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Gloria Gaynor was an early proponent of resilience, winning many converts with her reflections on ‘how you did me wrong I grew strong, and I learned how to get along’. Tapping into this – resilience, not ‘70s disco – to improve mental health outcomes is a growing concept, but does evidence support this sensible, if sometimes loosely defined, idea? Dray et al provide a timely systematic review of 57 randomised controlled trials of universal resilience-focused interventions targeting children and adolescents in school settings. Meta-analysis showed that, compared with control conditions, interventions were effective in reducing depressive symptoms, internalising and externalising problems, and general distress, but not anxiety, hyperactivity or conduct problems. However, there was variation between age groups and duration of intervention. Not all data were amenable to meta-analysis – the inability to divide results by gender being noteworthy – but these findings support the principle of general resilience-focused preventive programmes in this cohort.

How much do different countries invest in mental health research compared with other branches of healthcare? As part of the ROAMER project, Hazo et al compared four European nations: the UK, France, Spain and Finland. Using 2011 data, public and private (not-for-profit) annual spends were calculated, respectively, at ₠127.6, ₠84.8, ₠16.8 and ₠10.2 million. To look on it another way, that equates to a national spend per disability-adjusted life year (DALY) of ₠48.7, ₠31.2, ₠39.5 and ₠12.5. How does this relate to wider research spending? In the UK, just 4% of health research funding goes on mental health – given that it accounts for 12% of total DALYs, that's an enormous underspend (the Finns do better at almost 10%). A recent paper in the BJPsych confirmed that greater national investment in mental health services produces better clinical outcomes, but the burden remains enormous and we need more research into prevention, intervention and treatment. We can all play a positive role: only 1.7% of charity research spend went to mental health – time to put your hands into your pockets.

We always hope you enjoy the free journal that comes with your Kaleidoscope subscription. A paper in this month's issue (pp. ) showed that most scales assessing risk performed no better than the clinician/patient predictions following self-harm; this provoked a lively discussion on the journal's Twitter feed. A new paper by Seena Fazel's team explores their utility in criminal justice settings and forensic psychiatry. The authors note how such tools are used to inform critical aspects of patient management such as in-patient detention and discharge, custodial sentencing, parole, and post-release monitoring. This is despite a lack of reliable validation on predictive accuracy, especially in important groups such as women, ethnic minority populations, and those motivated by religious or political extremism. Furthermore, they find the literature is marred by significant publication and authorship bias, and suggest that better-quality data will allow better matching of relevant tools to clinical contexts. This is best exemplified by assessing the balance between optimising false positive v. false negative findings: highly sensitive tools (with low false negatives) may be optimal where ‘protecting the public’ is seen as key, whereas highly specific ones might best protect prisoner and patient rights and interests. Assessment tools have had accusations of implicit discrimination levelled against them, as they commonly capture sociodemographic data – age, gender, ethnicity, immigration status – that risk profiling and perpetuating stigma. But should this information be excluded, especially as some data may improve predictive accuracy? The analogy of racial profiling at airports is put forward: if this helps a limited, but highly contentious, screening resource prevent more atrocities, is it warranted? It's clearly a charged debate, and perhaps that is part of the problem, balancing emotion and fairness with science. In the absence of robust data, we walk the fine line between coarse variables that may perpetuate discrimination, and the risk of their politically driven removal.

Deprivation in early life is associated with childhood psychiatric disorders, but the developmental trajectories of these are not well understood. An intriguing study by Sonuga-Barke et al followed up long-term outcomes (to ages 22–25) of children who had suffered severe deprivation, from birth until 4 years of age, in Romanian institutions before being adopted into the UK. Their plight, including partial starvation and a lack of human contact and care under Ceauşescu's regime has been well reported, as has the fact that many showed a remarkable and rapid improvement in developmental delays upon reaching the UK. Through childhood, those who had spent less than 6 months in such an environment suffered comparatively low levels of psychiatric symptoms, similar to their British counterparts. However, despite well-resourced and loving care from their adoptive UK families, children who had spent more than 6 months in this deprivation had persistently greater rates of autism spectrum disorder (ASD), disinhibited social behaviour, and inattention and hyperactivity symptoms that persisted into adulthood. Although childhood cognitive impairment in this more vulnerable group returned to normal levels by later life, they had lower educational attainments and higher rates of unemployment and increased use of mental health services. The authors praise the resilience of the children, noting how a fifth of those who spent more than 6 months in deprived care still remained problem-free at all points: it also underlines how this was not the case for the other 80% of them. In seemingly introspective political times, it reminds us to look outwards.

