ObjectiveTo investigate if people with subjective memory complaints (SMC) but no objective deficits are at increased risk of developing mild cognitive impairment (MCI) and dementia. MethodsMajor electronic databases were searched till 03/2014 and a meta-analysis was conducted using inception cohort studies. ResultsAcross 28 studies there were 29,723 unique individuals (14,714 with SMC and 15,009 without SMC) (mean 71.6 years) followed on average for 4.8 years through to dementia. The annual conversion rate (ACR) of SMC to dementia was 2.33% (95% CI = 1.93% -2.78%) a relative risk (RR) of 2.07 (95% CI = 1.76 to 2.44) compared to those without SMC (n=15,009). From 11 studies the ACR of developing MCI was 6.67% (95% CI = 4.70 -8.95%).In long-term studies over 5 years, 14.5% (9.67 -19.1%) of people with SMC developed dementia and 26.6% (95% CI =15.3-39.7) went on to develop MCI. The ACR from SMC to dementia and MCI were comparable in community and non-community settings. ConclusionOlder people with SMC but no objective complaints are twice as likely to develop dementia as individuals without SMC. Approximately 2.3% and 6.6% of older people with SMC will progress to dementia and MCI per year. Summations •Among people with SMC but without objective complaints, the annual conversion rate (ACR) to MCI is 6.6%, whilst it is 2.3% to dementia, compared to 1% in those without SMC• Over about 5 years, 24.4% of those with SMC will develop MCI, whilst 10.9% will convert to dementia, compared to 4.6% in those without SMC. 4• Overall, the risk of developing dementia is double in those with SMC compared to those without SMC.• Considerations• It was not possible to stratify the results according to type of dementia or the diagnosis method.• A wide range of definitions were used to capture SMC and it was not possible to conduct subgroup analysis to determine if this influenced the results.• Most of the analysis had high heterogeneity and there was evidence of publication bias in some of the analyses.

Depression, adjustment disorder and anxiety are common after stroke. Risk factors are aphasia, dominant hemispheric lesions and past personal/family history of depression but not time since stroke.

BackgroundThe Patient Health Questionnaire (PHQ) is the most commonly used measure to screen for depression in primary care but there is still lack of clarity about its accuracy and optimal scoring method.AimsTo determine via meta-analysis the diagnostic accuracy of the PHQ-9-linear, PHQ-9-algorithm and PHQ-2 questions to detect major depressive disorder (MDD) among adults.MethodWe systematically searched major electronic databases from inception until June 2015. Articles were included that reported the accuracy of PHQ-9 or PHQ-2 questions for diagnosing MDD in primary care defined according to standard classification systems. We carried out a meta-analysis, meta-regression, moderator and sensitivity analysis.ResultsOverall, 26 publications reporting on 40 individual studies were included representing 26 902 people (median 502, s.d.=693.7) including 14 760 unique adults of whom 14.3% had MDD. The methodological quality of the included articles was acceptable. The meta-analytic area under the receiver operating characteristic curve of the PHQ-9-linear and the PHQ-2 was significantly higher than the PHQ-9-algorithm, a difference that was maintained in head-to-head meta-analysis of studies. Our best estimates of sensitivity and specificity were 81.3% (95% CI 71.6–89.3) and 85.3% (95% CI 81.0–89.1), 56.8% (95% CI 41.2–71.8) and 93.3% (95% CI 87.5–97.3) and 89.3% (95% CI 81.5–95.1) and 75.9% (95% CI 70.1–81.3) for the PHQ-9-linear, PHQ-9-algorithm and PHQ-2 respectively. For case finding (ruling in a diagnosis), none of the methods were suitable but for screening (ruling out non-cases), all methods were encouraging with good clinical utility, although the cut-off threshold must be carefully chosen.ConclusionsThe PHQ can be used as an initial first step assessment in primary care and the PHQ-2 is adequate for this purpose with good acceptability. However, neither the PHQ-2 nor the PHQ-9 can be used to confirm a clinical diagnosis (case finding).Declaration of interestNone.Copyright and usage© The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

Rates of mammography screening are lower in women with mental illness, particularly women with SMI, and this is not explained by the presence of emotional distress. Disparities in medical care due to mental illness clearly extend into preventive population screening.

The pericardium is an uncommon site for manifestation of pheochromocytoma. Herein, the case of a 57-year-old man with cardiac tamponade is presented. Pericardiocentesis was performed, and the vital signs were stabilized afterwards. An abdominal computed tomography (CT) scan illustrated a nonhomogeneous right adrenal mass suspicious of pheochromocytoma, planned for right adrenalectomy. He recovered well after surgery, and his subsequent follow-ups did not reveal any complications.