The aim was to critically appraise and synthesize the literature relating to set-shifting ability in eating disorders. PsycINFO, Medline, and Web of Science databases were searched to December 2005. Hand searching of eating-disorder journals and relevant reference sections was also undertaken.

The 15 selected studies contained both eating disorder and healthy control groups, and employed at least one of the following six neuropsychological measures of set-shifting ability; Trail Making Test (TMT), Wisconsin Card Sort Test (WCST), Brixton task, Haptic Illusion, CatBat task, or the set-shifting subset of the Cambridge Neuropsychological Test Automated Battery (CANTAB). The outcome variable was performance on the set-shifting aspect of the task. Pooled standardized mean differences (effect sizes) were calculated.

TMT, WCST, CatBat and Haptic tasks had sufficient sample sizes for meta-analysis. These four tasks yielded acceptable pooled standardized effect sizes (0·36; TMT −1·05; Haptic) with moderate variation within studies (as measured by confidence intervals). The Brixton task showed a small pooled mean difference, and displayed more variation between sample results. The effect size for CANTAB set shifting was 0·17.

Problems in set shifting as measured by a variety of neuropsychological tasks are present in people with eating disorders.

Despite a growing body of literature reporting eating disorders (EDs) in non-Western countries in recent years, most of these studies are limited to questionnaire-based surveys or case-series studies. This study aimed to investigate the prevalence and correlates of EDs in Taiwanese high-school students.

The study subjects consisted of all the female high-school students enrolled in the gifted dance class in 2003 in Taiwan (n=655) and non-dance female students randomly chosen from the same school (n=1251). All the participants were asked to complete self-report questionnaires, including the 26-item Eating Attitudes Test (EAT-26) and the Bulimic Investigatory Test Edinburgh (BITE). All the screen positives and an approximate 10% random sample of the screen negatives were then interviewed using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders Patient Version (SCID-I/P).

The prevalence of individual EDs was much higher in the dance [0·7% for anorexia nervosa (AN), 2·5% for bulimia nervosa (BN) and 4·8% for EDs, not otherwise specified (EDNOS)] than in the non-dance (0·1, 1·0 and 0·7% respectively) students. Multivariate logistic regression analyses revealed that being in the dance class, higher concern about body shape and lower family support were correlates of EDs for all students, whereas lower parental education level was associated with EDs only for non-dance students.

EDs were more prevalent in the weight-concerned subpopulation. Although AN is still rare, BN has emerged as a comparable prevalent disorder in Taiwan, as in Western countries.

Previous studies have reported that the current DSM-IV eating disorder (ED) criteria do not adequately describe ED symptomatology. The objective of the current study was to examine the clustering of ED symptoms in a general population sample using latent class analysis (LCA).

ED symptoms from 3723 female young adult twins (mean age 22) were analyzed using LCA, and resulting classes were compared on external validators reflecting ED and other co-morbid psychiatric diagnoses, substance use disorders (SUDs), and suicidality.

The optimal solution consisted of five latent classes characterized as: (1) Unaffected; (2) Low Weight Gain; (3) Weight Concerned; (4) Dieters; and (5) ED. Members of the ED class had significantly higher prevalence of co-morbid psychiatric disorders, SUDs, and suicidality than the Unaffected and Low Weight Gain classes, and elevated rates of suicidality and major depression compared to the Weight Concerned and Dieter classes, which differed from each other primarily in terms of current body mass index (BMI). Dieter class members were more likely to be overweight and obese and less likely to be underweight than Weight Concerned class members. The majority of women with an ED diagnosis were assigned to the ED class, and few differences were found between ED class members with and without an ED diagnosis.

The results add to the evidence that many women with significant ED psychopathology are not being identified by the DSM-IV ED categories.

We explored the course of broadly defined eating disorders during pregnancy in the Norwegian Mother and Child Cohort Study (MoBa) at the Norwegian Institute of Public Health.

