bluuebunny/crossref_metadata_2025 huggingface dataset:
Emerging homosexual conduct during hospitalization among chronic schizophrenia patients
Authors: Bai Ya‐Mei , Huang Ying , Lin Chao‐Cheng , Chen Jen‐Yeu
Published: March 2003

Objective: The study investigated the emerging homosexual conduct during hospitalization among chronic schizophrenia patients.

Method: We interviewed 55 male and 58 female chronic schizophrenic patients to investigate their sexual history before and after admission. Those patients were under 45 years old, without significant deteriorated cognitive function, lived in a homogeneous gender chronic ward and did not demonstrate homosexual behaviour before admission.

Results: Nineteen patients (16.8%) reported having homosexual conducts during hospitalization. Their characteristics were: 1) having sexual experience before admission; 2) with younger age at first sexual experience; and 3) female patients having more sexual partners before admission.

Conclusion: A significant proportion of patients need a sexual outlet during long‐term hospitalization. Sexual education and counselling are greatly needed.
The relationship between depressive and vital exhaustion symptomatology post‐myocardial infarction
Authors: Wojciechowski F.L. , Strik J.J.M.H. , Falger P. , Lousberg R. , Honig A.
Published: March 2003

Objective: Many peri‐myocardial infarction patients experience decreased wellbeing, which is either conceptualized as depression or as vital exhaustion. The objective of the present study is to investigate whether or not depression and vital exhaustion are separate entities. It was hypothesized that, if depression and vital exhaustion are separate phenomena, the correlation between two depression questionnaires would be higher than those between either of the two depression questionnaires and a vital exhaustion questionnaire.

Method: Subjects were 143 patients who had recently experienced a first acute myocardial infarction (MI). At 1, 3, 6 and 12 months post‐MI, patients completed two self‐report depression questionnaires (the Zung‐SDS and the Depression scale of the SCL‐90), and a vital exhaustion questionnaire (the Maastricht Questionnaire). Correlation coefficients were calculated for the two depression questionnaires and the vital exhaustion questionnaire. Furthermore, an exploratory principal component analysis was performed on the combined items of the three questionnaires.

Results: Strong and virtually identical correlations were found between the three measures at all four time‐points. A one‐factor model was the best fit in the exploratory principal component analysis.

Conclusion: The present results do not support the hypothesized separate conceptual identity of depression and vital exhaustion.
Augmentation with sulpiride for a schizophrenic patient partially responsiveto clozapine
Authors: Stubbs Jean H. , Haw Camilla M. , Staley Christopher J. , Mountjoy Christopher Q.
Published: March 2003

Objective: Schizophrenic patients who are only partially responsive to clozapine pose a therapeutic challenge. In these circumstances some clinicians would consider adding in a second antipsychotic. We present a case report and review evidence for the efficacy of such augmentation strategies.

Method: Single case report and literature review.

Results: The total number of patients in studies and case reports of combining clozapine with other antipsychotics is small. There has been only one randomized controlled trial. This found the addition of sulpiride to clozapine resulted in clinical improvement in some patients.

Conclusion: Further randomized controlled studies of augmentation of clozapine therapy are needed to provide scientific justification for this clinical practice.
On the role of cortical glutamate inobsessive‐compulsive disorder and attention‐deficit hyperactivity disorder, two phenomenologically antithetical conditions
Authors: Carlsson Maria L.
Published: March 2003

Objective: The objective of the present study was to compare the phenomenology and pathophysiology of obsessive‐compulsive disorder (OCD) and attention‐deficit hyperactivity disorder/deficits in attention, motor control and perception (ADHD/DAMP).

Method: Through detailed studies of the literature on OCD and ADHD/DAMP the phenomenology of these two conditions is compared, and possible underlying pathophysiological mechanisms involving interactions between glutamate, dopamine, serotonin and acetylcholine are discussed, with emphasis on OCD. The present paper also discusses possible mechanisms of action for current pharmacological treatments of OCD and ADHD, as well as possible future treatment strategies for these disorders.

Results: OCD and ADHD/DAMP are common neuropsychiatric conditions which in many regards appear to be each other's antipodes with respect to clinical manifestations, associated personality traits and brain biochemistry, notably prefrontal cortical glutamate activity. Future pharmacological treatments of these disorders may involve manipulations with glutamate, dopamine D1, serotonin 2A and nicotine receptors.

Conclusion: It appears that OCD is a hyperglutamatergic and ADHD a hypoglutamatergic condition, with prefrontal brain regions being especially affected.
Psychoactive substance use diagnoses among psychiatric in‐patients
Authors: Hansen S.S. , Munk‐Jørgensen P. , Guldbæk B. , Solgård T. , Lauszus K.S. , Albrechtsen N. , Borg L. , Egander A. , Faurholdt K. , Gilberg A. , Gosden N.P. , Lorenzen J. , Richelsen B. , Weischer K. , Bertelsen A.
Published: March 2003

Objective: To estimate the prevalence and possible under‐diagnosing of substance use disorders and to consider factors that might influence diagnosing of substance use disorders.

Method: Data collected from case records and PSE interviews of psychiatric in‐patients from 12 psychiatric departments in Denmark admitted during October 1996 were compared with data from the Danish Psychiatric Register.

