Recall of adverse life events under brain imaging conditions has been shown to coincide with activation of limbic and prefrontal brain areas in borderline personality disorder (BPD). We investigate changes of functional magnetic resonance imaging (fMRI) activation patterns during the recall of unresolved adverse life events (ULE) over 1 year.

Thirteen female BPD patients participated in the study. During fMRI measurement subjects recalled ULE and negative but resolved life events (RLE) after individual cue words to stimulate autobiographical memory retrieval. Subjective intensity of emotional and sensoric experiences during recall was assessed as well as standardized measures of psychopathology.

A 2×2 factorial analysis of fMRI data (Δt1/t2×ΔULE/RLE) revealed major right more than left differences of activation (i.e. t1>t2) of the posterior more than anterior cingulate, superior temporal lobes, insula, and right middle and superior frontal lobes (second-level analysis, t=3.0, puncorrected=0.003). The opposite contrast (Δt2/t1×ΔULE/RLE) did not reveal any differences. We did not find changes of emotional or sensoric qualities during recall (ULE versus RLE) or of psychopathology measures over the 1-year period.

Although subjective and clinical data did not change within 1 year, we observed a substantial decrease of temporo-frontal activation during the recall of ULE from t1 to t2. If future research confirms these findings, the question arises whether the decrease of neural activation precedes clinical improvement in BPD.

Previous research has found that many patients with anorexia nervosa (AN) are unable to maintain normal weight after weight restoration. The objective of this study was to identify variables that predicted successful weight maintenance among weight-restored AN patients.

Ninety-three patients with AN treated at two sites (Toronto and New York) through in-patient or partial hospitalization achieved a minimally normal weight and were then randomly assigned to receive fluoxetine or placebo along with cognitive behavioral therapy (CBT) for 1 year. Clinical, demographic and psychometric variables were assessed after weight restoration prior to randomization and putative predictors of successful weight maintenance at 6 and 12 months were examined.

The most powerful predictors of weight maintenance at 6 and 12 months following weight restoration were pre-randomization body mass index (BMI) and the rate of weight loss in the first 28 days following randomization. Higher BMI and lower rate of weight loss were associated with greater likelihood of maintaining a normal BMI at 6 and 12 months. An additional predictor of weight maintenance was site; patients in Toronto fared better than those in New York.

This study found that the best predictors of weight maintenance in weight-restored AN patients over 6 and 12 months were the level of weight restoration at the conclusion of acute treatment and the avoidance of weight loss immediately following intensive treatment. These results suggest that outcome might be improved by achieving a higher BMI during structured treatment programs and on preventing weight loss immediately following discharge from such programs.

The ‘gateway’ pattern of drug initiation describes a normative sequence, beginning with alcohol and tobacco use, followed by cannabis, then other illicit drugs. Previous work has suggested that ‘violations’ of this sequence may be predictors of later problems but other determinants were not considered. We have examined the role of pre-existing mental disorders and sociodemographics in explaining the predictive effects of violations using data from the US National Comorbidity Survey Replication (NCS-R).

The NCS-R is a nationally representative face-to-face household survey of 9282 English-speaking respondents aged 18 years and older that used the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) to assess DSM-IV mental and substance disorders. Drug initiation was estimated using retrospective age-of-onset reports and ‘violations’ defined as inconsistent with the normative initiation order. Predictors of violations were examined using multivariable logistic regressions. Discrete-time survival analysis was used to see whether violations predicted progression to dependence.

Gateway violations were largely unrelated to later dependence risk, with the exception of small increases in risk of alcohol and other illicit drug dependence for those who initiated use of other illicit drugs before cannabis. Early-onset internalizing disorders were predictors of gateway violations, and both internalizing and externalizing disorders increased the risks of dependence among users of all drugs.

Drug use initiation follows a strong normative pattern, deviations from which are not strongly predictive of later problems. By contrast, adolescents who have already developed mental health problems are at risk for deviations from the normative sequence of drug initiation and for the development of dependence.

The aim of this study was to investigate the functioning of patients with borderline personality disorder (BPD) compared to healthy controls on five neuropsychological domains, with regard to the possible effect of differences in IQ.

Out-patients and in-patients with BPD (n=35) and healthy comparison subjects (n=35) were tested with an extensive neuropsychological battery, where most cognitive domains were covered by several tests.