A total of 41 157 pregnant women, enrolled at approximately 18 weeks' gestation, had valid data from the Norwegian Medical Birth Registry. We collected questionnaire-based diagnostic information on broadly defined anorexia nervosa (AN), and bulimia nervosa (BN), and eating disorders not otherwise specified (EDNOS). EDNOS subtypes included binge eating disorder (BED) and recurrent self-induced purging in the absence of binge eating (EDNOS-P). We explored rates of remission, continuation and incidence of BN, BED and EDNOS-P during pregnancy.

Prepregnancy prevalence estimates were 0·1% for AN, 0·7% for BN, 3·5% for BED and 0·1% for EDNOS-P. During early pregnancy, estimates were 0·2% (BN), 4·8% (BED) and 0·1% (EDNOS-P). Proportions of individuals remitting during pregnancy were 78% (EDNOS-P), 40% (BN purging), 39% (BED), 34% (BN any type) and 29% (BN non-purging type). Additional individuals with BN achieved partial remission. Incident BN and EDNOS-P during pregnancy were rare. For BED, the incidence rate was 1·1 per 1000 person-weeks, equating to 711 new cases of BED during pregnancy. Incident BED was associated with indices of lower socio-economic status.

Pregnancy appears to be a catalyst for remission of some eating disorders but also a vulnerability window for the new onset of broadly defined BED, especially in economically disadvantaged individuals. Vigilance by health-care professionals for continuation and emergence of eating disorders in pregnancy is warranted.

Rates of depression have been rising, as have rates of work stress. We tested the influence of work stress on diagnosed depression and anxiety in young working adults.

Participants were enrolled in the Dunedin study, a 1972–1973 longitudinal birth cohort assessed most recently in 2004–2005, at age 32 (n=972, 96% of 1015 cohort members still alive). Work stress (psychological job demands, work decision latitude, low work social support, physical work demands) was ascertained by interview. Major depressive disorder (MDD) and generalized anxiety disorder (GAD) were ascertained using the Diagnostic Interview Schedule (DIS) and diagnosed according to DSM-IV criteria.

Participants exposed to high psychological job demands (excessive workload, extreme time pressures) had a twofold risk of MDD or GAD compared to those with low job demands. Relative risks (RRs) adjusting for all work characteristics were: 1·90 [95% confidence interval (CI) 1·22–2·98] in women, and 2·00 (95% CI 1·13–3·56) in men. Analyses ruled out the possibility that the association between work stress and disorder resulted from study members' socio-economic position, a personality tendency to report negatively, or a history of psychiatric disorder prior to labour-market entry. Prospective longitudinal analyses showed that high-demand jobs were associated with the onset of new depression and anxiety disorder in individuals without any pre-job history of diagnosis or treatment for either disorder.

Work stress appears to precipitate diagnosable depression and anxiety in previously healthy young workers. Helping workers cope with work stress or reducing work stress levels could prevent the occurrence of clinically significant depression and anxiety.

To explore the risk of suicide associated with occupation while evaluating the impact of socio-economic, demographic and psychiatric differences.

A nested case–control study with 3195 suicides and 63 900 matched controls. Information on causes of death, occupation, psychiatric admission, marital status and socio-economic factors was obtained from routine registers.

Across the 55 occupations investigated, the risk of suicide ranged from 2·73 [95% confidence interval (CI) 1·77–4·22] among doctors to 0·44 (95% CI 0·27–0·72) among architects and engineers compared with primary school teachers. With the exception of doctors and nurses, most of the excess risk of suicide associated with particular occupations is explained by the social and economic characteristics of people in those occupations. Much, but not all, of the excess risk in doctors and nurses is due to their increased use of self-poisoning, a method for which they have the knowledge to use effectively. Occupation has little association with suicide among people who suffer from a psychiatric illness, except for doctors, where the excess risk is 3·62 (p=0·007).

Most of the considerable variation in suicide risk across occupations is explained by socio-economic factors, except for doctors and nurses. Apart from in doctors, the risk of suicide has little association with occupation among people who suffer from a psychiatric illness. Restriction of access to lethal means is an important strategy in suicide prevention.