Results: A substantially lower prevalence of substance use diagnoses were found in the register (26.1%) than in the research data (50.0%). A high prevalence of co‐occurrence between substance use disorders and mental disorders other than substance use disorders was found (37.3%).

In the majority of cases knowledge of the substance use disorders was present in the case records, although they had not resulted in a diagnosis.

Conclusion: The under‐diagnosis of substance use disorders is due not only to concealed diagnostic signs and symptoms but also to an under‐diagnosis by the psychiatrists, in spite of the fact that information on the substance use was accessible.
Sex ratio of transsexuals in Germany: the development over three decades
Authors: Garrels L. , Kockott G. , Michael N. , Preuss W. , Renter K. , Schmidt G. , Sigusch V. , Windgassen K.
Published: March 2003

Objective: The higher incidence of man‐to‐woman transsexuals compared to woman‐to‐man transsexuals varies markedly from country to country. This is the first survey of the sex ratio to be made in Germany.

Method: It covers 1785 patients who between 1964 and 1998 were diagnosed as transsexual at the four largest German centres offering treatment.

Results: From 1970 to 1994 the sex ratio remained constant at 2:1 in favour of man‐to‐woman transsexuals. Over the past 4 years, however, it has altered considerably and reached 1.2:1.

Conclusion: Up to 1994 our results do not support the assumption that transsexualism is gradually becoming equally prevalent in both sexes. The drop in the sex ratio after 1994 can be explained either as a reduction of an overhang of male‐to‐female transsexuals or as an artificial phenomenon caused by recent developments in therapy and by the views of transsexuals' groups on the treatment they are offered.
Predicting medication adherence in severe mental disorders
Authors: Adams J. , Scott J.
Published: March 2003

Objective: This study explored the utility of the health belief model (HBM) in explaining medication adherence in subjects with severe and disabling mental disorders.

Method: Six well‐established measuring instruments, with confirmed reliability and validity, were used to assess each component of the HBM and medication adherence in 39 hospital‐treated subjects with affective disorders (n=27) or schizophrenia (n=12).

Results: Highly adherent and partially adherent subjects differed significantly in their perception of illness severity, their beliefs about themselves and their control over the disorder, and their concerns about further hospitalization. Two components of the HBM (perceived severity of illness and perceived benefits of treatment) explained 43% of the variance in adherence behaviour.

Conclusion: Although the study has a number of methodological limitations, the results suggest that clinical assessment of components of the HBM may improve the detection of patients at risk of medication non‐adherence.
Neuromorphological abnormalities in schizophrenic patients with good andpoor outcome
Authors: Rossi A. , Bustini M. , Prosperini P. , Marinangeli M. G. , Splendiani A. , Daneluzzo E. , Stratta P.
Published: March 2003

Objective: The present study was designed specifically to assess the relationship between brain morphology and outcome in schizophrenia. Methods: Fifty‐six schizophrenic patients and a matched group of 32 healthy subjects were studied with magnetic resonance (MR) imaging scans. Clinical assessment included the Krawiecka–Manchester Scale (K‐MS) and the Outcome scale by Strauss and Carpenter. Results: Along several neuromorphological measures the patients differed from controls only for right and left ventricular volumes. The ‘poor outcome’ patients had a left and right ventricular enlargement when compared to the ‘good outcome’ patients and healthy controls. A regression analysis showed that right ventricle volume, left temporal lobe volume and left hippocampal volume entered into the regression equation, accounting for a 27% of the outcome measure. Conclusion: The outcome does not seem to be predicted by one particular morphological site but involves different brain regions; however, the ventricular enlargement identifies a subgroup of patients with poor outcome.
Mental health economic studies from developing countries reviewed in the context of those from developed countries
Authors: Shah A. , Jenkins R.
Published: March 2003

Objective: Mental health economic studies from developing countries were reviewed in the context of such studies from developed countries.

Method: Mental health economic studies were ascertained through a systematic Medline search, chasing references at the end of papers acquired from the initial medline search and details of studies furnished by members of the WHO collaborating centre.

Results: Only a small number of mental health economic studies from developing countries were identified. They were mainly cost‐of‐illness and cost‐effectiveness studies.

Conclusion: Psychiatric disorders impose a significant burden in developing countries. It is not always possible to extrapolate findings from developed countries to developing countries. Potential avenues for future research and development are discussed.
Major demographic, social and economic factors associated to suicide rates in Latvia 1980–98
Authors: Rancans E. , Salander Renberg E. , Jacobsson L.
Published: March 2003

Objective: The aim of this study is to analyse the dynamics of suicide rates in Latvia 1980–98, when dramatic social and economical changes took place. Special attention is given to demographic risk groups and major socioeconomic correlates influencing the dynamics of suicide rates.

Method: Descriptive statistics of suicide rates and major social and economical correlates.

Results: During 1980–98 there were rapid swings of suicide rates. The increase was generated mainly by males reaching a maximum of 72 per 100 000 population in 1993. The sudden drop in gross domestic product, the rapid increase in first‐time alcohol psychosis and the percentage of people unemployed did not correspond strictly with the dynamics of suicide rates.

