BackgroundPersonality disorders are now internationally recognised as a mental health priority. Nevertheless, there are no systematic reviews examining the global prevalence of personality disorders.AimsTo calculate the worldwide prevalence of personality disorders and examine whether rates vary between high-income countries and low- and middle-income countries (LMICs).MethodWe systematically searched PsycINFO, MEDLINE, EMBASE and PubMed from January 1980 to May 2018 to identify articles reporting personality disorder prevalence rates in community populations (PROSPERO registration number: CRD42017065094).ResultsA total of 46 studies (from 21 different countries spanning 6 continents) satisfied inclusion criteria. The worldwide pooled prevalence of any personality disorder was 7.8% (95% CI 6.1–9.5). Rates were greater in high-income countries (9.6%, 95% CI 7.9–11.3%) compared with LMICs (4.3%, 95% CI 2.6–6.1%). In univariate meta-regressions, significant heterogeneity was partly attributable to study design (two-stage v. one-stage assessment), county income (high-income countries v. LMICs) and interview administration (clinician v. trained graduate). In multiple meta-regression analysis, study design remained a significant predictor of heterogeneity. Global rates of cluster A, B and C personality disorders were 3.8% (95% CI 3.2, 4.4%), 2.8% (1.6, 3.7%) and 5.0% (4.2, 5.9%).ConclusionsPersonality disorders are prevalent globally. Nevertheless, pooled prevalence rates should be interpreted with caution due to high levels of heterogeneity. More large-scale studies with standardised methodologies are now needed to increase our understanding of population needs and regional variations.

BackgroundCurrently, terrorism and suicide bombing are global psychosocial processes that attracts a growing number of psychological and psychiatric contributions to enhance practical counter-terrorism measures. The present study is a systematic review that explores the methodological quality reporting and the psychometric soundness of the instruments developed to identify risk factors of terrorism, extremism, radicalisation, authoritarianism and fundamentalism.MethodA systematic search strategy was established to identify instruments and studies developed to screen individuals at risk of committing extremist or terrorist offences using 20 different databases across the fields of law, medicine, psychology, sociology and politics. Information extracted was consolidated into two different tables and a 26-item checklist, reporting respectively background information, the psychometric properties of each tool, and the methodological quality markers of these tools. 37 articles met our criteria, which included a total of 4 instruments to be used operationally by professionals, 17 tools developed as research measures, and 9 inventories that have not been generated from a study.ResultsJust over half of the methodological quality markers required for a transparent methodological description of the instruments were reported. The amount of reported psychological properties was even fewer, with only a third of them available across the different studies. The category presenting the least satisfactory results was that containing the 4 instruments to be used operationally by professionals, which can be explained by the fact that half of them refrained from publishing the major part of their findings and relevant guidelines.ConclusionsA great number of flaws have been identified through this systematic review. The authors encourage future researchers to be more thorough, comprehensive and transparent in their methodology. They also recommend the creation of a multi-disciplinary joint working group in order to best tackle this growing contemporary problem.

Background Depressive symptoms, o en of substantial severity, are found in 50% of newly diagnosed su ers of schizophrenia and 33% of people with chronic schizophrenia who have relapsed. Depression is associated with dysphoria, disability, reduction of motivation to accomplish tasks and the activities of daily living, an increased duration of illness and more frequent relapses. Objectives To determine the clinical e ects of antidepressant medication for the treatment of depression in people who also su er with schizophrenia.

Background: Many patients experience extended stays within forensic care, but the characteristics of long-stay patients are poorly understood.Aims: To describe the characteristics of long-stay patients in high and medium secure settings in England.Method: Detailed file reviews provided clinical, offending and risk data for a large representative sample of 401 forensic patients from 2 of the 3 high secure settings and from 23 of the 57 medium secure settings in England on 1 April 2013. The threshold for long-stay status was defined as 5 years in medium secure care or 10 years in high secure care, or 15 years in a combination of high and medium secure settings.Results: 22% of patients in high security and 18% in medium security met the definition for “long-stay,” with 20% staying longer than 20 years. Of the long-stay sample, 58% were violent offenders (22% both sexual and violent), 27% had been convicted for violent or sexual offences whilst in an institutional setting, and 26% had committed a serious assault on staff in the last 5 years. The most prevalent diagnosis was schizophrenia (60%) followed by personality disorder (47%, predominantly antisocial and borderline types); 16% were categorised as having an intellectual disability. Overall, 7% of the long-stay sample had never been convicted of any offence, and 16.5% had no index offence prompting admission. Although some significant differences were found between the high and medium secure samples, there were more similarities than contrasts between these two levels of security. The treatment pathways of these long-stay patients involved multiple moves between settings. An unsuccessful referral to a setting of lower security was recorded over the last 5 years for 33% of the sample.Conclusions: Long-stay patients accounted for one fifth of the forensic inpatient population in England in this representative sample. A significant proportion of this group remain unsettled. High levels of personality pathology and the risk of assaults on staff and others within the care setting are likely to impact on treatment and management. Further research into the treatment pathways of longer stay patients is warranted to understand the complex trajectories of this group.