bluuebunny/crossref_metadata_2025 huggingface dataset:
Protean nature of mass sociogenic illness
Authors: Bartholomew Robert E. , Wessely Simon
Published: August 2002

Background

Episodes of mass sociogenic illness are becoming increasingly recognised as a significant health and social problem that is more common than is presently reported.

Aims

To provide historical continuity with contemporary episodes of mass sociogenic illness in order to gain a broader transcultural and transhistorical understanding of this complex, protean phenomenon.

Method

Literature survey to identify historical trends.

Results

Mass sociogenic illness mirrors prominent social concerns, changing in relation to context and circumstance. Prior to 1900, reports are dominated by episodes of motor symptoms typified by dissociation, histrionics and psychomotor agitation incubated in an environment of preexisting tension. Twentieth-century reports feature anxiety symptoms that are triggered by sudden exposure to an anxiety-generating agent, most commonly an innocuous odour or food poisoning rumours. From the early 1980s to the present there has been an increasing presence of chemical and biological terrorism themes, climaxing in a sudden shift since the 11 September 2001 terrorist attacks in the USA.

Conclusions

A broad understanding of the history of mass sociogenic illness and a knowledge of episode characteristics are useful in the more rapid recognition and treatment of outbreaks.
Recruitment into psychiatry
Authors: Brockington Ian F. , Mumford David B.
Published: August 2002

Background

Despite improvements in psychiatric teaching, British medical schools have never produced enough graduands aiming for psychiatry.

Aims

To inform the strategy for improving recruitment.

Method

A literature review.

Results

The number of psychiatrists required depends on the role of psychiatry, which is constantly changing. The present requirement is about 250–300 per year, including replacements and new posts. The number of psychiatric trainees has always been higher than expected from the career plans of newly qualified doctors, but the number of British graduates passing the Royal College of Psychiatrists' Membership examination has still fallen short, requiring a supplement of foreign medical graduates. The recent 50% expansion in medical students may make this country self-sufficient.

Conclusions

To improve recruitment, the College should focus on influences before and after undergraduate training – the kind of student entering medical school and the factors favouring sustained psychiatric practice after graduation.
Sustained attention deficit in bipolar disorder
Authors: Clark Luke , Iversen Susan D. , Goodwin Guy M.
Published: August 2002

Background

Recovery in bipolar disorder is central to its definition but is rarely complete. Previous work has suggested that neuropsychological impairment persists during the euthymic state but has been confounded partly by mild affective symptoms in remitted patients.

Aims

To characterise neuropsychological functioning in the euthymic phase of bipolar disorder with an emphasis on tasks of executive functioning.

Method

Thirty euthymic patients with bipolar disorder were compared with thirty healthy controls on neuropsychological tasks differentially sensitive to damage within prefrontal cortex.

Results

Bipolar I patients were impaired on tasks of attentional set shifting, verbal memory and sustained attention. Only sustained attention deficit survived controlling for mild affective symptoms. This deficit was related to progression of illness, but was none the less present in a subgroup of patients near illness onset.

Conclusions

Sustained attention deficit may represent a neuropsychological vulnerability marker for bipolar disorder, providing a focus for further understanding of the phenotype and analysis of the neuronal networks involved.
Case–control study of neurocognitive function in euthymic patients with bipolar disorder: An association with mania
Authors: Cavanagh J. T. O. , Van Beck M. , Muir W , Blackwood D. H. R.
Published: August 2002

Background

Neurocognitive impairments in euthymic patients with bipolar disorder may represent trait rather than state variables.

Aims

To test the hypothesis that euthymic patients with bipolar disorder would exhibit impairment in verbal learning and memory and executive function compared with healthy controls matched for age, gender and premorbid IQ.

Method

Twenty euthymic patients with bipolar disorder were matched, on a case-by-case basis, to twenty healthy community controls. Cases and controls were tested with a battery of neuropsychological tests.

Results

Impairments were found in cases compared with controls in tests of verbal learning and memory. Verbal learning and memory correlated negatively with the number of manic episodes.

Conclusions

Impaired verbal learning and memory may be a trait variable in bipolar disease. There are implications for adherence to medication and relapse and for the role of early treatment interventions. Prospective designs and targeting first-episode groups may help to differentiate traitv.disease process effects.
Randomised trial of thyroxine to prevent postnatal depression in thyroid-antibody-positive women
Authors: Harris Brian , Oretti Rossana , Lazarus John , Parkes Arthur , John Rees , Richards Colin , Newcombe Robert , Hall Reginald
Published: August 2002

Background

Women who are positive for thyroid antibodies in early gestation are prone to post-partum depression, apparently independent of thyroid dysfunction, as measured by serum levels of free thyroxine, free triodothyroxine and thyroid-stimulating hormone. This finding may be due to infrequent monitoring of thyroid function, because hyperthyroidism, hypothyroidism and combinations of both may occur post-partum.

Aims

To test the hypothesis that stabilising thyroid function post-partum by administering daily thyroxine reduces the rate of occurrence and severity of associated depression.

