bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic systems for schizophrenia
Authors: Kulhara P. , Mattoo S. K. , Chandiramani K. , Bhave S. , Awasthi A.
Published: August 2007

ABSTRACT In a cross‐sectional study, five diagnostic systems for schizophrenia: CATEGO, Research Diagnostic Criteria, DSM‐III, Feighner's Criteria, and Schneider's First Rank Symptoms, were evaluated for their usefulness, comprehensiveness and concordance, using a clinical diagnosis conforming to the ICD‐9 concept of schizophrenia. The sample consisted of 112 patients. It was found that all the diagnostic systems had good agreement with the index diagnosis. The rate of concordance among the systems varied. The advantages and limitations of each system and its usefulness in Indian context are discussed.
Epidemiology of benzodiazepine dependence
Authors: Fleischhacker W. W. , Barnas C. , Hackenberg B.
Published: August 2007

ABSTRACT The charts of 10,861 patients of the Innsbruck University Department of Psychiatry were evaluated for this study. The patients were in‐ and outpatients admitted between January 1978 and September 1981. WHO criteria were used for the diagnosis of dependence. 1,743 inpatients and 2,130 outpatients were dependent on psychotropic substances (most of them being alcoholics). 57 (1.1 %) resp. 73 (1.3 %) suffered from polydrug abuse including benzodiazepines. Only nine inpatients and 21 outpatients were addicted to benzodiazepines only. Details of benzodiazepine dependence are discussed.
Psychosocial aspects of coronary heart disease
Authors: Kringlen E.
Published: August 2007

ABSTRACT Attention is drawn to studies which throw doubt upon the importance of nutrition and smoking in the etiology of coronary heart disease (CHD). The main part of the review deals with psychosocial research in the field of CHD. A number of studies show that there is a clearcut association between life style, life events, social class, economic cycles, culture and CHD. The modern coronary epidemic is related to the economic boom which the US experienced during the 1940‐60s and which followed a decade later in Western Europe. The later decline of CHD is related to the economic stagnation that took place in the US at the end of the 1960s. Obviously, risk factors must be seen in a cultural perspective, and the moderating effects of social support should be taken into account.
Continuity of formal thought disorder from childhood to adulthood in a high‐risk sample
Authors: Parnas J. , Schulsinger H.
Published: August 2007

ABSTRACT Within a longitudinal prospective study of children of schizophrenic mothers, premorbid, childhood levels of formal thought disorder correlated positively with measures of formal thought disorder obtained in adulthood. It is therefore concluded that schizophrenic symptomatology develops by gradual accretion and that schizophrenia is not a sudden, unexpected disease. Orthogonal factor analysis of formal thought disorder measures obtained in adulthood revealed two factors: one reflecting vague and drifting thinking, and the second relating to the richness of speech.
Personality in depression: concordance between clinical assessment and questionnaires
Authors: Bech P. , Jørgensen B. , Jeppesen K. , Poulsen D Loldrup , Vanggaard T.
Published: August 2007

ABSTRACT The concordance between Vanggaard's concept of character neurosis and three personality questionnaires (Marke‐Nyman Temperament Scale, Cesarec‐Marke Personality Scale, and Eysenck Personality Questionnaire) was evaluated in 73 patients who were treated for a major depression in general practice. After an interview with the patients Vanggaard classified 57 of them to be without character neurosis, and the remaining 16 patients were considered to have a character neurosis. It was found that Eysenck's Neuroticism scale significantly corresponded to Vanggaard's classification. Among the other personality scales Acquiescence and Autonomy were the most important. Studies on the predictive validity of these subscales are in progress.
Stability of treatment outcome in short‐term psychiatric care
Authors: Hansson L. , Berglund M. , Öhman R.
Published: August 2007

ABSTRACT The general trend of avoiding and shortening in‐patient treatment raises the question of the stability of treatment gains made during hospitalization. A 6‐month follow‐up was made for patients treated on a short‐term psychiatric ward. The origin was a controlled study of two models of patient involvement in treatment planning. Patients benefiting most from a cooperation procedure during hospitalization were those with socio‐psychological treatment objectives and those treated in a Basic Activation Group on the ward. The superior outcome for these patients was not stable during the period of follow‐up, resulting in an incongruence between in‐hospital and post‐hospital adjustment. Furthermore, these patients at time of follow‐up showed an increased confidence in the staff of the ward and a decrease in the rated importance of their social network. It is suggested that this is the result of dependency reactions and a separation process from the therapeutic milieu of the ward which were not resolved at time of discharge. Greater concern should be invested in formulating the treatment contract in an out‐patient context in order to place the emphasis on the real life situation of the patient.
The effect of lithium on platelet count
Authors: Balon R. , Berchou R. , Lycaki H. , Pohl R. B.
Published: August 2007

