Attention-deficit hyperactivity disorder (ADHD) increases the risk of suicidal behaviours through psychiatric comorbidities; however, a significant direct association has not been observed between ADHD and suicide attempts.

To evaluate the risk of suicide attempt in adolescents and young adults with ADHD.

Using a nationwide, population-based insurance claims database, this longitudinal cohort study enrolled 20 574 adolescents and young adults with ADHD and 61 722 age- and gender-matched controls between 2001 and 2009. Any suicide attempt was identified from enrolment to 31 December 2011. The association between ADHD medications and the likelihood of suicide attempt was assessed.

ADHD was an independent risk factor for any suicide attempt (hazard ratio = 3.84, 95% CI = 3.19–4.62) and repeated suicide attempts (hazard ratio = 6.52, 95% CI = 4.46–9.53). Subgroup analyses of men, women, adolescents and young adults demonstrated the same trend. Methylphenidate or atomoxetine treatment did not increase the risk of suicide attempt or repeated suicide attempts. Long-term methylphenidate treatment was associated with a significantly decreased risk of repeated suicide attempts in men (hazard ratio = 0.46, 95% CI = 0.22–0.97).

ADHD was a risk factor for suicide attempt and a stronger predictor of repeated suicide attempts, independent of comorbidities. Further investigation is warranted to explore the mechanism underlying the association between ADHD and suicidal behaviours.

None.

Clinical samples have identified a number of psychosocial risk factors for suicidal acts but it is unclear if these findings relate to the general population.

To describe the prevalence of and psychosocial risk factors for suicidal acts in a general adult population.

Data were obtained from a Canadian epidemiological survey of 36 984 respondents aged 15 years and older (weighted sample n=23 662 430).

Of these respondents, 0.6% (weighted n=130 143) endorsed a 12-month suicidal act. Female gender (OR=4.27, 95% CI 4.05–4.50), being separated (OR=37.88, 95% CI 33.92–42.31) or divorced (OR=7.79, 95% CI 7.22–8.41), being unemployed (OR=1.70, 95% CI 1.50–1.80), experiencing a chronic physical health condition (OR=1.70, 95% CI 1.67–1.86) and experiencing a major depressive episode in the same 12-month period as the act (OR=9.10, 95% CI 8.65–9.59) were significantly associated with a suicidal act.

The psychosocial correlates of suicidal acts in this sample are consistent with those previously reported in clinical and general population samples. These findings reinforce the importance of the determination of suicide risk and its prevention not only of psychiatric illness but of physical and psychosocial factors as well.

The concept of transference has broadened to a recognition that patients often express enduring relational patterns in the therapeutic relationship.

To examine the structure of patient relational patterns in psychotherapy and their relation with DSM–IV personality disorder symptoms.

A random sample of psychologists and psychiatrists (n=181) completed a battery of instruments on a randomly selected patient in their care.

Exploratory factor analysis identified five transference dimensions: angry/entitled, anxious/preoccupied, avoidant/counterdependent, secure/engaged and sexualised. These were associated in predictable ways with Axis II pathology; four mapped on to adult attachment styles. An aggregated portrait of transference patterns in narcissistic patients provided a clinically rich, empirically based description of transference processes that strongly resembled clinical theories.

The ways patients interact with their therapists can provide important data about their personality, attachment patterns and interpersonal functioning. These processes can be measured in clinically sophisticated and psychometrically sound ways. Such processes are relatively independent of clinicians' theoretical orientation.

Age- and gender-specific suicide rates in England and Wales have changed considerably since 1950.

To assess whether cohort effects underlie some of these changes.

Graphical displays to assess age–period–cohort effects on suicide for the period 1950–1999.

Successive male birth cohorts born after 1940 carried with them, as they aged, a greater risk of suicide than their predecessors although this effect diminished for the 1975 and 1980 birth cohorts. There was less clear evidence of any increased risk of suicide in post-war female birth cohorts.

Succeeding generations of males born in the post-war years have experienced increasing rates of suicide at all ages, an observation in keeping with patterns seen in other countries. If these trends continue into middle- and old-age they will lead to a great increase in overall male suicide rates.

