bluuebunny/crossref_metadata_2025 huggingface dataset:
Living situation, subjective quality of life and social network among individuals with schizophrenia living in community settings
Authors: Hansson L. , Middelboe T. , Sørgaard K. W. , Bengtsson‐Tops A. , Bjarnason O. , Merinder L. , Nilsson L. , Sandlund M. , Korkeila J. , Vinding H. R.
Published: March 2003

Objective:  To investigate the relationships between characteristics of the living situation in the community and subjective quality of life and social network among community‐based individuals with schizophrenia.

Method:  A total of 418 individuals with schizophrenia from 10 sites were interviewed with regard to quality of life, psychopathology, social network and needs for care. Characteristics of the living situation investigated were: living alone or not, living with family or not, and having an independent or a sheltered housing situation.

Results:  An independent housing situation was related to a better quality of life concerning living situation and living with the family to a better quality of life concerning family relations. An independent housing situation was associated with a better social network regarding availability and adequacy of emotional relations.

Conclusion:  People with schizophrenia with an independent housing situation have a better quality of life associated with more favorable perceptions of independence, influence, and privacy. Their social network is better irrespective of whether they live alone or not, or with family or not.
One‐year outcome in first episode psychosis patients in the Swedish Parachute project
Authors: Cullberg J. , Levander S. , Holmqvist R. , Mattsson M. , Wieselgren I.‐M.
Published: March 2003

Objective:  Implementing a system designed to treat first episode psychotic (FEP) patients.

Method:  Every FEP patient (n=253) from a catchment area of 1.5 million inhabitants were asked to participate in this 5‐year project. One historical (n=71) and one prospective (n=64) FEP group were used for comparisons.

Results:  A total of 175 patients (69%) were followed up through the first year of treatment. Global Assessment of Functioning (GAF) values were significantly higher than in the historical comparison group but similar to the prospective group. Psychiatric in‐patient care was lower as was prescription of neuroleptic medication. Satisfaction with care was generally high in the Parachute group. Access to a small overnight crisis home was associated with higher GAF.

Conclusion:  It is possible to successfully treat FEP patients with fewer in‐patient days and less neuroleptic medication than is usually recommended, when combined with intensive psychosocial treatment and support.
Confirmatory factor analysis of DSM‐IV borderline, schizotypal, avoidant and obsessive‐compulsive personality disorders: findings from the Collaborative Longitudinal Personality Disorders Study
Authors: Sanislow Charles A. , Morey Leslie C. , Grilo Carlos M. , Gunderson John G. , Tracie Shea M. , Skodol Andrew E. , Stout Robert L. , Zanarini Mary C. , McGlashan Thomas H.
Published: March 2003

Objective: To test the diagnostic constructs implied by DSM‐IV Axis‐II personality disorders by examining relationships between different combinations of DSM‐IV criteria.

Method: Confirmatory factor analysis was used to test the borderline, schizotypal, avoidant and obsessive‐compulsive personality disorder constructs in a large treatment‐seeking sample (N=668) from a multisite study. A model based on the three DSM‐IV Axis II clusters was also tested. Both models were tested against a unitary ‘generic’ model constructed from four criteria sets combined.

Results: Goodness‐of‐fit for both the three‐cluster and four disorder models was significantly better than the unidimensional model, and the four‐disorder model was significantly better than the three‐cluster model. Results were replicated using data from 2‐year follow‐up obtained by interviewers blind to original Axis II diagnoses at baseline.

Conclusion: Support is provided for the DSM‐IV disorder‐level classification for schizotypal, borderline, avoidant and obsessive‐compulsive personality disorders in a treatment‐seeking sample.
The impact of depression on the well‐being, disability and use of services in older adults: a longitudinal perspective
Authors: Beekman Aartjan T. F. , Penninx Brenda W. J. H. , Deeg Dorly J. H. , Beurs Edwin de , Geerlings Sandra W. , Tilburg Willem van
Published: March 2003

Objective: To study the impact of depression on the wellbeing, disability and use of health services of older adults.

Method: Prospective community‐based study, using a large (n=2200) sample of the elderly (55–85) in the Netherlands. Using a 3‐year follow‐up, the effect of depressive symptoms (CES‐D) on disability, wellbeing and service utilization was assessed, controlling for competing need‐for‐care (chronic physical illness, functional limitation and cognitive decline), enabling (partner status, size of the social network, social support and locus of control), and predisposing factors (age, sex and level of education).

Results: Depressive symptoms have considerable impact on the wellbeing and disability of older people and clear economic consequences caused by inappropriate service utilization. Compared with other need‐for‐care variables the impact of depression is weaker (service utilization), similar (disability) or stronger (wellbeing).

Conclusion: The steeply rising prevalence of competing health risks in later life does not influence the significance of depression.
Elderly suicide rates in Asian and English‐speaking countries
Authors: Pritchard C. , Baldwin D. S.
Published: March 2003

Objective: Asian culture venerates elderly people. It was hypothesized that elderly suicides would be proportionately lower in Asian societies than in English‐speaking countries (ESC).