The effect of lithium on platelet count was studied by examing 12 patients treated with lithium carbonate without any additional medication, 13 patients treated with lithium carbonate with additional psychotropic medication, 25 patients with major affective disorder prior to any treatment, 25 patients with panic disorder prior to any treatment and 25 healthy controls. The platelet counts were increased in the group of subjects treated with lithium carbonate without any additional psychotropic medication. The increase was not clinically significant.
Experiences from a marital‐sex therapy clinic in Nairobi
Authors: Ndetei D. M. , Wazome E. G. M.
Published: August 2007

Out of 100 first referrals to a newly started family/marital ‐ sex therapy clinic in Nairobi, 52 cases were studied for sociodemographic characteristics, help‐seeking pattern for their sexual problems, presentation of the sexual problems, factors that might sustain the sexual problems, types of sexual problems and the treatment approaches. There was a male preponderance. Both married and non‐married patients were seen. The problems tended to occur in relatively young people, and for those who were married in relatively early years of their marriage. The patients attributed the causes of the sexual problems to physical rather than psychological factors, although objective assessment found relatively very few possible physical causes. Elementary rather than subtle psychological causes were frequent. These formed fertile grounds for intervention. The findings are discussed in the light of the social‐cultural context in which they were obtained.
Detection of physical disorder in newly admitted psychiatric patients
Authors: Ferguson B. , Dudleston K.
Published: August 2007

Screening tests for the detection of physical illness in 650 newly admitted psychiatric patients were examined critically. Almost 17% of these investigations were found to be abnormal and certain high risk groups were identified. These included patients suffering from significant weight loss, substance abuse, disorientation and self‐neglect in addition to the elderly and patients with clinical evidence of physical disorder on examination. The young and physically fit had the least number of abnormalities, and it is suggested that more clinical common sense should determine the screening procedure and that no test is rightly “routine”.
Parapartum mental illness: timing of illness onset and its relation to symptoms and sociodemographic characteristics
Authors: Bågedahl‐Strindlund M.
Published: August 2007

Clinical pictures and certain sociodemographic factors were studied retrospectively in all women in the county of Stockholm who had a baby during 1976–77 and also had been admitted to a psychiatric department after the 20th week of pregnancy or during the first postpartum year. The sample was classified according to the Research Diagnostic Criteria. A significant rise in the incidence of mental illness was found within the first 3 months postpartum and particularly so within 1 month postpartum as compared with during pregnancy and the following 9 months. This peak in incidence was due to a rise in the number of women classified as Unspecified Functional Psychosis. The nosology of postpartum psychosis is discussed. An increased frequency of neurotic or minor psychiatric disorders was noted during pregnancy as compared with the first 3 months postpartum and the following 9 months. No associations were found between the sociodemographic factors considered and the time of illness onset, although marital discord tended to be more frequent in women with onset of illness during pregnancy.
Immunoglobulin and C3 abnormalities in acute psychiatric disorders
Authors: Ahokas A.
Published: August 2007

In a prospective study of 54 patients with acute psychiatric disorders, elevated absolute concentrations of immunoglobulin G (IgG), IgM and complement factor C3 were found in the cerebrospinal fluid (CSF) in seven (P< 0.001), eight (P< 0.01) and in four patients, respectively, and in serum in seven, 19 and 17 patients (P< 0.001 in all), respectively, quantified by automated immunoprecipitin nephelometry in unconcentrated CSF and serum and compared with neurological controls with peripheral neurological symptoms. Elevation of the IgG‐index was observed in seven patients (P< 0.001) and CSF/S albumin ratio in four patients (P< 0.05). The presence of oligoclonal IgG bands was found in 22 patiens (P< 0.001). The results suggest that viral infections, inflammatory and autoimmune processes may have significance in the etiopathogenesis of acute psychiatric disorders.
Identifying children at high somatic risk: long‐term effects on mother‐child interaction
Authors: McNeil T. F. , Harty B. , Thelin T. , Aspegren‐Jansson E. , Sveger T.
Published: August 2007

The identification of α1 antitrypsin deficiency (ATD) by neonatal screening was hypothesized to have had negative long‐term effects on the mother‐child relationship. This hypothesis was tested by studying selected aspects of mother‐child interaction in a structured task situation in the home, and comparing 53 cases with clinically healthy 5–7‐year‐old children with ATD versus 52 control cases with children without ATD. The mothers in the two groups did not differ notably from each other. However, as compared with controls, ATD‐children were found to evidence considerably more problematic behavior in interacting with their mothers (being e.g. inappropriately childish, silly, precocious, inhibited, tense, irritated). The findings were interpreted as supporting the hypothesis of a negative long‐term effect of identifying the child's ATD.
Comparison between the Brief Psychiatric Rating Scale and the Manchester Scale for the rating of schizophrenic symptoms
Authors: Manchanda R. , Saupe R. , Hirsch S. R.
Published: August 2007

