Background: The diagnostic significance of first-rank symptoms (FRSs) remains uncertain. Ethnic differences in FRSs may account for high rates of schizophrenia in minority groups. This study aims to examine the prevalence of FRSs in an epidemiological sample of first-episode psychoses stratified by relevant demographic variables. Sampling and Method: We identified everyone aged 16–64 presenting with their first psychosis over 2 years in 3 UK centres. Results: A total of 426 subjects had consensus diagnoses of DSM-IV and ICD-10 psychotic conditions. Thirty-eight percent (95% CI = 33–42) reported FRSs; more frequent in those classified as having schizophrenia (DSM-IV: 55%, 95% CI = 47–63; ICD-10: 51%, 95% CI = 44–58) than those with affective psychoses (DSM-IV: 31%, 95% CI = 22–39; ICD-10: 29%, 95% CI = 21–38). FRSs in schizophrenia were more common in white British subjects, while in affective psychoses, they were more frequent in the black group. The sensitivities, specificities and positive predictive values for schizophrenia of FRSs were 55, 69 and 72% according to DSM-IV and 51, 71, 74% according to ICD-10, respectively. The sensitivities were higher in white British than in the black group. Conclusions: FRSs were common but unhelpful for differentiating schizophrenia from other psychoses as they occurred frequently in both diagnoses. Phenomenological differences did not explain the higher incidence of schizophrenia in black ethnic minority groups.

OBJECTIVES To determine the effects of mood and additional clinical variables on different domains of current interviewer-rated social adjustment reflecting the reported behaviour of patients with bipolar disorder (BD). METHOD Multi-center cross-sectional study employing multiple linear regression to investigate whether mood and other clinical features, previously linked to self-rated social adjustment, were associated with eight domains of interviewer-rated social adjustment in 253 BD patients. Baseline variables were entered sequentially in blocks representing current mood, demographic, current other psychiatric, past psychiatric and current treatment variables. RESULTS Mood episode or symptoms together with five other variables (borderline/antisocial personality disorder, male gender, living alone, hypnotic drug and drugs for physical illness) were associated with impairment on two or more domains of interviewer-rated social adjustment. They explained up to 31% of the variance in social adjustment, although friction, dependence and overactivity were associated with a different pattern of variables. Hypomanic symptoms were associated with increased friction and worse social adjustment with the extended family in the whole sample but improved performance and social and leisure activities in patients who were not in acute bipolar episode. CONCLUSION Clinicians may determine up to about 30% of outcome in current social adjustment in BD patients from the patient's current mood episode or symptoms and a small number of other clinical or demographic variables. Hypomanic episodes and symptoms usually worsen friction and overall social adjustment, but in patients who are not in acute episode, hypomanic symptoms can increase performance and social and leisure activities.

Generic utility measures of health-related quality of life provide an independent net valuation of health states. They are increasingly used with condition-specific outcome measures in assessing treatments. In Bipolar Disorder, a few studies indicate poorer quality of life for depressed vs. euthymic patients. A single study suggests mania is less negative than depression. This analysis examines the relationship of one such scale, the EuroQol (EQ-5D), to objective and subjective measures of depression and mania in 221 Bipolar subjects, recently or still in an episode of illness. Results: Depressed patients showed a very poor quality of life (median EQ-5D Index score 0.41). Index and Visual Analogue scores improved significantly as level of depression decreased (Jonckheere–Terpstra test p<0.001). Both scores were significantly negatively related to all depression measures. Patients reported problems across all areas of life covered by the EQ-5D. No such relationships were observed between EQ-5D scores and mania measures, though all mania measures were inter-related. However, the range of mania shown was quite restricted. Conclusions: The EQ-5D is a useful measure of quality of life for Bipolar patients suffering from depression. Conclusions about the role of the EQ-5D in mania are restricted by the limited range of mania observed.

Background There have been few detailed longitudinal symptom studies of bipolar disorder. Aims To describe the course of bipolar disorder over 18 months in 204 patients receiving mental healthcare. Method Patients were interviewed every 8 weeks, with weekly ratings of depression, mania and overall severity. Results Participants were symptomatic 53% of the time, with sub-syndromal symptoms present for twice as long as major disorder, and depressive symptoms three times more than manic symptoms. Individuals who were experiencing an episode at baseline spent 33% of the 18 months with substantial sub-syndromal symptoms, 17% with major disorder and 28% symptom free. Those not experiencing a baseline episode spent twice as long symptom free and half as long at disorder levels. Changes in symptom level were frequent. Predictors of sub-syndromal symptoms were similar to those of major disorder. Conclusions Sub-syndromal residual symptoms are an important problem in recurrent bipolar disorder and require therapeutic intervention.

BackgroundThere is a lack of data on the cost-effectiveness of relapse prevention in depression.MethodA total of 158 subjects with partially remitted major depression despite adequate clinical treatment were randomly allocated to cognitive therapy in addition to antidepressants and clinical management v. antidepressants and clinical management alone. Relapse rates and health care resource utilisation were measured prospectively over 17 months.ResultsCumulative relapse rates in the cognitive therapy group were significantly lower than in the control group (29%v.47%). The incremental cost incurred in subjects receiving cognitive therapy over 17 months (£779; 95% CI £387–£1170) was significantly lower than the overall mean costs of cognitive therapy (£1164; 95% CI £1084–£1244). The incremental cost-effectiveness ratio ranged from £4328 to £5027 per additional relapse prevented.ConclusionsIn individuals with depressive symptoms that are resistant to standard treatment, adjunctive cognitive therapy is more costly but more effective than intensive clinical treatment alone.