bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychiatric Classification and Empiricist Theories of Meaning
Authors: Malmgren H.
Published: August 2007

The philosophical background of the contemporary debate over psychiatric classification is reviewed in some detail. It is shown that the philosophy behind DSM‐III and DSM‐III‐R is based on a theory about the semantic status of operational definitions, which was abandoned several decades ago by empiricist philosophers of science. It is argued that the newer empiricist and realist theories of meaning developed after 1960, particularly the idea of an indirect specification of meaning through contingent operational criteria, offer a better foundation for psychiatric classification.
Morning bright light therapy for sleep and behavior disorders in elderly patients with dementia
Authors: Mishima K. , Okawa M. , Hishikawa Y. , Hozumi S. , Hori H. , Takahashi K.
Published: August 2007

Fourteen inpatients with dementia showing sleep and behavior disorders (average age = 75 years), and 10 control elderly people (average age = 75 years) were carefully observed for 2 months. Four weeks of morning light therapy markedly improved sleep and behavior disorders in the dementia group. The measurement of sleep time and the serum melatonin values suggests that sleep and behavior disorders in the dementia group are related to decreases in the amplitude of the sleep‐wake rhythm and decreases in the levels of melatonin secretions. Morning light therapy significantly increased total and nocturnal sleep time and significantly decreased daytime sleep time. These results indicate that morning bright light is a powerful synchronizer that can normalize disturbed sleep and substantially reduce the frequency of behavior disorders in elderly people with dementia.
Mortality and suicide rates of involuntarily committed patients
Authors: Engberg M.
Published: August 2007

The mortality and suicide rates for involuntarily committed patients in Denmark are presented. Two cohorts of psychiatric patients committed to a mental hospital from January 1, 1971 to December 31, 1975 (8322 people) and January 1, 1981 to December 31, 1985 (5253 people) have been followed. The standard mortality rate (SMR) in relation to the total Danish population were 4.9 (4.5–5.4) and 5.2 (4.7–5.8), respectively, for the two cohorts, during the first year after involuntarily commitment to a mental hospital. During the same period, the SMR for suicide among the committed patients were 44.9 (37.1–53.9) and 30.9 (24.2–38.9), respectively. The crude suicide rates among the committed patients during the first year after the commitment were 14.3 and 14.0, respectively, per 1000 years, unchanged between the cohorts. Short length of stay in hospital (< 14 days), a nonpsychotic main diagnosis, male sex, and age 35 years or more were equally related to high risk of suicide in the 1971 cohort as evaluated to proportional hazard methods (Cox regression), and short length of stay and commitment on the danger indication provided the most information in relation to high suicidal risk in the 1981 cohort. Methodological problems and the reasons for the results are discussed.
A latent variable causal model of the quality of life and community tenure of psychotic patients
Authors: Mercier C. , King S.
Published: August 2007

Services are intended to maintain patients in the community while improving the quality of their lives. The purpose of this study was to determine the extent to which psychiatric patients’ diagnoses, levels of autonomy, objective living conditions and degree of service utilization are associated with their perceived quality of life and, in turn, community tenure. A latent variable causal model was developed and tested using data from 152 schizophrenic and affective psychotic patients. Information was obtained using a semistructured interview, a quality of life scale, ratings on the Global Assessment Scale and patient hospital records. Results indicate that greater autonomy is significantly associated with greater perceived quality of life and that greater quality‐of‐life ratings are associated with greater community tenure.
Suicide in adolescent psychiatric inpatients: incidence and predictive factors
Authors: Kjelsberg E. , Neegaard E. , Dahl A. A.
Published: August 2007

Of 1969 previous adolescent psychiatric inpatients, 1792 (91%) were traced after a mean follow‐up period of 15 years. Thirty‐five patients, 1.7% of the females and 2.2% of the males, had committed suicide, corresponding to a yearly suicide rate of 145/100,000 for males and 110/100,000 for females. This represents a 6‐fold increase for males and a 19‐fold increase for females compared with the suicide rate for 15‐ to 29‐year‐old males and females in the general population. There was seasonality in violent but not in nonviolent suicides. The patients who had committed suicide were compared with matched patients from the same sample who stayed alive. The suicide group had more depressive symptoms, more learning difficulties, poorer self esteem, were more help‐rejecting, and had more immature defense mechanisms. They lacked parental support and were more often verbally abused by their parents. They had more frequently experienced serious losses in early childhood and had a higher score on enduring stressors on Axis IV in DSM‐III‐R. They more often came from urban areas and received poorer follow‐up after discharge from hospital. Eight of these discriminating factors were combined into a predictive model for the lifetime risk of suicide in adolescent psychiatric inpatients. The model had strong predictive power, classifying 84% of the population correctly.
Parental bonding and vulnerability to adolescent suicide
Authors: Martin G. , Waite S.
Published: August 2007

