bluuebunny/crossref_metadata_2025 huggingface dataset:
Evolving methodologies in bipolar disorder maintenance research
Authors: Calabrese Joseph R. , Rapport Daniel J. , Shelton Melvin D. , Kimmel Susan E.
Published: August 2002

Background

During the development of a new treatment for bipolar disorder, maintenance studies are used to evaluate the ability of the putative mood stabiliser to prevent relapse and recurrence of further episodes. Comparisons with the early bipolar disorder maintenance studies indicate that the methodologies of recent trials have evolved substantially.

Aims

To review the methods used in the first- and second-generation maintenance studies, highlighting the differences of the various designs.

Method

Literature review.

Results

Methods that have evolved the most include patient enrolment, randomisation schemes and the use of outcome measures and statistical analyses. In addition, regulatory and commercial issues have also influenced study design.

Conclusion

There is little consensus on the methodology of bipolar disorder maintenance studies. As the integration of newer therapies into routine clinical practice is dependent on the evidence from controlled studies, it is essential that future maintenance trials in bipolar disorder achieve adequate methodological rigour without sacrificing overall feasibility.
Cognitive therapy as an adjunct to medication in bipolar disorder
Authors: Scott Jan
Published: August 2002

Background

There is increasing support for the use of cognitive behaviour therapy as an adjunct to medication for patients with bipolar disorder.

Aims

To explore current psychological models of bipolar disorder, describing the clinical rationale for using cognitive therapy and providing a brief overview of the approach.

Method

Results from outcome studies are discussed.

Results

Preliminary findings indicate that cognitive therapy may be beneficial for patients with bipolar disorder. The collaborative, educational style of cognitive therapy, the use of a stepwise approach and of guided discovery is particularly suitable for patients who wish to take an equal and active role in their therapy.

Conclusions

Randomised, controlled trials of cognitive therapy in bipolar disorder are required to establish the short-term and long-term benefits of therapy, and whether any reported health gain exceeds that of treatment as usual.
The Stanley Foundation Bipolar Network
Authors: Post Robert M. , Denicoff Kirk D. , Leverich Gabriele S. , Nolen Willem A. , Kupka Ralph W. , Keck Paul E. , McElroy Susan L. , Rush A. John , Suppes Trisha , Altshuler Lori L. , Frye Mark A. , Grunze Heinz , Walden Jörg
Published: August 2002

Background

The Stanley Foundation Bipolar Network (SFBN) was created to address the paucity of help studies in bipolar illness.

Aims

To describe the rationale and methods of the SFBN.

Method

The SFBN includes five core sites and a number of affiliated sites that have adopted consistent methodology for continuous longitudinal monitoring of patients. Open and controlled studies are performed as patients' symptomatology dictates.

Results

The reliability of SFBN raters and the validity of the rating instruments have been established. More than 500 patients are in continuous daily longitudinal follow-up. More than 125 have been randomised to one of three of the newer antidepressants (bupropion, sertraline and venlafaxine) as adjuncts in a study of mood stabilisers and 93 to omega-3 fatty acids. A number of open clinical case series have been published.

Conclusions

Well-characterised patients are followed in a detailed continuous longitudinal fashion in both opportunistic case series and double-blind, randomised controlled trials with reliable and validated measures.
The Stanley Foundation Bipolar Network
Authors: Kupka Ralph W. , Nolen Willem A. , Altshuler Lori L. , Frye Mark A. , Denicoff Kirk D. , Leverich Gabriele S. , Post Robert M. , Keck Paul E. , McElroy Susan L. , Rush A. John , Suppes Trisha
Published: August 2002

Background

The Stanley Foundation Bipolar Network (SFBN) evaluates treatments, course and clinical and neurobiological markers of response in bipolar illness.

Aims

To give a preliminary summary of emerging findings in these areas.

Method

Studies with established and potentially antimanic, antidepressant and mood-stabilising agents range from open case series to double-blind randomised clinical trials, and use the same core assessment methodology, thereby optimising the comparability of the outcomes. The National Institute of Mental Health Life Chart Method is the core instrument for retrospective and prospective longitudinal illness description.

Results

The first groups of patients enrolled show a considerable degree of past and present symptomatology, psychiatric comorbidity and functional impairment. There are associations of both genetic and early environmental factors with more severe courses of illness. Open case series with add-on olanzapine, lamotrigine, gabapentin or topiramate show a differential spectrum of effectiveness in refractory patients.

Conclusions

The SFBN provides important new data for the understanding and treatment of bipolar disorder.
Long-term clinical effectiveness of lithium maintenance treatment in types I and II bipolar disorders
Authors: Tondo Leonardo , Baldessarini Ross J. , Floris Gianfranco
Published: August 2002

Background

The effectiveness of lithium is being questioned increasingly and requires clarification.

Aims

To assess the effectiveness of lithium treatment in depression and mania, syndromal types I and II, with predominantly mixed or psychotic episodes or rapid cycling, during treatment resumed following discontinuation, and across three decades.

Method

The longitudinal course of 360 patients with bipolar disorder compliant with lithium treatment for at least 1 year and without comorbidity for substance use disorder was reviewed.