Conclusion: Demographic and socioeconomic factors could not explain sufficiently the rapid changes in suicide rates in Latvia during the years 1980–98; psychological factors also have to be considered.
Neuropsychological functioning in chronic fatigue syndrome: a review
Authors: Michiels Veronique , Cluydts Raymond
Published: March 2003

Objective: In this paper we review critically the current status of neurocognitive studies in patients with chronic fatigue syndrome (CFS).

Method: CFS literature was monitored as part of a large research project which involved several neuropsychological and psychopathological studies. The literature survey was the result of several consecutive searches on Medline and PsycInfo databases.

Results: The neurocognitive studies are reviewed in terms of scientificaly accepted aspects of attention and memory. In addition, we review possible explanations for cognitive dysfunction in CFS. This is preceded with a discussion of the methodological limitations that are considered to explain inconcistencies across neuropsychological studies in CFS.

Conclusion: The current research shows that slowed processing speed, impaired working memory and poor learning of information are the most prominent features of cognitive dysfunctioning in patients with CFS. Furthermore, to this date no specific pattern of cerebral abnormalities has been found that uniquely characterizes CFS patients. There is no overwhelming evidence that fatigue is related to cognitive performance in CFS, and researchers agree that their performance on neuropsychological tasks is unlikely to be accounted solely by the severity of the depression and anxiety.
A statistical model for length of psychiatric in‐patient treatment and an analysis of contributing factors
Authors: Stevens Andreas , Hammer Katrin , Buchkremer Gerhard
Published: March 2003

Objective: Direct illness costs in psychiatry are strongly related to the length of in‐patient stay (LOS). Prior studies have shown that LOS depends upon many factors; however, there is no systematic work on their interrelation and relative contribution.

Method: A detailed statistical analysis of the factors explaining LOS for n=4706 consecutive admissions (1994–97) to the psychiatric hospital of the University of Tübingen is presented.

Results: The distribution of LOS follows an exponential decay function, suggesting a hazard‐based process. Cox regression indicates that the incidence of discharge and hence LOS is modulated by a number of illness‐related and other factors, and their relationship is explored.

Conclusion: While a linear model is commonly assumed, LOS in psychiatry is governed by a hazard‐based process. As a tool in quality management, LOS data for psychiatric hospitals might be routinely analyzed and the effects of non‐illness‐related factors minimized.
A review of psychosocial outcome in patients with bipolar disorder
Authors: MacQueen Glenda M. , Young L. Trevor , Joffe Russell T.
Published: March 2003

Objective: The aim of this paper is to review outcome in patients with bipolar disorder as assessed by interepisode level of functioning, as until recently this dimension of outcome has been relatively under‐emphasized.

Method: Studies that examined psychosocial outcome in bipolar disorder were reviewed on the basis of rating measurements employed, length of follow‐up, number of subjects followed and degree of impairment reported. Studies were included only if results from patients with bipolar and unipolar disorder were reported in such a way that the groups could be distinguished.

Results: When studies of psychosocial outcome in bipolar disorder are examined in aggregate, it appears that 30–60% of individuals with this disorder fail to regain full functioning in occupational and social domains.

Conclusion: This review highlights the fact that inter‐episode functional recovery is incomplete in some patients, suggesting that comprehensive rehabilitative assessment and intervention may be essential to reduce the morbidity associated with this disorder.
The quest for biological correlates of social phobia: an interim assessment
Authors: Dewar K. M. , Stravynski A.
Published: March 2003

Objective:The primary goal of this review was to assess critically the literature concerning the ongoing search for possible biological correlates of social phobia.

Methods:In addition to manual searches, Medline, Current Contents and Psych Info databases were searched for relevant publications.

Results:On the evidence of an extensive body of research, so far biological correlates of social phobia remain elusive. Furthermore, the majority of studies reveal by default that the neurobiological functioning of social phobics is very much like that of normal control subjects.

Conclusion:The conceptual and methodological foundations underpinning the current research programme are discussed critically. Its main weaknesses were found to be: lack of theory to guide research and aid the interpretation of results, static comparisons between subject groups and analysis oblivious to great individual variations. Possibilities of alternative approaches to study the neurobiology of social phobia are raised. Among others, continuous and situation‐specific measurement, subjects used as their own controls and neurobiological correlates of clinical improvement following psychotherapy are considered.
Neuropsychological performance of psychotic patients in community care: results from the UK700 study
Authors: Gilvarry C. M. , Barber J. A. , Van Os J. , Murray R. M. ,   UK700 Group*
Published: March 2003

Objective: To compare cognitive performance in chronic schizophrenic and affective psychotic patients maintained in community care.

Method: We studied a sample of community‐based patients (n=707) with chronic psychotic disorders. Neuropsychological assessment was completed using the National Adult Reading Test (NART) and the Trail Making Test (TMT).

Results: Affective psychotic patients had higher premorbid IQ than schizophrenic patients before adjustment for confounding factors (P=0.03); however, after adjustment for ethnic group and social class this became non‐significant (P=0.19). There were no significant differences between groups on the TMT, parts A or B.