A reliability study was carried out to compare the short Manchester Scale (MS) to the longer Brief Psychiatric Rating Scale (BPRS), to see if similar items scored the same aspect of pathology and to find the sources of error. The raters were a psychiatrist and a psychologist cum medical student; they had recently arrived in Britain, came from different cultures and had not used the scale previously. Comparisons between the scales were made by interviewing the patients separately and together using either one or both scales. The items on the MS showed a higher interrater reliability as compared to the BPRS, both with independent and simultaneous ratings. Items based on observation only correlated poorly as compared to items based on verbal report. Lower between‐scale correlations for delusions and affect were observed even where the same rater used the two scales, suggesting that the scales have different meanings for these items. The MS is a suitable alternative to the BPRS for quantifying schizophrenic symptoms.
Female alcoholics
Authors: Haver B.
Published: August 2007

In a follow‐up study of 44 female alcoholics, different aspects of outcome were studied. These were alcohol consumption, the use of drugs and psycho‐social functioning. Also studied was a sumscore of these items called total outcome score. Childhood experiences such as having had a mentally disturbed father, a violent mother and/or unstable childhood environment were associated with a poor total outcome score. The same was true for alcohol abuse and violence in partner during follow‐up period. Those women who had had their children removed from the home by the social authorities during follow‐up period, also had a poor outcome. Destructive patterns of interaction experienced in family of origin may repeat themselves in adult life in relationship with partner and children. The successful treatment of female alcoholics would require modification of these behavioural patterns as well as drinking behaviour.
Research and society
Authors: Cohen Jerome , Serafetinides E. A. , May Philip R. A.
Published: August 2007

ABSTRACT‐

The values and value judgements of individual scientists, of the institution to which they belong and of society at large are heavily involved in political and administrative issues related to research. It would be desirable to devise a system that might reconcile the goals and values of the various components of society, rather than set them against each other in adversary stance. Assessment of the various benefits to society of a particular research activity would spell out the values of those involved, show how they differ, and could lead to a productive discussion of the differences. Scientists are in partnership with the public: the development and use of knowledge are their joint responsibility. Optimal allocation of research resources for the common good requires that scientists rise above personal and institutional self interest and take a broader perspective in promoting research in other than their own discipline; and that relevant information on external social merit and moral and ethical values should be sought from whoever can supply it, professional or layman; and that contradictory values must be accepted ‐ and examined scientifically ‐ as a fact of life.
The potential values and benefits of research
Authors: May Philip R. A. , Serafetinides E.A. , Cohen Jerome , Glaser Edward M. , Smedby Björn , Wetterberg Lennart , Dixon W. J.
Published: August 2007

The potential social values and benefits of sxi widely different research projects were described systematically, using a checklist and description form that addressed 10 different general aims of research and 47 subcategories (items) of benefit.

The checklists and descriptions were given to 280 persons at nine centers in five countries as the information base for making scaled judgements of the projects’ potential value to society, overall and along each of the 10 major dimensions and 47 items. For this purpose, 100‐point Likert‐type scales were used. The raters also used a constrained allocation procedure to indicate what proportion of the public funds available for research they would allocate for research (not service) in each of the 10 main areas. The primary focus was on developing and testing the instruments and taking a preliminary look at differences in value systems. We emphatically did not envisage a sur‐vey of public opnion nor a definitive statement as to the values that are held by any particular segment of society. Such studies would, in the absence of preliminary trials, be premature.
Composition of the rater group of the research values and benefits project
Authors: May Philip R. A.
Published: August 2007

The rater group for the study of research values and benefits comprised 280 persons from nine centers in fice countries: 73% were from Europe, 27% from North America. Compared to the general population, there was a greater proportion of persons with a higher education; of health care and other professionals; of persons with research background; and of persons involved in political and media activities. The group inducluded a respectable spread of the various kinds of persons whose opinions might be considered relevant in considering the social value of re‐search projects.

Such a group is appropriate for the modest purposes of a preliminary study to test a methodology; to obtain information of the variation in opinion and on statistical and methodological problems that might be encountered; to suggest hypotheses; and to draw attention to the need for scientific study of research values and benefits. It does not represent the general population as a whole, not will it support definitive statements about differences between groups or countries on or about research pri‐orities.
The relationship between category, item, and global ratings of the social value of individual research projects
Authors: Scott Alex
Published: August 2007

This paper estimates the relationship between Category and Item Ratings and Global Ratings of overall social value using multiple regression techniques. It is found that the Categories and Items vary considerably in their implicit weights, and the reader is warned that the estimates are unlikely to tally with his prior expectations. The estimation is carried out in both linear and log odds forms, using a variety of models, and estimates are also generated of the association between Item Ratings and Category Ratings. The results suggest that there are powerful underlying connections between the characteristics of the research Projects as described by the Categories and Items and Global assessments of overall social value.
Cluster patterns in project ratings
Authors: Wetterberg Lennart , Calltorp Johan
Published: August 2007

A cluster analysis of the ratings of overall social value assigned to the six projects by 242 raters indentified five clusters with roughly equal numbers of raters in each cluster. The analysis identified five clusters with roughly equal numbers of raters in each cluster. The analysis identifies two extremist groups: One who gave high ratings to all six projects, and another who gave low ratings to all of them. The other three clusters are differentiated by the particular projects that was valued most highly.
The sensitivity of the research priorities rating scales as depicted by the effect of the invasion of the Falkland Islands on the allocation of research funding to improving national security
Authors: Sainsbury Peter
Published: August 2007

