Lack of social interaction, which is characteristically seen in people with autistic-spectrum disorder, may be caused by malfunctioning of the frontostriatal reward systems. However, no reported in vivo brain imaging studies have investigated reward mechanisms in autistic-spectrum disorder.

To investigate functional brain activation during reward feedback in people with autistic-spectrum disorder and control individuals.

We used event-related functional magnetic resonance imaging to examine the neural substrates of monetary reward in individuals with autistic-spectrum disorder and matched controls.

When rewarded, individuals with autism compared with control individuals showed significantly greater brain activation in the left anterior cingulate gyrus. In addition, activation of this region was negatively correlated with social interaction as measured by the Autism Diagnostic Interview.

In people with autistic-spectrum disorder, achieving reward is associated with significant differences in the activation of areas known to be responsible for attention and arousal, and this may partially underpin some deficits in social behaviour.

Understanding trends in public attitudes towards people with mental illness informs the assessment of ongoing severity of stigma and evaluation of anti-stigma campaigns.

To analyse trends in public attitudes towards people with mental illness in England and Scotland using Department of Health Attitudes to Mental Illness Surveys, 1994–2003.

We analysed trends in attitudes for 2000 respondents in each survey year (6000 respondents in 1996 and 1997) using quota sampling methods and the adapted Community Attitudes Toward the Mentally Ill scale.

Comparing 2000 and 2003, there was significant deterioration for 17/25 items in England and for 4/25 items in Scotland. Neither country showed significant improvements in items between 2000 and 2003.

Public attitudes towards people with mental illness in England and Scotland became less positive during 1994–2003, especially in 2000–2003, and to a greater extent in England. The results are consistent with early positive effects for the ‘see me’ anti-stigma campaign in Scotland.

Attention-deficit hyperactivity disorder (ADHD) is a common childhood condition, and is more prevalent in boys. The adult outcome of girls with ADHD has never been studied.

To identify predictors for adult psychiatric outcome of children with ADHD, including gender and comorbidity.

Children aged 4–15 years, referred for hyperactivity/inattention and treated with stimulants were included (n=208). The Psychiatric Case Register provided follow-up data on psychiatric admissions in adulthood until a mean age of 31 years.

A total of 47 cases (22.6%) had a psychiatric admission in adulthood. Conduct problems in childhood were predictive (hazard ratio HR=2.3; 95% CI 1.22–4.33). Girls had a higher risk compared with boys (HR=2.4; 95% CI 1.1–5.6).

Girls with ADHD had a higher risk of adult psychiatric admission than boys. Conduct problems were also associated with a higher risk. Girls with ADHD with conduct problems had a very high risk of a psychiatric admission in adulthood.

Acamprosate is a newly registered drug that appears to reduce alcohol-drinking in both animal models and clinical conditions.

In order to assess the efficacy and safety of the drug in the treatment of detoxified alcoholics, we performed a 90-day double-blind trial comparing two dosages of acamprosate (1332 mg/day and 1998 mg/day).

For all efficacy parameters, acamprosate appeared to be significantly superior to placebo, with a trend towards a better effect at the higher dosage. Furthermore, acamprosate appeared to be extremely safe.

This study confirms that acamprosate could be an interesting adjuvant for maintaining abstinence in detoxified alcoholics.

3,4-methylenedioxymethamphetamine (MDMA or ‘Ecstasy’) has become one of the most widely used illicit substances in the UK. Little is known of the psychiatric morbidity which may be associated with its use. We have examined this association by collecting a series of psychiatric cases in which MDMA use was a prominent feature.

Patients presenting between 1990 and 1992 with psychiatric symptoms which developed in the context of MDMA use (n = 13) were interviewed, and their psychiatric, medical and drug history, sociodemographic background and mental state were examined in detail. The psychopathology of cases with psychosis (n = 8) was assessed with the Present State Examination and compared with that of substance-naïve psychotic controls (n = 40).