Part of a series of studies into early detection in adolescent suicide, this study investigated relationships between parenting style and suicidal thoughts, acts and depression. Students (mean age 15 years) from 4 randomly chosen high schools completed self‐report questionnaires containing the Parental Bonding Instrument (PBI) and the Youth Self Report, which provided information about suicide ideation, deliberate self‐harm and depression. Significant differences for mean scores on the PBI subscales were noted between cases and noncases of depression, suicidal thoughts and deliberate self‐harm. Assignment by adolescents of their parents to the “affectionless control” quadrant of the PBI doubles the relative risk for suicidal thoughts, increases the relative risk for deliberate self‐harm 3‐fold and increases the relative risk for depression 5‐fold. It seems that the PBI may play a role in identification of vulnerable adolescents; further, it both elucidates aspects of adolescent‐parent interaction and points toward areas for intervention with at‐risk adolescents. We recommend the use of the PBI in early detection studies of adolescent suicide.
Antinuclear antibodies in psychiatric patients
Authors: de Vries E. , Schipperijn A. J. M. , Breedveld F. C.
Published: August 2007

To investigate whether unrecognized systemic lupus erythematosus (SLE) might occur more frequently among psychiatric patients than expected on clinical examination, sera of 100 patients from a psychiatric hospital were tested for the presence of antibodies against nuclear antigens (ANA) and antibodies against DNA. The occurrence of sera positive for ANA was compared with the test results of serum samples of 859 individuals randomly selected from the general population. Positive tests for ANA were found in 7% of the psychiatric patients and 4% of the individuals selected from the population. Antibodies against dsDNA were not found in sera of the psychiatric patients. After categorizing both groups for age and sex, no difference was found as for the frequency of ANA positive sera between both groups, indicating that on the basis of serology, no evidence exists that SLE might be underestimated among psychiatric patients.
Neurocirculatory asthenia: a reassessment using modern psychosomatic criteria
Authors: Fava G. A. , Magelli C. , Savron G. , Conti S. , Bartolucci G. , Grandi S. , Semprini F. , Saviotti F. M. , Belluardo P. , Magnani B.
Published: August 2007

The purpose of this study was to assess the prevalence of mental illness and to evaluate the quality of life of patients with neurocirculatory asthenia. A consecutive series of 80 patients who satisfied the diagnostic criteria developed by Kannel et al. for neurocirculatory asthenia was included in this study. Patients underwent a psychiatric diagnostic research interview and extensive psychometric evaluation, with both observer and self‐rated scales for depression, anxiety, phobic symptoms, quality of life and abnormal illness behavior. In 47 patients (59%), a psychiatric diagnosis (mainly an anxiety disorder) antedated the onset of neurocirculatory asthenia, which was thus defined as secondary, also because cardiorespiratory symptoms were part of the mental symptoms. In the remaining 33 patients (41%) neurocirculatory asthenia was the primary disorder. Patients with secondary neurocirculatory asthenia reported significantly higher levels of anxiety, depression, social phobia, abnormal illness behavior and an impaired quality of life compared with patients with primary neurocirculatory asthenia. This latter did not significantly differ in these variables (except for depression) from healthy control subjects matched for sociodemographic variables. At a 1‐year follow‐up, patients with primary neurocirculatory asthenia had a much better prognosis than those with secondary neurocirculatory asthenia. The results indicate the feasibility of the primary/secondary distinction based on the time of onset of mental and cardiorespiratory symptoms in neurocirculatory asthenia. Since only about one quarter of the patients were found to suffer from decreased energy and fatigue according to specified criteria, the terms neurocirculatory asthenia and effort syndrome should probably be discarded.
Human immunodeficiency virus antibody test and seroprevalence in psychiatric patients
Authors: Naber D. , Pajonk F.‐G. , Perro C. , Löhmer B.
Published: August 2007

Psychiatric inpatients are at risk for human immunodeficiency virus (HIV) infection. Investigations in the United States revealed seroprevalence rates of 5.5–8.9%. Therefore, inclusion of HIV antibody testing in routine laboratory screening is sometimes suggested. To investigate this issue for inpatients in the Department of Psychiatry, University of Munich, the incidence, reason for HIV testing and results were analyzed. Of 12,603 patients, hospitalized from 1985 to 1993, 4.9% (623 patients, 265 in risk groups) underwent the HIV test after informed consent. Thirty patients (4.8% of those tested) were found to be positive, but only in 5 cases (all of risk groups) was infection newly detected. Data indicate that, in psychiatry, HIV testing is reasonable only in patients in risk groups or if clinical variables suggest HIV infection.
Evaluation and interpretation of symptom structures in patients with schizophrenia
Authors: Kawasaki Y. , Maeda Y. , Sakai N. , Higashima M. , Urata K. , Yamaguchi N. , Kurachi M.
Published: August 2007