Results

Risk of single-episode recurrences, a common index of treatment failure, was similar to that in other reports. Both episode frequency and ‘time ill’ improved more in type II than type I cases. Reduced morbidity during treatment was similar in patients with mixed or psychotic episodes, or rapid cycling, and in less complex cases. Retreatment yielded minor decrements in response, and there was no tendency for lesser responses in more recent years.

Conclusions

Based on overall affective morbidity, long-term lithium treatment in compliant patients without comorbid substance use disorder, though imperfect, remains effective, even in subgroups of supposedly poor prognosis.
Bipolar disorder: clinical uncertainty, evidence-based medicine and large-scale randomised trials
Authors: Geddes John , Goodwin Guy
Published: August 2002

Background

The increasing use of the methods of evidence-based medicine to keep up-to-date with the research literature highlights the absence of high-quality evidence in many areas in psychiatry.

Aims

To outline current uncertainties in the maintenance treatment of bipolar disorder and to describe some of the decisions involved in designing a large simple trial.

Method

We describe some of the strategies of evidence-based medicine, and how they can be applied in practice, focusing specifically on the area of bipolar disorder.

Results

One of the key clinical uncertainties in the treatment of bipolar disorder is the place of maintenance drug treatments and their relative efficacy. A large-scale study, the Bipolar Affective Disorder: Lithium Anticonvulsant Evaluation (BALANCE) trial, is proposed to compare the effectiveness of lithium, valproate and the combination of lithium and valproate.

Conclusions

Providing reliable answers to key clinical questions in psychiatry will require new approaches to clinical trials. These will need to be far larger than previously appreciated and will therefore need to be collaborative ventures involving front-line clinicians.
Tryptophan depletion and its implications for psychiatry
Authors: Bell Caroline , Abrams Jolane , Nutt David
Published: August 2002

Background

Over the past 10 years the technique of tryptophan depletion has been used increasingly as a tool for studying brain serotonergic systems.

Aims

To review the technique of tryptophan depletion and its current status as a tool for investigating psychiatric disorders.

Method

Systematic review of preclinical and clinical studies.

Results

Tryptophan depletion produces a marked reduction in plasma tryptophan and consequently brain serotonin (5-HT) synthesis and release. In healthy volunteers the effects of tryptophan depletion are influenced by the characteristics of the subjects and include some mood lowering, some memory impairment and an increase in aggression. In patients with depression tryptophan depletion tends to result in no worsening of depression in untreated subjects but a relapse in those who have responded to antidepressants (particularly serotonergic agents). In panic disorder the results are similar.

Conclusions

The findings that tryptophan depletion produces a relapse of symptoms in patients with depression and panic disorder who have responded to treatment with antidepressants suggests that enhanced 5-HT function is important in maintaining response in these conditions.
International representation in psychiatric literature
Authors: Patel Vikram , Sumathipala Athula
Published: August 2002

Background

Despite the growing recognition of the global burden of psychiatric disease, there are questions about the strength of the evidence base from non-Western societies.

Aims

To compare the contribution of Euro-American countries and the rest of the world (RoW) to psychiatric literature.

Method

Survey of the country of origin of papers submitted to and published in six leading psychiatric journals over a 3-year period (1996–1998).

Results

Only 6% of the literature is published from regions of the world that account for over 90% of global population. The three journals published in Europe had a significantly higher proportion of international articles when compared to the three American journals. Less than 1% of all published articles described mental health interventions in the RoW. Acceptance rates were significantly lower for papers submitted from the RoW.

Conclusions

There is a gross under-representation of research from the RoW. This has implications for the development of a truly international psychiatry.
Structural brain abnormalities associated with deletion at chromosome 22q11
Authors: Van Amelsvoort Therese , Daly Eileen , Robertson Dene , Suckling John , Ng Virginia , Critchley Hugo , Owen Michael J. , Henry Jayne , Murphy Kieran C. , Murphy Declan G. M.
Published: August 2002

Background

Velo-cardio-facial syndrome (VCFS) is associated with deletions in the q11 band of chromosome 22, learning disability and psychosis, but the neurobiological basis is poorly understood.

Aims

To investigate brain anatomy in adults with VCFS.

Method

Magnetic resonance imaging was used to study 10 patients with VCFS and 13 matched controls. We carried out three analyses: qualitative; traced regional brain volume; and measurement of grey and white matter volume.

Results

The subjects with VCFS had: a high prevalence of white matter hyperintensities and abnormalities of the septum pellucidum; a significantly smaller volume of cerebellum; and widespread differences in white matter bilaterally and regional specific differences in grey matter in the left cerebellum, insula, and frontal and right temporal lobes.

Conclusions

Deletion at chromosome 22q11 is associated with brain abnormalities that are most likely neurodevelopmental and may partially explain the high prevalence of learning disability and psychiatric disorder in VCFS.
Predictors of later schizophrenia and affective psychosis among attendees at a child psychiatry department
Authors: Cannon Mary , Walsh Elizabeth , Hollis Christopher , Kargin Maresc , Taylor Eric , Murray Robin M. , Jones Peter B.
Published: August 2002

Background

Schizophrenia has been linked with psychological problems in childhood but there is little information on precursors of affective psychosis.

