This issue features groups of papers dealing with ethnic and transcultural psychiatry, psychopathology in adolescents and their parents, and nicotine withdrawal, together with three papers on other issues, respectively severely mentally ill patients in residential facilities in Italy, interferon-induced cognitive changes, and persistence of impairment in personality disorders. The lead review article by Verdoux et al. (pp. 307–315) reviews studies addressing the question of whether dependence on benzodiazepines, drugs well known to produce cognitive effects when administered currently, is followed by enduring cognitive deficits after withdrawal.

This issue features groups of papers on genetic epidemiology, personality traits and associations with psychopathology, depression, social support and psychiatric disorder, schizophrenia, together with papers on other topics.

This issue features a group of papers and a review article on the neuropsychology of attention deficit hyperactivity disorder (ADHD), groups of papers on schizophrenia, mental disorders in primary care, and affective disorders, and an additional paper by Dew et al. (pp. 1215–1227) regarding course of psychological distress over 4 years after heart transplantation.

We are pleased to announce that from this month Psychological Medicine will be published monthly. Psychological Medicine has long had a tradition of issues which are substantial in thickness, and produce large annual volumes. With progressive expansion of the total number of pages published annually over the last ten years, we have moved from the previous quarterly issues to every two months and then to eight issues per year. Increasing to monthly issues will thin each issue a little but it coincides with a further increase in the total annual number of pages and of papers published. We will now be able to serve our authors better by publishing their papers more quickly. Since last year, all papers have also been published online rapidly, as soon as they have been typeset and proofread, well in advance of being assigned to a printed issue, further enhancing rapid dissemination to readers.

We are also making some changes in the regional distribution of editorial responsibilities. In future, papers from Europe and Australasia will continue to be handled by the UK Editorial Office but, in addition to papers from the Americas, those from Asia, Africa and the Middle East should be sent to the US Editorial Office.

This issue features groups of papers dealing with nosology of depression and psychoses, biology of depression, structural brain MRI in schizophrenia and autism, together with papers on other topics.

This issue features papers using functional imaging in psychiatric disorders linked with neuropsychology to explore underlying brain systems, together with other neuropsychological papers, and a related Invited Review by Nelson et al. (pp. 163–174) on neural changes which may underlie the developmental social changes of adolescence. Three papers deal with psychiatric disorders in childhood and adolescence. Two further papers report studies of suicidal behaviours and of depression. An additional paper from Barrett et al. (pp. 281–293) describes the prevalence and features of schizophrenia in an unusual cultural population isolate, the Iban of Sarawak.

This issue features an editorial on light therapy in non-seasonal depression, with a lead paper describing a trial reporting efficacy of this use, two other papers reporting treatment-related studies, and groups of papers reporting findings of longitudinal studies, and functional MRI and neuropsychology of psychiatric disorders.

This issue features groups of papers on neuroimaging and neuropsychology of psychiatric disorders, suicidal behaviours, depression, together with additional papers.

This issue features groups of papers on depression in later life, controlled trials of psychological interventions, and chronic fatigue, together with additional papers.

This issue features groups of papers on neuropsychology and neuroimaging of psychiatric disorders, adult attention deficit hyperactivity disorder, data from controlled treatment trials, epidemiology and longitudinal studies, eating disorders, together with an additional paper describing a specific disorder involving a desire for a limb amputation.

This issue features a review article on costs of eating disorders, two papers on bulimia, groups of papers on genetics, family studies in obsessive–compulsive disorder, treatment, and an additional paper on catatonia.

This issue features groups of papers on bipolar disorder, neuropsychology and psychophysiology of psychiatric disorders, epidemiology, and relationships of adolescent disorders to parental psychopathology.

Background. The economic burden and health service use of eating disorders have received little attention, although such data are necessary to estimate the implications of any changes in clinical practice for patient care and health care resource requirements. This systematic review reports the current international evidence on the resource use and cost of eating disorders.

Method. Relevant literature (1980–2002) was identified from searches of electronic databases and expert contacts.

Results. Two cost-of-illness studies from the UK and Germany, one burden-of-disease study from Australia and 14 other publications with relevant data from the UK, USA, Austria, Denmark and The Netherlands could be identified. In the UK, the health care cost of anorexia nervosa was estimated to be £4·2 million in 1990. In Germany, the health care cost was €65 million for anorexia nervosa and €10 million for bulimia nervosa during 1998. The Australian study reported the health care costs of eating disorders to be Aus$22 million for year 1993/1994. Other costing studies focused mostly on in-patient care reporting highly variable estimates. There is a dearth of research on non-health care costs.

Conclusions. The limited available evidence reflects a general under-detection and under-treatment of eating disorders. Although both cost-of-illness studies may significantly underestimate the costs of eating disorders because of important omitted cost items, other evidence suggests that the economic burden is likely to be substantial. Comprehensive data on the resource use of patients with eating disorders are urgently needed for better estimations, and to be able to determine cost-effective treatment options.

Background. Executive dysfunctions in relatives of schizophrenic patients may be trait markers of genetic liability and thus help us to elucidate the aetiology of schizophrenia. As a large amount of data has been published, a synthesis through a meta-analysis was needed to demonstrate the existence of executive impairments in relatives of schizophrenic patients and to assess their magnitude.

Method. We conducted a meta-analysis of articles that compared performances of controls and relatives of schizophrenic patients on the four tests most frequently used to assess executive functions: the Wisconsin Card Sorting Test (WCST), the Trail Making Test (TMT), the Stroop Test and the Verbal Fluency (VF) Test. When needed and possible, published data were supplemented with information from the authors. After assessing the homogeneity of the data, effect sizes were estimated and publication bias was tested by use of funnel plots.