Seventy Japanese DSM‐III‐R schizophrenic patients were assessed for 30 clinical symptoms using the Positive and Negative Syndrome Scale (PANSS) of Kay et al. Principal component analysis was applied to the full item set of this scale and disclosed 5 orthogonal independent symptom groups: negative, hostile/excited, thought‐disordered, delusional/hallucinatory and depressive components. Our results provided further support of the contention that more than 2 (i.e., positive and negative) dimensions are required to account for structures of the schizophrenic symptoms.
Circadian rhythms of melatonin, cortisol and prolactin in patients with obsessive‐compulsive disorder
Authors: Monteleone P. , Catapano F. , Del Buono G. , Maj M.
Published: August 2007

Plasma melatonin, cortisol and prolactin (PRL) levels were measured over a 24‐h period in 13 drug‐free patients with obsessive‐compulsive disorder and in matched healthy subjects. The circadian profiles of melatonin and PRL were altered in patients; the circadian rhythm of cortisol was preserved, although at a higher level compared with normal controls. These changes were significantly related to the severity of the obsessive‐compulsive symptoms. Further studies need to clarify the state‐ or trait‐dependent character of these abnormalities.
Diagnosing the personality organization of drug abusers by rating ego balance
Authors: Sandell R.
Published: August 2007

A community‐based case‐finding sample of 1824 narcotic abusers in Stockholm County was used to standardize a set of rating scales in order to reflect levels of personality organization (PO), in the spirit of Kernberg's theory. PO is assumed to be a function of the ego's capacity to endure inner and outer stress, which manifests itself in the frequency and depth of regressions and the rate of recovery from them. The principles of a method, Rating Ego Balance, for charting the person's characteristic pattern of regression are presented, and its psychometric properties are described on the basis of item response theory. The scales have satisfactory reliabilities and maximal discrimination at subneurotic levels of PO. They show strong construct validity in relation to Kernberg's theory.
Effects of pimozide on cognition in children with Tourette syndrome: interaction with comorbid attention deficit hyperactivity disorder
Authors: Sallee F. R. , Sethuraman G. , Rock C. M.
Published: August 2007

Pimozide, a dopamine receptor antagonist, dopamine uptake inhibitor and L‐type calcium channel blocker, is used in children suffering from Tourette syndrome (TS), but its effect on frequently comorbid attention deficit hyperactivity disorder (ADHD) is unknown. We have characterized the cognitive effects of pimozide and haloperidol in TS in relation to comorbid ADHD. Sixty‐six consecutive outpatients with TS (DSM‐III‐R), ages 7–16, were randomly assigned to pimozide, haloperidol or medication‐free clinical treatment and evaluated cognitively after 6 weeks. Continuous performance task (CPT) and memory search efficiency were compared across treatments. Treatment, comorbid ADHD and their interaction were significant on the CPT task. Pimozide treatment was superior to haloperidol and improved memory search efficiently over the no‐drug condition.
The middle‐aged generation is at high risk for suicide in Japan
Authors: Ohara K. , Xie D. , Matsunaga T. , Sano H. , Miyasato K. , Ohara K.
Published: August 2007

The suicide rate in Japan was the highest in the world the 10 years after World War II. There were many suicides among young and aged people. Now, Japan has many suicides among middle‐aged people, and suicides among elderly people are still remarkable. These findings suggest that middle‐aged people in 1980s have a high risk of suicide and that suicide among elderly people will increase in 10–20 years.
SCID II interviews and the SCID Screen questionnaire as diagnostic tools for personality disorders in DSM‐III‐R
Authors: Ekselius L. , Lindström E. , von Knorring L. , Bodlund O. , Kullgren G.
Published: August 2007

A modified version of the SCID Screen questionnaire covering 103 criteria by means of 124 questions was compared with SCID II interviews in 69 psychiatric patients. The correlation between the number of criteria fulfilled in the SCID II interviews or the questionnaires was 0.84. In the SCID interviews, 54% of the patients had a personality disorder. When the SCID Screen questionnaire was used, 73% had a personality disorder. When the cut‐off level for diagnosis was adjusted, the frequency found by means of the SCID screen questionnaire or the interviews was roughly the same, 58% and 54%, respectively. The overall kappa for agreement between the SCID II interviews and questionnaire with adjusted cut‐off was 0.78.
The thyroid and mixed affective states
Authors: Joffe R. T. , Young L. T. , Cooke R. G. , Robb J.
Published: August 2007

The relationship between Grade II subclinical hypothyroidism and mixed affective states was examined in a cohort of 66 patients with bipolar affective disorder. The overall frequency of Grade II subclinical hypothyroidism was 20%. There was no difference in frequency of subclinical hypothyroidism or in mean thyroid hormone levels between the mixed state and non‐mixed‐state group.
A four‐year prospective follow‐up study of 49 eating‐disordered adolescents: differences in course of illness
Authors: van der Ham T. , van Strien D. C. , van Engeland H.
Published: August 2007