Conclusion: Unlike studies suggesting that schizophrenic patients are more cognitively impaired than affective psychotic patients, our study suggests a degree of cognitive homogeneity between those patients who develop a chronic illness. Measures of premorbid IQ suggest that this cognitive homogeneity exists prior to the onset of illness.
A randomized, controlled trial of a brief interventional package for schizophrenic out‐patients
Authors: Cunningham Owens D. G. , Carroll A. , Fattah S. , Clyde Z. , Coffey I. , Johnstone E. C.
Published: March 2003

Objective: To evaluate the impact on outcome of a simple educational intervention in schizophrenic patients at risk of relapse.

Method: At discharge, 114 schizophrenic patients with at least one previous episode were assigned randomly to a simple educational intervention which had no resource implications, or standard care.

Results: The intervention failed to improve outcome. While insight and treatment attitudes improved, suicidal ideation increased. Systematic management of treatment‐emergent adverse effects offered no benefits, although incapacitation from extrapyramidal side‐effects at discharge predicted relapse.

Conclusion: There are limits to which psychoeducational interventions can be simplified without loss of effectiveness in terms of relapse prevention in schizophrenia. Enhanced insight may be associated with increased suicidal ideation.
Symptomatic recovery and social functioning in major depression
Authors: Furukawa T. A. , Takeuchi H. , Hiroe T. , Mashiko H. , Kamei K. , Kitamura T. , Takahashi K.
Published: March 2003

Objective: To determine whether social functional recovery precedes, runs in parallel with, or lags behind symptomatic recovery from major depressive episodes.

Method: Psychiatric out‐patients or in‐patients aged 18 years or over, diagnosed with unipolar major depressive disorder according to DSM‐IV, and who had received no antidepressant medication in the preceding 3 months were identified at 23 collaborating centres from all over Japan (n=95). They were rated with the 17‐item Hamilton Rating Scale for Depression (HRSD) and the Global Assessment Scale (GAS) monthly, and with the Social Adjustment Scale‐Self Report (SAS‐SR) 6‐monthly. Remission was defined as 7 or less on the HRSD and recovery as 2 or more consecutive months of remission.

Results: The GAS ratings showed continuous amelioration from baseline to remission, remission to recovery, and after sustained recovery. The same trends were observed for SAS‐SR scores.

Conclusion: We can expect further amelioration in social adjustment after symptomatic remission and recovery of major depressive episodes.
Effectiveness of psychological debriefing
Authors: Arendt M. , Elklit A.
Published: March 2003

Objective: To identify literature concerning the effectiveness of psychological debriefing (PD) and analyse results according to different criteria of success and different uses of the intervention format.

Method: Literature search was made in databases PubMed, PsycInfo and Psychlit. Twenty‐five studies were selected for a thorough description. Forty‐two studies provided additional information.

Results: Results indicate that, in general, debriefing does not prevent psychiatric disorders or mitigate the effects of traumatic stress, even though people generally find the intervention helpful in the process of recovering from traumatic stress. The intervention holds potential as a screening procedure, and there may be economic arguments for continued use. When used with adherence to traditional descriptions of treatment group, events, group format, leadership and time spent, a preventive effect emerges. No tendency according to timing was found.

Conclusion: Current uses of PD are problematic. The concept needs to be redefined, and the scope of application must be revised. The objectives for use need to be clarified.
Visual binding abilities in the initial and advanced stages of schizophrenia
Authors: Parnas J. , Vianin P. , Sæbye D. , Jansson L. , Volmer Larsen A. , Bovet P.
Published: March 2003

Objective: The study tests the hypothesis that intramodal visual binding is disturbed in schizophrenia and should be detectable in all illness stages as a stable trait marker.

Method: Three groups of patients (rehospitalized chronic schizophrenic, first admitted schizophrenic and schizotypal patients believed to be suffering from a pre‐schizophrenic prodrome) and a group of normal control subjects were tested on three tasks targeting visual ‘binding’ abilities (Müller‐Lyer's illusion and two figure detection tasks) in addition to control parameters such as reaction time, visual selective attention, Raven's test and two conventional cortical tasks of spatial working memory (SWM) and a global–local test.

Results: Chronic patients had a decreased performance on the binding tests. Unexpectedly, the prodromal group exhibited an enhanced Gestalt extraction on these tests compared both to schizophrenic patients and to healthy subjects. Furthermore, chronic schizophrenia was associated with a poor performance on cortical tests of SWM, global–local and on Raven. This association appears to be mediated by or linked to the chronicity of the illness.

Conclusion: The study confirms a variety of neurocognitive deficits in schizophrenia which, however, in this sample seem to be linked to chronicity of illness. However, certain aspects of visual processing concerned with Gestalt extraction deserve attention as potential vulnerability‐ or prodrome‐ indicators. The initial hypothesis of the study is rejected.
Operating conditions of psychiatric hospitals and early readmission — effects of high patient turnover
Authors: Heggestad Torhild
Published: March 2003

Objective: To study the association between hospitals' operating conditions and the risk of early readmission. The hypothesis was that high patient turnover might lead to a rise in the risk of readmission soon after discharge (within 30 days).

Method: A multivariate model including hospital and patient variables was tested using Cox's regression analysis, adjusting for clustering effects. The material included data from 20 hospitals, with 5520 patients in the final model.