Method: Elderly (i.e. aged 75 years or more) to general population suicide ratios were compared for six Asian societies and six ESC, based upon the latest 5‐year suicide rates.

Results:
Males: The general population suicide rate was highest in rural China (227 per million) and third highest in Japan (217 per million), but other countries with high rates were all ESC (ranging from 224 to 198 per million). Asian countries had the six highest elderly suicide rates, 1327–1373 per million, whilst the highest ESC elderly rate was in the United States (507 per million). Asian societies had the widest range of elderly/general ratios, ranging from 6.62 to 2.6.

Females: The overall suicide rates were higher in Asian countries (57–95 per million) than in ESC (40–56 per million). Asian elderly suicide rates differed (932 per million in rural China to 154 per million in Korea) but the highest ESC rate was in Australia (76 per million). The Asian countries elderly/general ratios ranged from 5.82 : 1 to 2.70 : 1, but the widest ESC ratio was 1.71 : 1, in the United Kingdom.

Conclusion: There is a need for country‐specific prevention measures in elderly people, and particularly for older women in Asian countries.
Low serum cholesterol is correlated to suicidality in a Korean sample
Authors: Kim Yong‐Ku , Lee Heon‐Jeong , Kim Ji‐Yeon , Yoon Do‐Kyung , Choi So‐Hyun , Lee Min‐Soo
Published: March 2003

Objective: The aim of this study was to examine further the association between low total serum cholesterol and suicidal behaviour.

Method: We measured the serum cholesterol levels in 231 patients admitted to an emergency room following a suicide attempt, in 231 age‐, sex‐ and diagnosis‐matched non‐suicidal psychiatric controls, and in 231 age‐ and sex‐matched normal controls. The suicide attempt patients were divided into five grades according to the degree of injury.

Results: The mean total cholesterol level of the suicide attempt patients was significantly lower than that of the psychiatric and normal controls. When the suicide attempt patients and non‐suicidal psychiatric controls were divided by diagnosis, this significant relationship held true for major depressive disorders and personality disorders, but not for schizophrenia and bipolar disorders. Cholesterol level and the severity of suicide attempt were inversely correlated.

Conclusion: The results suggest that cholesterol level may serve as a marker for suicide risk. Possible explanations are discussed.
Quality of life in patients with schizophrenia in five European countries: the EPSILON study
Authors: Gaite L. , Vázquez‐Barquero J. L. , Borra C. , Ballesteros J. , Schene A. , Welcher B. , Thornicroft G. , Becker T. , Ruggeri M. , Herrán A. ,   the EPSILON Study Group
Published: March 2003

Objective: To compare subjective quality of life (QOL) and objective QOL indicators in patients with schizophrenia from five European sites: Amsterdam, Copenhagen, London, Santander and Verona.

Method: A representative sample of 404 patients with schizophrenia, in contact with mental health services, was randomly selected and evaluated with the Lancashire Quality of Life Profile (EU).

Results: The level of satisfaction in certain domains, religion, family and social relations appears to be associated with local style of living and culture while work, finances, and safety were more independent from local variations. In addition to the severity of symptoms, frequency of contacts with family, friendship and age appear as predictors of QOL, all of them influenced by the characteristics of the surroundings.

Conclusion: The centres participating in the study presented differences in subjective measures of QOL, objective indicators and also in service provision and styles of living.
Religious coping and psychological wellbeing in carers of relatives with schizophrenia
Authors: Rammohan A. , Rao K. , Subbakrishna D. K.
Published: March 2003

Objective: To examine the use of religious coping and its relation to psychological wellbeing in carers of relatives with schizophrenia.

Method: Sixty carers of patients with an ICD‐10 diagnosis of schizophrenia, were assessed on strength of religious belief, perceived burden, religious and other coping strategies and psychological wellbeing.

Results: Coping strategies of denial and problem solving, strength of religious belief and perceived burden were significant predictors of wellbeing.

Conclusion: Strength of religious belief plays an important role in helping family members to cope with the stress of caring for a mentally ill relative. In addition to psychoeducation and problem solving coping, the role of religious coping in enhancing wellbeing of carers needs to be considered in family intervention programmes.
Comparisons between schizophrenia patients recruited from Australian general practices and public mental health services
Authors: Carr Vaughan J. , Lewin Terry J. , Barnard Rosemary E. , Walton Jane M. , Allen Jennifer L. , Constable Paul M. , Chapman Jenny L.
Published: March 2003

Objective: To examine differences between samples of schizophrenia patients recruited from general practice and public mental health services.

Method: Demographic, psychosocial, disability and 12‐month service utilization data are reported from a multicentered survey of psychotic disorders and an associated study of schizophrenia in general practice. Patients with schizophrenia from three recruitment sources (in‐patient, community services, general practice) were compared.

Results: General practice patients had fewer symptoms, better functioning, lower service use, but comparable substance abuse, to patients from mental health services. They were generally similar to community mental health patients, with the exception of family support, premorbid work adjustment, negative symptoms and disability. Service contact models are also reported which demonstrate that general practitioners deal with schizophrenia patients across the range of illness severity and acuity.