Overworking is one of the most frequent stressors. The purpose of this study was to determine the effectiveness of behavioural/psycho-educational group training in men who are chronically stressed from overworking.

Of 72 male subjects, 36 were randomly assigned to training for 8 weeks and another 36 formed the control group, which received a placebo intervention. Primary outcome measures were systolic blood pressure, salivary cortisol concentration upon awakening, and self-reported changes on the scales of the Trier Inventory for the Assessment of Chronic Stress (TICS), the State-Trait Anger Expression Inventory (STAXI) and the 36-item Short Form Health Survey (SF-36).

A significant reduction in mean values was observed in daily systolic blood pressure and salivary cortisol concentration on all the TICS and most of the STAXI and SF-36 scales.

Behavioural/psycho-educational group training appears to be effective in the treatment of men suffering from chronic stress due to overworking.

There is evidence that greater body mass index (BMI) protects against depression, schizophrenia and suicide. However, there is a need for prospective studies.

We examined the association of BMI with future hospital admissions for psychoses or depression/anxiety disorders in a large prospective study of 7036 men and 8327 women. Weight and height were measured at baseline (1972–76) when participants were aged 45–64. Follow-up was for a median of 29 years.

Greater BMI and obesity were associated with a reduced risk of hospital admission for psychoses and depression/anxiety in both genders, with the magnitude of these associations being the same for males and females. With adjustment for age, sex, smoking and social class, a 1 standard deviation (s.d.) greater BMI at baseline was associated with a rate ratio of 0·91 [95% confidence interval (CI) 0·82–1·01] for psychoses and 0·87 (95% CI 0·77–0·98) for depression/anxiety. Further adjustment for baseline psychological distress and total cholesterol did not alter these associations.

Our findings add to the growing body of evidence that suggests that greater BMI is associated with a reduced risk of major psychiatric outcomes. Long-term follow-up of participants in randomized controlled trials of interventions that effectively result in weight loss and the use of genetic variants that are functionally related to obesity as instrumental variables could help to elucidate whether these associations are causal.

The relationship between personality and psychiatric illness is complex. It is not clear whether one directly causes the other.

In a population-based sample of male twins (n=3030), we attempted to predict major depression (MD) from neuroticism (N) and extraversion (E) and vice versa, to evaluate the causal, scar, state, and prodromal hypotheses. In a longitudinal, structural equation twin model, we decomposed the covariation between N and MD into (a) genetic and environmental factors that are common to both traits, as well as specific to each one and (b) direct causal effects of N at time 1 on subsequent MD, as well as between MD and subsequent N.

E was negatively correlated with lifetime and one-year prevalence of MD. N predicted the new onset of MD, and was predicted by both current and past MD. It did not predict the time to onset of MD. All of the covariation between N and MD was due to additive genetic and individual-specific environmental factors shared by both traits and a direct causal path between MD and N assessed later. No genetic factors were unique to either trait.

In men, N may be a vulnerability factor for MD but does not cause it directly. However, MD may have a direct causal effect on N. The genetic overlap between N and MD in men may be greater than in women.

Few studies have examined the course of illness among severely depressed patients ascertained at first hospitalization. Using data from the Suffolk County Mental Health Project (SCMHP), we investigated the times to and predictors of the first full remission and the first relapse during a 4-year period in a first-admission cohort with major depressive disorder (MDD) with psychotic features.

The cohort included 87 county-wide, first-admission patients with a longitudinal consensus diagnosis of MDD with psychotic features who were systematically followed over a 4-year period. We examined the associations of background, clinical and treatment factors, and time-varying indices of antidepressant (AD) and antipsychotic (AP) medication use to time to remission and relapse using Cox regression.

By the 4-year follow-up, 60 respondents (69·0%) had achieved a period of full remission (median time of 22 weeks among remitters and 54 weeks in the full sample). In the multivariable analysis, longer time to remission was associated with longer latency between initial episode and hospitalization, lower pre-hospital Global Assessment of Functioning (GAF) score, and lack of insurance, but not use of medication. Twenty-six remitters (43·3%) relapsed (median time of 50 weeks among those who relapsed and 192 weeks among all remitters). None of the risk factors or time-varying medication variables was significantly associated with time to relapse.

