Background. There is a limited literature examining face affect recognition in offenders. In line with the Integrated Emotion Systems (IES) model, existing studies suggest a psychopathy-related deficit in sad/fear recognition. However, many of these studies have small samples, and few include a healthy control group in order to examine the contribution of criminality.

Method. We compared the performance of male criminals with dissocial (antisocial) personality disorder (PD group) and healthy male IQ-matched controls, on a morphed face affect-processing task and examined the relationship between psychopathy (assessed using the Psychopathy Checklist: Screening Version, PCL: SV), score and performance on this task in the PD sample.

Results. The PD group had a specific deficit in the recognition of sad facial affect that was present even at 100% expression intensity. This deficit could not be attributed to impulsive responding as the PD group generally had longer mean reaction times than healthy controls. Within the PD group, those with high scores on the PCL: SV were less accurate than low scorers at classifying sad facial affect. There was also a significant negative correlation between total psychopathy score and sad affect recognition accuracy. There were no specific relationships between affect recognition and the subcomponents of psychopathy.

Conclusions. The findings suggest that criminality/antisocial personality may be associated with a deficit in the recognition of aversive cues in others, and that this deficit is more severe in psychopathic offenders. The findings lend further support to the IES model.

Background. Well-being is an important determinant of health and social outcomes. Measures of positive mental health states are needed for population-based research. The 12-item General Health Questionnaire (GHQ-12) has been widely used in many settings and languages, and includes positively and negatively worded items. Our aim was to test the hypothesis that the GHQ-12 assesses both positive and negative mental health and that these domains are independent of one another.

Method. Exploratory (EFA) and confirmatory (CFA) factor analyses were conducted using data from the British Household Panel Survey (BHPS) and the Health Survey for England (HSE). Regression models were used to assess whether associations with individual and household characteristics varied across positive and negative mental health dimensions. We also explored higher-level variance in these measures, between electoral wards.

Results. We found a consistent, replicable factor structure in both datasets. EFA results indicated a two-factor solution, and CFA demonstrated that this was superior to a one-factor model. These factors correspond to ‘symptoms of mental disorder’ and ‘positive mental health’. Further analyses demonstrated independence of these factors in associations with age, gender, employment status, poor housing and household composition. Statistically significant ward-level variance was found for symptoms of mental disorder but not positive mental health.

Conclusions. The GHQ-12 measures both positive and negative aspects of mental health, and although correlated, these dimensions have some independence. The GHQ-12 could be used to measure positive mental health in population-based research.

Depressives responding to initial treatment were maintained on amitriptyline for eight months, withdrawn double-blind to placebo after two months, or withdrawn overtly onto no medication. In each group half the patients received weekly psychotherapy and half were seen, once monthly. Effects on symptom ratings were examined. Maintenance amitriptyline gave a significant advantage over early withdrawal in preventing symptom recrudescence. There were no differences between double-blind or overt withdrawal. There were no interactions between drug withdrawal and psychotherapy. Psychotherapy produced no significant advantages over low contact on symptoms, although it did improve social adjustment ratings reported elsewhere.

Background. Assessment of lifetime major depression is usually made from a single interview. Most previous studies have investigated reliability. Comparison of recall of key symptoms and longitudinal reports shows the accuracy of recall, not just reliability.

Method. At age 25, 1003 members of the Christchurch Health and Development Study cohort were asked to recall key symptoms of depression (sadness, loss of interest) up to age 21. This recall was compared with longitudinal reports at ages 15, 16, 18 and 21 years. Diagnosis was by DSM-III-R and DSM-IV criteria.

Results. Only 4% of those without previous reports recalled key symptoms. Of those with a diagnosis of depression up to age 21, 44% recalled a key symptom. Measures of severity of an episode (number of symptoms, impairment, duration, suicidality) and chronicity (years with a diagnosis, years with suicidal ideation) all strongly predicted recall. Current key symptoms increased recall, even after taking account of severity and chronicity. Being female and receiving treatment also predicted recall, although odds ratios were reduced to 1·6–1·7 when all other predictors were included. Comparison of risk factors for key symptoms showed similar results from longitudinal reports and recall. Sexual abuse, neuroticism, lack of parental attachment, gender, physical abuse and maternal depression were major risk factors in both sets of analyses.

Conclusions. Forgetting of prior episodes of depression was common. Severity, chronicity, current depression, gender and treatment predicted recall. Lifetime prevalence based on recall will be markedly underestimated but the identification of major risk factors may be relatively little impaired.