Aims

To compare childhood psychological antecedents of adult schizophrenia and affective psychosis.

Method

Childhood item sheets, which give standardised information on signs and symptoms of mental illness in the year preceding assessment are completed for all attendees at the children's department of the Maudsley and Bethlem Royal Hospital. We examined item sheet data on individuals with an adult diagnosis of schizophrenia (n=59) or affective psychosis (n=27) and a comparison group with no adult mental illness (n=86) (all had attended the department).

Results

Abnormal suspiciousness or sensitivity and relationship difficulties with peers are associated with later schizophrenia. In contrast, affective psychosis is associated with childhood hysterical symptoms and disturbances in eating.

Conclusions

Childhood psychological precursors for schizophrenia and affective psychosis differ and do not simply reflect non-specific psychiatric disturbance in adolescence.
Psychosocial characteristics and needs of mothers with psychotic disorders
Authors: Howard Louise M. , Kumar R. , Thornicroft Graham
Published: August 2002

Background

It is not known whether mothers with psychotic disorders are clinically and socially distinct from women with psychoses who have not had children.

Aims

To determine the proportion of mothers in an epidemiologically representative population of women with psychotic disorders, to examine the factors associated with having children, and to examine the factors associated with having children ‘looked after’ by social services.

Method

Descriptive analysis and two case–control studies.

Results

Sixty-three per cent of women with psychotic disorders were mothers. There were no clinical differences between women with or without children, but mothers were more likely to be older and live in unsupported accommodation. Having had a ‘looked after’ child was associated with Mental Health Act detention, younger age, a forensic history and being Black African.

Conclusion

Many women with psychoses are mothers. Mothers with psychoses are as disabled and have as many needs as women with psychoses without children.
Aggressive incidents in first-episode psychosis
Authors: Milton John , Amin Shazad , Singh Swaran P. , Harrison Glynn , Jones Peter , Croudace Tim , Medley Ian , Brewin John
Published: August 2002

Background

Recent research has reported increased risk of aggressive incidents by individuals with psychotic illness.

Aims

To examine acts of aggression in first-episode psychosis.

Method

Subjects with a first-episode psychosis were ascertained from a defined catchment area (Nottingham, UK) and reassessed at 3 years (n=166) using clinical interview, informants, health care and forensic records.

Results

Of the subjects, 9.6% demonstrated at least one act of serious aggression (defined as weapon use, sexual assault or victim injury) during at least one psychotic episode and 23.5% demonstrated lesser acts of aggression (defined as all other acts of aggression). For all aggressive subjects (33.1%), unemployment (OR=3.6, 95%CI 1.6–8.0), comorbid substance misuse (OR=3.1, CI 1.1–8.8) and symptoms of overactivity at service contact (OR=6.9, CI 2.7–17.8) had independent effects on risk of aggression.

Conclusions

We confirmed some previously reported demographic and clinical associations with aggression in first-episode psychosis but no relationship with specific psychotic symptoms or diagnostic groups was observed.
Factors that influence the cost of caring for patients with severe psychotic illness
Authors: Byford Sarah , Barber Julie A. , Fiander Matthew , Marshall Sarah , Green John
Published: August 2002

Background

Many factors influence the type and quantity of services received by patients and, thus, the total cost of care. Knowledge of these factors can aid budgetary and service-planning decisions.

Aims

To investigate factors that influence the cost of caring for patients with severe psychotic illness.

Method

Univariate and multivariate analyses were used to examine associations between baseline characteristics and subsequent 2-year total direct costs in 667 patients from the UK700 case management trial.

Results

Significantly more money was spent on younger patients, those with longer duration of illness, those who had spent less time living independently and those who had spent longer in hospital for psychiatric reasons.

Conclusions

Total costs of caring for patients with severe psychotic illness appear to be influenced to a large extent by age, duration of illness and past levels of dependence on statutory services. The strength of these relationships is greater than the impact of illness severity.
Effects of rapid tryptophan depletion on brain 5-HT2receptors: a PET study
Authors: Yatham Lakshmi N. , Liddle Peter F. , Shiah I-Shin , Lam Raymond W. , Adam Michael J. , Zis Athanasios P. , Ruth Thomas J.
Published: August 2002

Background

The mechanism by which rapid tryptophan depletion (RTD) paradigm induces depressive relapse in recently remitted patients with depression is unknown.

Aims

To determine the effects of RTD on brain 5-HT2receptors using positron emission tomography (PET) and18F-labelled setoperone.

Method

Ten healthy women underwent two PET scans. Each scan was done 5 h after the ingestion of either a balanced or a tryptophan-deficient amino acid mixture, and the two test sessions were separated by at least 5 days.

Results

The RTD decreased plasma free tryptophan levels significantly but it had no significant effects on mood. Subjects showed a significant decrease in brain 5-HT2receptor binding in various cortical regions following the RTD session.

Conclusions

When taken with the evidence that antidepressant treatment is associated with a decrease in brain 5-HT2receptors, these findings suggest that a decrease in 5-HT2binding following RTD might be an adaptive response that provides protection against depressive symptoms.
Decreased sensitivity of 5-HT1D receptors in melancholic depression
Authors: Whale Richard , Clifford Elizabeth M. , Bhagwagar Zubin , Cowen Philip J.
Published: August 2002

Background

Brain serotonin (5-HT) function is abnormal in major depression, but the involvement of different 5-HT receptor subtypes has been little studied. The availability of selective ligands now makes it possible to test the sensitivity of 5-HT1D receptors in patients with depression.