Conclusion: Recruitment source impacts in schizophrenia research need to be more carefully considered during sample selection and better accounted for in the interpretation of results.
Development of specific social skills training programmes for schizophrenia patients: results of a multicentre study
Authors: Roder V. , Brenner H. D. , Müller D. , Lächler M. , Zorn P. , Reisch T. , Bösch J. , Bridler R. , Christen C. , Jaspen E. , Schmidl F. , Schwemmer V.
Published: March 2003

Objective: The efficacy of three newly developed cognitive social skills training programmes for residential, vocational and recreational functioning (experimental groups) were compared with a traditional social skills training programme (control group) referring to cognitive and social abilities, psychopathology and generalisation effects.

Method: One hundred and five patients with a diagnosis of schizophrenia or schizoaffective disorder according to ICD‐10 criteria were selected and assigned to the different treatment groups, using a matching procedure. The treatment phase lasted 6 months. A follow‐up assessment was carried out after 1 year.

Results: Higher global therapy effects were obtained on almost all dependent variables in the experimental groups. Analyses of variance and covariance indicated higher symptom reduction for the experimental groups, but significantly greater improvements in some cognitive variables for the control group. Correlation analysis suggested associations between improvement of social behaviour with symptom reduction and improvements of cognitive skills.

Conclusion: In view of these favourable effects, the developed cognitive social skills training programmes might facilitate the abilities of schizophrenia patients for their integration in the community.
Could the hypofrontality pattern in schizophrenia be modified through neuropsychological rehabilitation?
Authors: Penadés R. , Boget T. , Lomeña F. , Mateos J. J. , Catalán R. , Gastó C. , Salamero M.
Published: March 2003

Objective: The effects of neuropsychological treatment on cognitive hypofrontality were examined in schizophrenic patients through the score activation.

Method: Eight subjects (six men and two women) with persistent negative symptoms and cognitive impairments were evaluated with single photon emission computed tomography (SPECT) procedures and neuropsychological battery before and after a neuropsychological treatment group.

Results: After treatment an enhancement in neuropsychological performance was found, especially in executive functions. The activation score showed an increase over baseline levels and no cognitive‐dependent hypofrontality after treatment was found. Although the prefrontal blood flow changes were small and non‐specific, they suggest a reduction of the cognitive hypofrontality after neuropsychological treatment.

Conclusion: Cognitive improvements after neuropsychological treatment would possibly be related with the diminution of the functional hypoactivity in the prefrontal areas.
Clinical issues related to depression in schizophrenia: an international survey of psychiatrists
Authors: Addington D. D. , Azorin J. M. , Falloon I. R. H. , Gerlach J. , Hirsch S. R. , Siris S. G.
Published: March 2003

Objective: Depressive symptoms in schizophrenia are associated with a substantial morbidity and mortality burden. The `International Survey of Depression in Schizophrenia' was designed to evaluate current awareness and clinical approaches in this area.

Method: A 48‐item questionnaire was distributed to approximately 80 000 consultant psychiatrists world‐wide. Responses were analysed using descriptive statistics.

Results: Respondents demonstrated considerable awareness of the prevalence and consequences of depression in schizophrenia. Although there was widespread adjunctive use of antidepressants, one‐third of respondents indicated that they rarely or never prescribe these agents in combination with antipsychotic medication. There were considerable variations in opinions about the best approach to the treatment of depressive symptoms associated with schizophrenia.

Conclusion: The considerable clinical burden of depressive symptomatology in schizophrenia was acknowledged by the majority of respondents to this survey. There was, however, little agreement on the best management strategy.
Treatment non‐adherence in affective disorders
Authors: Lingam Ravi , Scott Jan
Published: March 2003

Objective: The aim of this paper is to review the prevalence, predictors and methods for improving medication adherence in unipolar and bipolar affective disorders.

Method: Studies were identified through Medline and PsycLit searches of English language publications between 1976 and 2001. This was supplemented by a hand search and the inclusion of selected descriptive articles on good clinical practice.

Results: Estimates of medication non‐adherence for unipolar and bipolar disorders range from 10 to 60% (median 40%). This prevalence has not changed significantly with the introduction of new medications. There is evidence that attitudes and beliefs are at least as important as side‐effects in predicting adherence. The limited number of empirical studies of how to reduce non‐adherence offer encouraging evidence that, if recognized, the problem can be overcome.

Conclusion: Only 1–2% of all publications on the treatment of affective disorders explore factors associated with medication non‐adherence. This is disappointing as research and clinical data highlight the importance of extended courses of medication in improving the long‐term prognosis of affective disorders.
Social phobia: overview of community surveys
Authors: Furmark T.
Published: March 2003

Objective: Social phobia has in recent years been recognized as a considerable public health concern. This paper presents an overview of community studies that have estimated the prevalence of social phobia, its subtypes, and specific social fears in the adult general population. Sociodemographic findings are also summarized.

