Special Interest: Mental health

One in three women with a previous diagnosis of bipolar disorder or postpartum psychosis will relapse during the postpartum period, a meta-analysis has found. Women with bipolar disorder or previous postpartum psychosis should be referred for specialist preconception advice.

Anxiety disorder in the elderly is twice as common as dementia and four to six times more common than major depression. Anxiety is associated with poorer quality of life, significant distress and contributes to the onset of disability. Mortality risks are also increased, through physical causes, especially cardiovascular disease, and suicide. Diagnosing anxiety disorders in older adults remains a challenge because of the significant overlap in symptoms between physical disorders and depression.

The postnatal period appears to be associated with higher rates of adjustment disorder, generalised anxiety disorder, and depression. Women who have a history of serious mental illness are at higher risk of developing a postpartum relapse, even if they have been well during pregnancy. Postnatal depression is more severe than baby blues, follows a chronic course and may relapse outside the perinatal period. Bipolar disorder may present as a first depressive episode in pregnancy or the postnatal period. In the postpartum period women have a high risk of severe relapse.

There is a worse prognosis for psychosis and schizophrenia when onset is in childhood or adolescence. Better outcomes in terms of symptoms and social function are associated with a shorter duration of untreated psychosis. The detection of psychotic symptoms in primary care therefore warrants an urgent referral to secondary care mental health services for assessment and treatment. [With external links to the evidence base]

Common mental health disorders affect as many as one in six people in the community. The 2007 ONS household survey of adult psychiatric morbidity in England found that 16.2% of 16-64 year olds were suffering from an anxiety or depressive disorder. Of those 4.4% were diagnosed with generalised anxiety disorder (GAD); 3.0% with post-traumatic stress disorder (PTSD); 2.3% with major depression; 1.4% with phobias; 1.1% obsessive compulsive disorder (OCD); and 1.1% with panic disorder. The conditions are not mutually exclusive and the most common problem was mixed anxiety and depression, found in 9% of patients. The diagnoses were established through diagnostic psychiatric interviews with subjects screening positive in the survey.These disorders are even more common in primary care. The New Zealand Magpie Study found that 20.7% of people presenting to primary care had suffered a common mental health disorder over a 12-month period, compared with 14.8% in the community.

Attention deficit hyperactivity disorder (ADHD) is the term most widely used to cover a group of common, chronic neurodevelopmental disorders characterised by developmentally abnormal and disabling levels of restlessness and overactivity (usually combined with impulsiveness) and/or inattention. ADHD is multifactorial in origin, with a strong genetic component and is four times more common in boys than girls. The prevalence of ADHD is at least 5% and that of the most severe form i.e. hyperkinetic disorder (HKD) 1-2%. However, a survey of services for ADHD in Scotland found that only 0.6% of children and adolescents were receiving treatment. [With external links to the evidence base]

Apathy symptoms may identify older patients who are at increased risk of developing dementia, a Dutch prospective cohort study has found.

The incidence of suicide in adolescent boys is more than twice that among adolescent girls, whereas non-fatal self-harm is much more common in girls than boys, an English retrospective database study has found.

Depression may be a prodromal feature of, rather than a risk factor for, dementia, a UK prospective cohort study has found. A total of 10,308 participants (6,895 men) in the Whitehall ll study, aged 35-55 at recruitment, were followed up between 1985 and 2015.