In a 4‐year prospective follow‐up study of 25 anorectic and 24 bulimic adolescents (DSM‐III‐R criteria), we studied fluctuations and differences in the course of illness, using repeated measurement. Morgan & Russell general outcome categories on the Outcome Schedule were more favourable than in adult studies. Of all patients, 47% had good, 43% intermediate and 10% poor outcome scores after 4 years. The groups differed significantly as to the kind and severity of disturbed eating behaviour and its consequences, but were rather similar in mental, psychosocial and psychosexual symptoms during the course of the illness. Eight percent of the anorectic patients became bulimic. We conclude that anorexia nervosa and bulimia nervosa can be considered as different symptom patterns of one basic eating disorder, in which preoccupation with food and a disturbed body image are core symptoms.
Lower degree of esterification of serum cholesterol in depression: relevance for depression and suicide research
Authors: Maes M. , Delanghe J. , Meltzer H. Y. , Scharpé S. , D'Hondt P. , Cosyns P.
Published: August 2007

Previous studies have suggested that depression and suicide are related to alterations in total cholesterol serum concentrations, and that an altered distribution of haptoglobin (Hp) phenotypes in major depression indicates that variation on chromosome 16 may be associated with that illness. Lecithin:cholesterol acyl transferase (LCAT, EC 2.3.1.43), the enzyme that catalyzes the esterifying reaction of cholesterol in serum, is located close to the Hp gene. This study examined the serum concentrations of total and free cholesterol and the esterified cholesterol ratio in 26 healthy controls, 47 unipolar depressed subjects (16 minor, 14 simple major and 17 melancholic depressed subjects) and 12 relatives of melancholic subjects. Depressed subjects (regardless of subtype) and relatives of depressed subjects had a significantly lower esterified cholesterol ratio than normal controls. No significant differences in total or free cholesterol concentrations were found between the above study groups. In depressed subjects, there were no significant relationships between the esterified cholesterol ratio, total or free cholesterol and postdexamethasone adrenocorticotropic or cortisol values, Hp phenotypes, severity of illness or suicidal symptoms. It is hypothesized that lower esterification in serum cholesterol may constitute a vulnerability factor for depression through alterations in cell membrane microviscosity.
Uptake of 99mTc‐exametazime shown by single photon emission computerized tomography in obsessive‐compulsive disorder compared with major depression and normal controls
Authors: Edmonstone Y. , Austin M.‐P. , Prentice N. , Dougall N. , Freeman C. P. L. , Ebmeier K. P. , Goodwin G. M.
Published: August 2007

Twelve patients with obsessive‐compulsive disorder (OCD) were investigated at rest using single photon emission computerized tomography with 99mTc‐exametazime. The uptake of 99mTc‐exametazime was expressed relative to calcarine/occipital cortex. Patients were matched for drug treatment with 12 patients with a major depressive episode and the patient groups were compared with a control group. Significant bilateral decreases in tracer uptake were confined to basal ganglia in the OCD group. There was a paradoxical positive correlation between anxiety ratings and tracer uptake to basal ganglia in the OCD group. The findings confirm that the functional topography of OCD implicates altered function in the basal ganglia.
Patient satisfaction with inpatient psychiatric care
Authors: Svensson B. , Hansson L.
Published: August 2007

The aim of the study was to investigate the influence of personality traits, diagnosis and perceived coercion on patient satisfaction with inpatient psychiatric care. The study was performed as a cross‐sectional study on 7 inpatient wards in southern Sweden. A cohort of 50 psychiatric inpatients evaluated satisfaction with care and also made ratings on a personality questionnaire. Patients with a higher level of the trait aggressive nonconformity were significantly less satisfied with the ward's physical and psychosocial environment, the treatment design and the treatment program. The phenomenon of acquiescence was not related to the reported level of satisfaction. Analyses of patient satisfaction according to diagnostic groups showed that patients with affective disorders had significantly better satisfaction than patients with a diagnosis of schizophrenia. Patients who perceived that they were involuntarily admitted were measured as being significantly less satisfied with the care in all areas. It is concluded that, to attain a higher specificity in analyses of variation in patient satisfaction, focus may be put on situational and setting factors of the care delivered along with specific patient characteristics. Risk groups, which require great attention in the development of quality assessment and quality assurance policies, are patients with schizophrenia and patients who perceive coercion in connection with inpatient psychiatric treatment.
Low platelet monoamine oxidase activity in pathological gambling
Authors: Carrasco J. L. , Sáiz‐Ruiz J. , Hollander E. , César J. , López‐Ibor J. J.
Published: August 2007

Decreased platelet monoamine oxidase (MAO) activity has been reported in association with sensation‐seeking personality type and in some mental disorders associated with a lack of impulse control. Pathological gambling itself has been related with both sensation‐seeking and reduced impulse control. Platelet MAO activity was investigated in 15 DSM‐III‐R pathological gamblers from our outpatient clinic. Gamblers had a significantly lower platelet MAO activity than a group of 25 healthy controls. The range of MAO levels in gamblers was also significantly shorter than in controls. In controls, platelet MAO levels showed the previously described negative correlations with sensation‐seeking scores but not in gamblers. The findings are consistent with previous studies showing an association of low platelet MAO activity with impulse control disorders and raise some interesting therapeutic alternatives for pathological gambling.
Interviews of psychiatric inpatients about their family situation and young children
Authors: Wang A.‐R. , Goldschmidt V. V.
Published: August 2007