Method: Forty‐three epidemiological studies from 1980 to the present were located in electronic databases and by complementary searches of citations in journal articles and book chapters.

Results: Recent surveys estimate the lifetime prevalence of social phobia at about 7–13% in Western countries. However, prevalence rates vary considerably and are prone to several influencing methodological variables such as the diagnostic criteria, diagnostic threshold, assessment method, number of situational probes, and prevalence period selected by the researcher.

Conclusion: Although there are difficulties in delineating social phobia from subsyndromal social anxiety or shyness, social phobia is even when narrowly defined remarkably common in the general population.
The application of transcranial magnetic stimulation in psychiatry and neurosciences research
Authors: Fitzgerald P. B. , Brown T. L. , Daskalakis Z. J.
Published: March 2003

Objective: Over recent years transcranial magnetic stimulation (TMS) has become widely applied in the study of neuropsychiatric disorders. The aim of this article is to review the application of TMS as an investigative tool and as a potential therapeutic modality in psychiatric disorders.

Method: A comprehensive literature review.

Results: When applied as an investigative tool, TMS provides innovative ways to directly study the excitability of the cortex, cortical regional connectivity, the plasticity of brain responses and cognitive functioning in illness and disease states. A number of studies suggest the potential of treatment with TMS in disease states, especially in patients with depression, although difficulties exist with the interpretation of the published literature.

Conclusion: TMS has a considerable role in neuropsychiatric research. It appears to have considerable potential as a therapeutic tool in depression, and perhaps a role in several other disorders, although widespread application requires larger trials and establishment of sustained response.
Increased incidence of affective disorders, anxiety disorders, and non‐natural mortality in women after breast cancer diagnosis: a nation‐wide cohort study in Denmark
Authors: Hjerl K. , Andersen E. W. , Keiding N. , Mortensen P. B. , Jørgensen T.
Published: March 2003

Objective: To investigate whether breast cancer patients have increased incidence of psychiatric admission with affective disorders, anxiety disorders, or non‐natural mortality compared with the general female population.

Method: Register‐linkage between nation‐wide registries: The Danish Psychiatric Central Register, The Danish Cancer Registry, and The Danish National Register of Causes of Death. A total of 61 709 women registered with primary invasive breast cancer between 1970 and 1993 were included and 356 023 person‐years were accrued.

Results: The standardized incidence ratio of first‐ever psychiatric admission with affective disorder was 1.49 (95% CI: 1.35–1.63) and with anxiety disorder 1.25 (95% CI: 1.06–1.46). The standardized non‐natural mortality ratio during the first year after breast cancer diagnosis was 1.54 (95% CI: 1.27–1.87). All analyses were adjusted for age, calendar period, and place of residence.

Conclusion: Breast cancer patients have significantly increased incidence of psychiatric admission with affective disorders, anxiety disorders, and non‐natural mortality.
Evaluation of the psychometric characteristics of the Spanish version of the Hospital Anxiety and Depression Scale
Authors: Quintana J. M. , Padierna A. , Esteban C. , Arostegui I. , Bilbao A. , Ruiz I.
Published: March 2003

Objective:  To assess the psychometric properties of the Spanish version of the Hospital Anxiety and Depression Scale(HADS).

Method:   We administered HADS to 685 participants (256 controls and 429 patients with five different diagnoses). The reliability of the instrument was assessed by a test–retest study. Construct validity studies were carried out through item–subscale correlation and factor analysis for the whole group and by each of the five different diagnoses. Three instruments were used as external criteria to assess concurrent validity.

Results:  HADS test–retest reliability presented correlation coefficients above 0.85. The internal consistency was high, with a Cronbach's α of 0.86 (anxiety) and 0.86 (depression). Factor analysis showed a clear two‐factor structure for all groups. The results showed high concurrent validity with the Beck Depression Inventory and State‐Trait Anxiety Inventory and with the mental domains of the Short‐Form Health Survey.

Conclusion:  The Spanish version of the HADS demonstrated good reliability and validity when used in medical patients.
Stressful life events and affective illness
Authors: Brostedt E. M. , Pedersen N. L.
Published: March 2003

Objective:  To investigate the association between the occurrence of affective illnesses and the number/type of experienced negative stressful life events in a twin material. A case–control study with an unrelated twin as control to the case and a co‐twin control study were both undertaken with the same material.

Method:  Postal questionnaire responses were used for confirming diagnosis and to inventory stressful life events. Risk ratios (RR) for groups of events were calculated using conditional logistic regression.

Results:  A dose–response relationship was observed for the association between stressful life events and affective illness. The RRs for specific groups of exposures were higher in the co‐twin control study and higher for dizygotic twin pairs than for monozygotic twin pairs.

Conclusion:  Individuals with a history of affective illness select themselves into high‐risk environments, in part due to their genetic propensity to the disease. Thus, the association represents a classic genotype–environment correlation.
Socio‐economic differences in psychiatric in‐patient care
Authors: Lorant V. , Kampfl D. , Seghers A. , Deliège D. , Closon M.‐C. , Ansseau M.
Published: March 2003

Objective: We seek to investigate socio‐economic differences in psychiatric in‐patient care regarding admission, treatment and outcome.