Only two-thirds of the sample had at least one full remission by 4 years, and almost half of them subsequently relapsed. Poorer pre-hospital resources predicted remission but not relapse. Medication use over the follow-up was not associated with remission or relapse.

Few studies have investigated non-suicidal self-injury (NSSI), or the deliberate, direct destruction of body tissue without conscious suicidal intent, and the motivations for engaging in NSSI among adolescents. This study assessed the prevalence, associated clinical characteristics, and functions of NSSI in a community sample of adolescents.

A total of 633 adolescents completed anonymous surveys. NSSI was assessed with the Functional Assessment of Self-Mutilation (FASM).

Some form of NSSI was endorsed by 46·5% (n=293) of the adolescents within the past year, most frequently biting self, cutting/carving skin, hitting self on purpose, and burning skin. Sixty per cent of these, or 28% of the overall sample, endorsed moderate/severe forms of NSSI. Self-injurers reported an average of 12·9 (s.d.=29·4) incidents in the past 12 months, with an average of 2·4 (s.d.=1·7) types of NSSI used. Moderate/severe self-injurers were more likely than minor self-injurers, who in turn were more likely than non-injurers, to have a history of psychiatric treatment, hospitalization and suicide attempt, as well as current suicide ideation. A four-factor model of NSSI functions was indicated, with self-injurers likely to endorse both reasons of automatic reinforcement and social reinforcement. The most common reasons for NSSI were ‘to try to get a reaction from someone’, ‘to get control of a situation’, and ‘to stop bad feelings’.

Community adolescents reported high rates of NSSI, engaged in to influence behaviors of others and to manage internal emotions. Intervention efforts should be tailored to reducing individual issues that contribute to NSSI and building alternative skills for positive coping, communication, stress management, and strong social support.

Longitudinal, genetically informed, prospective data collected on a large population of male twins (n=1037) were used to examine developmental differences in the etiology of antisocial behavior.

Analyses were carried out on both mother- and child-reported symptoms of conduct disorder (CD) in 10- to 17-year-old twins from the Virginia Twin Study of Adolescent Behavioral Development (VTSABD) and self-reported antisocial behavior by the twins as young adults from the Young Adult Follow-Up (YAFU) study.

The following trends were identified: (1) a single genetic factor influencing antisocial behavior beginning at age 10 through young adulthood (‘life-course persistent’); (2) a shared-environmental effect beginning in adolescence (‘adolescent-onset’); (3) a transient genetic effect at puberty; and (4) a genetic influence specific to adult antisocial behavior.

Overall, these etiological findings are consistent with predictions from Moffitt's developmental theory of antisocial behavior. The genetic effect at puberty at ages 12–15 is also consistent with a genetically mediated influence on the timing of puberty affecting the expression of genetic differences in antisocial outcomes.

Drug-related stimuli reliably induce craving in experimental paradigms, yet are rarely cited by drug users as major precipitants of relapse. We examined the motivational significance of drug cues in opiate dependence, by exploring their impact on central attentional processes.

Fourteen methadone-maintained subjects and 14 matched controls were studied. Subjects performed a novel active visual oddball task, consisting of opiate-related and matched neutral pictures, some of which (the oddballs) included a white cup. Subjects were fitted with a 32-channel electrode cap. The P300 for each stimulus category was identified using temporal principal components analysis.

The P300 elicited by opiate stimuli was significantly larger than that elicited by neutral stimuli in the methadone-maintained group but not in the controls. There was also a non-significant trend for the opiate stimuli to elicit larger P300s than the oddball stimuli in the addicted group.

These results suggest that drug cues acquire motivational salience and automatically capture attentional resources in opiate addicts, even when engaged in a non-drug-related task. Enhanced P300s to drug cues may provide an important biological marker of crucial psychological mechanisms relevant to addiction.