It has been reported that real ECT is more effective than simulated treatment among depressed patients with delusions and/or retardation, and that ECT is not effective among depressed patients who lack these features.

In two randomised, double-blind studies, 143 patients with major depression were subtyped regarding psychosis, retardation and agitation. In both studies, low dosage, right unilateral ECT was ineffective compared with other forms of ECT. This report examined whether the depressive subtypes differed in clinical response to the ineffective and effective forms of ECT.

The therapeutic advantage of effective forms of ECT was similar across the depression subtypes. Patients who lacked both psychosis and retardation showed this pattern.

The findings cast doubt on the utility of these depression subtypes in predicting ECT response. ECT is a viable treatment option for patients with major depression regardless of the presence or absence of psychosis, retardation and/or agitation.

Numbers of immigrant elders are increasing and it is unclear whether they can access services.

To examine service utilisation of older immigrants compared with their UK-born counterparts and relate it to health difficulties.

Cross-sectional study in inner London measuring service use, mental health and disability.

A total of 1085 people aged ⩾65 years were interviewed. Independent predictors of contact with a general practitioner included being born in Cyprus. Cypriots were the only immigrant population to report significantly more somatic symptoms than those born in the UK (P=0.005). Africans and Caribbeans used daycare and other social services most frequently.

Immigrants could access services. Africans and Caribbeans appear to have poorer physical health and thus have greater contact with services. Cypriots who experience depression may present with prominent somatic symptoms. This is likely to be due to a different idiom of distress.

Little is known about gender differences in the long-term outcomes of people with schizophrenia living in the community.

To explore gender differences in the 14-year outcome of people with schizophrenia in rural China.

A 14-year follow-up study among a 1994 cohort (n = 510) of participants with schizophrenia was conducted in Xinjin County, Chengdu, China. All participants and their informants were followed up in 2004 and 2008 using the Patients Follow-up Schedule.

Compared with female participants, male participants were significantly younger, had significantly higher rates of mortality, suicide and homelessness, and poorer family and social support. There was no significant gender difference in Positive and Negative Syndrome Scale scores, previous suicide attempts, those never treated, previous hospital admission or inability to work. Longer duration of illness was associated with functional decline and comparatively poorer family economic status.

The long-term outcomes of men with schizophrenia is worse than those of women with the disorder in rural China. Higher mortality, suicide and homelessness rates in men may contribute partly to the higher prevalence of schizophrenia in women in China. Policies on social and family support and gender-specific intervention strategies for improving long-term outcomes should be developed for people with this disorder.

Women with schizophrenia are at increased risk for adverse pregnancy outcomes. It is not known whether offspring born to fathers with schizophrenia also have an increased risk.

To evaluate paternal and maternal influences on the association between schizophrenia and pregnancy outcomes.

A record linkage including 2 million births was made using Swedish population-based registers. The risk for adverse pregnancy outcomes was evaluated through logistic regression.

Offspring with a mother or father with schizophrenia faced a doubled risk of infant mortality, which could not be explained by maternal behaviour alone during pregnancy. Excess infant death risk was largely attributable to post-neonatal death. Maternal factors (e.g. smoking) explained most of the other risks of adverse pregnancy outcomes among both mothers and fathers with schizophrenia.

The risks to offspring whose fathers had schizophrenia suggest that, in addition to maternal risk behaviour, nonoptimal social and/or parenting circumstances are of importance.

Patients with chronic fatigue syndrome (CFS) report neuropsychological symptoms as a characteristic feature. We sought to assess cognitive performance in patients with CFS, and compare cognitive performance and subjective workload experience of these patients with that of two disease comparison groups (non-melanchonic depression and acute infection) and healthy controls.

A computerised performance battery employed to assess cognitive functioning included tests of continuous attention, response speed, performance accuracy and memory. Severity of mood disturbance and subjective fatigue were assessed by questionnaire.

All patient groups demonstrated increased errors and slower reaction times, and gave higher workload ratings than healthy controls. Patients with CFS and non-melancholic depression had more severe deficits than patients with acute infection. All patient groups reported more severe mood disturbance and fatigue than healthy controls, but patients with CFS and those with acute infection reported less severe mood disturbance than patients with depression.