Help-seeking is important to access appropriate care and improve mental health. However, individuals often delay or avoid seeking help for mental health problems. Interventions to improve help-seeking have been developed, but their effectiveness is unclear. A systematic review and meta-analysis were therefore conducted to examine the effectiveness of mental health related help-seeking interventions. Nine databases in English, German and Chinese were searched for randomised and non-randomised controlled trials. Effect sizes were calculated for attitudes, intentions and behaviours to seek formal, informal and self-help. Ninety-eight studies with 69 208 participants were included. Interventions yielded significant short-term benefits in terms of formal help-seeking, self-help, as well as mental health literacy and personal stigma. There were also positive long-term effects on formal help-seeking behaviours. The most common intervention types were strategies to increase mental health literacy, destigmatisation (both had positive short-term effects on formal help-seeking behaviours) as well as motivational enhancement (with positive long-term effects on formal help-seeking behaviours). Interventions improved formal help-seeking behaviours if delivered to people with or at risk of mental health problems, but not among children, adolescents or the general public. There was no evidence that interventions increased the use of informal help. Few studies were conducted in low- and middle-income countries (LMICs). This study provides evidence for the effectiveness of help-seeking interventions in terms of improving attitudes, intentions and behaviours to seek formal help for mental health problems among adults. Future research should develop effective interventions to improve informal help-seeking, for specific target groups and in LMICs settings.

Forty-eight medical students took part in a study to assess the value of giving students some feedback about their interviewing skills. During the study they all received training from their clinical firms. In addition, 36 of the students received 1 of 3 types of feedback training. This was given by tutors who used television replays, audiotape replays or ratings of practice interviews conducted by the students.

As in previous studies there was little improvement in the interviewing skills of those students who only received training from their clinical firms. In contrast, all 3 feedback groups improved their ability to elicit accurate and relevant information. However, only the television and audiotape groups also showed gains in techniques. While the differences between these 2 groups were not significant, they all favoured the television group.

Background. Major depression has far-reaching consequences for work functioning and absenteeism. In most cases depression is treated by medication and clinical management. The addition of occupational therapy (OT) might improve outcome. We determined the cost-effectiveness of the addition of OT to treatment as usual (TAU).

Method. Sixty-two adults with major depression and a mean absenteeism of 242 days were randomized to TAU (out-patient psychiatric treatment) or TAU+OT [6 months, including (i) diagnostic phase with occupational history and work reintegration plan, and (ii) therapeutic phase with individual sessions and group sessions]. Main outcome domains were depression, work resumption, work stress and costs. Assessments were at baseline and at 3, 6, 12 and 42 months.

Results. The addition of OT to TAU: (i) did not improve depression outcome, (ii) resulted in a reduction in work-loss days during the first 18 months, (iii) did not increase work stress, and (iv) had a 75·5% probability of being more cost-effective than TAU alone.

Conclusion. Addition of OT to good clinical practice does not improve depression outcome, improves productivity without increasing work stress and is superior to TAU in terms of cost-effectiveness.

Background. There is little agreement on whether the prevalence of psychiatric disorder is elevated in HIV-seropositive (HIV +) populations compared with uninfected persons. However, evaluation of this issue has been limited by difficulties of sampling, study design and failure to control for other risk factors for disorder.

Methods. Prevalence and clinical characteristics of DSM-III-R major depressive disorder (MDD), generalized anxiety disorder, adjustment disorder, and alcohol and substance abuse/dependence were evaluated in a representative sample of HIV + men attending primary care physicians' offices in a defined geographical area. Lifetime prevalence at baseline and 1-year rates during longitudinal follow-up were determined for the 113 HIV + men, as well as 57 HIV – men, via standardized interview. Multivariate analyses considered unique and combined effects of HIV serostatus and other risk factors on likelihood of disorder.

Results. Although there were no differences in lifetime rates prior to baseline, HIV + men were at greater risk for disorders during the prospective study period. For MDD, this effect was maintained even after controlling for other risk factors. Several of these other factors bore their own effects: regardless of HIV serostatus, men were susceptible to psychopathology if at baseline they were younger, had a lifetime psychiatric history, or had poor social supports or a low sense of personal mastery.

Conclusions. The risk of certain psychiatric disorders appears uniquely elevated in HIV + men. Since other factors also influence risk, interventions designed to minimize psychopathology during HIV infection should attend to both HIV-related and non-HIV-related risk factors.

