bluuebunny/crossref_metadata_2025 huggingface dataset:
Training General Practitioners in the Assessment of Childhood Mental Health Problems
Authors: Luk Ernest S.L. , Brann Peter , Sutherland Sharon , Mildred Helen , Birleson Peter
Published: November 2003

Epidemiological studies have found that most children with mental health problems are not receiving appropriate help. The aim of this study was to assess an approach to train general practitioners (GPs) to detect mental health problems early, engage the families, and assist them in the access of service. Five GPs were given three hours of training on a brief assessment method. Each then interviewed parents whose children they suspected might have a mental health problem. An experienced research clinician then repeated the assessment. This information was fed back to the GP who then assisted the family in obtaining appropriate help. Twenty-nine parents were interviewed in six months. The research clinician and the GPs were in agreement for 90% of the cases for the recognition of mental health problems. GPs’ opinions on the brief assessment method were: easy to use (100%), helpful in obtaining information (100%) and helpful in engaging the parent (100%). The parents were followed up by telephone 3-4 months after the interview. Eighty-eight percent reported that the process was helpful, 67% had received help from services and 67% had improved. We conclude that with brief training, the GPs in this study were able to improve their capacity to provide early intervention for childhood mental health problems.
Treatment of Feeding Disorders in Children with Down Syndrome
Authors: Shaw Richard J. , Garcia Manuel , Thorn Marianna , Farley Courtney A. , Flanagan Gretchen
Published: November 2003

This article describes a 6-year-old boy with Down Syndrome who was referred with a refractory feeding disorder and his successful treatment using a multidisciplinary treatment team approach. The case highlights the complex nature of feeding disorders in this population, as well as the need to consider multiple issues during their assessment and treatment.
The Mental Health Needs of Looked after Children: An Integrated Multi-Agency Model of Care
Authors: Kelly Ciaran , Allan Susan , Roscoe Patricia , Herrick Elizabeth
Published: November 2003

The mental health needs of looked after children are reviewed and the challenges involved with developing accessible mental health services are discussed. This article describes a multi-agency approach to the delivery of mental health services and focuses on the development, operation and evaluation of a Tier 4 multi-agency team; The Behaviour Resource Service (BRS). The BRS community and residential teams provide an intensive service to children and young people identified as having the most complex needs. Approximately 50% of the service users are looked after children. The needs-led model of multi-agency assessment, intervention and collaborative working is described with attention to the role of the BRS within the professional network. Particular issues pertinent to multi-agency work with looked after children are considered.
Outcome in Adult Life for more Able Individuals with Autism or Asperger Syndrome
Authors: Howlin Patricia
Published: November 2003

The paper reviews what is known about outcome in adult life for more able individuals within the autistic spectrum. Because of the problems associated with differential diagnosis, the results of studies involving high-functioning people with autism and Asperger syndrome are combined. The review focuses predominantly on long-term follow-up research and covers outcome in terms of cognitive, linguistic, academic and adaptive functioning; educational and employment history; independence and social relationships; and behavioural and psychiatric problems. The stability of IQ and other measures over time, and variables related to outcome, are also investigated.
The Rett Syndrome Complex
Authors: Sandberg Annika Dahlgren , Ehlers Stephan , Hagberg Bengt , Gillberg Christopher
Published: November 2003

Communicative functions and their relationship with overall developmental level and autistic features were studied in eight young women with disorders in the Rett syndrome complex, three with the classical variant and five with variants with partially preserved/regained speech. The Vineland Adaptive Behaviour Scales, individual structured observation, and a specially designed structured interview covering early pre-linguistic and linguistic development, current receptive and expressive language and non-verbal communication skills, were used. Autistic features were evaluated in accordance with the DSM-IV. Low levels of communicative abilities and overall functioning were demonstrated. In most cases, the communicative abilities did not reach the level expected on the basis of overall development. Joint attention behaviours and expressions of communicative intent were rare. However, six of the eight subjects showed clear examples of social interaction abilities.‘Eye pointing’, as distinct from ‘eye communication’, was demonstrated only in a minority of the cases. The level of communicative function at developmental arrest did not predict later language ability. It is suggested that intervention should focus on developing further the joint attention behaviours, intentional communications and communicative functions spontaneously used by individuals with disorders in the Rett syndrome complex.
Executive Functioning and Memory Strategy Use in Children with Autism
Authors: Bebko James M. , Ricciuti Christina
Published: November 2003