A comparison was made between the research priorities of 21 United Kingdom raters who had completed the Research Values and Priorities form before the Argentine invasion of the Falkland Islands and 19 raters who did so following it. There was a statistically significant increase in funding allotted to research related to national security. Within its obvious limits, this modest experiment in nature demonstrates that the constrained allocation methodology is sensitive to changes in opinions on research priorities. It also points to one of the difficulties entailed in assessing the time may be rapidly reappraised by the turn of events in the social or potitical scene: Socaial values can be quite fickle.
Pharmacokinetics of temazepam compared with other benzodiazepine hypnotics—some clinical consequences
Authors: Jochemsen R. , Breimer D. D.
Published: August 2007

When the various benzodiazepine hypnotics are studied, large differences are seen with regard to their pharmacokinetic properties and metabolism in man. Some are eliminated from the body at a relatively slow rate (e.g. nitrazepam), others are metabolized rather rapidly (temazepam, triazolam). Some benzodiazepine hypnotics have major active metabolites that are slowly eliminated (flurazepam, quazepam), while others have non‐active metabolites (temazepam, lormetazepam). In hypnotic treatment, the duration of drug action should be restricted to the duration of the night, hence a compound with a relatively short elimination half‐life may represent a more rational choice.

An overview is given of the pharmacokinetics of the currently available benzodiazepine hypnotics with emphasis on temazepam and other hydroxylated benzodiazepines.
Normal sleep, disturbed sleep, transient and persistent insomnia
Authors: Dement W. C.
Published: August 2007

There are three fundamental principles for understanding sleep; (1) the sleeping brain is not a resting brain, (2) the sleeping brain functions in a different manner from the waking brain and (3) the activity and work of the sleeping brain are purposeful. The sleeping brain does fail and this failure is mainfest in a variety of clinical symptoms; all sleep complaints should be taken seriously and investigated. Transient insomnia is uniformly associated with objective sleep disturbances which have been documented following phase shifts of the major sleep period such as that caused by transmeridian travel. However, the degree to which the individual responds to these factors is variable. There is a consensus that sleep medications are indicated for transient and short‐term insomnia. Benzodiazepine hypnotics are commonly used to induce and maintain sleep, and improve daytime alertness.
Drugs and impaired performance
Authors: Nicholson A. N.
Published: August 2007

ABSTRACT:‐

Transient insomnia is known to occur in people who normally sleep well but whose sleeping pattern has been altered (e.g. by shift‐work, intercontinental travel). The occasional use of an hypnotic is likely to be beneficial in these cases although, in the past, the problem of daytime sedation precluded the use of such drugs in certain occupations. Recent advances in therapeutics reflect the increasing interest in the impairment of performance and it is now recognized that both the nature and persistence of any effect must be determined. Two broad approaches are used at present: the laboratory study of isolated skills and some form of simulation such as car handling. There is, however, clear disagreement concerning the relevance of these two methods to the real‐life situation and both have their limitations, so results must be interpreted with caution. In addition, an inability to demonstrate impaired performance does not necessarily mean that the drug is completely free from adverse effects, and different effects may be seen in a patient population compared with healthy volunteers because of variations in age, gender or concomitant drug therapy etc. It is fortunate that there are many drugs within a specific group which, though they have similar efficacy, have different effects on performance and so, accepting a limited impairment of performance, it should be possible for therapy to be suited to the day‐to‐day needs of any individual patient.
Saccadic eye movements as a measure of residual effects: temazepam compared with other hypnotics
Authors: Hofferberth B.
Published: August 2007

ABSTRACT Eye movements are classified into two categories: quickly running saccades and smooth pursuit movements. Saccades are fast conjugate eye movements with a preprogrammed direction, amplitude, and speed course; their purpose is to register new objects in the visual field. The duration and velocity of saccadic eye movements are very much dependent on vigilance. Comparisons were made with a number of psychometric tests [d 2 Durchstreichtest (cross out test), Viennese determination apparatus, and flicker fusion frequency] and the velocity of fast eye movements. The results of three separate investigations are presented. Standardization was undertaken in 100 healthy volunteers, 50 male and 50 female subjects aged between 20 and more than 50 years were included. In an open parallel group study, comparisons were made between various hypnotics with different half‐lives (temazepam, flunitrazepam, flurazepam, and phenobarbital). There were 10 healthy volunteers in each group, and medication was taken as a single night‐time dose for 7 nights. In a double‐blind study, temazepam (20 mg/day) was tested against flunitrazepam (2 mg/day). Dosing lasted 7 days. A marked impairment of the saccadic eye movements was observed with flunitrazepam but not with temazepam. Of all the benzodiazepines tested, only temazepam had no influence on the parameters of the saccade test. These results can be explained by temazepam's short half‐life and also by the fact that no active metabolites are formed.
The effects of repeated doses of temazepam and nitrazepam on several measures of human performance
Authors: Griffiths A. N. , Tedeschi G. , Richens A.
Published: August 2007