Results: High patient turnover (annual discharges per bed) was significantly associated with an increased risk of readmission (hazard ratio (HR)=3.37 (95% CI=2.39–4.75)). In addition, being discharged from a ward with relatively low access to therapists increased the hazard further.

Conclusion: High patient turnover at the discharging ward was found to increase the patients' hazard of early readmission. This observation supports the hypothesis of a link between the operation conditions of the hospitals and patient outcome on a short time‐scale.
Musical hallucinations associated with abruptly developed bilateral loss of hearing
Authors: Tanrıverdi Nilgün , Akif Sayılgan Mehmet , Özçürümez Gamze
Published: March 2003

Objective: To present a depressive patient who developed abrupt hearing loss with musical hallucinations.

Method: This study is a case report. The patient was evaluated by cranial CT, EEG, audiometry, brain SPECT, MMPI and the Hamilton Depression Scale.

Results: A patient with depression developed abrupt hearing loss with musical hallucinations following an intramuscular injection of gentamycin. Audiometry showed mild sensorineural hearing loss in both ears. The Hamilton Depression Scale disclosed moderate depression. Her symptoms disappeared with the initiation of antidepressive medication.

Conclusion: Musical hallucinations are the hearing of tunes, melodies, harmonics, rhythms and timbres. They have been reported to be in association with hearing loss in several published cases. The uniqueness of our patient was that she was younger than previously reported cases of musical hallucinations, who were elderly people, and her symptoms of depression disappeared gradually after the initiation of moclobemide.
Screening for autism spectrum disorders in adult psychiatric out‐patients: a preliminary report
Authors: Nylander Lena , Gillberg Christopher
Published: March 2003

Objective: To estimate the prevalence of autism spectrum disorders (ASD) among adult psychiatric out‐patients; to evaluate the efficacy of a new brief screening questionnaire (ASDASQ).

Method: 1323 adult psychiatric out‐patients were screened by staff. Analysis of psychiatric records of patients (n=66) scoring high on the ASDASQ yielded 31 patients with a suspected ASD. Twenty‐two of these patients were clinically examined. Three psychometric aspects of the questionnaire were studied.

Results: Seventeen patients were found by clinical examination to have an ASD. Since two patients scoring low on the ASDASQ were known to have an ASD, at least 19 patients in this population (1.4%) had a definite ASD. Seventeen of the ASD patients had been previously diagnosed with other psychiatric disorders, most frequently schizophrenia (n=5). Of patients attending a treatment centre for severe psychiatric disabilities (n=499), 3.2% had an ASD. The ASDASQ showed good reliability across and within raters. Internal consistency was excellent.

Conclusion: Adult psychiatric patients sometimes have undiagnosed autism spectrum disorders. The ASDASQ can be useful for screening.
Psychometric properties of the Temperament and Character Inventory (TCI) questionnaire in a Spanish psychiatric population
Authors: Gutiérrez F. , Torrens N. , Boget T. , Martín‐Santos R. , Sangorrín J. , Pérez G. , Salamero M.
Published: March 2003

Objective: The psychometric properties of the Spanish version of Cloninger's Temperament and Character Inventory (TCI) were examined in a psychiatric population.

Method: Internal consistency, factor structure and concurrent validity were studied in a sample of 416 psychiatric patients.

Results: A moderate to high internal consistency for all personality dimensions was found, except for Persistence. A confirmatory factor analysis of the TCI performed at the subscale level revealed an uncertain factor structure. However, when analysed separately, both the 11 temperament subscales (plus Persistence) and the 13 character subscales shaped four and three factors, respectively, in agreement with the biosocial model of personality. Finally, concurrent validity analyses were conducted using EPQ, SPSR and SSS questionnaires showing results consistent with theory.

Conclusion: The Spanish version of the TCI is a reliable and valid instrument, although the Persistence dimension might require further revision.
HIT, hallucination focused integrative treatment as early intervention in psychotic adolescents with auditory hallucinations:a pilot study
Authors: Jenner J. A. , Van De Willige G.
Published: March 2003

Objective: Early intervention in psychosis is considered important in relapse prevention. Limited results of monotherapies prompt to development of multimodular programmes. The present study tests feasibility and effectiveness of HIT, an integrative early intervention treatment for auditory hallucinations, in community psychiatry.

Method: Adolescents with auditory hallucinations consecutively referred to Groningen Voices Outpatient Department. Independent research staff collected diagnosis, sociodemographics, psychiatric history, former treatment and current treatment status from medical files. The auditory Hallucinations Rating Scale, Groningen Social Disabilities Scale and five‐point rating scales on characteristics and subjective burden of voices, and satisfaction with therapy were scored with semi‐structured interview.

Results: Good compliance and high satisfaction with HIT treatment in most cases; 65% free of voices; majority demonstrates substantial improvement on mastery, anxiety, interference with thinking and social functioning; none worsened.

Conclusion: Integrative treatment as composed in the HIT‐programme is feasible in community psychiatry and appears to be an effective early intervention in adolescents with schizophrenia both in reducing psychotic symptoms as improving quality of life.
Relatives' distress and patients' symptoms and behaviours: a prospective study of patients with schizophrenia and their relatives
Authors: Boye B. , Bentsen H. , Ulstein I. , Notland T. H. , Lersbryggen A. , Lingjærde O. , Malt U. F.
Published: March 2003

Objective: The aim of this study is to explore the relationship between relatives' distress and patients' symptoms and behaviours.