An executive functioning deficit in autism should be reflected in a low level of active strategy use on memory tasks. This study was a direct examination of memory strategy use in two problem-solving situations by children with autism. Two groups with autism were tested, one high-functioning group and one with moderate cognitive impairments. All participants took part in two memory experiments to examine the effect of changing the nature of the learning situation on strategy use: one experiment used a serial recall task, and the other a recall readiness task. In contrast to previous studies, significant spontaneous strategy use was found on both memory tasks, particularly among the high-functioning group. Similarly, changing task structure was found to have an important impact on increasing strategy use, particularly for the moderate-functioning group. However, the overall rate of strategy use for the children with autism was still lower than would be expected for non-handicapped groups. The results support an executive functioning deficit interpretation, but a deficit that is less extensive among high-functioning individuals. Practical implications of the study in terms of cognitive training are also discussed.
Diagnosis of Autism: The Connection between Current and Historical Information
Authors: Boelte Sven , Poustka Fritz
Published: November 2003

The connection between current and historical autism- specific behaviour reported using the Autism Diagnostic Interview- Revised (ADI-R) was investigated in this cross-sectional analysis. In general, the association was high although there was a tendency for diagnostic exclusion of adolescent and adult subjects, especially verbal, high-functioning individuals who had ‘improved’ in the restricted, repetitive behaviour domain.
Social and Language Skills in Adolescent Boys with Asperger Syndrome
Authors: Koning Cyndie , Magill-Evans Joyce
Published: November 2003

Twenty-one adolescent boys with Asperger syndrome and 21 boys matched on age and an estimate of IQ were assessed using standardized measures of social perception (Child and Adolescent Social Perception Measure, CASP), social skills (parent, teacher, and student forms of the Social Skills Rating System, SSRS), number of close friends and frequency of contact (Child Behavior Checklist) and expressive and receptive language (Clinical Evaluation of Language Fundamentals-Revised). There were significant differences between groups on CASP scores, SSRS scores, number of friends, frequency of contact and social competence. There was also a significant difference on receptive language. The clinically and statistically significant differences between the groups on the measures of social skills help us understand the nature of the social deficits in Asperger syndrome and suggest the need to focus on specific deficits. These findings are discussed in relation to diagnostic criteria and intervention.
Executive Function Deficits in Non-Retarded Autistic Children
Authors: Shu Bih-Ching , Lung For-Wey , Tien Allen Y. , Chen Bor-Chih
Published: November 2003

The purpose of this study was to examine differences between Taiwanese children with autism and their typically developing peers on the Wisconsin Card Sorting Test (WCST). Twenty-six children with autism of normal IQ were included, and matched for chronological age with 52 controls. The WCST scores of the typically developing children were significantly higher for categories completed and percent conceptual level than in the autism group. Scores on perseverative responses, perseverative errors, the number of trials to complete the first category and non-perseverative errors were significantly higher in the autism group. The implications of these findings are discussed.
The Phenomenology of Depressive Illness in People with a Learning Disability and Autism
Authors: Perry D. W. , Marston G. M. , Hinder S. A.J. , Munden A. C. , Roy A.
Published: November 2003

People with autism may develop new behaviours in adolescence or early adult life, in addition to those associated with the primary disorder. Some of these behaviours have been postulated to be symptoms of depressive disorder. This article notes the methodological problems of investigating depression in people with autism. The authors also attempt to clarify the symptoms that may be significant in diagnosing depression in this group, by using treatment response methods.
Anxiety in High-Functioning Children with Autism
Authors: Gillott Alinda , Furniss Fred , Walter Ann
Published: November 2003

High-functioning children with autism were compared with two control groups on measures of anxiety and social worries. Comparison control groups consisted of children with specific language impairment (SLI) and normally developing children. Each group consisted of 15 children between the ages of 8 and 12 years and were matched for age and gender. Children with autism were found to be most anxious on both measures. High anxiety subscale scores for the autism group were separation anxiety and obsessive-compulsive disorder. These findings are discussed within the context of theories of autism and anxiety in the general population of children. Suggestions for future research are made.
Developmental Profile and Regression in a Child with Autism
Authors: Bernabei Paola , Camaioni Luigia
Published: November 2003

The developmental profile of a child with autism during the first 3 years of life is presented. Clinical material obtained from different sources is discussed: home videos from birth to 3 years, and cognitive and communicative evaluations at 24, 34 and 38 months. The videos show how the child appeared to make progress up to 12 months, but from 12 to 18 months some abilities that had been previously acquired were lost, and a decrease in social interaction, communication and language was observed. From 18 to 38 months communicative and linguistic abilities remained unchanged, but social interactive behaviours continued to decrease. The particular profile identified is discussed as one of the possible pathways through which autism may develop.
Monitoring the Progress of Preschool Children with Autism Enrolled in Early Intervention Programmes
Authors: Magiati Iliana , Howlin Patricia
Published: November 2003

This report examines how conclusions about the progress of preschool children enrolled in early intervention programmes may be influenced by the use of different cognitive assessment tools. As part of a longitudinal treatment outcome study, 24 children with autism aged between 27 and 58 months were each tested on the Bayley, Merrill-Palmer and Vineland scales. Their performance on each of these tests was compared. Results showed that, while scores on the different tests were highly correlated, actual test scores varied considerably, with the Bayley tending to produce the lowest IQ scores and the Merrill-Palmer the highest. These findings have important implications, as it is evident that judgements about the effects of therapy may be significantly influenced by the selection of the tests for pre-and post-treatment assessments. Possible ways of collecting, recording and reporting test data, so as to avoid spurious conclusions about treatment effects, are discussed.
Outcome Survey of Early Intensive Behavioral Intervention for Young Children with Autism in a Community Setting
Authors: Boyd Richard D. , Corley Michael J.
Published: November 2003