Method: This study is undertaken on a comprehensive and exhaustive psychiatric case register of all psychiatric in‐patient care carried out in Belgium in 1997 and 1998 (n=144 754).

Results: Lower socio‐economic groups were more likely to be compulsorily admitted, to be cared for in a non‐teaching or psychiatric hospital, to be admitted in a hospital with unexpectedly long average length of stay and to be admitted to a ward with a more severe case‐mix. They were less likely to receive antidepressants and psychotherapies. The improvements in functioning and in symptoms were also less favourable for these groups. The lowest group had a higher risk of dying in the hospital.

Conclusion: Psychiatric in‐patient care is associated with moderate socio‐economic differences in access, treatment and outcome. Further research is needed to clarify the causes of such disparities.
Protracted acute stress reaction following an earthquake
Authors: Bergiannaki J. D. , Psarros C. , Varsou E. , Paparrigopoulos Th. , Soldatos C. R.
Published: March 2003

Objective: To verify the official criteria of ICD‐10 diagnosis of acute stress reaction (ASR) among earthquake victims.

Method: Data on psychosocial variables and the diagnosis of ASR were collected from 91 subjects.

Results: The diagnosis of ASR was made in 70% of the sample. However, the restrictive duration criterion (i.e. symptoms not exceeding the first 48 h) was fulfilled only in 10%; in the remaining 60% the symptoms lasted for about another week. Thus, 60% of the sample constituted a group with protracted ASR (PASR) and 40% a group without it (n‐PASR). Medical history was more frequent among PASR than n‐PASR; PASR showed higher anxiety levels (both pre‐ and post‐disaster) than n‐PASR; finally, the persistence of ASR related positively to the fear of death at the time of the earthquake and pre‐disaster anxiety levels.

Conclusion: As in the vast majority of earthquake victims the ASR is protracted beyond 48 h, a revision of ICD‐10 guidelines should be considered.
Antenatal screening for postnatal depression: a systematic review
Authors: Austin M.‐P. , Lumley J.
Published: March 2003

Objective: To describe the screening properties of the antenatal tools which have been developed to predict depression after birth and to summarize the implications of the findings for antenatal screening.

Method: Systematic review and secondary analysis of published papers.

Results: Sixteen studies including sufficient data for the calculation of screening properties were identified. The majority developed a study‐specific screening instrument. Outcome assessments used the Edinburgh Postnatal Depression Scale or standardized diagnostic psychiatric interviews, or both. In the two largest population‐based studies, the proportion of women screening as positive (‘at risk’ of postnatal depression) was 16 and 52%, respectively, and of these only 35 and 8% actually developed depression after birth.

Conclusion: No screening instrument(s) met the criteria for routine application in the antenatal period. Factors that may have affected poor sensitivity and positive predictive values include the exclusion of key domains in predicting risk, particularly personality, a past history of abuse and postnatal events, the contribution of which may be being under‐estimated in studies evaluating antenatal risk prediction tools.
The association between age and depression in the general population: a multivariate examination
Authors: Stordal E. , Mykletun A. , Dahl A. A.
Published: March 2003

Objective:  In a large general population study we found a close to linear rise with age in the mean score and prevalence of self‐reported symptoms of depression. The aim of this study was to examine if this linear relation prevailed when controlled for multiple variables and to examine factors that eventually explained the association.

Method:  Among individuals aged 20–89 years living in Nord‐Trøndelag County of Norway, 60 869 filled in valid ratings of the Hospital Anxiety and Depression Scale as well as many other variables. Covariates were grouped into a multivariate model with six blocks. Logistic regression was used to model the blocks and variables with caseness of depression as the dependent variable.

Results:  The model explains a considerable part of the age‐related pattern on depression. The pattern became less distinct in the age groups above 50 years. Variables within the blocks of somatic diagnoses and symptoms, as well as impairment, had most explanatory power.

Conclusion:  Because of our large sample we were able to control for more relevant variables than earlier studies. In contrast to most other studies, we found that an age‐related increase of the prevalence of depression persisted after control for multiple variables.
Gender and depression: a study of severity and symptomatology of depressive disorders (ICD‐10) in general practice
Authors: Hildebrandt M. G. , Stage K. B. , Kragh‐Soerensen P.
Published: March 2003

Objective:  Gender differences in severity and symptomatology of depression in a large and representative sample of depressive patients from general practice were examined.

Method:  During a 2‐year study period, 31 Danish general practitioners consecutively assessed patients, aged >18, for depression. A total of 1033 patients (692 female, 341 male) fulfilled ICD‐10 criteria for depressive disorders. Gender differences were examined with regard to severity and symptomatology of depression.

Results:  The severity of depression was similar for men and women with the following distribution: 22% mild, 56% moderate and 23% severe depressive episodes. The mean number of symptoms presented was 6.6 of 10 for both genders. There were no gender differences in prevalence of single depressive symptoms.