Method: Fifty relatives in close contact with 36 patients with schizophrenia DSM‐III‐R filled in the General Health Questionnaire (GHQ) and the Perceived Family Burden Scale (PFBS) at the patient's hospital admission, 4.5 and 9 months post‐discharge. The patients were assessed by means of the Positive and Negative Syndrome Scale (PANSS).

Results: The PFBS anxiety‐depression cluster was at all three assessments positively correlated with relative's distress (GHQ), not with PANSS anxiety and depression measurements. In multiple regression analysis PFBS, but not PANSS, was related to relatives' distress.

Conclusion: Relatives' distress was related to their reports of problematic patient behaviours, especially anxiety‐depressive behaviour, not to symptoms as measured by clinical interviews. High distress is related to high expressed emotion, suggesting that relatives' report of patient's behaviour should be addressed to improve patient's outcome.
Gender‐related differences in the onset of panic disorder
Authors: Barzega Giulio , Maina Giuseppe , Venturello Sara , Bogetto Filippo
Published: March 2003

Objective: To investigate gender‐related differences in premorbid conditions and in the role of triggering events in the onset of panic disorder (PD).

Method: One hundred and eighty‐four out‐patients with a principal diagnosis of PD (DSM‐IV) were evaluated with a semi‐structured interview to generate Axis I and Axis II diagnoses according to DSM‐IV, to collect family history of psychiatric disorders and life events. The statistical analysis was performed comparing men and women.

Results: Men and women showed similar age at onset of PD. A family history of mood disorders characterized females. Men had higher rates of cyclothymia, body dysmorphic disorder and depersonalization disorder preceding PD, while women had higher rates of bulimia nervosa. Dependent and histrionic PDs were more common among women, while borderline and schizoid PDs were more common among men. Life events showed a significant role in precipitating PD onset in women.

Conclusion: Premorbid clinical conditions of PD seem to differentiate between males and females in the role of precipitating events.
Predictors and outcome characteristics associated with suicidal behaviour in early psychosis: a two‐year follow‐up of first‐admitted subjects
Authors: Verdoux H. , Liraud F. , Gonzales B. , Assens F. , Abalan F. , Van Os J.
Published: March 2003

Objective: To assess the baseline characteristics associated with a greater risk of suicidal behaviour (suicide and parasuicide) over the 2 years following a first admission for psychosis, and the associations between suicidality and outcome.

Method: First‐admitted subjects with psychosis (n=65) were assessed at 6‐monthly intervals over a 2‐year follow‐up period.

Results: Over this period, 11.3% of the patients displayed suicidal behaviour. Baseline predictors of suicidal behaviour were a lifetime history of parasuicide before first admission (OR=5.9, 95% CI 1.5–23.4), lower Positive And Negative Symptom Scale positive subscores (OR=0.8, 95% CI 0.6–0.97) and a longer duration of first admission (OR=1.1, 95% CI 1–1.2). Subjects with suicidal behaviour presented with a longer duration of psychotic symptoms (OR=1.1, 95% CI 1.02–1.2) and a greater risk of being readmitted (OR=4.6, 95%CI 1.1–19.1). Subjects with substance misuse over the follow‐up period were seven times (95%CI 1.3–39) more likely to engage in suicidal behaviour. Conclusion: Subjects with a previous history of parasuicide, with a deteriorating clinical course, or with substance misuse are at increased risk of suicidal behaviour in the 2 years after the onset of a first psychotic episode.
A comparison of needs of patients with schizophrenia in five European countries: the EPSILON Study
Authors: McCrone Paul , Leese Morven , Thornicroft Graham , Schene Aart , Knudsen Helle Charlotte , Vázquez‐Barquero José Luis , Tansella Michele , Becker Thomas ,   EPSILON Study Group
Published: March 2003

Objective: To compare the occurrence of needs of patients with schizophrenia in Amsterdam, Copenhagen, London, Santander and Verona.

Method: Patients with schizophrenia were interviewed with the Camberwell Assessment of Need. The mean numbers of total, met and unmet needs were compared across the sites. Ratings for individual domains were also examined. Means were adjusted, using multiple regression analysis, to control for patient differences between sites.

Results: The highest levels of unmet need were in Amsterdam and London. The number of met needs were similar. Adjusting for patient differences reduced the estimated number of unmet needs and total needs in Copenhagen, but made little difference elsewhere. There were many site differences for individual domains.

Conclusion: Needs vary between different countries. Unmet needs are greater in large urban areas like London and Amsterdam. Differences in the pattern of individual needs may be partly explained in terms of service provision.
Late mortality in severe depression
Authors: Brådvik Louise , Berglund Mats
Published: March 2003

Objective: To assess late mortality among psychiatric in‐patients with severe depression/melancholia.

Method: 1206 in‐patients rated at discharge on a multidimensional diagnostic schedule had received the diagnosis severe depression/melancholia between 1956 and 1969. A first follow‐up was made in 1984. The present follow‐up constitutes 675 survivors 15–42 years after the first admission. They were followed‐up by means of the general population register and local parish registers to January 1st 1998.