Aims

The aim of the study was to use the 5-HT1D receptor agonist, zolmitriptan, to test the sensitivity of 5-HT1D receptors in patients with depression before and after treatment with selective serotonin reuptake inhibitors (SSRIs).

Method

We measured the growth hormone response to zolmitriptan (5 mg orally) in patients with major depression before and after SSRI treatment. A matched sample of healthy subjects acted as a control group.

Results

The growth hormone response to zolmitriptan was blunted in patients with a melancholic depressive syndrome. SSRI treatment produced a marked reduction in zolmitriptan-induced growth hormone release.

Conclusions

Patients with melancholic depression have impaired sensitivity of the post-synaptic 5-HT1D receptors that mediate growth hormone release. The reduction in 5-HT1D receptor sensitivity following SSRI treatment is probably an adaptive response to increased levels of synaptic 5-HT.
Relationship of suicide rates to social factors and availability of lethal methods
Authors: Schapira Kurt , Linsley K. R. , Linsley J. A. , Kelly T. P. , Kay D. W. K.
Published: August 2002

Background

The UK Government's White Paper Saving Lives: Our Healthier Nation included among its targets a reduction in suicide.

Aims

To study causes of change in suicide rate over a 30-year period in Newcastle upon Tyne.

Method

Suicide rates and methods, based on coroners' inquest records, were compared over two periods (1961–1965 and 1985–1994) and differences were related to changes in exposure to poisons and prescribed drugs, and to socio-demographic changes.

Results

Demographic and social changes had taken place which would adversely affect suicide rates. However, a dramatic fall was found in the rate for women, and a modest decline in that for men. Reduced exposure to carbon monoxide and to barbiturates coincided with the fall in rates.

Conclusions

Reduced exposure to lethal methods was responsible for the fall in rate in both genders, while the gender difference in favour of women may be related to their preference for non-violent methods or to their being less affected by the social changes.
Open verdict v. suicide – importance to research
Authors: Linsley K. R. , Schapira Kurt , Kelly T. P.
Published: August 2002

Background

Open verdicts are often included in with suicides for research purposes and for setting health targets.

Aims

To examine similarities and differences in cases defined by the coroner as suicide and open verdicts and the implications of open verdicts for suicide research.

Method

All cases of open and suicide verdicts recorded in the Newcastle Coroner's Court in the period 1985–1994 were compared on demographic and medical parameters.

Results

Open and suicide verdicts had many similarities, differing only in some respects, of which logistic regression identified the most significant to be a suicide note, method used and age.

Conclusions

Open verdicts should be included in all suicide research after excluding cases in which suicide was unlikely. Objective criteria are needed to facilitate comparison between different studies.
Suicide in children and adolescents in England and Wales 1970–1998
Authors: McClure G. M. G.
Published: August 2002

Background

Suicide rates for England and Wales have been decreasing recently, but rates for young adult males remain high.

Aims

To review changes in suicide rates for children and adolescents in England and Wales between 1970 and 1998.

Method

Rates for suicide, ‘accidental’ death by causes similar to suicide and ‘undetermined’ death for 10–14- and 15–19-year-olds are calculated between 1970 and 1998 using suicide data and estimated mid-year populations obtained from the Office for National Statistics.

Results

There has been a substantial increase in suicide rate between the 1970s and the 1990s for males aged 15–19 years. This remains true even when ‘undetermined’ and ‘accidental’ death rates for causes similar to suicide are examined. The increase was associated with an increase in self-poisoning with vehicle exhaust gas in the 1980s and an increase in hanging which has continued into the 1990s. Although there was a slight decrease in the official suicide rate for females aged 15–19 years, ‘undetermined’ deaths increased. There is no indication of a major change in suicide rate in 10–14-year-olds.

Conclusions

The substantial increase in suicide rate in 15–19-year-old males may indicate increased psychosocial stress, particularly affecting this group.
Community mental health team management in severe mental illness: A systematic review
Authors: Simmonds Shaeda , Coid Jeremy , Joseph Philip , Marriott Sarah , Petertyrer
Published: August 2002

Background

Community mental health teams are now generally recommended for the management of severe mental illness but a comparative evaluation of their effectiveness is lacking.

Aims

To assess the benefits of community mental health team management in severe mental illness.

Method

A systematic review was conducted of community mental health team management compared with other standard approaches.

Results

Community mental health team management is associated with fewer deaths by suicide and in suspicious circumstances (odds ratio=0.32, 95% CI 0.09–1.12), less dissatisfaction with care (odds ratio=0.34, 95% CI 0.2–0.59) and fewer drop-outs (odds ratio=0.61, 95% CI 0.45–0.83). Duration of in-patient psychiatric treatment is shorter with community team management and costs of care are less, but there are no gains in clinical symptomatology or social functioning.