Eight patients presented with psychotic syndromes, two experienced visual illusions, hallucinations and palinopsia, one had panic attacks, one suffered from depression, and one described chronic depersonalisation and derealisation. The psychopathology of the patients with psychoses was very similar to that of controls.

Use of MDMA may be associated with a broader spectrum of psychiatric morbidity than heretofore suspected. Cases with psychosis may be clinically similar to psychotic patients with no history of substance use.

There is controversy about whether psychotherapies are effective in the treatment of subclinical depression, defined by clinically relevant depressive symptoms in the absence of a major depressive disorder.

To examine whether psychotherapies are effective in reducing depressive symptoms, reduce the risk of developing major depressive disorder and have comparable effects to psychological treatment of major depression.

We conducted a meta-analysis of 18 studies comparing a psychological treatment of subclinical depression with a control group.

The target groups, therapies and characteristics of the included studies differed considerably from each other, and the quality of many studies was not optimal. Psychotherapies did have a small to moderate effect on depressive symptoms against care as usual at the post-test assessment (g = 0.35, 95% CI 0.23–0.47; NNT = 5, 95% CI 4–8) and significantly reduced the incidence of major depressive episodes at 6 months (RR = 0.61) and possibly at 12 months (RR = 0.74). The effects were significantly smaller than those of psychotherapy for major depressive disorder and could be accounted for by non-specific effects of treatment.

Psychotherapy may be effective in the treatment of subclinical depression and reduce the incidence of major depression, but more high-quality research is needed.

Adolescent self-harm is a major public health concern, yet little is known about the factors that distinguish adolescents who think about self-harm but do not act on these thoughts from those who act on such thoughts.

Within a new theoretical model, the integrated motivational–volitional model, we investigated factors associated with adolescents having thoughts of self-harm (ideators) v. those associated with self-harm enaction (enactors).

Observational study of school pupils employing an anonymous self-report survey to compare three groups of adolescents: self-harm enactors (n = 628) v. self-harm ideators (n = 675) v. those without any self-harm history (n = 4219).

Enactors differed from ideators on all of the volitional factors. Relative to ideators, enactors were more likely to have a family member/close friend who had self-harmed, more likely to think that their peers engaged in self-harm and they were more impulsive than the ideators. Enactors also reported more life stress than ideators. Conversely, the two self-harm groups did not differ on any of the variables associated with the development of self-harm thoughts.

As more adolescents think about self-harm than engage in it, a better understanding of the factors that govern behavioural enaction is crucial in the effective assessment of the risk of self-harm.

Consensus has been achieved about how depression should be treated in primary care, and guidelines have been issued by the Royal Colleges of General Practitioners and Psychiatrists, and by the British Association for Psychopharmacology. One of the principal recommendations is to prescribe antidepressant medicine at effective doses. This study was established to investigate how current prescribing practices in primary care compared with these guidelines.

Information on prescribing of antidepressant medicines was obtained using three independent data sources: Prescribing Analysis and Cost (PACT) data; medical notes; and a large, computerised patient record database.

Data were obtained on populations in excess of 1.5 million people, and over 80 000 prescriptions were reviewed. All three data sources showed very similar patterns of prescribing, in particular that as many as 88% of prescriptions for older tricyclic antidepressants are prescribed by GPs at doses below those recommended by the consensus guidelines. Newer antidepressants – lofepramine and the SSRIs – are prescribed comparatively well.

Prescribing of antidepressants by GPs is not in line with the consensus recommendations on dosage. This may have major educational implications for GPs. A pragmatic approach to improve prescribing in the short term may be to advocate the use of lofepramine or the SSRIs as first line treatment for depression. This study validates the use of PACT data as a useful audit tool in this area of clinical practice.

Social adversity may be a risk factor for depression, by increasing Cortisol secretion, which impairs serotonin (5-HT) neurotransmission.

To examine this causal pathway in a community setting.