This article presents findings from an outcome survey of the effects of early intensive behavioral intervention (EIBI) for young children with autism in a community setting. Results from both individual case reviews and parent questionnaires are presented, with the data failing to support any instances of 'recovery' while still yielding a high degree of parental satisfaction with the treatment. Moreover, a follow-up inquiry into the type of services each child was receiving in his or her post-EIBI setting documents continued dependence on extensive educational and related developmental services, suggesting that the promise of future treatment sparing did not materialize. Limitations of the survey in evaluating community-based EIBI services are discussed along with the need for further research designed to document the effectiveness of services provided to young children with ASD in the community.
The Scottish Centre for Autism Preschool Treatment Programme
Authors: Salt Jeff , Shemilt John , Sellars Val , Boyd Sheila , Coulson Tracey , Mc Cool Susan
Published: November 2003

This article evaluates the effectiveness of a developmentally based early intervention programme. Two groups of children were compared, a treatment group and a no-treatment control group. Standardized assessments were administered before and after the intervention period by an independent clinician. Pre-treatment comparisons revealed that the control group had a significantly higher pre-treatment IQ; but the two groups were comparable for age, mental age, socioeconomic status and number of hours of non-experimental therapy. Results demonstrated that children in the treatment group improved significantly more than those in the control group on measures of joint attention, social interaction, imitation, daily living skills, motor skills and an adaptive behaviour composite. A measure of requesting behaviour fell short of statistical significance. The total stress index reduced for treatment group parents and increased for the control group parents (but not significantly). The results of the study are considered to support the efficacy of this treatment approach.
Developing a Diagnostic and Intervention Package for 2 to 3-Year-Olds with Autism
Authors: Chandler Susie , Christie Phil , Newson Elizabeth , Prevezer Wendy
Published: November 2003

The aim of the research was to develop and evaluate a model of good practice which would make an explicit link between diagnosis and intervention, and so give parents a very clear rationale for the autism-specific yet individualized programme that they were carrying out. It employed an action research design, which essentially is responsive to participants, thus developing a user-friendly model of service. The programme was based on the developmental perspective that the pragmatics of language are the precursors of speech itself and enable both communication and relationship between child and parents. Since these are impaired in autism they should therefore be prioritized in early intervention. Ten children aged 1:10 to 2:9 at assessment, and with a diagnosis of autism, underwent an intervention based on home visits, modelling, workshops and written information, with parents as ‘therapists’ in naturally occurring situations. Within 18 months all children made substantial progress in social interaction and expressive communication, including gestural and verbal communication.
Challenging Behaviour
Authors: Van Berckelaer-Onnes I. A. , Van Loon J. , Peelen A.
Published: November 2003

People with intellectual disability often exhibit severe behavioural problems. Treatment of these problems is frequently very difficult. In The Netherlands, parents, institutes, schools and others can request the services of an independent advisory team with a pool of professionals who have experience with individuals who exhibit challenging behaviour. In this article the methods of the team will be described using a 24-year-old man as an example. The process took almost 7 years. Finally, this man, who had been living full time in one room in total isolation from the rest of the world, fulfilled his heart’s desire - visiting the UK by Hovercraft.
Temperament and Character in Adults with Asperger Syndrome
Authors: Soderstrom Henrik , Rastam Maria , Gillberg Christopher
Published: November 2003

To study the personality characteristics of adults with Asperger syndrome, and investigate the value of self-rating personality inventories, we administered the Temperament and Character Inventory (TCI) to 31 outpatients with Asperger syndrome. The TCI is a self-rating personality inventory that has been validated in the Swedish general population. The results were compared with age- and sex-matched norm groups. Participants with Asperger syndrome scored significantly higher on harm avoidance and lower on self-directedness and cooperativeness. Reward dependence and novelty seeking tended to be low. They also had significantly higher rarity scores, reflecting idiosyncratic perspectives. The most common temperament configurations were ‘obsessional’, ‘passive-dependent’ and ‘explosive’. Character, reflecting conceptual maturity, was poorly developed in the majority of our subjects. The self-ratings of persons with Asperger syndrome thus indicated anxious personalities with coping difficulties in the areas of social interaction and self-directedness, a picture corresponding to the clinical descriptions of Asperger syndrome.
Urinary Peptides in Rett Syndrome
Authors: Solaas K. M. , Skjeldal O. , Gardner M. L. G. , Kase B. F. , Reichelt K. L.
Published: November 2003