Results: At this second follow‐up another 279 patients were deceased, standardized mortality ratio 1.3, indicating a continuous increased mortality late in the course of depression. Eleven suicides (4%) were included, eight men and three women, which was less than the 22% found in the first investigation. Male patients showed a higher suicide rate than female patients late in the course.

Conclusion: The general mortality and suicide rate remain increased late in the course.
Suicidal behaviour and family factors among Dutch and Slovenian high school students: a comparison
Authors: Tomori M. , Kienhorst C. W. M. , De Wilde E. J. , Van Den Bout J.
Published: March 2003

Objective: East European countries have much higher suicide rates than West European countries. Whether this also applies for suicidal ideation and suicide attempts is not known. In addition, the role of family factors in relation to suicidal behaviour has not been investigated in East European countries.

Method: Two representative samples of 19250 Dutch and 4706 Slovenian high school students were compared on the basis of self‐report data.

Results: Slovenian students report more suicidal behaviour (ideation and attempts) as well as more unfavourable family circumstances than Dutch students. This applies especially to the death of parent(s), the number of changes in their living situation, and to conflicts between or with parents.

Conclusion: A relation between family characteristics and suicidal behaviour is established in both samples, but proved to be strongest in Slovenian girls. Complicated cultural and socioeconomic differences between the two countries may account for the reported differences.
Citalopram versus nortriptyline in late‐life depression: a 12‐week randomized single‐blind study
Authors: Navarro V. , Gastó C. , Torres X. , Marcos T. , Pintor L.
Published: March 2003

Objective: The aim of this single‐blind study was to examine the efficacy and tolerability of citalopram compared to nortriptyline in moderate to severe major depressive patients aged 60 years or over.

Method: In‐ and out‐patients (N=58) with unipolar major depression were randomized to 12‐week flexible dose treatment with nortriptyline or citalopram.

Results: No significant differences between the number of drop‐outs in either group were observed, but the autonomic side‐effects were significantly higher for nortriptyline than for citalopram. A significantly higher remission rate to nortriptyline than to citalopram was demonstrated, particularly if severe patients (endogenous or psychotic patients) were assessed.

Conclusion: The remission rate to a therapeutic plasma level of nortriptyline appears to be higher than the remission rate to a standard dose of citalopram in a group of elderly major depressed patients, especially those with endogenous or psychotic features. On the other hand, citalopram appears to be better tolerated.
Post‐traumatic stress disorder: a review of psychobiology and pharmacotherapy
Authors: Hageman I. , Andersen H. S. , Jørgensen M. B.
Published: March 2003

Objective: To review the literature on the psychobiology and pharmacotherapy of PTSD.

Method: Relevant studies were identified by literature searches (Pub‐med, web of science) and through reference lists. The search was ended by May 2001.

Results: There is evidence of involvement of opioid, glutamatergic, GABAergic, noradrenergic, serotonergic and neuroendocrine pathways in the pathophysiology of PTSD. Medications shown to be effective in double‐blind placebo‐controlled trials includes selective serotonin reuptake inhibitors, reversible and irreversible MAO‐inhibitors, tricyclic antidepressants and the anticonvulsant lamotrigine. Still more agents appear promising in open‐label trials.

Conclusion: The complexity of the psychobiology is reflected by the difficulties in treating the disorder. According to the present knowledge, suggestions for drug treatment of PTSD are made.
Dimensionality, responsiveness and standardization of the Bech–Rafaelsen Mania Scale in the ultra‐short therapy with antipsychotics in patients with severe manic episodes
Authors: Bech P. , Baastrup P. C. , De Bleeker E. , Ropert R.
Published: March 2003

Objective:  Typical antipsychotics have their indication in the ultra‐short (first week) treatment of severe episodes of mania. In this setting the Bech–Rafaelsen Mania Scale (MAS) was psychometrically compared with the Clinical Global Impression scale (CGI) to assess its ability to measure response.

Method:
 Ratings on patients with marked to severe mania (n=80) who participated in the clinical trials to evaluate the ultra‐short antimanic effect of zuclopenthixol acetate were assessed. The MAS was analysed for internal validity (total score a sufficient statistic) and for external validity.

Results:  The MAS was shown to have a high internal validity showing onset of action already after days of treatment. After 6 days of treatment 53% of the patients responded according to the MAS but only 30% according to the CGI. The difference was statistically significant.

Conclusion:  The MAS has been found to be a valid scale to measure early onset of action and response in the ultra‐short antimanic treatment with typical antipsychotics.
Dysfunction of transcallosally mediated motor inhibition and callosal morphology in patients with schizophrenia
Authors: Höppner Jacqueline , Kunesch Erwin , Großmann Annette , Tolzin Christoph‐Jonas , Schulz Merten , Schläfke Detlef , Ernst Klaus
Published: March 2003

Objective: In order to assess the functional integrity of motor pathways through the corpus callosum (CC) in patients with schizophrenia transcallosally mediated inhibition (TI) of voluntary tonic EMG activity of first dorsal interosseus muscle following ipsilateral focal transcranial magnetic stimulation (fTMS) was investigated. In addition thickness and length of CC were calculated.