Method

In a randomised double-blind placebo-controlled trial, 100 of thyroxine or placebo was given daily to 446 thyroid-antibody-positive women (342 of whom were compliant) from 6 weeks to 6 month spost-partum, assessing their psychiatric and thyroid status at 4-weeklyintervals.

Results

There was no evidence that thyroxine had any effect on the occurrence of depression. The 6-month period prevalence of depression was similar to that reported previously.

Conclusions

The excess of depression in thyroid-antibody-positive women in the post-partum period is not corrected by daily administration of thyroxine.
Amygdala volume in schizophrenia: post-mortem study and review of magnetic resonance imaging findings
Authors: Chance Steven A. , Esiri Margaret M. , Crow Timothy J.
Published: August 2002

Background

Claims that schizophrenia is a disease of the limbic system have been strengthened by meta-analyses of magnetic resonance imaging (MRI) studies finding reduced hippocampus and amygdala volumes. Some post-mortem studies do not find these abnormalities.

Aims

To assess the volume of the amygdala in a series of brains post-mortem.

Method

Amygdala volume was estimated using point-counting in both hemispheres of the brains of 10 male and 8 female patients with schizophrenia, and a comparison group of 9 males and 9 females.

Results

No significant reduction of amygdala volume was found.

Conclusions

Significant volume reduction of the amygdala is not a consistent feature of schizophrenia; findings from early MRI studies using coarse delineation methods may introduce bias to subsequent meta-analyses.
Evidence for non-progressive changes in adolescent-onset schizophrenia
Authors: James A. C. D. , Javaloyes A. , James S. , Smith D. M.
Published: August 2002

Background

It is not clear how far brain abnormalities in early-onset schizophrenia result from progressive neurodevelopmental or neurodegenerative processes.

Aims

To investigate the hypothesis that structural brain abnormalities in adolescent-onset schizophrenia are progressive in the early phase of the illness.

Method

A magnetic resonance imaging case–control study of 16 adolescents with schizophrenia (mean age 16.6 years, s.d.=1.9 years) with a meantime of 2.7 years (s.d.=1.7 years) between measurements and 16 matched controls (average age 16.0 years, s. d.=2.0 years) with a mean time of 1.7 years (s.d.=0.5 years) between measurements.

Results

There was no evidence of progressive structural brain changes during late adolescence. Significant ventricular enlargement (greater in males) and left-sided temporal lobe changes were evident from the outset of the illness.

Conclusions

Neurodevelopmental brain abnormalities are non-progressive during late adolescence.
Enhanced semantic priming in schizophrenia: a computer model based on excessive pruning of local connections in association cortex
Authors: Siekmeier Peter J. , Hoffman Ralph E.
Published: August 2002

Background

Many studies have found that people with schizophrenia exhibit abnormally high levels of semantic priming. Post-mortem and neuroimaging studies of schizophrenia suggest a reduction of neuritic processes (dendrites and synapses).

Aims

To demonstrate that reductions in neuritic processes can produce excessive priming in patients with schizophrenia.

Method

Associative memory was simulated using a computer-based neural network system consisting of two interactive neural groups, one coding for individual memories and the other for the category to which each memory belonged.

Results

Variation of a single parameter determining the density of local connections within the two neuronal groups gave a close approximation to levels of memory access and semantic priming previously reported in normal subjects and in patients with schizophrenia.

Conclusions

This study suggests that schizophrenia arises from excessive pruning of local connections in association cortex. Its findings shed light on the mechanisms underlying cognitive priming more generally, and how it might emerge developmentally.
Psychosis in high-security and general psychiatric services
Authors: Walsh Elizabeth , Leese Morven , Taylor Pamela , Johnston Ingrid , Burns Tom , Creed Francis , Higgit Anna , Murray Robin
Published: August 2002

Background

Serious violence is an unusual but significant correlate of psychosis, and leads to the need for specialist secure psychiatric services. Most such service users have previously used general psychiatric services.

Aims

To examine diagnostic and socio-demographic differences between high-security psychiatric service users from their peers in community services.

Method

Two groups of patients with psychosis were compared: a national sample of high-security hospital residents, and a sample of patients in contact with general psychiatric services.

Results

Schizophrenia was the almost invariable diagnosis for all special hospital patients. White patients in the community sample were significantly more likely to have affective components to their illness compared with African–Caribbean patients; unlike those in special hospitals. There was a small excess in the proportion of African–Caribbean patients in the special hospital group, controlling for diagnosis, gender and locality. Men were overrepresented in this group.

Conclusions

Among patients with psychosis, having a diagnosis of schizophrenia and being male increase the likelihood of special hospital admission. Suggestions that ethnic minority patients are much more likely to have engaged in serious violence and need high-security placement were not borne out.
Prader–Willi syndrome, compulsive and ritualistic behaviours: the first population-based survey
Authors: Clarke D. J. , Boer H. , Whittington J. , Holland A. , Butler J. , Webb T.
Published: August 2002

Background

Obsessive–compulsive disorder has been reported in association with Prader–Willi syndrome.

Aims

To report the nature and prevalence of compulsive and similar symptoms associated with Prader–Willi syndrome in a population ascertained as completely as possible.

Method

Attempted complete ascertainment of people with Prader– Willi syndrome in eight English counties. Administration of standardised rating scales and a structured interview. Comparison with people with learning disability and high body mass indices.