Women who were currently ICD–10 depressed (n=94), vulnerable to depression but not depressed (n=166) and non-vulnerable controls (n=177) were recruited. We assessed social adversity and vulnerability (Life Eventsand Difficulties Schedule; Self Evaluation and Social Support Scales) and psychiatric state (Schedules for Clinical Assessment in Neuropsychiatry). Salivary cortisol concentrations were measured at 09.00 and 23.00 h. Serotonin function was assessed using prolactin responses to dexfenfluramine.

Cortisol concentrations were not increased in the depressed or vulnerable. Morning salivary and serum cortisol were reduced in depression. Evening cortisol was increased after recent life events. Life events and depression were associated with increased prolactin responses.

The hypothalamic–pituitary–adrenal axis is sensitive to social stress but does not mediate vulnerability to depression. Exaggerated 5-HT2 receptor responsiveness to stress may play a role in the evolution of depression.

Knowledge of when and how to implement treatments to prevent criminal offending among people with schizophrenia is urgently needed.

To identify opportunities for interventions to prevent offending among men with schizophrenic disorders by tracking their histories of offending and admissions to hospital.

We examined 232 men with schizophrenic disorders discharged from forensic and general psychiatric hospitals. Data were collected from participants, family members and official records.

More than three-quarters (77.8%) of the forensic patients had previously been admitted to general psychiatric services; 24.3% of the general psychiatric patients had a criminal record. Offences had been committed by 39.8% of the forensic patients and 10.8% of the general psychiatric patients before their first admission to general psychiatry, and after their first admission these 59 patients committed 195 non-violent and 59 violent offences. Subsequently, 49 of them committed serious violent offences that led to forensic hospital admission. The offenders were distinguished by a pervasive and stable pattern of antisocial behaviour evident from at least mid-adolescence.

General psychiatry requires resources in order to prevent criminal offending among a subgroup of patients with schizophrenic disorders.

The risk of suicide in postnatal women is low and those suicides that occur appear to be associated with severe psychiatric illness. No previous study has specifically studied the risk of suicide following post-partum psychiatric disorder.

We calculated standardised mortality ratios (SMRs) for suicide, unnatural deaths and deaths from natural causes for women admitted to psychiatric hospital in the first year after childbirth, using computerised cross-linkages between the Danish Psychiatric Case Register and the Danish registers of birth and causes of death for 1973–1993.

During the study period 1567 women were admitted to psychiatric hospital of whom 107 (6.8%) died. The SMRs (compared with 100) were 1719 (95% CI 1284–2254) for suicide, 1329 (95% CI 1038–1676) for all unnatural causes and 238 (95% CI 167–329) for natural causes. Suicides and deaths from all unnatural causes were most likely to occur in the first year after childbirth, the SMR for suicide within one year being 7216 (95% CI 3945–12 108).

Although postnatal women as a whole appear to have a low rate of suicide, severe post-partum psychiatric disorder is associated with a high rate of deaths from natural and unnatural causes, particularly suicide. The risk is especially high in the first postnatal year, when the suicide risk is increased 70-fold. Close clinical superivision at this time is indicated.

The meaning of post-stroke depression is controversial.

To investigate the hypothesis that major post-stroke depression (PSD) may be due to organic factors (left frontal lesions) immediately after the stroke, but to psychosocial factors in later stages.

We studied 153 consecutive stroke patients, categorised on the basis of time elapsed since stroke, lesion location and presence/absence of major PSD, Fifty-eight were examined in the first two months following the stroke, 52 between two and four months, and 43 after four months or more. The symptom profiles and anatomical–clinical correlates of major PSD were studied in each subgroup. A group of 30 patients affected by a functional form of major depression were also investigated.

The symptom profiles and anatomical–clinical correlates of major PSD were not different in the acute and more chronic stages. Clear symptom differences were, however, observed between major PSD and endogenous major depression. Motivated (reactive) symptoms prevailed in the former, whereas unmotivated symptoms prevailed in the latter.

Our data are more consistent with a psychological than with a neurological model of post-stroke depression.