Conclusion:  No gender differences in the severity or symptomatology of depression were found in a highly representative sample of patients with depressive disorders.
Affective disorder and ‘psychopathy’ in a sample of younger male delinquents
Authors: Moeller A. A. , Hell D.
Published: March 2003

Objective:  The authors' goal was to determine the prevalence of affective disorder, a history of traumatic events and the prevalence of post‐traumatic stress disorder (PTSD) diagnosis in their relationship to ‘psychopathy’ in a sample of younger male delinquents admitted to a correctional institution.

Method:  As part of routine mental health screening, the SCID‐1 and Psychopathy Checklist (PCL‐R) were administered to 102 inmates aged 17–27 years.

Results:  Affective disorder was found in 28% and 29% had a history of suicidal attempts. The PCL‐R‐score was significantly correlated with the number of prior threatening events, but PTSD could not be diagnosed in the ‘psychopathic’ group. The prevalence of affective disorder was significantly higher in the ‘non‐psychopathic’ group.

Conclusion:  The inverse relationship between threatening events and the PTSD diagnosis seems to indicate other coping modalities than those found in ‘non‐psychopaths’. That finding is discussed against the background of psychophysiological data and psychosocial learning models.
Risk factors in neuroleptic malignant syndrome. A case–control study
Authors: Viejo L. F. , Morales V. , Puñal P. , Pérez J. L. , Sancho R. A.
Published: March 2003

Objective: To determine whether environmental temperature, agitation, neuroleptic use, mental retardation, and affective disorders were risk factors for neuroleptic malignant syndrome (NMS).

Method: Cases and age‐ and sex‐matched psychiatric controls admitted to a regional acute psychiatric unit over a 10‐year period.

Results: Both uni‐ and multivariate analysis revealed statistically significant differences between patients with NMS (n=15) and controls (n=45) with regard to the presence of mental retardation, psychomotor agitation, and a number of variables relating to neuroleptic use (newly introduced or increased, intramuscular administration, and dosage). We found no differences between NMS patients and psychiatric controls in respect of changes in environmental temperature.

Conclusion: Our study supports the need for caution when using intramuscularly administered, abruptly increasing, high‐dose neuroleptics, particularly in mentally retarded or agitated patients, regardless of environmental temperature.
Differences in fMRI and MRS in a monozygotic twin pair discordant for schizophrenia (case report)
Authors: Španiel F. , Hájek T. , Tintěra J. , Harantová P. , Dezortová M. , Hájek M.
Published: March 2003

Objective:  This paper presents functional magnetic resonance imaging (fMRI) and magnetic resonance spectroscopy (MRS) findings in a monozygotic twin pair discordant for schizophrenia.

Method:  Functional magnetic resonance imaging was used to determine hemispheric lateralization for speech and proton MRS (1H‐MRS) was employed to assess the extent of putative insult to anterior hippocampus.

Results:  Despite concordant right handedness, subject with schizophrenia displayed bilateral activation in areas subserving speech with greater extent of the total activated area compared with the healthy twin. The affected twin displayed relative bilateral decrease in N‐acetylaspartate/creatin concentration in the anterior hippocampus compared with the healthy one.

Conclusion:  This is an evidence for non‐genetic impairment of cerebral lateralization in monozygotic twin with schizophrenia.
The abnormal development of drive and guidance mechanisms in the brain: the pathogenesis of schizophrenia
Authors: van Hoof J. J. M.
Published: March 2003

Background:

It remains a mystery as to how genetic and environmental factors cause schizophrenia.

Objective:

To develop a pathophysiological model of schizophrenia that has greater explanatory power than existing hypotheses of the disorder.

Method:

Published findings on schizophrenia are integrated with more recent data from human and animal studies of striatal and cerebellar functions.

Results:

The analysis shows that during phylo- and ontogenesis two primarily motor-control mechanisms are applied at the intentional (limbic) level of functioning to organize emotional and cognitive behavior: one for initiating and dosing (drive) and the other for the representational guidance (guidance) of both movements and intentions. The intentional drive and guidance mechanisms are organized through a ventral, respectively, a dorsal cortical–subcortical circuitry.

Conclusions:

A deficient implementation of these mechanisms at the limbic domain manifests itself as schizophrenia, whereby the heterogeneity in symptomatology is explained by the extent of the remaining cerebral activity and by the degree of indirect activation of these systems. In general, activation manifests itself as positive symptomatology and the absence of such activation as negative symptomatology. The model provides a more comprehensive explanation for existing clinical and epidemiological data than do the current alternatives. It is compatible with the major prevailing views on the illness, such as the theories that regard this as a progressive neurodevelopmental, or a connectivity disorder, or one resulting from a deficient cerebral lateralization, or an interrupted cortico–thalamo–cerebello–cortical circuitry. The model fits with recent theories in evolutionary psychology and evolutionary psychiatry.
Seasonal variation and meteotropism in suicide: clinical relevance of findings and implications for research
Authors: Preti A.
Published: March 2003