We open with some major and significant randomised controlled trials exploring interventions in resource-poor societies. Two papers by the same team writing in the Lancet explore the use of non-specialist ‘lay counsellor’ health workers to deliver brief psychological interventions for excessive alcohol consumption and depression in India. Male harmful drinkers in ten primary health centres were randomised to receive either enhanced usual care (EUC), or EUC and Counselling for Alcohol Problems (CAP). The active intervention produced significantly greater remission and abstinence rates, with an incremental cost per additional remission of $217. A Healthy Activity Program (HAP) for moderately to severely depressed men and women was evaluated in a different cohort, with a parallel design of EUC compared with EUC plus therapy. Once again, the active intervention produced significant improvements, with reductions in depression symptomatology and remission, as well as decreased illness consequences such as days out of work and intimate partner violence. Both interventions were reported to be acceptable to patients and practical for delivery in primary care settings.

‘Psychobiotics’ is your new word this month: live microorganisms with mental health benefits. We've previously noted the links between the gut microbiome and changes in cognition and psychopathology. Now, Allen and colleagues test an intervention – using the bacterium Bifidobacterium longum 1714 – in 22 healthy volunteers who undertook cognitive assessments, resting electro-encephalography (EEG), and a social stress test at baseline, post-placebo, and post-psychobiotic. The active intervention was associated with reduced cortisol levels and subjective anxiety in response to the stress test, as well as lower levels of self-reported stress. It also resulted in enhanced frontal midline EEG mobility, which is representative of prefrontal cortical activity, and modest improvements in visuospatial memory performance. The authors propose a precision strategy, to rationally test particular candidate bacteria strains – rather than the ‘probiotic cocktail’ often administered – against specific psychopathology.

Tapping into your New Year resolutions, we present some cautionary data to consider.Recent research on novel addiction types suggests that, in addition to hunger, the urge to eat is considerably influenced by environmental cues. Obese individuals have been shown to be more sensitive to these, with subsequent stronger craving and larger portion sizes. Neurobiologically, this has been linked with pathological alterations to cue-triggered motivational responses in the nucleus accumbens (NAc) parallel to those seen in drug addiction. Oginsky et al investigated the effects of a junk-food diet on obesity-susceptible and obesity-resistant rats. Glutamatergic calcium-permeable AMPA receptor (CP-AMPAR) functioning in the NAc showed more rapid and long-lasting (for weeks after cessation of junk-food consumption) increases in the obesity-sensitive group. CP-AMPARs mediate cue-triggered food seeking, and their changes in the brain occurred before weight gain. The data support the concept that ‘junk food addiction’ induced by the consumption of fatty and high-sugar foods may be contributing to the obesity epidemic.

The Global Burden of Disease (GBD) is the most comprehensive global epidemiological study, and the analyses of the 2015 data have recently been published (thelancet.com/gbd). This is a rich data-set including observation on the general increase in global life expectancy, with the gains due to significant improvement in HIV outcomes balanced against the significant war-related decreases in male life expectancy in Syria. Interestingly, the age-standardised mortality rate for mental and substance use disorders dropped by over 12% between 2005 and 2015, though with considerable variations between conditions and countries, and the authors further note the difficulty in accurately attributing and coding excess deaths – for example, the years of life known to be indirectly lost to schizophrenia. Total deaths due to self-harm and interpersonal violence did not change much during this period.

Nordsletten and colleagues1 report on the first study looking at assortative mating and psychiatric disorders in a representative population sample (of over 700 000). Compared with the general population, the odds of having a partner who also suffers from a mental health problem – both within and across disorders – were significantly elevated: cross-assortative mating was approximately 0.15 for bipolar disorder, 0.36 for substance misuse, and over 0.40 for attention-deficit hyperactivity disorder, autism spectrum disorder (ASD) and schizophrenia. Overall, having one of these disorders was associated with an approximately two- to threefold increase in the odds of having a mate with the same or an alternative mental health condition. Interestingly and importantly, such cross-assortative mating was not found for a range of physical health conditions, including diabetes, rheumatoid arthritis and multiple sclerosis.