Rett syndrome is a neuro-developmental disorder related to autistic behavior. Persons with autism have previously been found to have hyperpeptiduria. We here report a significantly higher level of peptides in the first fasting morning urine from 53 girls with Rett syndrome (both classical and congenital) compared with 53 healthy girls. This elevation in urinary peptides was similar to that in 35 girls with infantile autism. As in persons with autism, the individual levels of urinary peptides in the Rett syndrome group varied, and about a fifth were within the normal range. Levels of peptides were lower in girls with classic Rett syndrome than in girls with congenital Rett syndrome. This may be due to different etiological causes or to active and stagnant phases of the disease. Urine from girls with Rett syndrome was found to have higher frequency and higher levels of some urinary peptides that may cause inhibition of brain maturation and epilepsy.
Executive Functions and the Natural Habitat Behaviors of Children with Autism
Authors: Ruble Lisa A. , Scott M.M.
Published: November 2003

Research suggests that impairments in executive functions play a role in the cognitive deficit in autism. Possible autism- specific impairments include an inability to engage in goal-directed behaviors and adjust behaviors given environmental demands. What has been described as executive functions is based largely on observations of performance in the laboratory rather than in natural settings. An ecological method first described by Barker and Wright and adapted by Scott was used to assess the patterns of goal-directed behaviors of eight children with autism and eight chronological and mental age comparable children with Down syndrome. Quantitative and qualitative features of naturalistic behaviors were collected, and coded using previously described categories of children’s behavior. Results indicated that children with autism exhibited shorter and less overlapping goal- directed behaviors. These data suggest a cognitive difference rather than developmental delay, and lend support for impaired executive functions in autism. Practical implications for educators and caregivers are discussed.
Family System and Coping Behaviors
Authors: Sivberg Bengt
Published: November 2003

The study deals with strain on the family system, as well as the level of coping and types of coping behavior of the parents, in families with a child diagnosed as having an autistic spectrum disorder (ASD) as compared to families in a control group. Thirty-seven families and 66 parents were involved in each case, and four psychological tests were used. It was found that lower levels of coping were associated with higher levels of strain on the family system, that the level of strain on the family system was greater in the families with a child with an ASD, and that the two groups differed in their pattern of coping behavior. It is argued that limited contact between the child with an ASD and its parents, claimed earlier to be a cause of autism, can be explained in terms of strain on the family system and the resulting pattern of coping.
How Well Does Early Diagnosis of Autism Stand the Test of Time?
Authors: Moore Vanessa , Goodson Sally
Published: November 2003

Twenty children who presented with severe interactional and communication difficulties at age 2 underwent a comprehensive assessment for autism, and were reassessed at age 4-5. In common with other recent studies, diagnosis of autistic spectrum disorders at age 2 was found to be reliable and stable. The communication and social skills of the children showed little change overall by the second assessment. However, children whose scores deteriorated in the social domain tended to have presented initially with more significant behaviour problems. Few repetitive behaviours were observed at age 2, whereas these were more apparent by age 4-5. The finding that early diagnosis of autism is reliable and stable has led to the development of an early diagnostic service in Southampton, which is described. The importance of early diagnosis is that it opens the door to early intervention programmes, which in turn prevent many problems from occurring in later life.
Ability Profiles in Children with Autism
Authors: Mayes Susan Dickerson , Calhoun Susan L.
Published: November 2003

To understand the effect of IQ and age on ability in children with autism, psychological data were analyzed for 164 3- to 15-year-olds with autism (IQs 14-143). As age increased, so did IQ, which probably reflects both an actual increase in IQ over time and the likelihood that brighter children are diagnosed later. Early in life, 67 percent had normal motor and delayed speech milestones. Verbal IQ continued to lag behind non-verbal IQ during the preschool years. By school age, the gap between verbal and non-verbal IQs had closed. Visual reasoning exceeded graphomotor scores for all children, and surpassed IQ for most. Graphomotor scores were significantly below IQ for both high-IQ groups. For school-age children with low IQs, math, spelling, and writing scores were consistent with IQ and reading was above IQ. School-age children with high IQs had average reading, math, and spelling scores and a weakness in writing.
A Peptide Found in Schizophrenia and Autism Causes Behavioral Changes in Rats
Authors: Sun Zhongjie , Cade J. Robert
Published: November 2003

In a previous study we showed that β-casomorphin-7 (β-CM7) is taken up by brain regions relevant to schizophrenia and autism. The present experiment was designed to find whether β-CM7 has any behavioral or analgesic effects in rats. About 65 seconds after treatment with different doses of β-CM7, rats became restless and ran violently, with teeth chattering and with rapid respiration. Seven minutes later, the rats became inactive with less walking, distancing themselves from the other rat in the same cage, and sitting in, or putting their head against, the corner of the cage. The sound response was reduced and social interaction was absent. One hour later, the rats showed hyperdefensiveness. The above behavioral effects of β-CM7 did not occur when rats were pretreated with naloxone (2 mg/kg, IP). The rats receiving saline did not show any behavioral changes throughout the 2 hour period of observation. β-CM7 also demonstrated analgesic effects, which could be blocked by naloxone. The results suggest that β-CM7 may play a role in behavioral disorders such as autism and schizophrenia.
The Outcome of a Supported Employment Scheme for High-Functioning Adults with Autism or Asperger Syndrome
Authors: Mawhood Lynn , Howlin Patricia
Published: November 2003

