The Schizophrenia Psychiatric Genome-Wide Association Consortium (PGC) highlighted 81 single nucleotide polymorphisms (SNPs) with moderate evidence for association to schizophrenia. After follow up in independent samples, 7 loci attained genome wide significance (GWS), but multi-locus tests suggested some SNPs that did not do so represented true associations. We tested 78 of the 81 SNPs in 2640 individuals with a clinical diagnosis of schizophrenia attending a clozapine clinic (CLOZUK), 2504 cases with a research diagnosis of bipolar disorder, and 2878 controls. In CLOZUK, we obtained significant replication to the PGC-associated allele for no fewer than 37 (47%) of the SNPs, including many prior GWS MHC SNPs as well as 3/6 non-MHC SNPs for which we had data that were reported as GWS by the PGC. After combining the new schizophrenia data with those of the PGC, variants at three loci (ITIH3/4, CACNA1C and SDCCAG8) that had not previously been GWS in schizophrenia attained that level of support. In bipolar disorder, we also obtained significant evidence for association for 21% of the alleles that had been associated with schizophrenia in the PGC. Our study independently confirms association to 3 loci previously reported to be GWS in schizophrenia and identifies the first GWS evidence in schizophrenia for a further 3 loci. Given the number of independent replications and the power of our sample, we estimate 98% (C.I. 78–100%) of the original set of 78 SNPs represent true associations. We also provide strong evidence for overlap in genetic risk between schizophrenia and bipolar disorder.

The introduction of case-based learning (CBL) by the School of Medicine at Cardiff University has encouraged innovation in medical teaching and learning. During years one and two of the modernized MBBCh program, students complete 17 cases as part of the newly developed C21 curriculum that emphasizes a patient-oriented and student-centered approach to learning. The mental health case, which is presented in year 2, incorporates a number of novel teaching resources that aim to enhance the students' learning experience and to further reinforce the patient-oriented and community-based philosophy of C21. These include the use of fictionalized video diaries, virtual patient cases, e-learning workbooks, an interactive practical session, and community placements. Novel teaching methods and resources were evaluated by students in terms of effectiveness and value as learning resources through the administration of a structured mixed questionnaire. The results revealed that students valued the inclusion of these resources, which they evaluated as having contributed to their understanding of the subject area. Furthermore, the case was found to have had an impact on student interest in psychiatry as a specialty as well as a career choice. The positive student evaluation of this case supports the innovations in teaching delivery inspired by C21.

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We are in full agreement with Carroll about the limited utility of clinical symptoms for 'diagnostic tests' and the consequent importance of efforts to discover biomarkers, endophenotypes or genetic markers. In fact, the main focus of our research is molecular genetic epidemiological investigation of mood disorders and psychoses that has precisely this aim. 1-4 Further, we have a keen interest in using findings to provide biological validators for psychiatric nosology, classification and clinical diagnosis. 5 However, for the moment, psychiatrists have to make do with the clinical tools available and be alert to diagnostic clues that can help in the delivery of optimal care to their patients. We stand by the statements in our paper: 'It is commonly, but wrongly, assumed that there are no important differences in the clinical presentation of unipolar and bipolar depression. .. The clinical features of depression are not, of course, a definitive guide to diagnosis but can help alert the clinician to a possible bipolar course. .. This is important because optimal management varies between bipolar and unipolar depression.'

Background: Despite its great clinical importance, there is a paucity of research evidence on bipolar depression after childbirth. It is also common, especially in non-specialist settings, to label all psychiatric disorders occurring in relation to childbirth as postpartum depression and to assume that bipolar and unipolar depression are the same. In this study we aimed to explore (1) whether a history of postpartum depression identified a distinct sub-group of women with bipolar disorder and (2) the clinical features that distinguished between bipolar and unipolar postpartum depression. Methods: One thousand two hundred and ninety five parous women with bipolar disorder and 426 with recurrent major depression were interviewed and case notes reviewed. Best-estimate diagnoses were made according to DSM-IV criteria. A range of clinical variables were investigated using parametric and non-parametric regression approaches. Results: In the bipolar disorder group, women with postpartum depression had a younger age at onset and more deliveries than women without postpartum episodes (p < 0.001). Compared to women with unipolar postpartum depression, those with a bipolar diathesis had more recurrences, younger age at onset and were less likely to have a family history of lifetime or postnatal depression. Combining information on family history, course and age at impairment about 8 out of 10 women with unipolar and bipolar postpartum depression were correctly classified. Conclusions: Our results supported the hypothesis that postpartum depression is an heterogeneous illness.In our analysis postpartum depression did not identify a distinct clinical subtype of bipolar disorder. Women with unipolar postpartum depression had fewer lifetime episodes and were more likely to have a family history of lifetime and postpartum major depression than those with a bipolar diathesis, suggesting a more specific relationship with the childbirth trigger. Background: Cannabis use seems to play a causal role in the development of psychotic disorders. Recent evidence suggests that it may also precipitate onset in bipolar disorder. We here investigate if there is a dose-response relationship between cannabis use and age at onset in bipolar disorder, and whether there are interactions between cannabis use and illness characteristics (presenting polarity and presence of psychosis). Methods: Consecutively recruited patients with a DSM-IV, SCID verified diagnosis of bipolar I, II or NOS disorder (n = 324) participated. Two-way ANCOVAS were used to investigate the effect of levels of cannabis use (<10 times during 1 month lifetime, >10 times during 1 month lifetime or a cannabis use disorder) on age at onset, including interaction effects with illness characteristics, while controlling for possible confounders. RC2 Abstract Withdrawn RC3Results: There was a significant association indicating an inverse dose-response relationship between cannabis use and age at onset, which remained statistically significant after controlling for possible confounder...