ABSTRACT The effects of six nightly doses of temazepam (20 mg), nitrazepam (10 mg) and placebo on saccadic eye movements, critical flicker fusion threshold, choice reaction time and mood were studied in eight volunteers. Performance was measured on nights 1 and 6 of each treatment. Nitrazepam produced a residual performance impairment on night 1 that disappeared by night 6, despite higher serum concentrations of the drug on the sixth night of treatment. Temazepam, with a shorter elimination half‐life, produced no significant performance impairment on night 1, but by night 6 a significant impairment of saccadic eye movements (p < 0.05) was seen 1 hour after drug intake. We conclude that tolerance to the sedative action of nitrazepam developed over the 6‐night period of the study. No evidence of tolerance was seen with temazepam. No residual effects of temazepam (20 mg) were seen the morning after the night‐time drug administration.
The clinical use of hypnotics: indications for use and the need for a variety of hypnotics
Authors: Rickels K.
Published: August 2007

ABSTRACT Insomnia may be categorized as difficulty falling asleep, frequent awakening, early awakenings or a combination of each. The ideal hypnotic must promote rapid sleep onset and maintain sleep throughout the night while allowing the patient to awake refreshed the following day. Several benzodiazepines, with differing pharmacokinetic and pharmacodynamic profiles are presently available. All are clinically effective and not only elimination half‐life but also dosage prescribed and pattern of distribution are important factors for determining treatment response. Hypnotics have been divided into those with long elimination half‐lives (e.g. nitrazepam, flunitrazepam, flurazepam), those with intermediately long half‐lives (brotizolam, loprazolam, lormetazepam, temazepam) and those with short half‐lives (midazolam and triazolam). Carry‐over effects into the morning such as excessive daytime sleepiness or drowsiness are related to drug half‐life, dosage and pattern of distribution. In equipotent dosages most controlled clinical trials have found no significant differences between the various benzodiazepine hypnotics. Nevertheless, clinicians in general tend to use long half‐life benzodiazepines in patients who have difficulties maintaining sleep and short half‐life benzodiazepines for treating sleep onset insomnia. Intermediately long half‐life benzodiazepines are used for both indications and most clinicians feel that the choice of hypnotic should not only be influenced by elimination half‐life or the dosage used, but by individual patient preference. Hypnotics should be used for only short periods of time and in those patients for whom a more chronic use is indicated, they should be used only on an intermittent basis.
Benzodiazepine hypnotics in the elderly
Authors: Cook P. J.
Published: August 2007

ABSTRACT A review is presented of the changes that occur in the pharmacodynamics of benzodiazepines during normal ageing and as a result of disease. Controlled studies in which subjects of different ages have received single doses of diazepam, temazepam, nitrazepam and flunitrazepam have consistently shown an increase in the response to benzodiazepines in the elderly which is not explained by the effects of disease or by altered plasma concentrations. In general, healthy elderly subjects have a 2–3 fold greater response compared with the young. This change appears to be due to a change in the post‐receptor mechanism of action. Cerebral diazepam concentrations are similar in young and elderly rats, though older animals also show an increased response and no consistent changes have been demonstrated in brain receptor binding. However, benzodiazepine‐induced increases in GABA binding and GABA‐induced increases in post‐synaptic inhibition have been reported to be greater in aged animals.

Regular daily dosing with most benzodiazepines leads to drug accumulation which is proportional to the elimination half‐life. Regular dosing with diazepam, chlordiazepoxide, nitrazepam and flurazepam has also been found to produce more sedation in the elderly, particularly long stay patients who have a high incidence of dementia, and those with a low albumen or chronic renal failure. A controlled trial of 1 week's dosing with 5 mg of nitrazepam or 20 mg of temazepam in elderly in‐patients showed that these doses produced significant impairment of psychomotor performance the morning after the last dose. Only about 50% of the patients were affected and many of these were frail patients with mild dementia on rehabilitation or long stay wards. The doses prescribed for these types of patients should not exceed 2.5 mg of nitrazepam or 10 mg temazepam.
Anxiety neuroses and DSM‐III
Authors: Torgersen S.
Published: August 2007

The relationship between ICD‐9 anxiety states, phobic states, obsessive‐compulsive disorder and DSM‐III anxiety disorder is discussed. Data are presented which show that one third of ICD‐9 anxiety states are diagnosed as affective disorder by DSM‐III. Research concerning cases with a concurrent affective and anxiety disorder is discussed. It is finally concluded that while DSM‐III has unsolved hierarchial problems, the identification of the two disorders, panic disorder and generalized anxiety disorder, seems advantageous and the inclusion of obsessive compulsive disorder, among the anxiety disorders, reasonable.
Experiences with the DSM‐III. in a psychiatric consultation/liaison service
Authors: Larsen Frode
Published: August 2007

375 patients referred to consultation/liaison service at a general hospital form the neurological and internal medical department were diagnosed according to the DSM‐III criteira for axis I and II.