Conclusions

Community mental health team management is superior to standard care in promoting greater acceptance of treatment, and may also reduce hospital admission and avoid deaths by suicide. This model of care is effective and deserves encouragement.
Recovery from psychotic illness: A 15- and 25-year international follow-up study
Authors: Harrison G. , Hopper K. , Craig T. , Laska E. , Siegel C. , Wanderling J. , Dube K. C. , Ganev K. , Giel R. , Der Heiden W. An , Holmberg S. K. , Janca A. , Lee P. W. H. , León C. A. , Malhotra S. , Marsella A. J. , Nakane Y. , Sartorius N. , Shen Y. , Skoda C. , Thara R. , Tsirkin S. J. , Varma V. K. , Walsh D. , Wiersma D.
Published: August 2002

Background

Poorly defined cohorts and weak study designs have hampered cross-cultural comparisons of course and outcome in schizophrenia.

Aims

To describe long-term outcome in 18 diverse treated incidence and prevalence cohorts. To compare mortality, 15- and 25-year illness trajectory and the predictive strength of selected baseline and short-term course variables.

Method

Historic prospective study. Standardised assessments of course and outcome.

Results

About 75% traced. About 50% of surviving cases had favourable outcomes, but there was marked heterogeneity across geographic centres. In regression models, early (2-year) course patterns were the strongest predictor of 15-year outcome, but recovery varied by location; 16% of early unremitting cases achieved late-phase recovery.

Conclusions

A significant proportion of treated incident cases of schizophrenia achieve favourable long-term outcome. Sociocultural conditions appear to modify long-term course. Early intervention programmes focused on social as well as pharmacological treatments may realise longer-term gains.
Patterns and predictors of hospitalisation in first-episode psychosis
Authors: Sipos Attila , Harrison Glynn , Gunnell David , Amin Shazad , Singh Swaran P.
Published: August 2002

Background

Little is known about predictors of hospitalisation in patients with first-episode psychosis.

Aims

To identify the pattern and predictors of hospitalisation of patients with a first psychotic episode making their first contact with specialist services.

Method

Three-year follow-up of a cohort of 166 patients with a first episode of psychosis making contact with psychiatric services in Nottingham between June 1992 and May 1994.

Results

Eighty-eight (53.0%) patients were admitted within 1 week of presentation; 32 (19.3%) were never admitted during the 3 years of follow-up. Manic symptoms at presentation were associated with an increased risk of rapid admission and an increased overall risk of admission; negative symptoms and a longer duration of untreated illness had an increased risk of late admission.

Conclusions

Community-oriented psychiatric services might only delay, rather than prevent, admission of patients with predominantly negative symptoms and a longer duration of untreated illness. First-episode studies based upon first admissions are likely to be subject to selection biases, which may limit their representativeness.
Neurodevelopmental indices and the development of psychotic symptoms in subjects at high risk of schizophrenia
Authors: Lawrie Stephen M. , Byrne Majella , Miller Patrick , Hodges Ann , Clafferty Robert A. , Owens David G. Cunningham , Johnstone Eve C.
Published: August 2002

Background

Neurological ‘soft signs’ and minor physical anomalies (MPAs) are reported to be more frequent in patients with schizophrenia than in controls.

Aims

To determine whether these disturbances are genetically mediated, and whether they are central to the genesis of symptoms or epiphenomena.

Method

We obtained ratings in 152 individuals who were antipsychotic drug-free and at high risk, some of whom had experienced psychotic symptoms, as well as 30 first-episode patients and 35 healthy subjects.

Results

MPAs and Neurological Evaluation Scale (NES) ‘sensory integration abnormalities’ were more frequent in high-risk subjects than in healthy controls, but there were no reliable differences between high-risk subjects with and without psychotic symptoms. MPAs were most frequent in high-risk subjects with least genetic liability and NES scores showed no genetic associations.

Conclusions

The lack of associations with psychotic symptoms and genetic liability to schizophrenia suggests that soft signs and physical anomalies are non-specific markers of developmental deviance that are not mediated by the gene(s) for schizophrenia.
The Wessex Recent In-Patient Suicide Study, 1
Authors: King Elizabeth A. , Baldwin David S. , Sinclair Julia M. A. , Baker Nigel G. , Campbell Michael J. , Thompson Chris
Published: August 2002

Background

Psychiatric patients have a higher suicide risk following hospital discharge.

Aims

To identify social, clinical and health-care delivery factors in recently discharged patients.

Method

Retrospective case-control study of 234 patients who died within 1 year of hospital discharge, matched for age, gender, diagnosis and admission period with 431 controls. Odds ratios for identified risk factors were calculated using conditional multiple logistic regression.

Results

Independent increased-risk factors were: not being White; living alone; history of deliberate self-harm (DSH); suicidal ideation precipitating admission; hopelessness; admission under different consultant; onset of relationship difficulties; loss of job; in-patient DSH; unplanned discharge; significant care professional leaving/on leave. Reduced-risk factors were: shared accommodation; delusions at admission; misuse of non-prescribed substances; and continuity of contact.

Conclusions

Continuity of contact may reduce suicide risk. Discontinuity of care from a significant professional is associated with increased risk of suicide.
The Wessex Recent In-Patient Suicide Study, 2
Authors: King Elizabeth A. , Baldwin David S. , Sinclair Julia M. A. , Campbell Michael J.
Published: August 2002

Background

Psychiatric patients have an elevated risk of suicide while in hospital.