The article describes the outcome of a 2 year supported employment project for high-functioning adults with autism. Thirty individuals with a diagnosis of autism or Asperger syndrome living within the London area took part in the scheme. The control group comprised 20 individuals of similar intellectual and linguistic ability,and previous employment history, living in metropolitan areas out-side London. Over the course of the project significantly more of the supported group than the controls found work; job levels were higher; they were in work for a greater percentage of the time; and they received significantly higher wages. Thirteen different employers (mostly multinational companies) were involved during the course of the project and several were willing to take more than one employee because of their positive experience of employing someone with autism. Although existing resources within the disability employment service hadnot previously been able to provide effective job finding and support services for this group, the current scheme demonstrated that, with specialist input, supported employment can be very effective. Moreover the costs, although initially high, reduced significantly over time. One of the most expensive and time-consuming aspects of the scheme, but one that appeared to be crucial for success, was the need for close liaison with employers in order to explore appropriate job opportunities and to match these carefully to the skills and abilities of individual clients. However, although some elements of the scheme can continue to be supported through government funding, no financial provision is available for this initial and essential stage of job finding. If programmes of this kind are to continue to provide help for individuals with autism, it is crucial that such funding is provided.
Autism
Authors: Helps Sarah , Newsom-Davis I. C. , Callias M.
Published: November 2003

Frequently changing conceptualizations of autism have caused widespread confusion over its precise nature and aetiology. This study aimed to investigate teachers’ views of autism, together with their training needs. The Stone Autism Questionnaire (1987) was modified and used to evaluate the level of knowledge and understanding among a sample of 72 teaching and support staff from four mainstream and four special (non-autism) schools in South London. Ten mental health professionals working in the field of autism completed the same questionnaire as a ‘control’ measure for comparison. Teachers and support staff were found to hold a number of views about autism that were significantly different from those of mental health professionals; the majority had received little or no training regarding the disorder. All three groups were unanimous in their demand for more training. The results have serious implications for the educational experiences and developmental achievements of children with autism in schools in England.
Pragmatic Language Impairment without Autism
Authors: Botting Nicola , Conti-Ramsden Gina
Published: November 2003

The ‘borderlands’ of autism are of particular interest to researchers and clinicians as we learn more about pervasive disorders and how to manage them. One group of children who have caused particular controversy are those referred to as having semantic-pragmatic disorder or pragmatic language impairment. The present article examines the profiles of 10 children (selected from a wider project on language impairment) who are definitely considered to have pragmatic impairments by their teachers, their speech and language therapists and the researchers and on the basis of scores from the Children’s Communication Checklist (CCC). These children are compared with each other and with children with more typical specific language impairments (SLIs) in the wider study. The 10 children’s characteristics are also examined in terms of classification and whether some might be better described using existing autistic spectrum disorder terminology. Children with pragmatic language impairment were all found to have developed first words earlier than the SLI group, but were more impaired than their peers in the areas of stereotyped language, rapport and context. Social communication skills as measured by the CCC did not seem more impaired than in other children with SLI, but on the Harter scale peer interactions were rated as significantly poorer. A preliminary comparison with autistic symptomatology suggested that four of the 10 did have difficulties in this area and might be better described as having autism or Asperger’s disorder.
Explaining Participation in Congressional Oversight Hearings
Authors: Duffin Diane L.
Published: November 2003

Scholarship on congressional oversight has documented an increase in the amount of time committees have devoted to oversight hearings since the post-1970s reform period that decentralized power in the House. Unknown thus far, though, is the extent to which members avail themselves of their opportunities to use hearings to monitor executive branch activities or what concerns might motivate such participation. Building on prior research on participation in other congressional activities, this study measures participation by House members in reauthorization and appropriations hearings for programs administered by the U.S. Department of Housing and Urban Development from 1978 to 1986. On the whole, participation in the hearings by rank-and-file committee members was low, but factors such as district and party interests, the timing of the hearings on the electoral cycle, and the presence of the department secretary at the witness table all served to increase participation.
Social systems intervention and crisis resolution. Part 1: Assessment
Authors: Bridgett Christopher , Polak Paul
Published: November 2003

Home treatment as an alternative to acute adult in-patient care is part of the National Health Service Plan for mental health services in the UK. As a form of crisis intervention, it benefits from an understanding of, and ways of working with, the social systems relevant to the patient in crisis. This article reviews relevant terminology and background theory, and considers the social factors associated with psychiatric admission.
Adverse effects of khat: a review
Authors: Cox Glenice , Rampes Hagen
Published: November 2003

