Special Interest: Mental health

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.

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.

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]

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.

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.

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.