Recent articles

Women with bipolar disorder at high risk of relapse after childbirth

21 Mar 2016Registered users

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.

Light therapy effective for nonseasonal depression

22 Feb 2016Paid-up subscribers

Light therapy, both as sole therapy and in combination with fluoxetine, is an effective treatment for nonseasonal depression, an American secondary care study has found.

Anxiety in older adults often goes undiagnosed

25 Jan 2016Paid-up subscribers

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.



Antidepressants and CBT are equally effective in major depression

05 Jan 2016Registered users

Second generation antidepressants (i.e. antidepressants other than tricyclics and MAOIs), cognitive behaviour therapy (CBT) and combination therapy are equally effective as initial treatments for adult patients with major depression, a systematic review and meta-analysis has found.

Be vigilant for perinatal mental health problems

23 Mar 2015Paid-up subscribers

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.


Improving the recognition of autism in children and adults

22 May 2018Registered users

Autism covers a wide spectrum across the dimensions of social communication, repetitive and stereotyped behaviours as well as other non-clinical and cognitive features. Individuals with autism can function well in certain environments, where there are fewer demands to multitask and factual information and pattern recognition are required, but they may not function well in highly social environments, or situations characterised by rapid and unpredictable change.

Managing patients with severe mental illness and substance misuse

22 May 2018Registered users

Co-occurring severe mental illness, usually schizophrenia or bipolar affective disorder, and substance misuse is termed dual diagnosis. Mental illness and its consequences may lead to substance misuse as a coping strategy. Substance misuse can lead to mental health problems, either by triggering a first episode in a susceptible person, or by exacerbating an existing disorder. However, substance misuse itself is unlikely to be the sole cause of a severe and enduring mental illness.

Diagnosing and managing mild cognitive impairment

23 May 2017Paid-up subscribers

The prevalence of mild cognitive impairment in adults aged 65 and over is estimated to be 10-20%. It is likely that this figure will increase in line with trends in dementia diagnosis. In some cases, mild cognitive impairment may be a prodrome for dementia, and may be caused by any of the dementia pathology subtypes. It is important to obtain a history of cognitive changes over time, as well as information about the onset and nature of cognitive symptoms, confirmed by a reliable informant, if available.

Be vigilant for dementia in Parkinson’s disease

23 May 2017Paid-up subscribers

It is estimated that up to 80% of patients with Parkinson’s disease will eventually develop cognitive impairment over the course of their illness. Even at the time of diagnosis, cognitive impairment has been reported in 20-25% of patients. Commonly affected domains are executive function, visuospatial ability and attention control. In addition, patients with Parkinson’s disease dementia may present with deficits in language function and verbal memory.

Be vigilant for post-traumatic stress reactions

23 May 2016Paid-up subscribers

The diagnosis of post-traumatic stress disorder (PTSD) differs from most psychiatric disorders as it includes an aetiological factor, the traumatic event, as a core criterion. The DSM 5 core symptoms of PTSD are grouped into four key symptom clusters: re-experiencing, avoidance, negative cognitions and mood, and arousal. Symptoms must be present for at least one month and cause functional impairment.

Diagnosing young onset dementia can be challenging

23 May 2016Paid-up subscribers

The most common causes of young onset dementia are early onset forms of adult neurodegenerative conditions and alcohol. Vascular dementia is the second most common cause of young onset dementia after Alzheimer’s disease. Conventional vascular risk factors may be absent and diagnosis relies on imaging evidence of cerebrovascular disease. Those with suspected young onset dementia should be referred to a neurology-led cognitive disorders clinic where available as the differential diagnosis is considerably broader than in older adults and requires specialist investigation.

Special reports and casebooks: Mental health

Psychotic symptoms in young people warrant urgent referral

21 Mar 2013Paid-up subscribers

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]

Diagnosing autism spectrum disorders in primary care

22 Nov 2011Paid-up subscribers

Autism, like most psychiatric disorders, covers a spectrum of severity from severely disabling classic autism to milder forms of Asperger’s syndrome which border on normality. The term autism spectrum disorder (ASD) includes autism, atypical autism and Asperger’s syndrome. Some parents consult their GP worried that their child might have autism. Others may attend with a range of concerns that might point to the condition such as problems with hearing, vision, hypersensitivity to sensory stimuli, behaviour management, language impairment or repetitive behaviour. Autism conditions often co-exist with neurological disorders (particularly those including epilepsy), and more than 300 syndromes which include autism have been described.The new NICE guidelines, launched in September 2011, cover children, from birth up to 19 years, on the autism spectrum and build on the guidance published by SIGN in 2007.ASD was once believed to be relatively rare but is now thought to occur in about 1% of children. There is certainly increasing demand for diagnostic services for children and young people. Whether the apparent increasing prevalence signifies an epidemic or an epidemic of discovery is debatable. [With external links to the evidence base]

Be vigilant for common mental health disorders

19 Oct 2011Paid-up subscribers

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.

Improving recognition of generalised anxiety disorder

23 Mar 2011Paid-up subscribers

Generalised anxiety disorder (GAD) is a common condition, with a point prevalence of 4.4% among the adult population in England. It is characterised by a persistent, unfocused sense of threat, associated with symptoms of tension, autonomic hyperactivity and vigilance. Patients repeatedly overestimate the danger of physical or social harm, and at the same time underestimate their ability to cope. As a result, they worry excessively about a wide range of activities and life events, such as work, family issues, financial difficulties and health problems. GAD is a chronic relapsing condition, with a remission rate of only 38% after five years. It is associated with even greater impairment of occupational and social functioning than that associated with major depression, and has a significant impact on quality of life. However, around two-thirds of patients are not recognised in primary care and only a third of those identified by the 2007 household survey in England were receiving any form of treatment. Both in research and in clinical practice, there has been an excessive focus on depression to the detriment of the anxiety disorders. This is unfortunate in view of the high prevalence of GAD, its substantial impact on functioning and its association with chronic physical health problems. It is to be welcomed that this imbalance is now being addressed.

Improving recognition and management of ADHD

03 May 2010Paid-up subscribers

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]

Tackling depression in patients with chronic conditions

15 Jan 2010Paid-up subscribers

For patients with  a chronic condition and depression the prognosis is thought to be  worse. Comorbid depression is associated with increased pain, greater functional impairment and reduced quality of life. Depressed patients may lack the confidence to self-manage their condition, increasing the risk of long-term complications.


Clinical reviews: Mental health

Consumption of nitrate-cured meat products increases odds of mania

20 Dec 2018Registered users

There is a strong and independent association between manic episodes and a history of eating nitrate-cured meat products, a US study has found.

Apathy associated with incident dementia in the elderly

24 Sep 2018Registered users

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

Postnatal depression may have adverse effects on offspring

22 Mar 2018Registered users

The children of women with severe persistent postnatal depression (PND) are at substantially increased risk of preschool behaviour problems, poor academic attainment and adolescent depression, a UK longitudinal cohort study has found.

Assessing suicide and self-harm risk in adolescents

22 Feb 2018Registered users

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.

Exercise can prevent depression

23 Nov 2017Paid-up subscribers

If healthy adults exercise for a minimum of an hour each week, their risk of incident depression can be reduced by 12%, a Norwegian prospective cohort study has found. 

Depression in midlife does not raise risk of dementia

23 Oct 2017Registered users

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.