Difficulties in set-shifting are commonly reported in both autism spectrum disorder (ASD) and anorexia nervosa (AN) populations. Despite this, it is not known whether this cognitive profile persists across different ages, or whether the profiles seen in ASD and AN are comparable. This systematic review and meta-analyses aimed to compare the set-shifting profiles, as measured by the Wisconsin Card Sorting Test (WCST) in adults and younger people with either ASD or AN, relative to healthy controls (HCs) and to statistically compare performance on the WCST between ASD and AN. In all, 24 studies on ASD and 22 studies on AN were identified. In ASD, there were significant differences between the clinical group and HCs, with the ASD group making significantly more perseverative errors, indicating greater difficulty in set-shifting [pooled effect size of d = 0.67, 95% confidence interval (CI) 0.53–0.81, p ⩽ 0.001]. This effect was consistent across the age span. For AN studies, there was a significant difference between adults with AN and HCs (d = 0.52, 95% CI 0.36–0.68, p ⩽ 0.001) but a non-significant effect in child studies (d = 0.25, 95% CI −0.05 to 0.55, z = 1.66, p = 0.096). Meta-regression indicated no effect of diagnosis (AN or ASD) on performance in adult studies but there was a non-significant trend (p = 0.053) towards children with ASD performing worse than children with AN. While difficulties with set-shifting appear to be stable in ASD, there may be differences between children and adults with AN, which warrant further investigation.

Background. We measured psychopathic traits in boys with autism spectrum disorder (ASD) selected for difficult and aggressive behaviour. We asked (i) whether psychopathic tendencies can be measured in ASD independent of the severity of autistic behaviour; (ii) whether individuals with ASD with callous–unemotional (CU) traits differ in their cognitive profile from those without such traits; and (iii) how the cognitive data from this study compare with previous data of youngsters with psychopathic tendencies.

Method. Twenty-eight ASD boys were rated on psychopathic tendencies, autistic traits and a range of cognitive measures assessing mentalizing ability, executive functions, emotion recognition and ability to make moral–conventional distinction.

Results. Our results indicate that psychopathic tendencies are not related to severity of ASD. In addition, such tendencies do not seem to be related to core autistic cognitive deficits, specifically in ‘mind-reading’ or executive function. Boys with co-occurring ASD and CU tendencies share some behaviours and aspects of cognitive profile with boys who have psychopathic tendencies alone.

Conclusions. Callous/psychopathic acts in a small number of individuals with ASD probably reflect a ‘double hit’ involving an additional impairment of empathic response to distress cues, which is not part and parcel of ASD itself.

Synopsis The CAGE questionnaire was used to screen for at risk drinking among attenders to an inner London health centre. The CAGE functioned most effectively at a cut-off point of two or more affirmative replies, with a sensitivity of 84%, a specificity of 95% and a positive predictive value of 45%. The usefulness of this instrument for screening in general practice is discussed.

Background. It is clearly established that emotional events tend to be remembered particularly vividly. The neurobiological substrates of this phenomenon are poorly understood. Recently, the noradrenergic system has been implicated in that beta blockade has been shown to reduce significantly the delayed recall of emotional material with matched neutral material being unaffected.

Methods. In the present study, 36 healthy young adults were randomly allocated to receive either yohimbine, which stimulates central noradrenergic activity, metoprolol which blocks noradrenergic activity, or matched placebo. The three groups were well matched. All capsules were taken orally, prior to viewing a narrated 11 slide show described a boy being involved in an accident.

Results. Yohimbine significantly elevated, and metoprolol reduced mean heart rate during the slide show relative to placebo, thus confirming the efficacy of the pharmacological manipulation. One week later, in a ‘surprise’ test, memory for the slide show was tested. As predicted, yohimbine-treated subjects recalled significantly more and metoprolol subjects fewer slides relative to placebo. This result was confirmed via analysis of multiple-choice recognition memory scores.

Conclusions. We conclude that stimulation of the noradrenergic system results in the enhancement and blockade in a reduction of recall and recognition of emotional material in man.

Introduction. Cannabis use is strongly associated with the use and abuse/dependence of other illicit drugs. Gateway and common liabilities models have been employed to explain this relationship. We sought to examine this association using a combination of the discordant twin design and modeling methods.

Method. We assess the relationship between early cannabis use and the subsequent use and abuse/dependence of other illicit drugs in a population-based sample of male and female twin pairs using four analyses: (i) analysis of the association between early cannabis use and other illicit drug use and abuse/dependence in the entire sample of twins, (ii) assessment of the influence of early cannabis use in twin 1 on twin 2's use or abuse/dependence of other illicit drugs, (iii) use of twin pairs discordant for early cannabis use in a discordant twin design and (iv) a model-fitting procedure.

Results. We found: (i) a strong association between early cannabis use and use and abuse/dependence of other illicit drugs in the sample, (ii) twin 1's early cannabis use is significantly associated with the twin 2's other illicit drug use, (iii) the role of correlated genetic factors with some evidence for a causal influence, and (iv) the correlated liabilities model fits the data well.

Conclusions. Early cannabis use is strongly associated with other illicit drug use and abuse/dependence. The relationship arises largely due to correlated genetic and environmental influences with persisting evidence for some causal influences.