The sample represents all the patients referred from the two department in a two year period.

The phenomenological approach of the DSM‐III and its reliability, is an advantage over older classification systems in the psychiatric consultation/liaison work. The system was easily applicable in this setting, leaving only 4 percent with “Diagnoses deferred” on both axes.

From the consultation/liaison Psychiatrist's point of view, special problems seemed to exist concerning the categories “Somatoform disorders” and “Psychological factors affecting physical condition”, and the concepts of the axis II.
Teaching DSM‐III to clinicians: Some problems of the DSM‐III system reducing reliability, using the diagnosis and classification of depressive disorders as an example
Authors: Malt Ulrik Fr.
Published: August 2007

Experiences from teaching DSM‐III to more than three hundred Norwegian psychiatrists and clinical psychologists suggest that reliable DSM‐III diagnoses can be achieved within a few hours training with reference to the decision trees and the diagnostic criteria only. The diagnoses provided are more reliable than the corresponding ICD diagnoses which the participants were more familiar with.

The three main sources of reduced reliability of the DSM‐III diagnoses are related to: (1) poor knowledge of the criteria which often is connected with failure of obtaining diagnostic key information during the clincal interview; (2) unfamiliar concepts and (3) vague or ambiguous criteria. The two first issues are related to the quality of the teaching of DSM‐III. The third source of reduced reliability reflects unsolved validity issues. By using the classification of five affective case stories as examples, these sources of diagnostic pitfalls, reducing reliability and ways to overcome these problems when teaching the DSM‐III system, are discussed.

It is concluded that the DSM‐III system of classification is easy to teach and that the system is superior to other classification systems available from a reliability point of view. The current version of the DSM‐III system, however, partly owes a high degree of reliability to broad and heterogenous diagnostic categories like the concept major depression, which may have questionable validity. Thus, the future revisions of the DSM‐III system should, above all, address the issue of validity.
Five years of experience with the DSM‐III system in clinical work and research: some concluding remarks
Authors: Malt Ulrik
Published: August 2007

‐ The reliability of the DSM‐III is superior to other classification systems available in psychiatry. However, reliability depends on proper knowledge of the system. Some pitfalls reducing reliability of axis 1 diagnosis which commonly are overlooked are discussed.

Secondly, some problems of validity of axis 1 and 2 are considered. This is done by discussing the differential diagnosis of organic mental disorders and other psychiatric disorders with concomittant physical dysfunction, and the diagnoses of post‐traumatic stress disorders and adjustment disorders among others. The emphasis on health care seeking behaviour as a diagnostic criteria in the DSM‐III system, may cause a social, racial and sexual bias in DSM‐III diagnoses.

The present discussion of the DSM‐III system from a clinical point of view indicates the need for validation studies based on clinical experience with the DSM‐III. These studies should include more out‐patients and patients with psychopathology who do not seek psychiatric treatment. Such studies must also apply alternative diagnostic standards like the ICD‐9 and not only rely on structured psychiatric interviews constructed for DSM‐III diagnoses.

The discussion of axis 4 points to the problem of wanting to combine reliable rating with clinically meaningful information. It is concluded that the most important issue to be settled regarding axis 4 in the future revisions is the aim of including this axis. The discussion of axis 5 concludes that axis 5 is biased toward poor functioning and thus may be less usefull when applied on patients seen outside hospitals.

Despite these problems of the DSM‐III, our experiences indicate that the use of the DSM‐III is fruitful both for the patient, the clinician and the researcher. Thus, the cost of time and effort needed to learn to use the DSM‐III properly are small compared to the benefits achieved by using the system.
Circulatory and respiratory effects of chlormethiazole
Authors: Scott D. B.
Published: August 2007

‐ The circulatory and respiratory effects of chlormethiazole were studied in volunteers and patients. The only clinically significant cardiovascular change was an increase in heart rate. However, this is only important if associated with a high arterial pressure in the presence of coronary artery disease. The respiratory effects were not significant.
Hypnotic effect of chlormethiazole in geriatric patients during long‐term treatment
Authors: Dehlin O.
Published: August 2007

The hypnotic effect of chlormethiazole was studied for 3 months in 20 geriatric in‐patients. Registered variables were the percentage of patients asleep at 10 pm and 6 am and the observed number of awakenings. Mental and somatic variables were rated according to the Crichton Geriatric Behavioural Rating Scale. Observations were made every second week. In 11 of the patients the plasma concentration of chlormethiazole was measured at regular intervals. No systematic significant change with time was observed for the percentage of patients asleep at 10 pm or for the number of awakenings. A significant decrease occurred in the percentage of patients asleep at 6 am. The long‐term treatment with chlormethiazole did not cause any deterioration in the patients’behaviour, according to the geriatric rating scheme. Observed peak plasma levels of chlormethiazole did not change significantly during the study. Great interindividual variations in the plasma concentrations were observed. The results indicate the chlormethiazole is lastingly effective as a hypnotic agent in geriatric patients.
The clinical stages of alcoholic delirium and their therapeutic significance
Authors: Kanzow W. T.
Published: August 2007