Aims

To compare social, clinical and health-care delivery factors in in-patient and out-patient suicides and their controls.

Method

Retrospective case-control study of 59 in-patients and 106 controls, matched for age, gender, diagnosis and admission date. Odds ratios were calculated using conditional multiple logistic regression.

Results

There were seven independent increased-risk factors: history of deliberate self-harm, admission under the Mental Health Act, involvement of the police in admission, depressive symptoms, violence towards property, going absent without leave and a significant care professional being on leave. When compared with out-patient suicides, in-patients were more often female and male in-patients had a psychotic illness. Unlike the out-patient suicides, social factors were not found to be significant.

Conclusions

The characteristics of inpatient and out-patient suicides differ. Identified risk factors have relatively low sensitivity and specificity.
Two-year follow-up after a randomised controlled trial of self- and clinician-accompanied exposure for phobia/panic disorders
Authors: Park Je-Min , Mataix-Cols David , Marks Isaac M. , Ngamthipwatthana Thienchai , Marks Melanie , Araya Ricardo , Al-Kubaisy Tarik
Published: August 2002

Background

Long-term follow-up has rarely been reported after self-exposure therapy for phobias.

Aims

Completion of such a follow-up.

Method

Two-year follow-up was achieved in 68 (85%) of 80 patients with phobias who had completed a previous 14-week randomised controlled trial comparing therapist-accompanied self-exposure, self-exposure or self-relaxation. Measures were self-reported ratings of symptoms, satisfaction and use of other treatment.

Results

Improvement at week 14 was maintained 2 years later. Clinician-accompanied exposure and self-exposure did not differ on any measure. Compliance with self-exposure homework during weeks 0–8 predicted more improvement 2 years later. Patients who failed to improve with relaxation by week 14 improved after subsequent crossover to exposure. A need for more treatment for their phobias was still felt by 33 patients (49%).

Conclusions

Patients with phobias maintained their improvement to 2-year follow-up after the end of self-exposure therapy.
Sensation-seeking, life events and depression
Authors: Farmer Anne , Redman Kate , Harris Tanya , Mahmood Arshad , Sadler Stephanie , McGuffin Peter
Published: August 2002

Background

The relationship between adversity and genetic risk factors in depression could be mediated by familial ‘hazard prone’ traits, as reflected in high levels of sensation-seeking.

Aims

To examine whether high sensation-seeking scores are associated with more adverse life events resulting in depression.

Method

In a sib-pair design, 108 probands with depression and their siblings and 105 healthy control subjects and their siblings were compared for psychopathology, life events and scores on the Sensation-Seeking Questionnaire (SSQ).

Results

The SSQ scores were correlated negatively with depression, were familial and were correlated positively with less severe events, but not the severe events typically associated with depressive onsets.

Conclusions

The SSQ measures a familial personality trait and depression is associated with lower scores. Although high sensation-seeking is associated with a higher rate of life events, these carry little threat.
Association of hypotension with positive and negative affect and depressive symptoms in the elderly
Authors: Jorm Anthony F.
Published: August 2002

Background

Previous research associating hypotension with depression has produced inconsistent results. A possible reasons is that depressive symptom scales reflect both high negative affect and low positive affect.

Aims

To examine the association of hypotension with depressive symptoms, negative affect and positive affect.

Method

Community survey of 340 elderly persons aged 77–99 years.

Results

Diastolic hypotension had a weak association with depression, no association with negative affect and a strong inverse association with positive affect. Systolic hypertension was associated with positive affect. Use of antihypertensive medication was independently associated with lower positive affect.

Conclusions

Diastolic hypotension shows a specific association with low positive affect. This association may explain the weak and inconsistent results of earlier studies relating hypotension to depression.
Incidence, correlates and predictors of post-traumatic stress disorder in the pregnancy after stillbirth
Authors: Turton P. , Hughes P. , Evans C. D. H. , Fainman D.
Published: August 2002

Background

Many women may suffer psychological symptoms after stillbirth and in the subsequent pregnancy. Stillbirth has not been demonstrated previously to be a stressor for post-traumatic stress disorder (PTSD).

Aims

To assess incidence, correlates and predictors of PTSD during and after the pregnancy following stillbirth.

Method

A cohort study of pregnant women whose previous pregnancy ended in stillbirth.

Results

PTSD symptoms were prevalent in the pregnancy following stillbirth. Case-level PTSD was associated with depression, state-anxiety and conception occurring closer to loss. Symptomsgenerally resolved naturally by 1 year postpartum (birth of healthy baby).

Conclusions

Women are vulnerabe to PTSD in the pregnancy subsequent to stillbirth, particularly when conception occurs soon after the loss.
Value of HoNOS in assessing patient change in NHS psychotherapy and psychological treatment services
Authors: Audin Kerry , Margison Frank R. , Clark John Mellor , Barkham Michael
Published: August 2002

Background

Little research on the value of Health of the Nation Outcome Scales (HoNOS) has occurred in out-patient settings, particularly psychotherapy services.

Aims

To determine whether HoNOS provides an adequate assessment for psychotherapy services which is sensitive to change.