As all patients demonstrated similar deficits in attention and response speed, it is possible that common pathophysiological processes are involved. The differences in severity of mood disturbance, however, suggest that the pathophysiological processes in patients with CFS and acute infection are not simply secondary to depressed mood.

Community-based care at the margin is a substitute for institutional care. Three factors are considered critical: definitions of eligibility, assessment procedures and balance of care.

To examine determinants of the margin between institutional and home-based care, review current practice, identify the implications and contribute to planning of integrated long-term care services.

A selective review was made of findings from research conducted after the community care reforms.

Marked variability and inconsistency in eligibility and assessment processes may contribute to misplacement of frail older people. There remains capacity to shift the balance of care from institutional to home-based care within reasonable cost parameters, particularly with more integrated services.

Greater standardisation of approaches to the determination of eligibility for social care and to assessment of need is required. Providing care at home for some of those currently entering care homes is feasible, but will require different service structures and staff roles, including specialist clinicians.

This is the third large-scale audit in the past 20 years and compares the practice of electroconvulsive therapy (ECT) in England and Wales with the standards derived from the Royal College of Psychiatrists' 2nd ECT handbook.

Facilities, equipment, practice, personnel and training were systematically evaluated during visits to all ECT clinics in the former North East Thames and East Anglia regions and Wales. All other English ECT clinics were surveyed with a postal questionnaire. Information was obtained for 184 (84%) of the 220 ECT clinics identified.

Although some aspects of ECT administration had improved since the last audit in 1991, overall only one-third of clinics were rated as meeting College standards. Only 16% of responsible consultants attended their ECT clinic weekly and only 6% had sessional time for ECT duties. Fifty-nine per cent of all clinics had machines of the type recommended by the College and 7% were still using machines considered outdated in 1989. Only about one-third of clinics had clear policies to help guide junior doctors to administer ECT effectively.

Twenty years of activity by the Royal College of Psychiatrists and three large-scale audits have been associated with only modest improvement in local practice.

Second-generation antipsychotics (SGAs) represent an advance in the long-term management of schizophrenia.

To review the available evidence concerning SGA long-acting injections (LAIs).

A systematic review of the literature was conducted using PubMed.

Risperidone long-acting injection was the first licensed SGA–LAI compound and is effective in the long-term management of schizophrenia, with a safety profile similar to that of oral risperidone. Olanzapine pamoate has recently been approved in Europe. In terms of efficacy, at injection intervals of up to 4 weeks it appears comparable to oral olanzapine, although the potential for ‘post-injection syndrome’ (delirium) calls for additional safety considerations. Paliperidone palmitate is currently under review with the licensing authorities. It also affords the potential advantage of monthly dosing.

More long-term comparisons of SGA–LAIs with oral SGAs as well as with first-generation antipsychotic LAIs are needed. These studies should include cost-effectiveness data.

Hippocampal shrinkage is commonly reported in schizophrenia, but its role in the illness is still poorly understood. In particular, it is unclear how clinical and psychosocial variables relate to hippocampal volumes.

To investigate neuroanatomic differences in the hippocampus using three-dimensional (3D) computational image analysis.

We used high-resolution magnetic resonance imaging and surface-based modelling to map the 3D profile of hippocampal differences in adults with schizophrenia (n=67) and a healthy control group (n = 72). Manual tracings were used to create 3D parametric mesh models of the hippocampus. Regression models were used to relate diagnostic measures to maps of radial distance, and colour-coded maps were generated to show the profile of associations.

There was no detectable difference between the schizophrenia and control groups in hippocampal radial distance. In the schizophrenia group, however, bilateral shape deflation was associated with greater illness severity (length of illness, positive and negative symptoms) and with poorer social functioning (educational level, quality of life and health status), which survived Bonferroni correction.

Illness severity and poor social functioning may be associated with hippocampal deflation in schizophrenia. As a structural sign of poor outcome, imaging measures might help to identify a subgroup of patients who may need specific treatment to resist hippocampal shrinkage, such as cognitive rehabilitation or physical exercise.