Hemispheric asymmetry is a cardinal feature of human brain organization. Altered brain asymmetry has also been linked to some cognitive and neuropsychiatric disorders. Here the ENIGMA consortium presents the largest ever analysis of cerebral cortical asymmetry and its variability across individuals. Cortical thickness and surface area were assessed in MRI scans of 17,141 healthy individuals from 99 datasets worldwide. Results revealed widespread asymmetries at both hemispheric and regional levels, with a generally thicker cortex but smaller surface area in the left hemisphere relative to the right. Regionally, asymmetries of cortical thickness and/or surface area were found in the inferior frontal gyrus, transverse temporal gyrus, parahippocampal gyrus, and entorhinal cortex. These regions are involved in lateralized functions, including language and visuospatial processing. In addition to population-level asymmetries, variability in brain asymmetry was related to sex, age, and brain size (indexed by intracranial volume). Interestingly, we did not find significant associations between asymmetries and handedness. Finally, with two independent pedigree datasets (N = 1,443 and 1,113, respectively), we found several asymmetries showing modest but highly reliable heritability. The structural asymmetries identified, and their variabilities and heritability provide a reference resource for future studies on the genetic basis of brain asymmetry and altered laterality in cognitive, neurological, and psychiatric disorders.Significance StatementLeft-right asymmetry is a key feature of the human brain's structure and function. It remains unclear which cortical regions are asymmetrical on average in the population, and how biological factors such as age, sex and genetic variation affect these asymmetries. Here we describe by far the largest ever study of cerebral cortical brain asymmetry, based on data from 17,141 participants. We found a global anterior-posterior 'torque' pattern in cortical thickness, together with various regional asymmetries at the population level, which have not been previously described, as well as effects of age, sex, and heritability estimates. From these data, we have created an on-line resource that will serve future studies of human brain anatomy in health and disease.

Electroencephalography (EEG) has been proposed as a neurophysiological biomarker to delineate psychotic disorders. It is known that increased delta and decreased alpha, which are apparent in psychosis, are indicative of inappropriate arousal state, which leads to reduced ability to attend to relevant information. On this premise, we investigated delta/alpha frequency activity, as this ratio of frequency activity may serve as an effective neurophysiological biomarker. The current study investigated differences in delta/alpha frequency activity, in schizophrenia (SCZ), bipolar I disorder with psychotic features and methamphetamine-induced psychosis. One hundred and nine participants, including individuals with SCZ (n = 28), bipolar I disorder with psychotic features (n = 28), methamphetamine-induced psychotic disorder (MPD) (n = 24) and healthy controls (CON, n = 29). Diagnosis was ascertained with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition disorders and current medication was recorded. EEG was undertaken in three testing conditions: resting eyes open, resting eyes closed and during completion of a simple cognitive task (visual continuous performance task). EEG delta/alpha frequency activity was investigated across these conditions. First, delta/alpha frequency activity during resting eyes closed was higher in SCZ and MPD globally, when compared to CON, then lower for bipolar disorder (BPD) than MPD for right hemisphere. Second, delta/alpha frequency activity during resting eyes open was higher in SCZ, BPD and MPD for all electrodes, except left frontal, when compared to CON. Third, delta/alpha frequency activity during the cognitive task was higher in BPD and MPD for all electrodes, except left frontal, when compared to CON. Assessment of EEG delta/alpha frequency activity supports the delineation of underlying neurophysiological mechanisms present in psychotic disorders, which are likely related to dysfunctional thalamo-cortical connectivity. Delta/alpha frequency activity may provide a useful neurophysiological biomarker to delineate psychotic disorders.

Pathways to care in this treatment setting correspond more to findings from first world and newly industrialized countries. A subgroup of multi episode patients had very long periods of untreated illness. Limitations include small sample size and the retrospective nature of data collection.

In the past few years, the sustainability of private practice in South Africa has been questioned, due to spiralling cost and a real reduction in the membership of medical schemes. An ever-increasing number of patients are opting out of medical schemes and now prefer to carry the risk of health expenditure themselves. This trend has implications for psychiatrists in private practice in the short, medium and long term.The realities of the past and current economic climates are discussed in relation to these realities.Government has committed itself again in December 2007, at the ANC Polokwane conference, to implementing a National Health Insurance System and to move much faster on the proposals than in the past. A set of amendment bills and regulations are currently before parliament for debate and promulgation. This legislation has profound implications for a sustainable private practice. Government has indicated that a sustainable and healthy private sector needs to be part of a health National Health System and needs to industry to adapt to the new challenges for the future. A critical review of these changes is presented and the impact on private practice.The National Health Reference List is currently under review, and SASOP P3 presented a detailed investigation to the Department of Health about the cost of running and managing a private psychiatric practice. The relevance of a NHRPL in the current economic and political climate is discussed and, due to these changes and challenges, alternative international and other models are discussed. SASOP CLINICAL GUIDELINES, PROTOCOLS AND ALGORITHMS: DEVELOPMENT OF TREATMENT GUIDELINES FOR BIPOLAR MOOD DISORDER AND MAJOR DEPRESSION Eugene Allers, Margaret Nair, Gerhard GroblerThe development of the SASOP clinical guidelines is presented. The specific guidelines on bipolar mood disorder and major depression are then discussed.Currently, the guidelines for major depression and bipolar mood disorder for 2008 are on the SASOP website for review and comment.The algorithms will be presented as they appear on the website, with a discussion on the differences between other international guidelines. THE REVOLVING DOOR PHENOMENON IN PSYCHIATRY: COMPARING LOW-FREQUENCY AND HIGH-FREQUENCY USERS OF PSYCHIATRIC INPATIENT SERVICES IN BACKGROUND:A major obstacle to establishing successful community-based treatment in South Africa has been that the reduction in number of inpatient beds did not coincide with the development of adequate community resources. This fact, in combination with our patients' poor socio-economic circumstances, has contributed to a substantial increase in the so-called 'revolving door' or high-frequency use phenomenon in state psychiatric facilities. In an attempt to address this problem, the APH in the Western Cape appointed three community treatment teams. Although these teams have faced many challenges, overall there has been a very positive response from service users, their families and other staff, leading us to conclude that this initiative seems to be ...