Methods

HoNOS ratings from 1688 patients from eight out-patient psychotherapy services were collected. Of these, 362 also had ratings post-treatment. Mean scores, pre- to post-treatment differences, and reliable and clinically significant change criteria were calculated for HoNOS items and for total scores.

Results

The mean total HoNOS rating was 8.93, which is comparable to psychiatric out-patients. Only three items showed sufficient variability to use in assessing pre- to post-treatment change.

Conclusions

Significant limitations were found in rating items that commonly present to psychotherapists. The lack of variability in most items limits HoNOS's usefulness in this population.
Cross-cultural implementation of a Chinese version of the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) in Taiwan
Authors: Cheng A. T. A. , Tien A. Y. , Chang C. J. , Brugha T. S. , Cooper J. E. , Lee C. S. , Compton W. , Liu C. Y. , Yu W. Y. , Chen H. M.
Published: August 2002

Background

There are no published reports of cross-cultural equivalence and interrater reliability at the level of individual symptom items assessed by a semi-structured clinical interview employing operationalised clinician ratings.

Aims

To assess the cross-cultural clinical equivalence and reliability of a Chinese version of the World Health Organization Schedules for Clinical Assessment in Neuropsychiatry (SCAN).

Method

UK-US and Taiwanese groups of psychiatrists used Chinese and English transcripts of videotape interviews of Taiwanese patients to discuss cross-cultural issues and ratings of SCAN items. Item ratings were compared quantitatively individually and pooled by SCAN section.

Results

Chinese equivalents were found for all SCAN items. No between-group differences were found for most individual items, but there were differences for some scaled items. Average agreement between the two groups was 69–100%.

Conclusions

Cross-cultural implementation based on SCAN in Taiwan appears valid.
Somatoform disorders: severe psychiatric illnesses neglected by psychiatrists
Authors: Bass Christopher , Peveler Robert , House Allan
Published: August 2002

Background

Somatoform disorders have few peers in terms of personal morbidity and cost to the health service, yet many psychiatrists train without any experience of them.

Aims

To review the prevalence, disability and economic burden of somatoform disorders, and to explore the reasons why they are neglected by psychiatrists.

Method

A selective review of the key literature.

Results

Psychiatrists' current preoccupation with so-called ‘serious mental illness’ gives somatoform disorders low priority. Some health planners have erroneously equated severity with diagnosis rather than level of need and disability. As a consequence the development of psychiatric services has been neglected.

Conclusions

Greater recognition of the importance of somatoform disorders will only occur if high quality research and teaching receive priority, and if the Royal Colleges continue to press for increasing public awareness of their importance. Services should be driven by clinical need rather than diagnosis.
Venlafaxine Extended Release (ER) in the Treatment of Generalised Anxiety Disorder
Authors: Allgulander Christer , Hackett David , Salinas Eliseo
Published: August 2002

Background

Generalised anxiety disorder (GAD) has received less study than other anxiety disorders, particularly its long-term treatment.

Aims

To assess the efficacy and safety of venlafaxine extended release (ER) in patients with GAD.

Method

A total of 541 out-patients, 18–86 years old, were recruited to this 24-week, placebo-controlled, double-blind study of three fixed doses (37.5, 75 and 150 mg/day) of venlafaxine ER.

Results

All doses of venlafaxine ER showed efficacy superior to placebo, apparent from week 2, that was sustained throughout the 24-week study for the two higher doses. The discontinuation rate did not differ significantly among the treatment groups.

Conclusions

Venlafaxine ER is an effective and safe treatment for GAD for up to 6 months.
Randomised controlled general practice trial of sertraline, exposure therapy and combined treatment in generalised social phobia
Authors: Blomhoff S. , Haug T. T. , Hellström K. , Holme I. , Humble M. , Madsbu H. P. , Wold J. E.
Published: August 2002

Background

No controlled trial of treatment of generalised social phobia has been conducted in general practice.

Aims

To examine the efficacy of sertraline or exposure therapy, administered alone or in combination in this setting.

Method

Study was of a randomised, double-blind design. Patients (n=387) received sertraline 50–150 mg or placebo for 24 weeks. Patients were additionally randomised to exposure therapy or general medical care.

Results

Sertraline-treated patients were significantly more improved than non-sertraline-treated patients (χ2=12.53,P<0.001; odds ratio=0.534; 95% CI 0.347–0.835). No significant difference was observed between exposure— and non-exposure-treated patients (χ2=2.18,P=0.140; odds ratio=0.732; 95% CI 0.475–1.134). In the pairwise comparisons, combined sertraline and exposure (χ2=12.32;P<0.001) and sertraline (χ2=10.13;P=0.002) were significantly superior to placebo.

Conclusions

Sertraline is an effective treatment for generalised social phobia. Combined treatment with sertraline and exposure therapy, conducted by the general practitioner, may enhance the treatment efficacy in primary care.
Seasonal affective disorder: prevalence, detection and current treatment in North Wales
Authors: Michalak Erin E. , Wilkinson Clare , Dowrick Chris , Wilkinson Greg
Published: August 2002

Background

There is a paucity of information concerning the prevalence and detection of seasonal affective disorder (SAD) in UK populations.