Results

Prader–Willi syndrome was associated with high rates of ritualistic behaviours, such as the need to ask or to tell something, insistence on routines, hoarding and ordering objects and repetitive actions and speech, compared with the control group, and was negatively correlated with IQ and socialisation age. Typical obsessive–compulsive symptoms, such as checking, counting and cleaning compulsions or obsessional thoughts, were not found.

Conclusions

Ritualistic and compulsive behaviours occur more frequently in association with Prader–Willi syndrome than among people with intellectual disability and significant obesity.
Dissociation and post-traumatic stress disorder: two prospective studies of road traffic accident survivors
Authors: Murray James , Ehlers Anke , Mayou Richard A.
Published: August 2002

Background

Dissociative symptoms during trauma predict post-traumatic stress disorder (PTSD), but they are often transient. It is controversial whether they predict chronic PTSD over and above what can be predicted from other post-trauma symptoms.

Aims

To investigate prospectively the relationship between dissociative symptoms before, during and after a trauma and other psychological predictors, and chronic PTSD.

Method

Two samples of 27 and 176 road traffic accident survivors were recruited. Patients were assessed shortly after the accident and followed at intervals over the next 6 months. Assessments included measures of dissociation, memory fragmentation, data-driven processing, rumination and PTSD symptoms.

Results

All measures of dissociation, particularly persistent dissociation 4 weeks after the accident, predicted chronic PTSD severity at 6 months. Dissociative symptoms predicted subsequent PTSD over and above the other PTSD symptom clusters. Memory fragmentation and data-driven processing also predicted PTSD. Rumination about the accident was among the strongest predictors of subsequent PTSD symptoms.

Conclusions

Persistent dissociation and rumination 4 weeks after trauma are more useful in identifying those patients who are likely to develop chronic PTSD than initial reactions.
Accessibility of health and social services to immigrant elders: the Islington Study
Authors: Livingston G. , Leavey G. , Kitchen G. , Manela M. , Sembhi S. , Katona C.
Published: August 2002

Background

Numbers of immigrant elders are increasing and it is unclear whether they can access services.

Aims

To examine service utilisation of older immigrants compared with their UK-born counterparts and relate it to health difficulties.

Method

Cross-sectional study in inner London measuring service use, mental health and disability.

Results

A total of 1085 people aged ⩾65 years were interviewed. Independent predictors of contact with a general practitioner included being born in Cyprus. Cypriots were the only immigrant population to report significantly more somatic symptoms than those born in the UK (P=0.005). Africans and Caribbeans used daycare and other social services most frequently.

Conclusions

Immigrants could access services. Africans and Caribbeans appear to have poorer physical health and thus have greater contact with services. Cypriots who experience depression may present with prominent somatic symptoms. This is likely to be due to a different idiom of distress.
War pensions (1900–1945): changing models of psychological understanding
Authors: Jones Edgar , Palmer Ian , Wessely Simon
Published: August 2002

Background

War pensions are used to examine different models of psychological understanding. The First World War is said to have been the first conflict for which pensions were widely granted for psychological disorders as distinct from functional, somatic syndromes. In 1939 official attitudes hardened and it is commonly stated that few pensions were awarded for post-combat syndromes.

Aims

To re-evaluate the recognition of psychiatric disorders by the war pension authorities.

Method

Official statistics were compared with samples of war pension files from the Boer War and the First and Second World Wars.

Results

Official reports tended to overestimate the number of awards. Although government figures suggested that the proportion of neurological and psychiatric pensions was higher after the Second World War, our analysis suggests that the rates may not have been significantly different.

Conclusions

The acceptance of psychological disorders was a response to cultural shifts, advances in psychiatric knowledge and the exigencies of war. Changing explanations were both a consequence of these forces and themselves agents of change.
Effects of antenatal stress and anxiety
Authors: Glover Vivette , O'Connor Thomas G.
Published: August 2002

It is increasingly apparent that antenatal maternal mood can have lasting effects on the psychological development of the child. Until recently, behavioural and biological evidence was limited to animal studies but there is growing evidence that a parallel process exists in humans. This editorial reviews findings from the animal research, considers how studies in humans have begun to tackle this issue, and examines what implications these findings have for developmental models of psychopathology.
Psychological consequences of traumatic injury
Authors: Thomas Christopher S.
Published: August 2002

Whiplash injuries commonly occur in road traffic accidents, although early descriptions of railway spine following rail accidents would appear to be similar (Trimble, 1981). Initial acute symptoms include neck pain, restricted mobility in the cervical spine, headache, pain in the thoracic spine, radiating pain, paraesthesiae and/or weakness in the arms or legs (Spitzer et al, 1995). These somatic symptoms often are accompanied by psychological symptoms such as initial ‘shock’, a ‘dazed’ feeling, anxiety, anger, depression, difficulty concentrating, insomnia, lassitude, loss of libido, altered appetite and weight and, in some cases, feelings of helplessness, horror, despair and reliving experiences (Mayou & Radanov, 1996).
Seasonal affective disorder among general practice attenders
Authors: Kendrick Tony
Published: August 2002