Catha edulis(khat) is a plant grown in the countries around the Red Sea and on the eastern coast of Africa. Its leaves are chewed by the local people for their stimulant action. Its principal active constituents are cathinone and cathine, which have sympathomimetic actions. Migration of Africans from these countries has spread the habit of khat chewing to the West. Chewing khat has a number of important psychological and physical sequelae. ‘Khat-related’ psychosis is very similar to that seen following use of amphetamines.
Paternal age and risk for schizophrenia
Authors: Zammit Stanley , Allebeck Peter , Dalman Christina , Lundberg Ingvar , Hemmingson Tomas , Owen Michael J. , Lewis Glyn
Published: November 2003

Background

Previously reported associations between advancing paternal age and schizophrenia could be due to an increase in paternal germ cell mutations or be confounded by heritable personality traits associated with schizophrenia that result in delayed parenthood.

Aims

To investigate this association while adjusting for personality traits related to poor social integration in the subjects.

Method

A cohort of 50 087 adolescent males was followed up by record linkage to determine hospital admissions for schizophrenia between 1970 and 1996.

Results

Advancing paternal age was associated with an increased risk of developing schizophrenia in a ‘dose-dependent’ manner. The adjusted odds ratio for each 10-year increase in paternal age was 1.3 (95% Cl 1.0–1.5; P=0.015).

Conclusions

Advancing paternal age is an independent risk factor for schizophrenia. Adjusting for social integration in subjects made little difference to this association, consistent with the hypothesis that advancing paternal age may increase liability to schizophrenia owing to accumulating germ cell mutations.
Cost-effectiveness of current and optimal treatment for schizophrenia
Authors: Andrews Gavin , Sanderson Kristy , Corry Justine , Issakidis Cathy , Lapsley Helen
Published: November 2003

Background

This paper is part of a project to identify the proportion of the burden of each mental disorder averted by current and optimal interventions, and the cost-effectiveness of both.

Aims

To use epidemiological data on schizophrenia to model the cost-effectiveness of current and optimal treatment.

Method

Calculate the burden of schizophrenia in the years lived with disability (YLD) component of disability-adjusted life-years lost, the proportion averted by current interventions, the proportion that could be averted by optimal treatment and the cost-effectiveness of both.

Results

Current interventions avert some 13% of the burden, whereas 22% could be averted by optimal treatment. Current interventions cost about AUS$200 000 per YLD averted, whereas optimal treatment at a similar cost could increase the number of YLDs averted by two-thirds. Even so, the majority of the burden of schizophrenia remains unavertable.

Conclusions

Optimal treatment is affordable within the present budget and should be implemented.
Choking deaths: the role of antipsychotic medication
Authors: Ruschena David , Mullen Paul E. , Palmer Simon , Burgess Philip , Cordner Stephen M. , Drummer Olaf H. , Wallace Cameron , Barry-Walsh Justin
Published: November 2003

Background

An increased risk of choking associated with antipsychotic medication has been repeatedly postulated.

Aims

To examine this association in a large number of cases of choking deaths.

Method

Cases of individuals who had died because of choking were linked with a case register recording contacts with public mental health services. The actual and expected rates of psychiatric disorder and the presence of psychotropic medication in post-mortem blood samples were compared.

Results

The 70 people who had choked to death were over 20 times more likely to have been treated previously for schizophrenia. They were also more likely to have had a prior organic psychiatric syndrome. The risk for those receiving thioridazine or lithium was, respectively, 92 times and 30 times greater than expected. Other antipsychotic and psychotropic drugs were not over-represented.

Conclusions

The increased risk of death in people with schizophrenia may be a combination of inherent predispositions and the use of specific antipsychotic drugs. The increased risk of choking in those with organic psychiatric syndromes is consistent with the consequences of compromised neurological competence.
Prescribing practices of community child and adolescent psychiatrists
Authors: Doerry Ursula , Kent Lindsey
Published: November 2003

Aims and Method

A questionnaire was sent to all 55 community child and adolescent psychiatrists working in the West Midlands to examine the prescribing practices of community child psychiatrists, because most previous studies have included prescribing data from specialist (tier 4) services.

Results

The survey had a good response rate (87%). The vast majority of child psychiatrists were prescribing stimulants and antidepressants, and over half were prescribing antipsychotics and melatonin. At least half of the consultants would consider prescribing an antipsychotic for the treatment of aggressive behaviour. One-third of consultants cited pressure on services as a reason for prescribing medication.

Clinical Implications

Community child psychiatrists were prescribing more medication than expected, which may have a considerable impact on referral rates to adult services in the future. It is concerning that the increased use of medication may be a reflection of pressure on services.
Background stressors and deliberate self-harm
Authors: Keeley Helen S. , O'Sullivan Mary , Corcoran Paul
Published: November 2003

Aims and Method

In this study we aimed to identify negative life events, especially those associated with repetition, in the background histories of patients in a 2-year prospective monitoring study of hospital-treated deliberate self-harm (DSH). Thematic analysis of the narratives recorded during assessment was used to produce general categories of life events.