In this study, the perception by mentally ill parents of their family situation and young children was explored with the purpose of improving the basis for cooperation between families and professionals, when intervention is needed. Fifty consecutively admitted psychiatric inpatients with children 0–10 years old were interviewed by child psychiatrists, and their information constitutes the study material. It was generally easy to approach the patients as parents. Most of them were already preoccupied with their children's situation and seemed relieved to talk about it when guaranteed anonymity. Half of the patients experienced and described having emotional difficulties in relation to their children. Half of the 64 children were reported to suffer from physical or mental health problems, and an unexpected accumulation of children with serious and relatively rare medical conditions was registered. Most of the children had parents who had been mentally ill all their life, and many had 2 parents with mental disorders. Family discord was frequent. Many women related the debut of mental symptoms to childbirth. Attention is drawn to special patterns concerning suicidal and addicted patients.
Panic Disorder
Authors: Dick C.L. , Bland R.C. , Newman S.C.
Published: August 2007

A random sample of 3258 adult household residents of Edmonton, Alberta, Canada were interviewed by trained lay interviewers using the Diagnostic Interview Schedule (DIS), which gives DSM‐III diagnostic data on each individual interviewed. This paper reports results for panic disorder. Panic disorder was found to affect women primarily (female:male morbidity risk 2.2:1). The mean age of onset (first symptom) was 19.3 years for men and 21.5 years for women. Rarely did symptoms first occur after the age of forty. The lifetime prevalence rate was 1.7% for women and 0.8% for men and the lifetime morbidity risk was 3.7% for females and 1.7% for males. All twelve panic symptoms were found to be highly specific for panic disorder. Women complained of more (means = 8.0) symptoms than men (means = 6.0). On average 7.3 symptoms were reported. Those with panic disorder showed increased lifetime prevalence rates for major depressive episode (73.4%), alcohol abuseldependence (54.2%), drug abuse/dependence (43%) and phobia (44.2%). Altogether, 90.4% of those with panic disorder also met criteria for another DSM‐III diagnosis, which was 2.7 times the rate in those who did not have panic disorder.
Epidemiology of depression: Prevalence, risk factors and treatment situation
Authors: Lehtinen V. , Joukamaa M.
Published: August 2007

Depending on the way it is defined depression can be seen as a state of mood, as a symptom, as a syndrome or as a clinical diagnosis. Epidemiological studies show that depression is the most common mental disorder in man. Up to 4 % of men and 8 % of women suffer from a clinically significant depressive disorder, while depressive symptoms are much more common. The occurrence of depression is associated with factors such as age, marital status, social class, and social conditions. In Finland, only one third of persons suffering from depression are actually being treated for their disorder.
Season and mental illness in an arctic area of northern Finland
Authors: Näyhä S. , Väisänen E. , Hassi J.
Published: August 2007

The seasonal variation in mental disturbances was examined in 1251 reindeer herding males in an arctic area of northern Finland using the psychiatric section of the Cornell Medical Index questionnaire (CMI‐MR). The mean age of subjects was 43 years. One third of them were full‐time reindeer herders and 1/10 were Lapps. The prevalence of mental disorders (CMI‐MR at least 5) was estimated at 14 %, and it showed peaks in spring and autumn. The pattern was repeated for different varieties of illness, except for depression which showed a single cycle with the highest prevalence in the light season. The authors conclude that mental disorders in the arctic are most common in spring and autumn, and they question the common belief in mid‐winter as the most common season for mental disorders.
Risk and protective factors in depression: a developmental perspective
Authors: Aro H.
Published: August 2007

The approach of developmental psychopathology is presented, and developmental research on the role of sex differences and protective factors in depression is reviewed. Results from our own study on family stress, protective factors and depression are presented as an example.
Depression and physical and Social functioning in old age
Authors: Kivelä S.‐L.
Published: August 2007

The relationships between physical and Social functioning and depression in old age are described. Findings from a longitudinal study carried out in 1984 on a population aged 60 years or over in the town of Ähtäri in Finland give evidence that disturbed physical and Social functioning can predispose individuals to depression. Having poor emotional relations with one's wife predicted depression within five years among the initially non‐depressed men, and not living alone among the women. From a preventive viewpoint, the independence of the elderly and Social roles that support self‐esteem in old age should be stressed. Marital counselling should be developed for the elderly.
Depression and back pain
Authors: Joukamaa M.
Published: August 2007

Depressive and anxiety neuroses are the most common psychiatric disorders associated with back pain. In assessing the connections between back pain and depression, the different forms of depression should be considered. There are some depressed back pain patients with the traditional depressed mood as the principal symptom of mood disorder. It seems, however, that the depression associated with back pain is usually atypical in nature and that signs of depression other than the depressed mood have to be taken into account. Alexithymic features associated with the pain can also mask the depression.
The borderline conditions ‐ an introduction from a Scandinavian perspective
Authors: Simonsen E.
Published: August 2007