In this issue, Eagles et al report that people suffering from seasonal affective disorder (SAD) are heavy users of primary health care services (Eagles et al, 2002, this issue). Nearly 10% of patients attending practices in Aberdeen screened positive for SAD using the Seasonal Pattern Assessment Questionnaire (SPAQ; Rosenthal et al, 1987), among whom around half of those attending for interview fulfilled DSM–IV (American Psychiatric Association, 1994) criteria for recurrent major depression with seasonal pattern. The patients with SAD had consulted significantly more frequently over a 5-year period, with a variety of symptoms both related and unrelated to SAD, and had received significantly more prescriptions, investigations and referrals than patients found not to fulfil the criteria for SAD.
Efficacy and tolerability of venlafaxine compared with selective serotonin reuptake inhibitors and other antidepressants: A meta-analysis
Authors: Smith David , Dempster Carrie , Glanville Julie , Freemantle Nick , Anderson Ian
Published: August 2002

Background

In individual studies and limited meta-analyses venlafaxine has been reported to be more effective than comparator antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs).

Aims

To perform a systematic review of all such studies.

Method

We conducted a systematic review of double-blind, randomised trials comparing venlafaxine with alternative antidepressants in the treatment of depression. The primary outcome was the difference in final depression rating scale value, expressed as a standardised effect size. Secondary outcomes were response rate, remission rate and tolerability.

Results

A total of 32 randomised trials were included. Venlafaxine was more effective than other antidepressants (standardised effect size was −0.14, 95% Cl −0.07 to −0.22). A similar significant advantage was found against SSRIs (20 studies) but nottricyclic antidepressants (7 studies).

Conclusions

Venlafaxine has greater efficacy than SSRIs although there is uncertainty in comparison with other antidepressants. Further studies are required to determine the clinical importance of this finding.
Genetic and host factors for dementia in Down's syndrome
Authors: Schupf Nicole
Published: August 2002

Background

The high risk for dementia in adults with Down's syndrome has been attributed to triplication and overexpression of the gene for amyloid precursor protein (APP). But the wide variation in age at onset must be due to other risk factors.

Aims

To identify factors which influence age at onset of dementia in Down's syndrome.

Method

Studies of factors which influence formation of beta-amyloid (Aβ) were reviewed, including atypical karyotypes, susceptibility genotypes, gender and oestrogen deficiency, and individual differences in Aβ peptide levels.

Results

The apolipoprotein E $4 allele, oestrogen deficiency and high levels of Aβl-42 peptide are associated with earlier onset of dementia, while atypical karyotypes and the apolipoprotein E $2 allele are associated with reduced mortality and reduced risk of dementia.

Conclusions

Factors which influence Aβ levels, rather than overexpression of APP, may account for the differences in age at onset of dementia in Down's syndrome.
Effects of exercise on depressive symptoms in older adults with poorly responsive depressive disorder
Authors: Mather Anne S. , Rodriguez Cesar , Guthrie Moyra F. , McHarg Anne M. , Reid Ian C. , McMurdo Marion E. T.
Published: August 2002

Background

Depression is common in later life.

Aims

To determine whether exercise is effective as an adjunct to antidepressant therapy in reducing depressive symptoms in older people.

Method

Patients were randomised to attend either exercise classes or health education talks for 10 weeks. Assessments were made ‘blind’ at baseline, and at 10 and 34 weeks. The primary outcome was seen with the 17-item Hamilton Rating Scale for Depression (HRSD). Secondary outcomes were seen with the Geriatric Depression Scale, Clinical Global Impression and Patient Global Impression.

Results

At 10 weeks a significantly higher proportion of the exercise group (55% v. 33%) experienced a greater than 30% decline in depression according to HRSD (OR=2.51, P=0.05, 95% Cl 1.00–6.38).

Conclusions

Because exercise was associated with a modest improvement in depressive symptoms at 10 weeks, older people with poorly responsive depressive disorder should be encouraged to attend group exercise activities.
Effectiveness of time-limited psychotherapy for minor psychiatric disorders
Authors: Blay Sergio Luís , Fucks Jair S. Vel , Barruzi Márcia , Di Pietro Mônica Cristina , Gastal Fábio Leite , Neto Alfredo Maluf , De Souza Mateus P. , Glausiusz Ladislau R. U. , Dewey Michael
Published: August 2002

Background

Psychotherapy research rarely has studied outcome in the longer term.

Aims

To evaluate the effectiveness of brief group dynamic psychotherapy (BGDP) intervention in patients with minor psychiatric disorders compared with the usual clinical management shortly after treatment termination and to investigate whether intervention would show a differential effect at 2-year follow-up.

Method

Patients were allocated randomly to an experimental or control group. The General Health Questionnaire (GHQ) was used as a primary outcome measure.

Results

Based on improvement in the GHQ, at termination of treatment the BGDP group showed a significant improvement in 23 out of 42 (54.8%) compared with II out of 41 (26.8%) in the clinical management group. The difference in the total improvement rate is 28% (95% Cl 8–48) (χ2=67; d.f.=l; P=0.009). In contrast, no differential follow-up effects were found between the BGDP and clinical management groups.