When controlling for the effect of IQ, patients were found to have reduced executive functioning as compared to healthy controls. With regard to the other neuropsychological domains (working memory, attention, long-term verbal memory, and long-term non-verbal memory), no differences were found between the two groups. Within-subject analyses also identified executive functioning as a selective deficit among patients whereas long-term verbal memory was identified as a relative strength. An association was identified between the covariate general intellectual functioning and every neuropsychological domain. No statistically significant differences were found between the subgroups of patients with and without co-morbid post-traumatic stress disorder (PTSD) or between those with and without co-morbid major depression, or between the medicated and unmedicated subgroups on any of the neuropsychological domains.

Patients with BPD demonstrate a selective deficit in executive functioning. This corroborates studies that have identified frontal regions as potential neurobiological substrates of the BPD syndrome. The relative strength of the verbal long-term memory function raises pertinent questions regarding the presumed importance of hippocampal structures.

Mental capacity is now a core part of UK mental health law and clinicians will increasingly be expected to assess it. Because it is a legal concept there is a need to clarify associations with variables that clinicians are more familiar with, especially insight.

In this cross-sectional study we recruited consecutive psychiatric admissions to the Maudsley Hospital, London. We carried out structured assessments of decision making using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), resulting in a clinical judgement about capacity status. We analysed associations with a range of sociodemographic and clinical variables, including insight score on the Expanded Schedule for the Assessment of Insight (SAI-E). The same variables were compared in an analysis stratified according to diagnostic group: psychotic disorders/bipolar affective disorder (BPAD)/non-psychotic disorders.

Psychotic disorders and manic episodes of BPAD are most strongly associated with incapacity. In such patients, insight is the best discriminator of capacity status. In patients with non-psychotic disorders, insight is less strongly associated with capacity; in this group depressed mood discriminates capacity status whereas it does not in psychotic disorders. Cognitive performance does not discriminate capacity status in patients with psychotic disorders.

Mental capacity has complex relationships with psychopathological variables, and these relationships are different according to diagnostic group. Insight is the best discriminator of capacity status in psychotic disorders and BPAD but not in non-psychotic disorders.

Evidence regarding the long-term separate and combined impact of adolescent psychiatric disorder and personality disorder (PD) on physical health is absent.

A total of 736 people randomly selected in childhood were contacted for home or telephone interviews four times over 20 years. DSM Axis I disorders and Axis II PDs were assessed at mean age 13.7 years in 1983 and physical health was assessed in 1985–1986, 1991–1994 and 2001–2004.

Comparisons were made between 506 adolescents without Axis I disorder or PD and adolescents with Axis I disorder or PD or both. Adolescents with an Axis I disorder (n=150) had significantly higher odds of pain and physical illness and poorer physical health. Adolescents with a PD (n=149) had higher odds of pain and physical illness and poorer physical health and a more rapid decline in physical health. In addition, the 81 participants with an Axis I disorder without co-morbid PD had poorer physical health, but this effect did not reach statistical significance, whereas the 80 participants with a PD but no Axis I disorder reported significantly more pain and more rapid decline in physical health. However, the 69 participants with co-morbid Axis I disorder and PD had the highest rates of pain and physical illness and the worst physical health.

Co-morbid PD accounted for many of the associations of adolescent Axis I disorder with physical health over the ensuing two decades. Co-morbid adolescent Axis I disorder and PD represent a particularly high risk for physical health.

Fatigue syndromes and irritable bowel syndrome (IBS) often occur together. Explanations include being different manifestations of the same condition and simply sharing some symptoms.

A matched case-control study in UK primary care, using data collected prospectively in the General Practice Research Database (GPRD). The main outcome measures were: health-care utilization, specific symptoms and diagnoses. Risk markers were divided into distant (from 3 years to 1 year before diagnosis) and recent (1 year before diagnosis).

A total of 4388 patients with any fatigue syndrome were matched to two groups of patients: those attending for IBS and those attending for another reason. Infections were specific risk markers for both syndromes, with viral infections being a risk marker for a fatigue syndrome [odds ratios (ORs) 2.3–6.3], with a higher risk closer to onset, and gastroenteritis a risk for IBS (OR 1.47, compared to a fatigue syndrome). Chronic fatigue syndrome (CFS) shared more distant risk markers with IBS than other fatigue syndromes, particularly other symptom-based disorders (OR 3.8) and depressive disorders (OR 2.3), but depressive disorders were a greater risk for CFS than IBS (OR 2.4). Viral infections were more of a recent risk marker for CFS compared to IBS (OR 2.8), with gastroenteritis a greater risk for IBS (OR 2.4).

Both fatigue and irritable bowel syndromes share predisposing risk markers, but triggering risk markers differ. Fatigue syndromes are heterogeneous, with CFS sharing predisposing risks with IBS, suggesting a common predisposing pathophysiology.