There is a growing conversion, confusion and controversy in clinical psychiatry concerning the usage of the borderline concept. An increasing number of hospitalized patients are classified as borderline conditions. This expansion and popularity of the borderline concept has many explanations and historical roots: the notion of a continuum of mental disorders, the concept of forme fruste of psychotic illnesses; clinicians' uncertainty as to where to categorize some difficult patients ‐ a non‐discriminatory synonym; the psychoanalytic establishment ‐ and decline ‐ in clinical psychiatry in the United States; a field for ideological battles between psychodynamic and biological oriented schools of psychiatry, etc. In ICD‐10, the borderline conditions are hierarchically divided and outlined in clinical description and diagnostic guidelines into schizotypal disorder and emotionally unstable personality disorder ‐ impulsive or borderline subcategory. This closer demarcation of prototypes in the classification system may facilitate less confusion in future. All Scandinavian countries have contributed a great deal to the research in the field of borderline conditions, especially with regard to genetic and nosological issues. A brief summary of these contributions is presented. Some important notions in the phenomenologic and prototypically oriented European tradition of classifying personality disorders are explained in order to understand the rather ambiguous reaction to the borderline concept in European countries.
Building structure for the borderline construct
Authors: Gunderson J. G.
Published: August 2007

This article overviews the development of the borderline personality disorder construct. In the past 25 years, the borderline personality diagnosis has grown remarkably in clinical usage even as its construct has undergone dramatic shifts in the process. It originated as a type of intrapsychic personality organization that reflected psychoanalytic observations and the hope for long‐term curative therapies. It was transformed by descriptive observations into a syndrome whose boundaries with first schizophrenia and then affective disorders became the subject of intense study. More recently, it is recognized as a specific type of personality disorder that communicates substantial information about pathogenesis and that helps guide clinical planning and prognostication. The context dependency of the borderline patient's presentation explains why the diagnosis can often elude recognition.
Genetics in borderline conditions
Authors: Torgersen S.
Published: August 2007

The published and some unpublished studies of the genetic of borderline conditions are reviewed. It appears that the DSM‐III‐R borderline personality disorder is not genetically transmitted. The evidence for the genetic transmission of schizotypal personality disorder also appears weak. An examination of the 2 personality disorders reveals multidimen‐sionality and heterogeneity. The borderline personality disorder seems to consist of 2 syndromes, an impulsive borderline and an empty borderline syndrome. The schizotypal personality disorder consists of 3 syndromes, one affect‐constricted/eccentric, one pseudo‐psychotic and one paranoiac isolated syndrome. The impulsive borderline, the affect‐constricted/eccentric and the pseudo‐psychotic syndromes seem slightly genetically influenced. The affect‐constricted/eccentric syndrome appears to be genetically related to schizophrenia. No other Axis I disorders are related to borderline conditions.
Cognitive therapy in the treatment of patients with borderline personality disorders
Authors: Perris C.
Published: August 2007

Cognitive therapy, originally conceived for the treatment of emotional illnesses, has been successively used also in treating patients with more severe mental disorders. In this article, the results obtained by Shearin & Linehan (this volume) in a few controlled trials of dialectical behavior therapy in patients with borderline personality disorders are discussed. Differences between the treatment approach followed by Shearin & Linehan, which focuses on the modification of specific behaviors, and that favored by the author, which is aimed at restructuring dysfunctional working models of self and environment, are highlighted. In the conclusion it is emphasized that the use of a structured, didactic and cognitive‐behaviorally oriented approach focused on personal growth might represent an important and much wanted breakthrough in the treatment of the most disturbed patients with a borderline personality disorder.
Motor and mental aspects of acute extrapyramidal syndromes
Authors: Casey D. E.
Published: August 2007

Acute extrapyramidal syndromes (EPS) are one of the major limitations to effective neuroleptic treatment. These disorders have both motor (objective) and mental (subjective) aspects, which must be considered in any evaluation and differential diagnosis of treatment‐related side effects. The disorders of akathisia, acute dystonia and parkinsonism have unique features that are best understood in the context of a careful assessment of patient characteristics, drug factors and temporal aspects. Though acute EPS are commonly explained on the basis of dopamine D, receptor antagonism, data from several lines of study raise important questions about this hypothesis. The roles of receptor subtype specificity, brain region selectivity and ratios of different receptor subtype antagonism are discussed. New and novel antipsychotic drugs with low rates of EPS are important clinical advancements that will increase patients' ability to participate in therapy and rehabilitation and thus improve their quality of life.
Long‐term clinical and Social outcome studies in schizophrenia in relation to the cognitive and emotional side effects of antipsychotic drugs
Authors: Lindström L. H.
Published: August 2007