Conclusions

Psychotherapy appears to have beneficial effects at termination of treatment but the changes attained were not stable.
Sexual orientation and mental health: results from a community survey of young and middle – aged adults
Authors: Jorm Anthony F. , Korten Ailsa E. , Rodgers Bryan , Jacomb Patricia A. , Christensen Helen
Published: August 2002

Background

Community surveys have reported a higher rate of mental health problems in combined groups of homosexual and bisexual participants, but have not separated these two groups.

Aims

To assess separately the mental health of homosexual and bisexual groups compared with heterosexuals.

Method

A community survey of 4824 adults was carried out in Canberra, Australia. Measures covered anxiety depression, suicidality alcohol misuse, positive and negative affect and a range of risk factors for poorer mental health.

Results

The bisexual group was highest on measures of anxiety depression and negative affect, with the homosexual group falling between the other two groups. Both the bisexual and homosexual groups were high on suicidality. Bisexuals also had more current adverse life events, greater childhood adversity, less positive support from family, more negative support from friends and a higher frequency of financial problems. Homosexuals reported greater childhood adversity and less positive support from family.

Conclusions

The bisexual group had the worst mental health, although homosexual participants also tended to report more distress.
Mental health and the built environment: Cross – sectional survey of individual and contextual risk factors for depression
Authors: Weich Scott , Blanchard Martin , Prince Martin , Burton Elizabeth , Erens Bob , Sproston Kerry
Published: August 2002

Background

Little is known about the effects of the physical environment on individual health.

Aims

The present study tested the hypothesis that the prevalence of depression is associated with independently rated measures of the built environment, after adjusting for individuals' socio-economic status and the internal characteristics of their dwellings.

Method

Cross-sectional survey of 1887 individuals aged 16 years and over in two electoral wards in north London. Depression was ascertained using the Center for Epidemiologic Studies Depression scale (CES–D). The built environment was rated independently, using a validated measure.

Results

After adjusting for socio-economic status, floor of residence and structural housing problems, statistically significant associations were found between the prevalence of depression and living in housing areas characterised by properties with predominantly deck access (odds ratio=1.28, 95% Cl 1.03–1.58; P=0.02) and of recent (post-1969) construction (odds ratio=l.43, 95% Cl 1.06–1.91; P=0.02).

Conclusions

The prevalence of depression was associated with independently rated features of the built environment, independent of individuals' socio-economic status and internal characteristics of dwellings.
Chronic, treatment-resistant depression and right fronto-striatal atrophy
Authors: Shah P. J. , Glabus M. F. , Goodwin G. M. , Ebmeier K. P.
Published: August 2002

Background

Treatment-resistant depression (TRD) is relatively common but its neurobiological basis is poorly understood. Fronto-striatal structural brain changes have been reported in patients with depression but their association with treatment resistance and chronicity has not been established.

Method

Magnetic resonance images of 20 patients with TRD were compared with images of 20recovered patients and 20 healthy controls. Images were compared using a voxel-based analysis (VBA) method; the results were validated by conventional volumetric analysis. The clinical associations of magnetic resonance imaging (MRI) changes with illness duration and severity were examined by VBA.

Results

Only the TRD group exhibited right fronto-striatal atrophy, and subtle MRI changes in the left hippocampus on VBA. Atrophy was confirmed on volumetric analysis, the degree correlating with the cumulative number of electroconvulsive therapy (ECT) treatments received, suggesting an acquired deficit.

Conclusions

This is the first study to demonstrate fronto-striatal atrophy in patients with depression with poor outcome; the atrophy is more marked in those with more severe illness.
Psychiatry of whiplash neck injury
Authors: Mayou Richard , Bryant Bridget
Published: August 2002

Background

The psychiatric outcome of whiplash neck injury is controversial.

Aims

To describe outcomes and predictors as compared with other types of road accident injury.

Method

Consecutive emergency department attenders (n=1148; whiplash 278) assessed by self-report at baseline, 3 months, 1 year and 3 years.

Results

Moderate to severe pain was reported by 27% of whiplash sufferers at I year and by 30% at 3 years. Psychiatric consequences were common and persistent. Whiplash victims and those with bony injury were more likely to seek compensation. Accident and early post-accident psychosocial variables predicted the pain at 1 year. Claiming compensation at 3 months predicted the pain at 1 year for those with whiplash or bony injury.

Conclusions

There is no special psychiatry of whiplash neck injury. Psychological variables and consequences are important following whiplash in a similar manner to other types of injury.
Use of health care services in seasonal affective disorder
Authors: Eagles John M. , Howie Fiona L. , Cameron Isobel M. , Wileman Samantha M. , Andrew Jane E. , Robertson Carol , Naji Simon A.
Published: August 2002

Background

Little is known about the presentation and management of seasonal affective disorder (SAD) in primary care.

Aims

To determine the use of health care services by people suffering from SAD.

Method

Following a screening of patients consulting in primary care, 123 were identified as suffering from SAD. Each was age— and gender-matched with two primary care consulters with minimal seasonal morbidity yielding 246 non-seasonal controls. From primary care records, health care usage over a 5-year period was established.

