Attention-deficit hyperactivity disorder (ADHD) is a common disorder affecting children and adults. Many young people treated with stimulants, as well as those in whom ADHD went unrecognised in childhood, need treatment as adults. Stimulants and atomoxetine effectively reduce ADHD symptoms at all ages and should be a standard treatment in general adult psychiatric practice.

Background Migration is a risk factor for the development of schizophrenia.

Aims To examine whether migration is also a risk factor for bipolar affective disorder, unipolar depressive disorder and mood disorders in general.

Method Medline was searched for population-based incidence studies concerning mood disorders among migrants and mean relative risks were computed using a mixed-effects statistical model.

Results Only a few studies of unipolar depressive disorder were retrieved. The mean relative risk of developing bipolar affective disorder among migrants was 2.47 (95% CI 1.33–4.59). However, after excluding people of African–Caribbean origin in the UK this risk was no longer significantly increased. The mean relative risk of mood disorders of unspecified polarity was 1.25 (95% CI 1.04–1.49) and that of any mood disorder was 1.38 (95% CI 1.17–1.62).

Conclusions There is no conclusive evidence for a large increase in the risk of mood disorders associated with migration.

Background With almost a million people dying by suicide worldwide each year, reducing the rate of suicidal behaviour is a priority in many countries.

Aims To examine whether additional psychosocial interventions following an episode of self-harm reduce the likelihood of subsequent suicide.

Method We conducted a systematic review and meta-analysis of data from randomised controlled trials of interventions for people following self-harm. Likelihood of suicide was compared by calculating the pooled root difference in suicide rate with 95% confidence intervals.

Results We obtained suicide data from 18 studies with a total population of 3918. Eighteen suicides occurred among people offered active treatment and 19 among those offered standard care (pooled root difference in suicide rate 0.0,95% CI –0.03 to 0.03). The overall rate of suicide among people participating in trials was similar to that reported in observational studies of people who self-harm.

Conclusions Results of this meta-analysis do not provide evidence that additional psychosocial interventions following self-harm have a marked effect on the likelihood of subsequent suicide.

Background Little is known of the epidemiology and care needs of people with adolescent-onset psychosis.

Aims To examine prevalence and the cross-sectional disability, needs and service provision for adolescent-onset psychosis in areas of central Scotland with a total population of 1.75 million.

Method We identified and contacted 103 young people using an opt-out research design. Fifty-three participants and their carers and keyworkers were interviewed using a modified version of the Cardinal Needs Schedule.

Results The 3-year prevalence was 5.9 per 100 000 general population. Twenty-one (20%) adolescents were not in contact with mental health services; 80% of first admissions were to adult acute psychiatric wards. Those interviewed had high levels of morbidity: 29 (55%) had serious to pervasive impairment of functioning; there were relatively high levels of side-effects, negative symptoms, anxiety, occupational, friendship and family difficulties. Care provision was better for‘clinical’than for‘social’domains; 20% had five or more unmet needs; 17% had at least one intractable problem.

Conclusions This low-prevalence disorder requires an assertive multi-agency approach in the context of a national planning framework.

Background Reported prevalence of mental ill-health among adults with intellectual disabilities ranges from 7 to 97%, owing to methodological limitations. Little is known about associations.

Aims To determine the prevalence of mental ill-health in adults with intellectual disabilities and to investigate factors independently associated with it.

Method Population-based study (n=1023) with comprehensive individual assessments modelled using regression analyses.

Results Point prevalence of mental ill-health was 40.9% (clinical diagnoses), 35.2% (DC–LD), 16.6% (ICD–10–DCR) and 15.7% (DSM–IV–TR). The most prevalent type was problem behaviours. Mental ill-health was associated with more life events, female gender, type of support, lower ability, more consultations, smoking, incontinence, not having severe physical disabilities and not having immobility; it was not associated with deprived areas, no occupation, communication impairment, epilepsy, hearing impairment or previous institutional residence.

Conclusions This investigation informs further longitudinal study, and development of appropriate interventions, public health strategy and policy. ICD–10–DCR and DSM–IV–TR undercount mental ill-health in this population compared with DC–LD.

Background Depression is common in Pakistan but no research on this subject has been reported from the North West Frontier Province (NWFP), host to numerous Afghan refugees.

Aims To measure depressive symptoms and associated features in a population-based sample.

Method A Pushto translation of the Self Reporting Questionnaire (SRQ) was administered to 471 adults living in a village in one of the federally administered tribal areas. Respondents were also assessed with a life events checklist for social problems, a social support questionnaire and the Brief Disability Questionnaire.

Results Sixty per cent (95/158) of women and 45% (140/313) of men scored 9 or more on the SRQ. High SRQ score was associated with few years of education, higher social problem score, less social support and greater disability. High social problem score was the strongest correlate.

Conclusions This population reports more depressive symptoms than other communities in Pakistan and this probably reflects the very high degree of social stress experienced in the NWFP, which has been affected by years of turmoilin neighbouring Afghanistan.

Background Few studies have prospectively examined psychosocial and psychiatric predictors of adolescent substance use disorders simultaneously.

Aims To identify psychosocial and psychiatric predictors of substance use disorders in adolescence.

Method School children aged 12 years (s.d.=0.3) free from any substance use disorder at grade 7 (n=428) were assessed in three consecutive years, using a standardised psychiatric interview. Their baseline psychosocial information was also collected. The outcome was the onset age of a substance use disorder. The Cox regression model was used for data analysis.

Results The most significant predictive factors for adolescent substance use disorder included male gender, attention-deficit hyperactivity disorder, conduct disorder and sibling use of tobacco. Three protective factors against such morbidity included living in a household withtwo parents, a good academic grade atgrade 7 and objection to the use of substances.

Conclusions Early intervention for disruptive behaviour disorders and specific psychosocial risk factors might prevent substance use disorders in early adolescence.

Attention-deficit hyperactivity disorder (ADHD) varies in its clinical presentation and course. Susceptibility gene variants for ADHD and associated antisocial behaviour are being identified with emerging evidence of gene–environment interaction. Genes and environmental factors that influence the origins of disorder are not necessarily the same as those that contribute to its course and outcome.