Evaluation of neuroleptics should include not only the effects on symptoms but also social functioning and the quality of life. Akathisia, cognitive and emotional impairment (cognitive and emotional parkinsonism) are probably the most important reasons for lack of compliance with classical neuroleptics. Atypical neuroleptics such as clozapine and remoxipride offer an advantage because of little impairment of cognitive and emotional functioning. In 122 schizophrenic and schizoaffective therapy‐resistent patients treated with clozapine for up to 17 years, the treatment was stopped in only 8 cases (7%) because of lack of compliance. In patients treated for more than 2 years, 40% were employed and functioned well socially. It is concluded that, in many schizophrenic patients, atypical neuroleptics should be preferred in long‐term maintenance treatment because of a low incidence of extrapyramidal syndromes as well as cognitive and emotional parkinsonism. An “awakening” is often seen when changing from a classical neuroleptic to an atypical one.
Oral versus depot administration of neuroleptics in relapse prevention
Authors: Gerlach J.
Published: August 2007

Depot administration of neuroleptic drugs offers several advantages in the long‐term maintenance therapy of chronic schizophrenic patients. The major advantage is the assurance of compliance leading to fewer relapses and rehospitalizations. Depot neuroleptics also eliminate bioavailability problems related to absorption and first pass metabolism and give a stable plasma concentration. Finally, depot neuroleptics assure better and safer possibilities to use the lowest effective dose principle, thereby reducing the frequency of side effects, including the subjectively distressing mental side effects such as akathisia, dysphoria and neuroleptic‐induced deficit syndrome. Disadvantages include delayed disappearance of side effects after discontinuation and, for many patients, a feeling of being controlled. Administered in the proper way, with suitable information to the patient and relatives, depot neuroleptics improve the quality of the antipsychotic treatment, reduce relapse frequency, stabilize the therapeutic effect and diminish the level of side effects.
Psychoeducational and family therapy in relapse prevention
Authors: Goldstein M. J.
Published: August 2007

Recent shifts to briefer hospitalization and an emphasis on community care have emphasized the significance of patient‐family interactions in this phase of treatment. Psychoeducational family programs designed to increase medication compliance and effectiveness in coping with stressors have been successful in reducing the risk of relapse in the first year following hospital discharge. Various models for family intervention are discussed and their strengths and weaknesses evaluated.
Psychological therapies
Authors: Paykel E. S.
Published: August 2007

Psychological therapies for depression may have several different targets: symptom amelioration, relapse prevention, and improving social adaptation. For cognitive therapy the targets are mainly the first two of these, for dynamic psychotherapies particularly the third. In dysthymia, provision of a coping repertoire for a long term illness may also be important. There have been few controlled trials of psychological therapies in dysthymia, but one study has found benefit from marital therapy, and uncontrolled studies suggest some benefit from cognitive therapy. Controlled trials in other forms of depression of specific targeted psychotherapies, most commonly interpersonal psychotherapy, but also group, marital and family therapy, and social work, show benefit on social adjustment and some benefit on symptoms. Controlled trials of cognitive therapy show symptom benefit in milder depression, and strongly suggestive evidence of relapse reduction.
Cognitive dysfunctions and psychosocial treatment of schizophrenics: research of the past and perspectives on the future
Authors: Rund Bjørn Rishovd
Published: August 2007

First, family research with the focus on the concept of communication deviance is reviewed. Then, the link between family factors and cognitive characteristics in the offspring is elaborated on. Research on cognitive dysfunctions with a basis in a vulnerability model is the theme of the next section. Finally, psychosocial and cognitive treatment programmes are outlined and discussed.
Is the concept of schizophrenia useful from an aetiological point of view?
Authors: Kringlen Einar
Published: August 2007

In this selective review of findings from aetiological schizophrenia research, attention is focused on problems of classification and paradoxical observations in family and twin research, as well as interesting findings from high risk studies. The author raises the question if our modern classification of the functional severe mental disorders hampers aetiological research.
Searching for the phenotypes of schizophrenia
Authors: Cromwell Rue L. , Elkins Irene J. , McCarthy Margaret E. , O'Neil Terry S.
Published: August 2007

Use of clinical diagnosis as the phenotype for genetic study is discussed, and criteria for appropriate alternative phenotypes are presented. Then, recent research on four alternatives is discussed: (a) resistance to interference from an associative prime, (b) reaction time crossover, (c) creativity, and (d) socioeconomic achievement. It is concluded that resistance to interference from an associative prime and reaction time crossover at 3‐sec. preparatory interval level are the most promising of these candidates.
Personality deviations within the schizophrenia spectrum
Authors: Torgersen Svenn
Published: August 2007

The aim of this paper is to find out what kind of nonpsychotic personality features may have the same origin as schizophrenia and thus constitute a nonpsychotic alternative to schizophrenia. Family, twin and adoption studies are reviewed. The conclusion is that only schizotypal personality disorder seems to be etiologically related to schizophrenia. Among the schizotypal criteria, only eccentricity, affect constriction and excessive social anxiety are unequivocally a nonpsychotic, etiologically linked alternative to schizophrenia.
A cognitive model for schizophrenia and its possible neural basis
Authors: Hemsley David R.
Published: August 2007