Results

Patients with SAD consulted in primary care significantly more often than controls and presented with a wider variety of symptoms. They received more prescriptions, under went more investigations and had more referrals to secondary care.

Conclusions

Patients with SAD are heavy users of health care services. This may reflect the condition itself, its comorbidity or factors related to the personality or help-seeking behaviour of sufferers.
Genetics, molecular biology, neuropathology and phenotype of frontal lobe dementia
Authors: Lovestone Simon , Philpot Michael , Connell James , Lantos Peter , Powell John , Russ Carsten , Anderton Brian
Published: August 2002

Background

Mutations in tau have been found in a group of related disorders including the frontal lobe dementias.

Aims

To describe the clinical features and molecular pathology changes in a single case of a patient with frontal lobe dementia.

Method

A case report was compiled from neuropathological reports and genomic and gene expression analyses.

Results

A case with a splice-site mutation resulting in a typical frontotemporal clinical and neuropathological phenotype was found. Gene expression analysis suggests differential expression of isoforms of tau in regions in the brain.

Conclusions

Frontotemporal dementia can result from gene mutations that alter splicing and expression of tau.
The Work and Social Adjustment Scale: a simple measure of impairment in functioning
Authors: Mundt James C. , Marks Isaac M. , Shear M. Katherine , Greist John M.
Published: August 2002

Background

Patients' perspectives concerning impaired functioning provide important information.

Aims

To evaluate the reliability and validity of the Work and Social Adjustment Scale (WSAS).

Method

Data from two studies were analysed. Reliability analyses included internal scale consistency, test – retest and parallel forms. Convergent and criterion validities were examined with respect to disorder severity.

Results

Cronbach's α measure of internal scale consistency ranged from 0.70 to 0.94. Test – retest correlation was 0.73. Interactive voice response administrations of the WSAS gave correlations of 0.81 and 0.86 with clinician interviews. Correlations of WSAS with severity of depression and obsessive–compulsive disorder symptoms were 0.76 and 0.61, respectively. The scores were sensitive to patient differences in disorder severity and treatment-related change.

Conclusions

The WSAS is a simple, reliable and valid measure of impaired functioning. It is a sensitive and useful outcome measure offering the potential for readily interpretable comparisons across studies and disorders.
Focus on psychiatry in New Zealand
Authors: Joyce Peter R.
Published: August 2002

New Zealand has been inhabited by the indigenous Maori people for more than 1000 years. The first European (Pakeha) to see the country, in 1642, was the Dutch explorer Abel Tasman. But the English explorer James Cook, who landed there in 1769, was responsible for New Zealand becoming part of the British Empire and, later, the British Commonwealth. In 1840 the Treaty of Waitangi was signed between Maori leaders and Lieutenant-Governor Hobson on behalf of the British Government. The three articles of the Treaty gave powers of Sovereignty to the Queen of England; guaranteed to the Maori Chiefs and tribes full, exclusive and undisturbed possession of their lands, estates, forests and fisheries; and extended to the Maori people Royal protection and all the rights and privileges of British subjects.
Does racial discrimination cause mental illness?
Authors: Chakraborty Apu , McKenzie Kwame
Published: August 2002

Different rates of mental illness have been reported in ethnic groups in the UK (Nazroo, 1997). Early work was criticised because of methodological flaws but more rigorous studies have confirmed high community prevalence rates of depression in both South Asian and African-Caribbean populations (Nazroo, 1997), high incidence and prevalence rates of psychosis in African-Caribbean groups (see Bhugra & Cochrane, 2001, for review), and higher rates of suicide in some South Asian groups (Neelemanet al, 1997) compared with the White British population. Similarly high rates have not been reported in the countries of origin of these groups (Hickling & Rodgers-Johnson, 1995; Patel & Gaw, 1996), which has led to a search for possible causes within the UK.
Adverse effects of maternal antenatal anxiety on children: Causal effect or developmental continuum?
Authors: Oates Margaret R.
Published: August 2002

There is much literature on the effects on the developing brain of adverse events in pregnancy and the sensitive period postpartum, both in humans and in animals (Perry & Pollard, 1998). The study published by O'Connor etal(2002, this issue) contributes to this by suggesting that maternal antenatal anxiety increases the risk of behavioural problems in early childhood. They suggest that this could be due to the direct effect of maternal anxiety and stress on foetal brain development. This study also contributes to the longstanding and increasing evidence base that suggests that maternal mental ill health is related to childhood difficulties (Murray et al, 1996).
A tale of corruption
Authors: Crisp Arthur H.
Published: August 2002

The multi-disciplinary team of Becker and colleagues elegantly present their findings addressing aspects of the impact on Fijian schoolgirls of exposure to Western television (Beckeret al, 2002, this issue). These findings support the notion that such exposure has generated disordered eating, underlying body dissatisfaction and intergenerational conflicts within the family that may, in part, be fuelling the process. Focusing on the expected escalation of such disordered eating in this population under these circumstances, their study was naturalistic in capitalising on the recent introduction of television to Fiji, with the first survey of these schoolgirls taking place within 1 month of its advent. The second survey was 3 years later in 1998. The authors point out that the traditional Fijian culture has ‘supported robust appetites and body shapes'.
Antipsychotics and sudden death: Is thioridazine the only bad actor?
Authors: Ray Wayne A. , Meador Keith G.
Published: August 2002