The clinical stages of alcoholic delirium include: autonomicmotor excitation; epileptic attacks; psychopathological symptoms; and terminal sleep. The course of these symptoms, their relationship to one another and their severity are discussed.
Changes in psychophysiological and conditioning variables during chlormethiazole‐medicated and unmedicated ethanol withdrawal: preliminary report
Authors: Wang M.
Published: August 2007

Autonomic liability during ethanol withdrawal in chlormethiazole‐medicated and unmedicated groups was investigated using electrodermal measures. Vulnerability to Pavlovian aversive conditioning was also assessed. Ethanol withdrawal was associated with increased autonomic arousal and aversive conditioning, suggesting an increased risk of phobia acquisition. Chlormethiazole administered during ethanol withdrawal may protect against such developments.
A retrospective comparison of delirium tremens cases before and after the availability of chlormethiazole
Authors: Schied H. W. , Kimmerie K. , Braunschweiger M.
Published: August 2007

To assess the contribution of chlormethiazole to the treatment of delirium tremens (DT), a retrospective analysis was carried out on cases of DT admitted to the Department of Psychiatry, University of Tübingen, West Germany before and after the introduction of chlormethiazole. Following the introduction of chlormethiazole, there was a significant reduction in DT mortality and in duration of DTs. The age and sex distribution of cases of DT were compared and were found to be similar before and after the introduction of chlormethiazole. The incidence of complications in the two periods were analysed. The dose of chlormethiazole on the first 4 days of DT and the doses of additional psychoactive drugs were also noted.
Chlormethiazole as a sleep cover for regional anaesthesia
Authors: Scott D. B.
Published: August 2007

Intravenous chlormethiazole has been used in conjunction with regional anaesthesia to induce sedation in several hundered patients. Advantages of using chlormethiazole include rapid induction and recovery. Disadvantages include nasal irritation.
A comprehensive study of chronic schizophrenic patients: I. Quantitative computed tomography: cerebral density, ventricle and sulcal measures
Authors: Dewan M. J. , Pandurangi A. K. , Lee S. Howard , Ramachandran T. , Levy B. , Boucher M. , Yozawitz A. , Major L.
Published: August 2007

Abstract— Based on recent computed tomography (CT) studies that have suggested the presence of distinct structural abnormalities in the brains of chronic schizophrenics, the authors evaluated 23 chronic schizophrenics and 23 controls by CT, using linear and area lateral ventricular measures, sulcal and Sylvian fissure widths and cerebral density measures. Technical problems inherent in CT studies and their impact on the use of data generated by such studies are discussed. Although there were few differences between groups, there emerged a distinct subgroup of schizophrenic patients with mild lateral ventricle enlargement associated with increased cortical density. The possible etiopathology for this atypical combination is discussed, including the striking parallels with a recent neuropathological study's findings.
Patients with delusions in a community psychiatric service: A follow‐up study
Authors: Jørgensen P. , Munk‐Jørgensen P.
Published: August 2007

Abstract— Case records of 546 patients referred for the first time to a community psychiatric service were studied. Fifty‐six patients revealed delusions of various types. The female/male ratio was 2:1, and the mean age 57 years. The majority of the paranoid patients belonged to the lowest socio‐economic groups. Symptomatology, including type of delusion, treatment given and diagnostic classification is presented. The delusions occurred as part of all major psychotic syndromes with a preponderance of organic and affective psychoses. After 5–20 years of observation a full remission without relapse was seen in only 5%. However, the predictive value of delusions has not been sufficiently established, and the need for prospective studies of course and prognosis of psychoses with delusions is stressed.
Age, period of death and birth cohort effects on suicide mortality in Italy, 1955–1979
Authors: La Vecchia C. , Bollini P. , Imazio C. , Decarli A.
Published: August 2007

Abstract— Trends in death rates from all suicides and specific methods of suicide in Italy over the period 1955–79 were analysed on the basis of age‐specific and age‐standardised rates, and through a log‐linear Poisson model to isolate the effects of age, birth cohort and calendar period. In both sexes, a large decrease in mortality from suicide was evident in the late 1950's and early 1960's. Thereafter, death certification rates showed fluctuating trends up to the mid 1970's, when steady increases became evident for both sexes. Nevertheless, overall age‐standardized mortality rates from suicide in the late 1970's were still considerably lower than in the two previous decades (15% in males, 7% in females). The observed variations in suicide mortality, mostly in males, can be explained in terms of period of death effect and be related to changes in the Italian economic situation. This view finds further support from analysis of age‐specific trends (e. g mortality rates in the younger age groups started rising in the early 1970's. together with a rise in unemployment rates among the young). Cohort curves for males born in the current century were U‐shaped as well, with marked declines for generations born between 1905 and 1930, and moderate increases for more recent cohorts. For females, the cohort curve was remarkably flat. Some of the changes in the various methods of suicide can be explained in terms of well‐defined exogenous factors (e.g., the large fall in poisoning by domestic gas is obviously attributable to domestic gas detoxification).
A polydiagnostic scale for dimensional classification of endogenous depression Derivation and validation
Authors: Maier W. , Philipp M.
Published: August 2007