It is proposed that the basic disturbance in schizophrenia corresponds to a disruption of the normal relationship between stored material and current sensory input. The link between information processing disturbances and their biological bases may be facilitated by the use of paradigms derived from animal learning theory. A model for the emergence of schizophrenic symptoms is presented. The core cognitive abnormality may result from a disturbance at any point in the neural circuit involved in the prediction of subsequent sensory input.
Psychology, psychologists, and psychiatric epidemiology
Authors: Dohrenwend Bruce P.
Published: August 2007

The purpose of this paper is to inquire into what interests psychologists might have in epidemiological approaches to the study of psychopathology, what psychologists have contributed in the past, and what they might be expected to contribute in the future. This inquiry starts with a consideration of epidemiological findings and issues that should command the interests of psychologists: differences between treated rates and untreated rates of psychiatric disorders, relations of psychiatric disorders to gender and socioeconomic status, and problems of case identification and diagnosis. My own experience with these issues and problems is discussed. An argument is made that there are important needs for the expertise of psychologists in psychiatric epidemiology and compelling reasons for them to enter the field in greater numbers than they have in the past.
Discussion of B.P. Dhorenwend: “Psychology, psychologists and psychiatric epidemiology”
Authors: Jablensky Assen
Published: August 2007

The author emphasizes the importance of earlier epidemiological studies and finds it a rather one‐sided view that psychiatric epidemiology, prior to DSM‐III and the ECA studies was in a pre‐scientific stage. In addition to the areas of interface between psychology and psychiatric epidemiology mentioned by Dohrenwend he adds the following areas: crosscultural studies, studies of gene‐environment interactions, the epidemiological validation of diagnostic and classification systems, and the study of the impact of various treatment and service systems and therapeutic approaches on the epidemiology of mental disorders.
Epidemiology and diagnostic systems in psychiatry
Authors: Mezzich Juan E.
Published: August 2007

Epidemiology and diagnosis are increasingly emerging as key topics in psychiatry. While each has particular roots, purposes and methods, a number of interesting points of contact can be elucidated. Bidirectional inter‐relations between these fields are being perceived as growing and promising. Modern approaches to diagnostic description have made possible the design of potent tools for epidemiological surveys, and results from the latter are contributing to the refinement of diagnostic profiles. The new international diagnostic systems, including multiaxial formulations not only of illness but of the patient's whole clinical condition, offer challenging opportunities for further interaction and progress.
A bio‐social model for common mental disorders
Authors: Goldberg David
Published: August 2007

It is argued that two major symptom dimensions underlie common mental disorders. These are depression related symptoms on the one hand, and anxious symptoms on the other. Each of these symptom dimensions is relate to a set of social variables, but an individual patient may have social factors present that are associated with each symptom dimension, thus producing an overlapping of symptoms. Another reason why the symptom dimensions overlap is that depression and anxiety relate to reward and punishment systems respectively, and these systems are necessarily reciprocally related to one another. Finally, each of these systems is related to abnormal activities in both nor‐adrenergic and 5‐hydroxytryptaminergic neurones. It is argued that in order to produce a useful model for common disorders one should distinguish between three groups of factors: those producing vulnerability to anxious or depressive symptoms, those factors releasing symptoms at a particular time, and those factors which determine how long illness lasts. These three groups of factors are respectively called vulnerability, destabilisation and restitution
Somatization in patients newly admitted to a neurological department
Authors: Ewald H. , Rogne T. , Ewald K. , Fink P.
Published: August 2007

The incidence of somatization and sociodemographic, clinical and mental factors in 100 consecutive patients newly admitted to a neurological department was investigated. Forty percent of the neurological inpatients were somatizers; they reported higher levels of distress and hypochondriacal concerns and were more often considered as having significant mental disorders by the neurologists. The somatizers were similar to patients with organic symptoms with respect to sociodemographic factors, duration of and number of symptoms, mode of admission and earlier consultations of psychiatric or other specialists. Most of the patients with somatization only believed that psychological factors influenced their somatic symptoms. No sex differences were found except that female somatizers had shorter duration of admission.
Obstetric complications in histories of monozygotic twins discordant and concordant for schizophrenia
Authors: McNeil T.F. , Cantor‐Graae E. , Torrey E.F. , Sjöström K. , Bowler A. , Taylor E. , Rawlings R. , Higgins E.S.
Published: August 2007

Histories of obstetric complications (OCs) during pregnancy, labor‐delivery and the neonatal period were investigated by detailed maternal report for 23 monozygotic (MZ) twin pairs discordant for schizophrenia, 10 MZ twin pairs concordant for schizophrenia and 7 normal MZ control pairs. Statistically significant differences in OC rates were found across these 3 groups, OCs being most frequent in discordant pairs and least frequent in normal control pairs. Labor complications were significantly more frequent in discordant than concordant pairs. Oc rates were equivalent in sick and well discordant twins. The results provide evidence for the role of OCs in the development of schizophrenia, complications at the time of birth being especially associated with the development of schizophrenia in discordant twins.