Results

In 3031 DSH episodes (n=2287 individuals), women reported more life events than men. Family and interpersonal problems were most commonly reported. Reporting a dysfunctional family of origin, a history of sexual abuse and the imprisonment of self or other were associated with repetition retrospectively and prospectively.

Clinical Implications

The background history of patients who harm themselves should be explored routinely on assessment in order to help establish risk of repetition and to determine appropriate follow-up.
Survey of expert second opinions in a tertiary psychiatric out-patient clinic in the Yorkshire region between 1988 and 2000
Authors: Nirodi Pratibha , Mitchell Alex J. , Mindham Richard H. S.
Published: November 2003

Aims and Method

A medical second opinion is an expert clinical case evaluation requested by a colleague for a patient already under specialist care. There is no literature on the provision for second opinions in psychiatric practice other than those relating to the Mental Health Act 1983, and the availability of clinics offering second opinions varies greatly from one area to another. We undertook a survey of an expert second opinion service in Leeds over the period 1988–2000 and examined the case notes of 103 referred patients, of whom 71 were included in the analysis data.

Results

In the majority of cases diagnoses were not changed, but alternative treatment strategies were suggested. The exception was for patients with a diagnosis of personality disorder, in whom neither a new diagnosis nor alternative management was commonly suggested. Half of the assessments were completed in a single visit, but a substantial minority required further evaluation as outpatients, close follow-up or even hospital admission for detailed review.

Clinical Implications

We believe that a second opinion service offers clinicians valuable support and expertise, especially in sector psychiatry. Evidence presented suggests that further therapeutic options are available for many patients regarded as ‘difficult to treat’. In some cases this may involve a period of observation free of all psychotropic medication. As in other specialities, psychiatrists should be aware of the value of further advice for patients with particularly refractory or unusual disorders.
Teaching psychiatry through cinema
Authors: Bhugra Dinesh
Published: November 2003

Films portray mental illness and mental health problems in a variety of ways. Some can be used to teach medical students and psychiatric trainees about certain aspects of psychiatry: watching a film is useful when learning about mental state examination, how to reach a diagnosis, doctor–patient interactions and personality disorder. I have chosen a list of films to watch for each of these topics; this list is not comprehensive, however, and I encourage readers to identify other films they might wish to use when teaching.
Organising and evaluating a Balint group for trainees in psychiatry
Authors: Fitzgerald Gearoid , Hunter Michael D.
Published: November 2003

Aims and Method

We describe the Balint case discussion group method and how it can be applied to training psychiatrists. In a group that we ran, the performance of members on a clinical task before and after a year in the group was investigated. Written responses to a case vignette were appraised blindly by psychotherapists who were also examiners for the Royal College of Psychiatrists.

Results

There were eight members in the Balint group, which met weekly for one year. We found that members' performance on the clinical task improved significantly following the year spent in the Balint group.

Clinical Implications

A Balint group, as part of an introduction to psychotherapy for psychiatrists, may represent a step towards achieving comprehensive training that is relevant to ordinary clinical practice.
Functional Outcome Following Extensor Synovectomy and Excision of the Distal Ulna in Patients With Rheumatoid Arthritis
Authors: JAIN A. , BALL C. , NANCHAHAL J.
Published: November 2003

We prospectively measured hand and wrist function in rheumatoid patients undergoing excision of the distal ulna. Range of motion, visual analogue pain scores and grip strength were measured in 22 wrists, and the Jebsen hand function test was administered to seven patients, preoperatively and at 3 and 12 months. At 1 year there were improvements in forearm pronation ( P = 0.04), supination ( P = 0.03) and wrist extension ( P = 0.02), but a reduction in flexion ( P = 0.009). Active radial deviation was reduced and ulnar deviation increased. There was a significant improvement in grip strength ( P = 0.05) and reduction in wrist pain ( P = < 0.0001). At 1 year the Jebsen hand function test showed improvements in simulated feeding, stacking checkers, and lifting large empty cans. Excision of the distal ulna in rheumatoid patients results in an improvement in some aspects of hand function.
The Shape of the Triangular Fibrocartilage During Pronation–Supination
Authors: MAKITA A. , NAKAMURA T. , TAKAYAMA S. , TOYAMA Y.
Published: November 2003