Friedman's statement that ‘most people who are violent are not mentally ill, and most people who are mentally ill are not violent’ remains apposite, but recent US gun killings inevitably reawaken the debate. In a moving editorial in the New England Journal of Medicine, Malina and colleagues compellingly compare gun lobbyists to a cancer growing in the mutated cells of the psychological and sociological make-up of the United States. What is the contribution of mental health to this problem? Estimates suggest it might have impacted the trajectory of 3–5% of the approximately 33 000 US gun deaths in 2013. Sadly, one imagines that psychiatry had a far bigger role in terms of the subsequent psychological impact on their relatives, witnesses of the violence, and the further 84 000 who survived such assaults that year. Against the backdrop of halting convulsions towards legislative change, the authors reason that mental healthcare cannot be held responsible for what they label the impossible task of identifying anyone who might conceivably start shooting others.

Life expectancy in England is related to income (and in London, it can be mapped by a resident's nearest tube station1). The arrival of a new government offers the opportunity to review the impact of earlier policies designed to reduce health inequality. A new report from the King's Fund2 has updated Michael Marmot's 2010 publication, Fair Society, Healthy Lives, and using a wider range of determinants of lifestyle and health, has found that income-related inequalities in life expectancy have improved since that report. Department of Health policies in the 2000s appear to have contributed to this, although reductions in child and pensioner poverty and improvements in employment and social housing have also impacted positively. Nevertheless, unemployment, housing deprivation, and binge drinking remain key factors in lowering life expectancy. The King's Fund report argues that a more nuanced and integrated policy response for the NHS and other public services will be required by the new government to continue to reduce inequality, but recognises that implementation in an era of austerity poses challenges, particularly for the most vulnerable.

Palcohol. What is it? It's a powdered alcohol that has recently been approved for sale in the USA.On the one hand, it is just adding choice, offering a new, crystalline form of one of the world's most commonly used and enjoyed chemicals (although recent news stories1 of some Australians brewing moonshine from Vegemite are surely pushing choice beyond the pale). However, there are some specific challenges with palcohol, which are well articulated in an editorial in JAMA by Naimi & Mosher.2 The powder is sold at 50% alcohol by weight, but the strength by volume will depend on how it is diluted. It can be more easily concealed than liquid alcohol, and it could be added – surreptitiously – to another alcoholic beverage. The potential for misuse, including by children, is self-evident; indeed, a video of an individual eating palcohol has already been uploaded, along with discussions on inhaling it, though such acts appear unlikely to produce intoxication. What is its current status in the UK? Answering a parliamentary question in the House of Lords earlier this year Lord Bates noted3 that ‘The Government is not aware of powdered alcohol being marketed or made available to buy in England and Wales'. However, a very quick and simple check on a well-known internet search engine gave a web-link to buy palcohol online.

Antidepressant effectiveness is a topic seldom out of the scientific or popular press, with claim and counter-claim about the disclosure, reporting, and interpretation of data. Hieronymus and colleagues1 have thrown their hats into the ring: noting that about half of company-sponsored trials failed to show any superiority over placebo, they challenge that most studies evaluated changes in total scores on the 17-point Hamilton Rating Scale for Depression (HRSD-17), but that this might mask improvement in important subcomponents. Not all items equally correlate with illness burden, so they undertook patient-level post hoc analyses focusing on the four-point depressed mood subcomponent in 18 placebo-controlled industry trials of various selective serotonin reuptake inhibitors (n = 6669). The choice of this question was based on its diagnostic importance and the fact it had the highest baseline severity in the pooled sample. The result was that 91% of comparisons showed superiority of the active drug over placebo, compared with 46% where the summed scale was used (P

Special K’ has had various connotations over the years, and with respect to depressive illness ketamine has most recently been mooted as a potential antidepressant. It is intriguing because of its almost immediate effects, and a pharmacology that has little connection with the predominant monoamine hypothesis. How does its blockade of glutamatergic NMDA receptors alleviate depressed mood? New data1 suggest that a critical step is that this stabilises an adaptor protein, 14-3-3η, which decouples GABAB receptor signalling and influences the activity of the intracellular protein mTOR. The upshot is a change in synaptic structure that produces a therapeutic effect; the rather innocuously named 14-3-3η protein seems to be the essential link for fast-acting antidepressants. Formidable problems exist with using ketamine as a therapeutic option, including a very quick decay in effectiveness, as well as concerns about the intravenous administration of a compound that is an anaesthetic, a commonly misused recreational drug, and a pro-psychotic. However, an improved understanding of its mechanisms of action is essential in enhancing our knowledge of the neuropathology of depression, offering the potential for development of novel compounds circumventing some of these limiting factors.