Seasonal asymmetry in yearly suicide occurrence is a long-observed phenomenon in psychiatric, suicidological and sociological research, and the effects of seasonal factors on suicidal behaviour have been the focus of a number of earlier studies. Taking into account limitations of data and methods, these studies have in general favoured interpretations based on psychosocial factors. Recent studies have challenged the widely held notion that seasonal effects on suicide are not influenced by age, gender or the circumstances of the act. The suicides committed with violent methods have been shown to follow clearer seasonal patterns than suicides by less violent methods, and differences have been found between male and female cycles of occurrence. The seasonal occurrence of suicides has also been found to differ significantly between the young and the elderly. The use of inappropriate statistics or age- and gender-biased samples may have hidden a seasonal component in some previous studies on attempted suicide. The absence of seasonality in earlier studies on attempted suicide was interpreted as depending upon the minor relevance of psychiatric and biological factors in non-fatal self-harm. However, recent studies have reported clear seasonality in attempted suicide samples, with older people showing greater seasonal effect. Recent literature after 1985 on seasonal variation and weather or climate influence in attempted and completed suicide is reviewed. Suggestions for research and the development of more effective preventative strategies are offered.
Effects of age and gender on the classification and phenomenology of unipolar depression
Authors: Maes M.
Published: March 2003

Aim:

The aim of the present study was to examine the effects of age and gender on depressive classification and phenomenology in unipolar depressed in-patients.

Methods:

The authors have assessed 14 items relevant to depressive symptomatology from the Structured Clinical Interview for DSM-III (SCID) and the Hamilton Depression Rating Scale (HDRS) in 180 depressed in-patients.

Results:

Melancholia was significantly more prominent in older depressed patients (≥ 55 years), whereas minor depression (i.e. adjustment disorder with depressed mood and dysthymic disorder) in younger (< 55 years) depressed subjects. Older depressed subjects exhibited significantly more anorexia/weight loss, non-reactivity, depressed mood, loss of interest, early morning awakening, loss of energy, somatic anxiety, loss of insight, psychotic symptoms and retardation than younger depressed people. Male depressed subjects showed significantly more loss of interest, suicidal ideation and agitation than their female counterparts. Psychomotor disorders, a distinct quality of mood and early morning awakening were characteristics of older depressed males, while diurnal variation occurred more frequently in older depressed females.

Conclusion:

It is concluded that increasing age in unipolar depression may be accompanied by an increase in severity of illness, increased frequency of some melancholic symptoms, particularly in men and a higher frequency of major depression in women and of melancholia in men.
Treatment of interictal psychiatric disorder in epilepsy. II. Chronic psychosis
Authors: van der Feltz-Cornelis Cm
Published: March 2003

Background:

Interictal psychosis is a serious comorbid condition in epilepsy patients that would benefit from treatment with psychotropic medication.

Objective:

This paper gives an overview of the pathophysiology, symptomatology and treatment of the schizophrenia-like psychosis of epilepsy. Use of the term ‘interictal chronic psychosis’ is suggested, to conform to current DSM-IV classification of schizophrenia.

Methods:

Literature review supplemented by clinical experience. There is a lack of randomized control trials (RCTs) concerning effectiveness and side-effects of neuroleptics in epilepsy patients.

Results:

Hypotheses concerning the pathophysiology of the interictal chronic psychosis are discussed. The concept of forced normalization and alternative psychosis is based on case descriptions, and was not substantiated by systematic research. The kindling hypothesis seems promising, but was never confirmed in humans. A third theory, supported by some studies, suggests that inhibitory cerebral mechanisms enhance psychotic symptoms in epilepsy patients. Treatment strategies are based on case studies and open studies by lack of RCTs. Treatment should consider the optimalization of the dosage of antiepileptics in combination with one or two antidepressants, mood stabilizers and/or atypical neuroleptics. Surgery plays no significant role in the treatment of treatment-refractive epilepsy with interictal chronic psychotic symptoms.

Conclusion:

There is a prominent role of antidepressant or double antidepressant treatment strategies in patients with epilepsy and interictal chronic psychosis compared with treatment guidelines of chronic psychotic patients in general psychiatry.
Affect regulation in borderline personality disorder: experimental findings from psychophysiology and functional neuroimaging
Authors: Herpertz S. C. , Dietrich T. , Werth U. , Qunaibi M. , Lukas G. , Schuerkens A. , Kunert H.-J. , Freese R. , Flesch M. , Mueller-Isberner R. , Osterheider M. , Sass H.
Published: March 2003

Background:

Intense and rapidly changing mood states are a major feature of borderline personality disorder (BPD), which is thought to arise from affective vulnerability.

Objective:

There have been only a few studies investigating affective processing in BPD, and particularly neither psychophysiological nor neurofunctional correlates of abnormal emotional processing have been identified so far.

Methods:

Studies are reported using psychophysiological or functional neuroimaging methodology.

Results:

The psychophysiological study did not indicate a general emotional hyperresponsiveness in BPD. Low autonomic arousal seemed to reflect dissociative states in borderline subjects experiencing intense emotions. In the functional magnetic resonance imaging study enhanced amygdala activation was found in BPD, and it is suggested to reflect the intense and slowly subsiding emotions commonly observed in response to even low-level stressors.

