Cannabis is commonly regarded as an innocuous drug and the prevalence of lifetime and regular use has increased in most developed countries. However, accumulative evidence highlights the risks of dependence and other adverse effects, particularly among people with pre-existing psychiatric disorders.

To re-evaluate the adverse effects of cannabis in the general population and among vulnerable individuals, including those with serious psychiatric disorders.

A wide-ranging review of the topics related to these issues.

An appreciable proportion of cannabis users report short-lived adverse effects, including psychotic states following heavy consumption, and regular users are at risk of dependence. People with major mental illnesses such as schizophrenia are especially vulnerable in that cannabis generally provokes relapse and aggravates existing symptoms. Health workers need to recognise, and respond to, the adverse effects of cannabis on mental health.

The prevelance of depression in older people is high, treatment is inadequate, it creates a substantial burden and is a public health priority for which exercise has been proposed as a therapeutic strategy.

To estimate the effect of exercise on depressive symptoms among older people, and assess whether treatment effect varies depending on the depression criteria used to determine participant eligibility.

Systematic review and meta-analysis of randomised controlled trials of exercise for depression in older people.

Nine trials met the inclusion criteria and seven were meta-analysed. Exercise was associated with significantly lower depression severity (standardised mean difference (SMD) =–0.34, 95% CI –0.52 to –0.17), irrespective of whether participant eligibility was determined by clinical diagnosis (SMD =–0.38, 95% CI –0.67 to –0.10) or symptom checklist (SMD =–0.34, 95% CI –0.62 to –0.06). Results remained significant in sensitivity analyses.

Our findings suggest that, for older people who present with clinically meaningful symptoms of depression, prescribing structured exercise tailored to individual ability will reduce depression severity.

Bipolar disorder and schizophrenia are associated with increased mortality relative to the general population. There is an international emphasis on decreasing this excess mortality.

To determine whether the mortality gap between individuals with bipolar disorder and schizophrenia and the general population has decreased.

A nationally representative cohort study using primary care electronic health records from 2000 to 2014, comparing all patients diagnosed with bipolar disorder or schizophrenia and the general population. The primary outcome was all-cause mortality.

Individuals with bipolar disorder and schizophrenia had elevated mortality (adjusted hazard ratio (HR) = 1.79, 95% CI 1.67–1.88 and 2.08, 95% CI 1.98–2.19 respectively). Adjusted HRs for bipolar disorder increased by 0.14/year (95% CI 0.10–0.19) from 2006 to 2014. The adjusted HRs for schizophrenia increased gradually from 2004 to 2010 (0.11/year, 95% CI 0.04–0.17) and rapidly after 2010 (0.34/year, 95% CI 0.18–0.49).

The mortality gap between individuals with bipolar disorder and schizophrenia, and the general population is widening.

The persistent and disabling nature of psychiatric stigma has led to the establishment of global programmes to challenge the negative stereotypes and discriminatory responses that generate social disability but these initiatives are rarely evaluated.

To assess the effectiveness of an intervention with young people aimed at increasing mental health literacy and challenging negative stereotypes associated with severe mental illness.

A total of 472 secondary school students attended two mental health awareness workshops and completed pre- and post-questionnaires detailing knowledge, attitudes and behavioural intentions.

Young people use an extensive vocabulary of 270 different words and phrases to describe people with mental health problems: most were derogatory terms. Mean positive attitude scores rose significantly from 1.2 at baseline to 2.8 at 1-week follow-up and 2.3 at a 6-month follow-up. Changes were most marked for female students and those reporting personal contact with people with mental illness.

Short educational workshops can produce positive changes in participants' reported attitudes towards people with mental health problems.

Previous studies of differences in mental health between urban and rural populations are inconsistent.

To examine whether a high level of urbanisation is associated with increased incidence rates of psychosis and depression, after adjustment for age, marital status, education and immigrant status.

Follow-up study of the total Swedish population aged 25–64 years with respect to first hospital admission for psychosis or depression. Level of urbanisation was defined by population density and divided into quintiles.

With increasing levels of urbanisation the incidence rates of psychosis and depression rose. In the full models, those living in the most densely populated areas (quintile 5) had 68–77% more risk of developing psychosis and 12–20% more risk of developing depression than the reference group (quintile 1).

A high level of urbanisation is associated with increased risk of psychosis and depression for both women and men.

Many adolescents with mental health problems experience transition of care from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS).