We studied the changes in the shape of the triangular fibrocatilage (TFC: disc proper) which occur during forearm rotation in disarticulated and articulated wrists. The influence of artificial 3 mm ulnar lengthening on distortion of the disc was also examined. In the disarticulated wrists, slight distortion of the central and radial portions of the TFC was observed in the ulnar neutral variance specimens. More distortion was noted in the radial and central portions of the TFC in specimens with positive ulnar variance or with the ulna lengthened. However, in the articulated wrist, the TFC demonstrated little change in shape during pronosupination even in the ulnar positive variance wrists or with the ulna lengthened. There was no significant change in palmar and dorsal peripheral lengths of the TFC in ulnar neutral, ulnar positive or ulna-lengthened specimens at three rotatory positions of the forearm. These findings suggest that changes in ulnar variance which occur during forearm rotation can produce distortion on the TFC, but the carpus helps to maintain the shape of the TFC during pronation–supination, even with positive ulnar variance.
Wrist Arthrodesis Using a Synthes Wrist Fusion Plate
Authors: MEADS B. M. , SCOUGALL P. J. , HARGREAVES I. C.
Published: November 2003

Thirty-nine patients were retrospectively reviewed after a wrist arthrodesis using a Synthes wrist fusion plate and iliac crest bone graft. Information was obtained from review of patient files, a questionnaire to assess pain, function and work status, and clinical assessment of grip strength, forearm rotation and fingers motion. All wrist fusions united except that the index carpometacarpal joint failed to unite in one patient. Thirty-seven patients were satisfied with the procedure, noting a reduction in wrist pain after fusion, but all reported some limitation of function. The wrist fusion plate was removed in six patients and a further four patients experienced minor symptoms over the dorsal aspect of the middle finger metacarpal.
Results of Ray Resection and Amputation for Ring Avulsion Injuries at the Proximal Interphalangeal Joint
Authors: NUZUMLALI E. , ORHUN E. , ÖZTÜRK K. , CEPEL S. , POLATKAN S.
Published: November 2003

We investigated the long-term functional results of ray resection (14 cases) and amputation (nine cases) for ring avulsion injuries of ring finger which could not be replanted or underwent failed replantation. The mean follow-up was 37 (range, 24–63) months in the ray resection group and 32 (range, 24–40) months in the amputation group. Grip strength, key pinch strength, chuck pinch strength, hand circumference and palmar volume were decreased in the ray resection group but only grip strength and pulp pinch strength were significantly decreased in the amputation group. These results suggest that ray resection should be avoided in patients with occupations that need strong key and chuck pinch functions.
Small Joint Fusion of the Hand – A Technique Using Coughlin Cup and Cone Reamers
Authors: AHMED H. A. , SHAIKH N. , GOLDIE B. S.
Published: November 2003

We describe a method of cup and cone arthrodesis using Coughlin concave and convex reamers, which we have used in a series of 22 hand joints in 19 patients. These reamers, originally designed for use in the foot, can be used in the hand to give very accurate preparation of bone surfaces. This results in maximum bone contact and the ability to fuse the joint in any desired position. The procedure is simple, rapid and forgiving. Union was achieved in all 22 cases, usually within 3 months.
Magmatic processes under mid‐ocean ridges: A detailed mineralogic study of lavas from East Pacific Rise 9°30′N, 10°30′N, and 11°20′N
Authors: Pan Yucheng , Batiza Rodey
Published: November 2003

Detailed petrologic study has been made for lavas from the northern East Pacific Rise (EPR) 9°30′N, 11°20′N, and 10°30′N. 9°30′N and 11°20′N have robust magma supply and a shallow melt lens while 10°30′N has nonrobust magma supply and no shallow melt lens. Lavas from all three localities are sparsely phyric and glassy, containing plagioclase ± olivine ± pyroxene. Typically, the lavas contain several to many (up to seven) distinct chemical groups of plagioclase that are not always distinct texturally. The lavas may also contain up to three chemically distinct groups of olivine and two groups of pyroxene. The lavas contain both individual crystals and groups comprising reticulate and dendritic clots that we interpret to represent bits of crystal networks forming in mushy zones of an axial magma chamber. 21 of the 23 samples studied in detail have diverse crystal compositions and require mixing, which most likely occurs when mostly liquid magma passes through mushy zones. We find no significant systematic differences between robust and nonrobust segments in terms of their crystal content, proportion of texturally distinct xenocrysts, crystal size, aspect ratio, roundness, modal abundance, magma residence time, number of diverse mineral‐chemical groups, and characteristics of mixing like the total range of composition of disequilibrium minerals present, and the magnitude of the chemical gaps between disequilibrium and equilibrium compositions. This unexpected and remarkable similarity suggests that the presence or absence of a seismically imaged shallow melt lens has essentially no effect on the mineralogy of erupted lavas. We conclude that the fundamentally important magmatic process under mid‐ocean ridges, from slow to fast, is the formation of crystal networks and their subsequent compaction; the seismically detected shallow melt lenses likely contain highly evolved magma, formed by expelled interstitial melt during crystal network compaction, and play very little role in crustal accretion. Our conclusion implies that the thick (>3 km) low velocity zone near the base of the crust produces the thin (<30 m) shallow melt lenses, not the other way around.