Is there still a role for neurosurgery in psychiatry in 2015? Proof-of-concept work by a Korean team1assessed a novel, minimally invasive, non-cranium-opening technique in four patients with refractory obsessive–compulsive disorder (OCD). With just local anaesthetic to the scalp, magnetic resonance-guided focused ultrasound (MRgFUS) was utilised to thermally ablate the anterior limb of the internal capsule bilaterally. Unlike many other invasive procedures, this neuroimaged technique affords real-time monitoring of lesion induction and the patient's neurological and psychological status. The treated individuals showed a gradual improvement in their OCD, with mean symptom reductions of about a third over the 6-month follow-up period, and almost immediate and sustained improvements in depressive and anxiety symptoms. No neuropsychiatric sequalae were seen in this limited sample, which certainly compares favourably with existing techniques. Psychosurgery evokes unsavoury images of the past, and it is uncertain how much will there is for such work: in an evidence-based profession, let the data lead.

June 27 this year was the day that funding was approved for San Francisco's Golden Gate Bridge physical suicide deterrent barrier (www.ggbsuicidebarrier.org). This follows over 1400 suicides since the bridge's opening in 1937: a morbid record 46 were in 2013 alone, possibly exacerbated by the global economic crisis. The barrier is in place to prevent the end-point of suicidal behaviour (physically preventing suicide) but how much effort is going into the examination of the external factors that drive such behaviour? Aleman & Denys argue that psychiatry has failed to tackle suicide as a disease entity in its own right, instead relegating the act of deliberately ending one's life to a symptom or consequence of an underlying psychiatric illness. They note that in DSM-5 suicidality is only mentioned as a symptom of borderline personality disorder and mood disorders, despite this presenting as the most prominent psychiatric emergency. They argue for a more experimental approach based on the National Institute of Mental Health's Research Domain Criteria (www.nimh.nih.gov/research-priorities/rdoc/index.shtml) that emphasises the study of psychiatric phenomena with reference to their underlying mechanisms: in this case, processing of negative valence, context and response selection, and mechanisms to regulate arousal.

Drugs and violence are often observed as bedfellows; both have been associated with psychosis but the nature and timing of their relationships remains unclear. As part of the UK Prisoner Cohort Study, Keers et al prospectively followed up 967 prisoners convicted of sexual or violent offences (about a quarter of whom had a psychotic illness) in the community after release. Schizophrenia was associated with greater rates of violence, but the risk was mediated by untreated psychosis or when presenting with persecutory delusions – and no other definable psychopathology. Interestingly, drug-induced psychosis did not increase the risk of violence per se, once the substance misuse itself was accounted for. Does treatment have an impact on risk of violence in a population-based sample of patients with psychosis? Fazel et al demonstrated reductions in violent crime in patients during the time they were prescribed antipsychotics. Interestingly, the rates of violent crime were also reduced in patients with bipolar disorder who received mood stabilisers. Therefore, in addition to the effects of antipsychotics and mood stabilisers on relapse rates, their potential effects on violence and crime could be used to make decisions about management for these groups of patients. There is a clearer need for the appropriate treatment of prisoners with psychotic illnesses if their risk of violence is to be moderated. Cannabis is one of the most commonly used social drugs worldwide; it increases risk of psychosis, but there has been little to offer pharmacologically to those dependent upon this most prevalent illicit drug, and various trials of mood stabilisers, antidepressants and α2 adrenergic agonists have generally been disappointing. Allsop et al evaluated the novel cannabis extract nabiximols, containing cannabidiol – which has been shown to attenuate paranoia and euphoria – and tetrahydrocannabinol, delivered as a buccal spray. The active drug group showed statistically significant benefits in reduced withdrawal irritability, depression and cravings and remained longer in treatment. However, both placebo and drug groups showed reduced cannabis use at follow-up, with placebo being as effective as nabiximols in promoting longer-term cessation.