As part of the TRACK study we evaluated the process, outcomes and user and carer experience of transition from CAMHS to AMHS.

We identified a cohort of service users crossing the CAMHS/AMHS boundary over 1 year across six mental health trusts in England. We tracked their journey to determine predictors of optimal transition and conducted qualitative interviews with a subsample of users, their carers and clinicians on how transition was experienced.

Of 154 individuals who crossed the transition boundary in 1 year, 90 were actual referrals (i.e. they made a transition to AMHS), and 64 were potential referrals (i.e. were either not referred to AMHS or not accepted by AMHS). Individuals with a history of severe mental illness, being on medication or having been admitted were more likely to make a transition than those with neurodevelopmental disorders, emotional/neurotic disorders and emerging personality disorder. Optimal transition, defined as adequate transition planning, good information transfer across teams, joint working between teams and continuity of care following transition, was experienced by less than 5% of those who made a transition. Following transition, most service users stayed engaged with AMHS and reported improvement in their mental health.

For the vast majority of service users, transition from CAMHS to AMHS is poorly planned, poorly executed and poorly experienced. The transition process accentuates pre-existing barriers between CAMHS and AMHS.

Over the past decade, developed Western countries have supplied increasingly stringent measures to discourage those seeking asylum.

To investigate the longer-term mental health effects of mandatory detention and subsequent temporary protection on refugees.

Lists of names provided by community leaders were supplemented by snowball sampling to recruit 241 Arabic-speaking Mandaean refugees in Sydney (60% of the total adult Mandaean population). Interviews assessed posttraumatic stress disorder (PTSD), major depressive episodes, and indices of stress related to pasttrauma, detention and temporary protection.

A multilevel model which included age, gender, family clustering, pre-migration trauma and length of residency revealed that past immigration detention and ongoing temporary protection each contributed independently to risk of ongoing PTSD, depression and mental health-related disability. Longer detention was associated with more severe mental disturbance, an effect that persisted for an average of 3 years after release.

Policies of detention and temporary protection appear to be detrimental to the longer-term mental health of refugees.

Knowledge of the prevalence and correlates of personality disorders in the community is important for identifying treatment needs and for provision of psychiatric services.

To estimate the prevalence of personality disorders in a community sample and to identify demographic subgroups with especially high prevalence.

Clinical psychologists used the International Personality Disorder Examination to assess DSM-IV and ICD-10 personality disorders in a sample of 742 subjects, ages 34–94 years, residing in Baltimore, Maryland. Logistic regression was used to evaluate the association between demographic characteristics and DSM — IV personality disorder clusters.

The estimated overall prevalence of DSM — IV personality disorders was 9%. Cluster A disorders were most prevalent in men who had never married. Cluster B disorders were most prevalent in young men without a high school degree, and cluster C disorders in high school graduates who had never married.

Approximately 9% of this community sample has a DSM-IV personality disorder. Personality disorders are over-represented in certain demographic subgroups of the community

Stigma defines people in terms of some distinguishing characteristic and devalues them as a consequence.

To describe the relationship of stigma with mental illness, psychiatric diagnosis, treatment and its consequences of stigma for the individual.

Narrative interviews were conducted by trained users of the local mental health services; 46 patients were recruited from community and day mental health services in North London.

Stigma was a pervasive concern to almost all participants. People with psychosis or drug dependence were most likely to report feelings and experiences of stigma and were most affected by them. Those with depression, anxiety and personality disorders were more affected by patronising attitudes and feelings of stigma even if they had not experienced any overt discrimination. However, experiences were not universally negative.

Stigma may influence how a psychiatric diagnosis is accepted, whether treatment will be adhered to and how people with mental illness function in the world. However, perceptions of mental illness and diagnoses can be helpful and non-stigmatising for some patients.

The management of depression in primary care is a significant issue for health services worldwide. ‘Collaborative care’ interventions are effective, but little is known about which aspects of these complex interventions are essential.

To use meta-regression to identify ‘active ingredients' in collaborative care models for depression in primary care.

Studies were identified using systematic searches of electronic databases. The content of collaborative care interventions was coded, together with outcome data on antidepressant use and depressive symptoms. Meta-regression was used to examine relationships between intervention content and outcomes.

There was no significant predictor of the effect of collaborative care on antidepressant use. Key predictors of depressive symptom outcomes included systematic identification of patients, professional background of staff and specialist supervision.

Meta-regression may be useful in examining ‘active ingredients' in complex interventions in mental health.