual working memory and attentional set-shifting from the Cambridge Neuropsychological Test Automated Battery. Their performance was compared to that of subjects with marginal mental retardation and normal controls.

Results. Violent offenders performed well on tasks for spatial and figurative working memory, as well as on a test for planning. A marked impairment was observed in the attentional set-shifting task: offenders made significantly more errors than the other groups when required to shift attention from one perceptual dimension to another. Reversal learning was also deficient. Correlational analyses within the offender group revealed that poor performance on the perceptual shift problem was associated with fewer errors in tasks for working memory and planning.

Conclusions. The present results suggest that violent offenders show dual impairments in inhibitory cognitive control. First, they are deficient in shifting attention from one category to another. Secondly, the ability to alter behaviour in response to fluctuations in the emotional significance of stimuli is compromised. These deficits might constitute cognitive reflections of the biological prefrontal alterations observed in this group of people.

Objective. This study sought to examine the factors associated with spatial working memory and the use of strategies to impairments in spatial working memory in children with attention deficit hyperactivity disorder (ADHD). The developmental trajectories for spatial working memory in medicated and medication naïve children with ADHD were investigated. In addition, the effect of psychostimulant medication on deficits in spatial working memory was examined.

Method. A cross-sectional study compared performance between 21 psychostimulant medicated children with ADHD, 27 medication naïve children with ADHD and 26 matched control subjects on computerized tests of spatial memory and spatial working memory.

Results. Compared with the controls, performance in medication naïve children with ADHD was significantly worse on the spatial working memory task. There was no difference in performance between the medicated children with ADHD and the control subjects on this same task, despite the ongoing symptoms of ADHD in the former group. The pattern of normal and abnormal performance in the ADHD groups was age-independent.

Conclusions. Deficits in executive functions related to spatial working memory do occur in children with ADHD, although the magnitude of these deficits is not related to the child's age or the level of ADHD symptoms. These deficits were not present in the current sample of children who were receiving psychostimulant medication.

Background. Mental mechanisms have evolved to enable animals (and humans) to be able to function in various social roles. It is suggested that the nature and functions of the mental mechanisms that enable animals to act as a hostile–dominant or threatened–subordinate can be distinguished. It is further suggested these can be internally activated and ‘play off’ against each other, such that a person ‘attacks’ themselves and then responds to their own internal attacks with subordinate defences. Hence, a depressed person can submit, feel defeated, belittled, beaten down, or want to run away (escape) from their own self-attacking thoughts, while psychotic voice hearers can feel similarly to their hostile voices. Such internal interactions may relate to depression in both psychotic voice hearers and depressed people.

Method. A group of 66 voice hearers with a diagnosis of schizophrenia and 50 depressed patients were compared on a series of self-report questionnaires measuring the power of hostile self-directed thoughts/voices and the activation of defensive responses, especially fight/flight.

Results. We present evidence that schizophrenic, malevolent voice hearers and self-critical depressed people experience their hostile, internally generated voices/thoughts as powerful, dominating and controlling (i.e. have typical characteristics of a hostile dominant). Moreover, these voices/thoughts activate evolved subordinate defences such as fight/flight and these are associated with depression in both depression and schizophrenia.

Conclusion. Conceptualizing aspects of depressed and psychotic thinking as relating to evolved mental mechanisms, which are role serving, but can internally play off against each other, may open new ways of investigating certain aspects of severe pathologies.

Background. Neuroticism has been shown to increase the risk of depression whereas extraversion is associated with a reduction of risk. These personality traits play a central role in aetiological theories of affective disorder but their role in schizophrenia is unclear. In this study, the risk for schizophrenia associated with neuroticism and extraversion was examined and quantified.

Methods. Neuroticism and extraversion rated at the age of 16 years were examined in relation to adult schizophrenia in a national birth cohort of 5362 individuals.

Results. Neuroticism increased the risk of later schizophrenia independent of the level of affective symptoms in adult life (odds ratio over three levels: 1·93, 95% CI 1·09–3·43), whereas extraversion reduced the risk (OR: 0·44, 95% CI 0·23–0·84).

Conclusions. Depression and schizophrenia may share personality risk-increasing and risk-reducing factors. Coping styles associated with particular personality traits may determine whether isolated symptoms progress to full-blown illness.