Abstract— Several operational diagnoses (OPD) for endogenous depression have been proposed. However ‐ though aiming at similar clinical concepts ‐ the amount of association and agreement between different OPD is rather low. In this study the relationship between eight OPD (Research Diagnostic Criteria, DSM‐III, Michigan Discrimination Index, Newcastle Scale I, Newcastle Scale II, Taylor‐Abrams Criteria, Vienna Research Criteria, Hamilton Endogenomorphy Index) was assessed by applying latent trait analyses to the classificatory data of these eight OPD which were rated simultaneously in a sample of 173 depressive inpatients. According to these analyses six OPD (RDC, DSM‐III, NCS‐I, NCS‐II, TAC and VRC) are tapping the same phenomenon. This latent trait represents compatible concepts of endogenous depression; it is strongly associated with the independently assessed clinical ICD‐9 diagnosis of endogenous depression. The six OPD can be considered as items of a scale (so‐called OPD‐scale). The total scores of the OPD‐scale represent a dimensional assessment of the decisiveness of the diagnosis endogenous depression. Coefficients and parameters of this new scale are presented.
Alcoholism followed by schizophrenia
Authors: Hays P. , Aidroos N.
Published: August 2007

Abstract— On the basis of findinps of earlier workers, and our own unsystematic observations, we put forward the hypothesis that alcohol abuse was an important etiological factor in some schizophrenia‐like psychoses. We tested the hypothesis by comparing schizophrenic patients who had abused alcohol with schizophrenic patients who had not. The findings generally support the hypothesis, and indicate that a chronic psychosis distinguishable by a hallucinatory onset and, at its height, by visual hallucinations, may be one of the complications of alcohol abuse.
A prospective study of postpartum psychoses in a high‐risk group: I. Clinical characteristics of the current postpartum episodes
Authors: McNeil T. F.
Published: August 2007

Abstract— Postpartum psychotic episodes (PPPs) occurring during the first 6 months after delivery were prospectively studied in 88 pregnant index women with a history of nonorganic psychosis and 104 pregnant controls with no such history. While no control developed a PPP, PPPs were found following 28% of the index deliveries, almost all of these 25 cases being psychiatrically hospitalized. PPPs were especially frequent among cases with total illness diagnoses of Cycloid Psychosis and Affective Illness. More than half of the 25 cases had symptom onset within 3 weeks of delivery, and these early onset cases represented predominantly affective disorders, many of whom were manic in this episode. Cases with onset after 3 weeks were predominantly schizophrenic. Confusion was part of the current episode symptomatology in about one third of the cases and was well distributed across the different diagnostic groups.
A matched‐paired comparison of treated versus untreated schizophrenia spectrum cases
Authors: Parnas J. , Teasdale T. W.
Published: August 2007

ABSTRACT— As a part of the American‐Danish prospective study of children of schizophrenic mothers, psychiatrically hospitalised and untreated cases of schizophrenia spectrum conditions, i.e. borderline schizophrenia, schizoid and paranoid personality disorders, were compared on a number of characteristics. This exploratory analysis revealed that the groups were similar to each other on childhood conditions, sociodemographic variables, premorbid IQ and levels of schizophrenia‐related psychopathology. The hospitalised group, however, exhibited higher levels of concomitant psychopathology, such as substance abuse, affective symptoms and psychopathic tendencies. It is suggested that the clinical population may not be representative of the diagnostic category in question owing to co‐existence of confounding symptomatology (Berkson's fallacy).
Pre‐infusion heart rates and laboratory‐induced panic anxiety
Authors: Yeragani V. K. , Pohl R. , Rainey J. M. , Balon R. , Ortiz A. , Lycaki H. , Gershon S.
Published: August 2007

ABSTRACT— Resting and pre‐infusion heart rates recorded in 66 panic disorder patients revealed no significant differences between panickers and nonpanickers. There was also no significant difference in pre‐fusion heart rates between either lactate or isoproterenol panickers and placebo nonpanickers. There was neither a sensitizing nor a desensitizing effect of laboratory‐induced panic attacks on subsequent pre‐infusion heart rates.
The importance of psychotic features to major depression: course and outcome during a 2‐year follow‐up
Authors: Coryell W. , Endicott J. , Keller M.
Published: August 2007

ABSTRACT— Despite substantially greater levels of impairment during the five years preceding intake to this study, patients with nonbipolar psychotic depression (n= 55) were as likely to recover as were patients with nonpsychotic depression (n= 451) during a 2‐year follow‐up. Though patients with psychotic depression were more psychosocially impaired at 6 months, these differences resolved during the ensuing 18 months. In replication of an earlier study, early outcome was more predictive of later outcome in psychotic patients than it was in nonpsychotic patients.