For at least the past 30 years it has been known that people with schizophrenia have higher death rates, particularly from cardiovascular causes, than would be expected on the basis of demographics (Allebeck & Wistedt, 1986; Mortensen & Juel, 1990; Newman & Bland, 1991; Walker et al, 1997). Initially, suspicion focused upon lifestyle factors, such as ubiquitous smoking and poor self-care, and perhaps upon a direct effect of the disease. However, some of the suspicion began to shift to the drugs used to treat the disease, fuelled both by the accumulation of case reports among antipsychotic users of serious ventricular arrhythmias and sudden unexpected deaths (Liberatore & Robinson, 1984; Kriwisky et al, 1990; Mehtonen et al, 1991; Donatini et al, 1992; Thomas, 1994; Jackson et al, 1997; Ravin & Levenson, 1997; Zarate et al, 1997; Dickinson, 2000), as well as advancing understanding of the electrophysiological properties of these drugs (Thomas, 1994; Suessbrich et al, 1997; Drici et al, 1998; Rampe et al, 1998; Shader & Greenblatt, 1998; Studenik et al, 1998; Reilly et al, 2000).
Rapid tranquillisation: Time for a reappraisal of options for parenteral therapy
Authors: McAllister-Williams R. Hamish , Ferrier I. Nicol
Published: August 2002

Background

When parenteral treatments are indicated for acutely disturbed behaviour, previous guidelines have recommended droperidol or haloperidol in combination with benzodiazepines. However, there has been recent concern over cardiotoxicity and sudden death associated with some antipsychotic medication and droperidol has now been withdrawn.

Aims

To ascertain what alternatives can be recommended to replace intramuscular droperidol.

Method

Selective review of current guidelines and the literature pertaining to rapid parenteral tranquillisation.

Results

Current guidelines recommend haloperidol as an alternative to droperidol. There is evidence of cardiotoxicity with haloperidol and it has a propensity to cause extrapyramidal side effects that may exacerbate disturbed behaviour and reduce longer-term compliance. The rapid-acting intramuscular formulations of atypical antipsychotic agents show promise.

Conclusions

It is recommended that the mainstay of pharmacological rapid tranquillisation should be parenteral benzodiazepines used with due care.
Violence and schizophrenia: Examining the evidence
Authors: Walsh Elizabeth , Buchanan Alec , Fahy Thomas
Published: August 2002

Background

It is now accepted that people with schizophrenia are significantly more likely to be violent than other members of the general population. A less acknowledged fact is that the proportion of societal violence attributable to schizophrenia is small.

Aims

To critically examine the epidemiological evidence for the association between violence and schizophrenia and estimate the impact of this association on society.

Method

A selective review of the key literature on the epidemiology of violence and schizophrenia. Population-attributable risks for violence in schizophrenia are calculated from population-based studies.

Results

Most studies confirm the association between violence and schizophrenia. Recent good evidence supports a small but independent association. Comorbid substance abuse considerably increases this risk. The proportion of violent crime in society attributable to schizophrenia consistently falls below 10%.

Conclusions

Less focus on the relative risk and more on the absolute risk of violence posed to society by people with schizophrenia would serve to reduce the associated stigma. Strategies aimed at reducing this small risk require further attention, in particular treatment for substance misuse.
Perinatal and childhood risk factors for later criminality and violence in schizophrenia
Authors: Cannon Mary , Huttunen Matti O. , Anen Antti J. Tansk , Arseneault Louise , Jones Peter B. , Murray Robin M.
Published: August 2002

Background

Individuals with schizophrenia appear to be at increased risk for violent and criminal behaviour. Obstetric complications, neuromotor problems and intellectual deficits have variously been reported as increasing the risk for criminality in the general population.

Aims

To investigate whether such risk factors are associated with criminal behaviour in an epidemiological cohort of patients with schizophrenia.

Method

We identified from health care registers all individuals with schizophrenia born in Helsinki between 1951 and 1960, and used the national criminal register to identify those with a criminal record by 1995. Childhood information was obtained from archived birth and school records.

Results

Poor educational attainment, poor grades for attention at school, higher birth weight and larger head circumference were significantly associated with the risk of criminal offending in adulthood in this sample of patients with schizophrenia. An association between labour/delivery complications and later violent offending among male patients was of borderline significance.

Conclusions

Our hypotheses that birth complications and childhood neuromotor problems would increase the risk of criminal offending in schizophrenia were not upheld.
Maternal antenatal anxiety and children's behavioural/emotional problems at 4 years
Authors: O'Connor Thomas G. , Heron Jonathon , Golding Jean , Beveridge Michael , Glover Vivette
Published: August 2002

Background

Animal experiments suggest that maternal stress and anxiety during pregnancy have long-term effects on the behaviour of the off spring.

Aims

To test the hypothesis that antenatal maternal anxiety predicts behavioural problems at age 4 years.

Method

Data were collected on multiple antenatal and postnatal assessments of maternal anxiety and depression, antenatal and obstetric risks, psychosocial risks and children's behavioural/emotional problems (n=7448).