Results. Relatives of schizophrenic patients performed less well than controls on all executive tests analysed. Effect estimates were in the small to moderate range (from 0·26 to 0·49) for Stroop, WCST and TMT, but were greater for the fluency tests (0·65 for phonological and 0·87 for semantic VF).

Conclusion. Relatives of schizophrenic patients appear to have wide, although not severe, executive dysfunctions. As the sensitivity of the different tests for impairments in relatives is not the same, the choice of test and method used should be carefully assessed.

Background. Several theoretical explanations of ADHD in children have focused on executive functioning as the main explanatory neuropsychological domain for the disorder. In order to establish if these theoretical accounts are supported by research data for adults with ADHD, we compared neuropsychological executive functioning and non-executive functioning between adults with ADHD and normal controls in a meta-analytic design.

Method. We compared 13 studies that (1) included at least one executive functioning measure, (2) compared the performance of an adult ADHD group with that of an adult normal control group, (3) provided sufficient information for calculation of effect sizes, and (4) used DSM-III-R or DSM-IV criteria to diagnose ADHD.

Results. We found medium effect sizes both in executive functioning areas [verbal fluency (d=0·62), inhibition (d=0·64 and d=0·89), and set shifting (d=0·65)] and in non-executive functioning domains [consistency of response (d=0·57), word reading (d=0·60) and color naming (d=0·62)].

Conclusions. Neuropsychological difficulties in adult ADHD may not be confined to executive functioning. The field is in urgent need of better-designed executive functioning tests, methodological improvements, and direct comparisons with multiple clinical groups to answer questions of specificity.

Background. The aim was to systematically integrate the available evidence on psychosocial and demographic factors associated with response prediction to prophylactic lithium.

Method. Each psychosocial or demographic variable that was related to lithium response in at least one study was examined with respect to response prediction. If several studies were located for the same variable results were integrated using a meta-analytical approach. To account for heterogeneity of primary studies aggregation of results was based on a random-effects model.

Results. Out of 27 psychosocial and demographic variables investigated in this review, nine variables were identified as significantly related to outcome under to prophylactic lithium: (1) high social status, (2) social support, (3) good compliance, and (4) dominance may be protective against a recurrence under lithium. In contrast, (5) stress, (6) high expressed emotions, (7) neurotic personality traits, (8) unemployment, and (9) a high number of life events were identified as possible risk factors for poor response.

Conclusions. This systematic review shows a surprisingly high number of psychosocial variables to be related to lithium response. Effect sizes were, however, small to moderate. Many variables should, therefore, be considered simultaneously to predict response.

Background. Despite the burden of depression in late life, its origins present a paradox to investigators and clinicians alike.

Method. We review biological (genetics and heredity factors, neurotransmitter dysfunction, endocrine changes, vascular disorders, and medical co-morbidities), psychological (personality attributes, neuroticism, cognitive distortions, and the lack of emotional control and self-efficacy) and social (stressful life events, bereavement, chronic stress or strain, socio-economic disadvantage and impaired social support) origins of late-life depression based upon an extensive though not exhaustive review of the extant literature. In addition, modifying psychological and social factors are discussed.

Results. Older adults appear to be at greater risk for major depression biologically, such as depression resulting from vascular changes, yet the frequency of depression is lower compared to younger adults. Older adults may be protected psychologically due to factors such as socio-emotional selectivity and wisdom, compared to younger adults, and perhaps relatively protected from social risks.

Conclusions. A biopsychosocial approach to evaluating the origins of late-life depression is heuristically valuable, a continual reminder of the many factors that contribute to the onset and persistence of clinically significant symptoms in late life.

Background. A major public health issue is to determine whether long-term benzodiazepine use may induce cognitive deficits persisting after withdrawal. The aim of the present review was to examine findings from prospective studies carried out in general population samples exploring whether exposure to benzodiazepines is associated with an increased risk of incident cognitive decline.

Method. Using a MEDLINE search and a hand-search of related references in selected papers, we retrieved original studies published in peer-reviewed journals that explored in general population samples the association between benzodiazepine exposure and change in cognitive performance between baseline and follow-up assessment.

Results. Six papers met the inclusion criteria. Two studies reported a lower risk of cognitive decline in former or ever users, two found no association whatever the category of user, and three found an increased risk of cognitive decline in benzodiazepine users.

Conclusions. The discrepant findings obtained by studies examining the link between benzodiazepine exposure and risk of cognitive decline may be due to methodological differences, especially regarding the definitions of exposure and cognitive outcome. As a large proportion of subjects are exposed to benzodiazepines, a small increase in the risk of cognitive decline may have marked deleterious consequences for the health of the general population. This issue needs to be explored further by pharmaco-epidemiological studies.

Background. The DSM concept of ‘major depression’ has accrued increased status but demonstrated limited utility since inception.

Method. An historical overview of models of depression and the initially perceived advantages presented by the concept of ‘major depression’ are presented before detailing its limitations in application.

Results. Challenges to the utility of ‘major depression’ are provided by examining its conceptual model, its validity, its utility and the limited information generated in aetiological and treatment efficacy studies.

Conclusion. It is argued that the concept of ‘major depression’ has led to sterility in depression research and clinical practice, and that there is a need for a paradigm shift in modelling and classifying the depressive disorders.