Studies have shown high levels of distress and mental disorder among people living in refugee camps, yet none has confirmed diagnosis through clinical reappraisal.

To estimate the prevalence of mental disorders, related disability and treatment gap in adult refugees living in the Burj el-Barajneh camp.

Randomly selected participants were screened by household representative (n = 748) and individual (n = 315) interviews; clinical reappraisal was performed on a subset (n = 194) of 326 selected participants. Weighted prevalence estimates and 95% confidence intervals were calculated.

The prevalence of current mental disorders was 19.4% (95% CI 12.6–26.2); depression was the most common diagnosis (8.3%, 95% CI 4.4–12.2) and multiple diagnoses were common (42%) among the 88 persons with mental disorder. Lifetime prevalence of psychosis was 3.3% (95% CI 1.0–5.5). Mental disorders were associated with moderate to severe dysfunction (odds ratio = 8.8, 95% CI 4.5–17.4). The treatment gap was 96% (95% CI 92–100).

A range of mental disorders and associated disability are common in this long-term refugee setting. Combined with an important treatment gap, findings support the current consensus-based policy to prioritise availability of mental health treatment in refugee camps, especially for the most severe and disabling conditions.

Schizophrenia occurring for the first time in late life may be a distinct entity or part of a continuum.

Can late-onset schizophrenia (LOS) and early-onset schizophrenia (EOS) be differentiated by their phenomenology and risk factors to their development?

Convenience samples of 27 DSM–III–R defined LOS subjects, 30 EOS subjects and 34 control subjects were systematically assessed.

Premorbidly, both groups of subjects with schizophrenia had personality traits that were different from controls but not from each other. The EOS subjects had more family members with a history of psychiatric illness or schizophrenia and less hearing impairment than the other two groups, which did not differ from each other. Clinically, LOS and EOS subjects were similar, except that EOS subjects had more negative symptom scores, tended to have more delusions of guilt/sin and of being controlled and more formal thought disorder, and had significantly poorer instrumental activities of daily living.

Phenomenology and risk factors do not distinguish discrete LOS.

Since bipolar disorder seems to be associated with purinergic system dysfunction, allopurinol might be effective in treating symptoms of mania.

To estimate the efficacy and tolerability of allopurinol as adjunctive treatment for mania symptoms in people with bipolar affective disorder.

We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) comparing the effects of adjunctive allopurinol and placebo on mania symptom changes.

Five RCTs were included in the meta-analysis. Participants with allopurinol augmentation had a significantly greater decrease in mania symptoms than those with placebo (SMD= −0.34, P = 0.007), especially in people with the most severe forms of mania. Remission rates, although based on only two studies (n = 177), were significantly higher among individuals receiving allopurinol, whereas for discontinuation and side-effects no difference was found.

Our finding of a small to moderate effect size and overall low evidence for add-on allopurinol in reducing mania symptoms indicate that its use in routine practice needs further elucidation.

We aimed to study the effect of weather conditions on the rate of all deaths due to fatal self-harm (FSH) reported in a population of 350 000. In this study the term FSH refers to all coroners' verdicts which were recorded in a specified period and included suicide, misadventure and open verdict.

Five-year data of FSH in North Cheshire was analysed in relation to meteorological data, which were measured at the nearest meteorological office to the study population.

Small but significant positive correlations were demonstrated between occurrence of FSH and hours of sunshine (P < 0.01) and diurnal variations in daily temperature (P < 0.05). These effects were independent of gender and psychiatric history.

Weather may influence the occurrence of FSH, probably interacting with biological and social variables. The rate of FSH death appears to be positively related to fine weather conditions, during early summer, and not to extreme weather conditions as previously reported.

The determinants of self-esteem have been little studied in non-clinic samples. It has been suggested recently that child sexual abuse (CSA) may be a major determinant of low self-esteem in adulthood.

The psychosocial circumstances associated with low self-esteem in two random samples of women, one reporting CSA, the other not were compared, with particular emphasis on characteristics of family of origin. A two-phase (postal-then-interview) random community study assessed self-esteem and related variables.

Psychosocial variables predicting low self-esteem were the same in the two groups. They included being a follower or a loner, having an overcontrolling mother, being poorly qualified, giving a history of depressive disorder and displaying current psychiatric disorder. In addition, the subject's CSA status led to low self-esteem but only when it was of the most intrusive type. The CSA women had a substantially lower mean total self-esteem score. However, not all aspects of self-esteem were diminished equally; 12/30 items differed between the two groups, and two of the five generated self-esteem factors, which we named Pessimism and Fatalism, which differed between the control group and the whole CSA group. There were no differences for Likeability and Determination.

Predictors of low self-esteem for women include childhood temperament, a poor relationship with the mother, low qualification attainment, psychiatric morbidity, both previous and current, and, only when it is the most intrusive, CSA.

Mental disorders in children and adolescents have an impact on educational attainment.

To examine the temporal association between attainment in education and subsequent diagnosis of depression or self-harm in the teenage years.

General practitioner, hospital and education records of young people in Wales between 1999 and 2014 were linked and analysed using Cox regression.

Linked records were available for 652 903 young people and of these 33 498 (5.1%) developed depression and 15 946 (2.4%) self-harmed after the age of 12 but before the age of 20. Young people who developed depression over the study period were more likely to have achieved key stage 1 (age 7 years) but not key stage 2 (age 11) (hazard ratio (HR) = 0.79, 95% CI 0.74–0.84) milestones, indicating that they were declining in academic attainment during primary school. Conversely, those who self-harmed were achieving as well as those who did not self-harm in primary school, but showed a severe decline in their attainment during secondary school (HR = 0.72, 95% CI 0.68–0.78).

Long-term declining educational attainment in primary and secondary school was associated with development of depression in the teenage years. Self-harm was associated with declining educational attainment during secondary school only. Incorporating information on academic decline with other known risk factors for depression/self-harm (for example stressful life events, parental mental health problems) may improve risk profiling methods.

None.

Treatment options for depression include antidepressants, psychological therapy and a combination of the two.

To develop cost-effective clinical guidelines.

Systematic literature reviews were used to identify clinical, utility and cost data. A decision analysis was then conducted to compare the benefits and costs of antidepressants with combination therapy for moderate and severe depression in secondary care in the UK.

Over the 15-month analysis period, combination therapy resulted in higher costs and an expected 0.16 increase per person in the probability of remission and no relapse compared with antidepressants. The cost per additional successfully treated patient was £4056 (95% CI 1400–18 300); the cost per quality-adjusted life year gained was £5777 (95% CI 1900–33 800) for severe depression and £14 540 (95% CI 4800–79 400) for moderate depression.

Combination therapy is likely to be a cost-effective first-line secondary care treatment for severe depression. Its cost-effectiveness for moderate depression is more uncertain from current evidence. Targeted combination therapy could improve resource utilisation.