Results

Antenatal maternal anxiety predicted behavioural/emotional problems in boys (OR=2.14,95% CI 1.48−3.10) and girls (OR=1.88,95% CI 1.3–2.69) after accounting for covariates. When covarying maternal anxiety up to 33 months postnatally, antenatal anxiety continued to predict total problems in boys (OR=1.56,95% CI 1.02–2.41) and girls (OR=1.5l, 95% CI 1.22–2.81).

Conclusions

There could be a direct effect of maternal mood on foetal brain development, which affects the behavioural development of the child.
Eating behaviours and attitudes following prolonged exposure to television among ethnic Fijian adolescent girls
Authors: Becker Anne E. , Burwell Rebecca A. , Herzog David B. , Hamburg Paul , Gilman Stephen E.
Published: August 2002

Background

There are no published studies evaluating the impact of introduction of television on disordered eating in media-naïve populations.

Aims

To assess the impact of novel, prolonged exposure to television on disordered eating attitudes and behaviours among ethnic Fijian adolescent girls.

Method

A prospective, multi-wave cross-sectional design was used to compare two samples of Fijian schoolgirls before and after prolonged regional television exposure with a modified 26-item eating attitudes test, supplemented with a semi-structured interview to confirm self-reported symptoms. Narrative data from a subset of respondents from the exposed sample were analysed for content relating television exposure to body image concerns.

Results

Key indicators of disordered eating were significantly more prevalent following exposure. Narrative data revealed subjects' interest in weight loss as a means of modelling themselves after television characters.

Conclusions

This naturalistic experiment suggests a negative impact of television upon disordered eating attitudes and behaviours in a media-naïve population.
Thioridazine and sudden unexplained death in psychiatric in-patients
Authors: Reilly J. G. , Ayis S. A. , Ferrier I. N. , Jones S. J. , Thomas S. H. L.
Published: August 2002

Background

Sudden death has been linked to antipsychotic therapy but the relative risk associated with specific drugs is unknown.

Aims

To assess the risk of sudden unexplained death associated with antipsychotic drug therapy and its relation to drug dose and individual agents.

Method

A case-control study of psychiatric in-patients dying suddenly in five hospitals in the north-east of England and surviving controls matched for age, gender and mental disorder. Logistic regression analysis was used to identify significant risk factors, and odds ratios were calculated.

Results

Sixty-nine case-control clusters were identified. Probable sudden unexplained death was significantly associated with hypertension, ischaemic heart disease and current treatment with thioridazine (adjusted odds ratio=5.3, 95% CI 1.7–16.2, P=0.004). There was no significant association with other individual antipsychotic drugs.

Conclusions

Thioridazine alone was associated with sudden unexplained death, the likely mechanism being drug- induced arrythmia.
Effectiveness of a brief cognitive–behavioural therapy intervention in the treatment of schizophrenia
Authors: Turkington Douglas , Kingdon David , Turner Trevor
Published: August 2002

Background

Little evidence exists to indicate whether community psychiatric nurses can achieve the results reported by expert cognitive–behavioural therapists in patients with schizophrenia.

Aims

To assess the effectiveness and safety of a brief cognitive- behavioural therapy (CBT) intervention in a representative community sample of patients with schizophrenia in secondary care settings.

Method

A pragmatic randomised trial was performed involving 422 patients and carers to compare a brief CBT intervention against treatment as usual.

Results

Patients who received CBT (n=257) improved in overall symptomatology (P=0.015; number needed to treat [NNT]= 13), insight (P<0.001; NNT=10) and depression (P=0.003;NNT=9) compared with the control group (n=165). Insight was clinically significantly improved (risk ratio =1.15,95% C1 1.01-1.31).There was no increase in suicidal ideation.

Conclusions

Community psychiatric nurses can safely and effectively deliver a brief CBT intervention to patients with schizophrenia and their carers.
Randomised controlled study of sleep after nefazodone or paroxetine treatment in out-patients with depression
Authors: Hicks Jane A. , Argyropoulos Spilios V. , Rich Ann S. , Nash Jon , Bell Caroline J. , Edwards Chris , Nutt David J. , Wilson Susan J.
Published: August 2002

Background

Sleep effects of antidepressants are important clinically and for elucidating mechanism of action: selective serotonin reuptake inhibitors disturb sleep and 5-HT2 receptor-blocking compounds may enhance sleep quality.

Aims

To compare the objective and subjective effects on sleep of paroxetine and nefazodone in patients with moderate to severe depression.

Method

Forty patients with depression were randomised to take paroxetine 20-40 mg/day or nefazodone 400–600 mg/day for 8 weeks. Objective and subjective quality of sleep and depression measures were assessed throughout.

Results

Nefazodone significantly increased objective sleep efficiency and total sleep time, and improved subjective sleep on days 3 and 10. Paroxetine decreased sleep efficiency early in treatment and some sleep disruption remained at week 8. Paroxetine but not nefazodone produced marked suppression of rapid eye movement (REM) sleep.

Conclusions

Nefazodone improves sleep in early treatment compared with paroxetine in patients with moderate to severe depression. These effects are seen within the first 2 weeks of treatment and diminish thereafter.