Aims

To determine the prevalence, detection and current treatment of SAD within a general population sample.

Method

The study was conducted in conjunction with the Outcomes of Depression International Network (ODIN) project, a large European study of depression. At the North Wales arm of the project, 1999 adults were randomly selected from a health authority database and screened by post for SAD with the Seasonal Patterns Assessment Questionnaire (SPAQ). Those scoring above cut-off were offered diagnostic interview, after which diagnosis of SAD according to DSM–IV criteria could be made.

Results

The prevalence rate of SAD was calculated to be 2.4% (95% CI 1.4–1.3). The majority of identified cases had not previously received a diagnosis of SAD from their general practitioner, although over half had been diagnosed with other forms of depression and had been prescribed antidepressant medication.

Conclusions

Although SAD was found to be common in this general population sample it appeared to be largely underdiagnosed and/or misdiagnosed.
Cigarette smoking and psychotic symptoms in bipolar affective disorder
Authors: Corvin Aiden , O'Mahony Ed , O'Regan Myra , Comerford Claire , O'Connell Robert , Craddock Nick , Gill Michael
Published: August 2002

Background

An association exists between smoking and schizophrenia, independent of other factors and related to psychotic symptomatology.

Aims

To determine whether smoking is associated with psychosis in bipolar affective disorder.

Method

Smoking data were collected from 92 unrelated patients with bipolar affective disorder. An ordinal logistic regression analysis tested the relationship between smoking severity and psychotic symptomatology, allowing for potential confounders.

Results

A significant relationship was detected between smoking/heavy smoking and history of psychosis (68.7%, n=44). Smoking was less prevalent in patients who were less symptomatic (56.5%, n=13) than in patients with a more severe psychosis (75.7%, n=31). Prevalence and severity of smoking predicted severity of psychotic symptoms (P=0.001), a relationship independent of other variables (P=0.0272).

Conclusion

A link between smoking and psychosis exists in bipolar affective disorder and may be independent of categorical diagnosis.
Twin study of symptom dimensions in psychoses
Authors: Cardno Alastair G. , Sham Pak C. , Murray Robin M. , McGuffin Peter
Published: August 2002

Background

Symptomatology in psychoses can be summarised as quantitative symptom dimensions, but their genetic basis is unknown.

Aims

To investigate whether genes make an important contribution to symptom dimensions.

Method

A total of 224 probandwise twin pairs (106 monozygotic, 118 same-gender dizygotic) where probands had psychosis were ascertained from the Maudsley Twin Register in London. Factor analysis was performed on lifetime symptoms rated on the Operational Checklist for Psychotic Disorders (OPCRIT). Correlations of dimension scores within monozygotic and dizygotic pairs concordant for Research Diagnostic Criteria psychoses were performed. Relationships between dimension scores and genetic loading for psychoses were assessed using logistic regression.

Results

Patterns of familial aggregation consistent with a genetic effect were found for the disorganised dimension and for some measures of the negative, manic and general psychotic dimensions. Disorganised dimension scores were related significantly to genetic loading for psychoses.

Conclusions

The disorganised dimension, and possibly other symptom dimensions, may be useful phenotypes for molecular genetic studies of psychoses.
Family history, place and season of birth as risk factors for schizophrenia in Denmark: A replication and reanalysis
Authors: Pedersen Carsten Bøcker , Mortensen Preben Bo
Published: August 2002

Background

Although a family history of schizophrenia is the strongest individual risk factor for schizophrenia, environmental factors related to urbanicity may contribute to a substantial proportion of the population occurrence of the disease.

Aims

This study replicates previous findings in four mutually exclusive Danish study populations, including out-patient information, ICD–10 diagnoses of schizophrenia, and a broader adjustment for mental illness in family members.

Method

We established a population-based cohort of 2.66 million Danish people using data from the Civil Registration System linked with the Psychiatric Case Register.

Results

Overall, 10 264 persons developed schizophrenia during the 50.7 million person-years of follow-up. The risk of schizophrenia was increased by urbanicity of place of birth and by family history of schizophrenia or other mental disorders.

Conclusions

Urban–rural differences of schizophrenia risk were replicated and could not be associated with the potential sources of bias we assessed. Environmental factors underlying the effect of place of birth are major determinants of schizophrenia occurrence at the population level, although the effect of family history is the strongest at the individual level.
Social Functioning and the Course of Early-Onset Schizophrenia
Authors: Lenior Marie E. , Dingemans Peter M. A. J. , Linszen Don H. , De Haan Lieuwe , Schene Aart H.
Published: August 2002

Background

Schizophrenia implies severe social impairments. Since the treatment of patients with schizophrenia shifted from long-term hospital admissions to community services, research on social functioning has become increasingly important.

Aims

Follow-up assessment of social functioning in young patients with schizophrenia during a 5-year period after intervention.

Method

During intervention, families were randomised into two conditions: standard intervention and standard plus family intervention.

Results

Although no differential treatment effect with regard to the course of the illness was found, patients from the standard plus family intervention condition stayed for fewer months in institutions for psychiatric patients than patients from the standard intervention condition.

Conclusions

Family intervention has helped parents to support their children, thereby diminishing institutional care.