Conclusions:

Implications for psychotherapy are discussed.
An object relations perspective on borderline personality
Authors: Yeomans F. E. , Levy K. N.
Published: March 2003

One of the principal formulations of borderline personality disorder is based on object relations theory, a component of psychoanalytic theory. To remain relevant, psychoanalytic formulations must find support from empirical research. After summarizing the object relations understanding of borderline personality, the authors review studies in biological neuroscience, developmental psychology and cognitive science related to the fundamental concepts of object relations theory as it aplies to borderline pathology. This review suggests that these empirical studies support psychoanalytic formulations originally derived from clinical practice and observation.
Outcome in adolescent anorexia nervosa
Authors: Herpertz-Dahlmann B.
Published: March 2003

The present paper compares course and outcome of adolescent anorexia nervosa to that of adult onset forms. In recent studies earlier onset of anorexia nervosa was associated with higher recovery rates and a lower mortality, although even in adolescent patients anorexia nervosa takes a prolonged course. A chronic eating disorder bears a high risk of other comorbid psychiatric or personality disorders. The most prevalent disturbances were anxiety and affective disorders and anxious–fearful–obsessive personality disorders, respectively. Patients who substantially overcame their eating disorder did not differ from normal controls in respect to psychosocial functioning, e.g. family relationships, partnership and occupational status. These results should encourage us to treat the eating disorder vigorously.
Catatonia: the rise and fall of an intriguing psychopathological dimension
Authors: van der Heijden F. M. M. A. , Tuinier S. , Pepplinkhuizen L. , Verhoeven W. M. A.
Published: March 2003

Background:

For at least 125 years the discussion about the clinical relevance of catatonic symptoms in psychiatry continues. It started from the original description by Kahlbaum and was revived by modern factor analytical studies, that identified the catatonic dimension in about 10% of newly admitted patients.

Objective:

Over a period of 2 years, four patients with an acute episodic psychosis and prominent catatonic symptoms were examined.

Methods:

A clinical description is given of the psychopathology and classification is performed according to the various diagnostic instruments.

Results:

All patients showed a circular fluctuation of their psychoses, with motor symptoms ranging from the excited to the inhibited pole within one episode. Their clinical pictures also comprised mood swings and anxieties as well as hallucinatory and delusional experiences, whereas the course of disease was characterized by complete recovery without residual symptoms.

Conclusions:

The significance of catatonic symptoms is not recognized in the current taxonomies despite the fact that this has major pharmacological treatment implications.
Depression and Parkinson's disease: a conceptual challenge
Authors: Leentjens A. F. G. , Verhey F. R. J.
Published: March 2003

Aim:

To explore the relation between Parkinson's disease (PD) and depression from a conceptual point of view.

Methods:

Discussion of the relevant literature on the conceptual, phenomenological and therapeutical aspects of depression in Parkinson's disease.

Results:

Both semantic confusion and an erroneous belief in the mind-body distinction have contributed to some common misunderstandings of the nosology and etiology of depression in Parkinson's disease.

Conclusion:

The consequences of a different, integrated, neuropsychiatric approach for both diagnosis and treatment are discussed.
Stress, norepinephrine and depression
Authors: Leonard Brian E.
Published: March 2003

Experimental and clinical evidence implicates stress as a major predisposing factor in depression and other severe psychiatric disorders. In this review, evidence is presented to show how the impact of stress on the central sympathetic system leads to changes in the endocrine, immune and neurotransmitter axes which underlie the main clinical symptoms of depression. Thus it can be shown that the noradrenergic system is dysfunctional in depression, a situation which reflects the chronic hypersecretion of glucocorticoids and inflammatory mediators within the brain in addition to an enhanced activity of the locus ceruleus. With regard to the actions of antidepressants in modulating the stress response and alleviating depression it is now evident that, irrespective of the presumed specificity of the antidepressants for the noradrenergic or serotonergic systems, they all normalize noradrenergic function. This action is due partly to the regulation of tyrosine hydroxylase activity in the locus ceruleus but also enhances neuronal sprouting which counteracts the neurodegenerative effects of chronic stress.
Stress, cortisol and memory as markers of serotonergic vulnerability
Authors: Riedel Wim J. , Sobczak Sjacko , Nicolson Nancy , Honig Adriaan
Published: March 2003

Objective:

In the present paper the association of stress-induced cortisol with memory impairment is discussed

Methods:

An experiment is described in which an attempt is made to block stress-induced cortisol by lowering 5-HT neurotransmission by means of acute tryptophan depletion (ATD). Forty-five healthy control subjects participated in the experiment.

Results:

Stress-induced peak cortisol and immediate memory performance were negatively associated. ATD tended to block stress-induced cortisol response. ATD also blocked the association between peak cortisol response and memory impairment.

Conclusions:

Stress-induced cortisol and its association with memory impairment is mediated at least partially by serotonin.