Method: Twelve patients suffering from schizophrenia and 12 healthy controls were investigated. CC morphology was measured in mid‐sagittal MRI‐slices. Latency and duration of TI were calculated.

Results: In schizophrenics the duration of TI was significantly prolonged, whereas latencies were not. In addition, a lack of TI was found unilaterally in three patients. Measurements of CC revealed a significantly reduction of the length and thickness in the anterior part of CC in patients.

Conclusion: These findings indicate that measurement of TI could be used to detect clinical silent affection of transcallosal motor pathways in schizophrenics. The effect of neuroleptic drugs has to be explored.
Subject and observer‐rated quality of life in schizophrenia
Authors: Fitzgerald P. B. , Williams C. L. , Corteling N. , Filia S. L. , Brewer K. , Adams A. , De Castella A. R. A. , Rolfe T. , Davey P. , Kulkarni J.
Published: March 2003

Objective: We aimed to explore the relationship between objectively rated quality of life and subjective measures of social functioning and life satisfaction.

Method: Participants of the Schizophrenia Care and Assessment Program (SCAP) study at Dandenong in Australia were included in this analysis. Subjective ratings of several domains of social functioning and life satisfaction were taken from the SCAP instrument and comparisons made with data from the Quality of Life scale rated by research staff as well as several psychopathology measures.

Results: Subjectively reported life satisfaction was not related to positive or negative symptoms of schizophrenia but did correlate with depressive symptoms. Quality of Life scale measures correlated with negative symptoms on most domains. There was very limited overlap in domain items between the life satisfaction and quality of life measures.

Conclusion: Life satisfaction and objectively rated quality of life are not closely related and appear to have different determinants in patients with schizophrenia.
A comparison of community‐dwelling older schizophrenia patients by residential status
Authors: Auslander Lisa A. , Lindamer Laurie L. , Delapena Jody , Harless Kelly , Polichar Dina , Patterson Thomas L. , Zisook Sidney , Jeste Dilip V.
Published: March 2003

Objective: Differences in residential status may contribute to the diversity of findings observed in community‐based samples of patients with schizophrenia. We compared older out‐patients living independently with those in assisted‐care facilities.

Method: Two hundred and fifty‐one out‐patients with schizophrenia or schizoaffective disorder, aged 40–97 years, who had been referred to our Intervention Research Center were examined.

Results: Assisted living status was associated with an earlier age at onset of illness, longer illness duration, lower probability of having ever been married, more severe negative symptoms, worse cognitive impairment, and a poorer health‐related quality of wellbeing. Independent living and assisted‐care patients had similar levels of positive and depressive symptoms, and were on comparable doses of neuroleptic medication. Significant ‘predictors’ of residential status were marital status, cognitive impairment and quality of wellbeing.

Conclusion: Among schizophrenia out‐patients, one needs to consider residential status in evaluating heterogeneity in cognitive performance or quality of wellbeing.
Suicides are seldom prescribed antidepressants: findings from a prospective prescription database in Jämtland county, Sweden, 1985–95
Authors: Henriksson Svante , Boëthius Göran , Isacsson Göran
Published: March 2003

Objective: This study presents data relating to prospectively monitored treatment and post‐mortem toxicology of individuals who committed suicide.

Method: A case–control study of prospectively monitored pharmacological treatment in suicides and controls. Psychiatric records and post‐mortem toxicology were also studied.

Results: Fifty‐nine subjects who committed suicide purchased twice the number of prescriptions as the 118 controls. Sixteen cases received psychiatric in‐patient care compared to four of the controls. In the last 3 months prior to suicide, 38 cases (64%) were dispensed drugs: anxiolytics‐hypnotics in 17 cases (29%), antipsychotics in six cases (10%) and antidepressants in seven cases (12%). More psychiatrists than GPs prescribed antidepressants. About one‐third of psychotropic drugs were retrieved in post‐mortem toxicology.

Conclusion: There is a frequent use of psychotropics and psychiatric care among suicides; however, few used antidepressants and complied. Many suicides are still misdiagnosed and are not adequately treated.
Differences of symptoms and standardized weight index between patients with early‐onset and late‐onset anorexia nervosa
Authors: Matsumoto H. , Takei N. , Kawai M. , Saito F. , Kachi K. , Ohashi Y. , Takeuchi H. , Mori N.
Published: March 2003

Objective: There have so far been no studies that directly compared clinical features between patients with early‐ and late‐onset anorexia nervosa (AN).

Method: We identified 64 patients with DSM‐III‐R AN. We defined individuals as an early‐onset group, who had an age of onset before 14 years (N=31), and the remaining as a late‐onset group (N=33). The clinical symptoms, body weight and weight index, were compared between the two groups. Subjects were dichotomized into those with extremely low weight and those remaining. We compared the proportion of the patients with extremely low weight between the two groups.

Results: The rates of ‘self‐induced vomiting’ and ‘purging’ were significantly lower in a group of patients with early‐onset AN than in those with late‐onset AN. There were significantly fewer subjects with extremely low weight in early‐onset than in late‐onset AN group.

Conclusion: We found clear differences in clinical features between early‐ and late‐onset AN groups.