bluuebunny/crossref_metadata_2025 huggingface dataset:
Helpfulness of interventions for mental disorders: Beliefs of health professionals compared with the general public
Authors: Jorm Anthony F. , Korten Ailsa E. , Jacomb Patricia A. , Rodgers Bryan , Pollitt Penelope , Christensen Helen , Henderson Scott
Published: October 2008

Background

The study aimed to compare the beliefs of health professionals about the potential helpfulness of various mental health interventions with those of the general public.

Method

Surveys were carried out in Australia of 872 general practitioners, 1128 psychiatrists, 454 clinical psychologists and 2031 members of the public. Respondents were presented with a case vignette describing either a person with depression or one with schizophrenia. Respondents were asked to rate the likely helpfulness of various types of professional and nonprofessional help and of pharmacological and non-pharmacological interventions.

Results

The professionals gave much higher ratings than the public to the helpfulness of antidepressants for depression, and of antipsychotics and admission to a psychiatric ward for schizophrenia. Conversely, the public tended to give much more favourable ratings to vitamins and minerals and special diets for both depression and schizophrenia, and to reading self-help books for schizophrenia.

Conclusion

The beliefs that health practitioners hold about mental disorders differ greatly from those of the general public. There is a need for mental health education campaigns to help close the gap between professional and public beliefs.
Poor memory, negative symptoms and abnormal movements in never-treated Indian patients with schizophrenia
Authors: McCreadie R. G. , Latha S. , Thara R. , Padmavathi R. , Ayankaran J. R.
Published: October 2008

Background

Cognitive impairment, frequently found in patients with schizophrenia, may be associated with negative symptoms and dyskinesia. However, antipsychotic medication may be a confounding variable. These putative associations may be clarified by examining never-treated patients.

Method

Never-treated elderly schizophrenic patients (n=19) living in south-east India were compared with treated patients (n=25) and normal subjects (n=55). Memory was assessed by the Wechsler Memory Scale, negative symptoms by the Positive and Negative Syndrome Scale, and dyskinesia by the Abnormal Involuntary Movements Scale.

Results

Normal subjects had a higher mean memory quotient than patients. There were no significant differences between never-treated and treated patients. Negative symptoms were associated with a poorer memory in the never-treated group. There was no association between memory and dyskinesia.

Conclusions

There is an association in never-treated patients between a poorer memory and negative symptoms, but not between a poorer memory and dyskinesia.
Age-related cognitive decline and vision impairment affecting the detection of dementia syndrome in old age
Authors: Reischies Friedel M. , Geiselmann Bernhard
Published: October 2008

Background

Currently the Mini Mental State Examination (MMSE) is widely used as a screening instrument for dementia syndrome. Diagnostic validity may be lowered in old age by normal age-related cognitive decline. Furthermore, visual impairment, occurring frequently in old age, leads to missing values which prevent an interpretation of the test result.

Method

In the Berlin Ageing Study (n=516, age range 70–103 years) MMSE and clinical dementia diagnosis, made by a psychiatrist investigating all subjects by the Geriatric Mental State–A and History and Aetiology Schedule interviews, were investigated independently. The MMblind was analysed, an MMSE version for vision impairment in which all items requiring image processing are omitted. The study sample is population-based; dementia cases (DSM–III–R) were excluded on the basis of the clinical diagnosis.

Results

Norms are reported for very old age regarding MMSE as well as MMblind. There is a considerable age effect on MMSE scores. In contrast to MMSE, sensitivity and specificity of the shorter MMblind version are not reduced.

Conclusions

The considerable age effect requires the adaptation of cut-off values for old age. The blind version of the MMSE seems to be a valid instrument improving the applicability of the MMSE in old age.
Costs of schizophrenia
Authors: Knapp Martin
Published: October 2008

Background

Schizophrenia is a common and burdensome illness, with implications not only for the health service but for a host of other care agencies – public and private – as well as for patients, families and the wider society.

Method

The paper reviews available UK evidence on the cost of schizophrenia (broadly defined) and on the cost-effectiveness of treatment options and alternative care arrangements. New evidence potentially alters our view of the costs of this illness.

Results

Aggregating the identifiable direct and indirect costs of schizophrenia for England suggests an annual cost of £2.6 billion, but even this sum omits some indirect impacts which cannot currently be costed. Just over half the identified total is accounted for by the direct costs falling to the NHS, local authorities, charities and the criminal justice system. In helping to tackle this cost burden, there is now a body of evidence on cost-effective community care arrangements, antipsychotic drugs and psychological interventions.

Conclusions

Although the costs of schizophrenia are considerable, there are treatments and care arrangements which can reduce this aggregate burden while maintaining or improving effectiveness.
Test of Xq26.3–28 linkage in bipolar and unipolar affective disorder in families selected for absence of male to male transmission
Authors: Smyth Ciaran , Kalsi Gursharan , Brynjolfsson Jon , O'Neill Jane , Curtis David , Rifkin Larry , Moloney Eamon , Murphy Patrice , Petursson Hannes , Gurling Hugh
Published: October 2008

Background

There have been several reports of linkage between genetic markers on the X chromosome at Xq26.3-28 and bipolar affective disorder in family samples obtained from distinct ethnic and geographical origins. As part of a genome search in a series of 23 UK and Icelandic families, specifically selected for their large size and power to resolve the issue of linkage heterogeneity, we have tested the hypothesis that there is a locus for a genetic subtype of bipolar affective disorder which is linked to this region.

Method

In families selected on the basis of absent male to male transmission for affective disorder, we performed two-point and FASTMAP multipoint linkage analyses with markers spanning the region between the genetic loci DXS102 and F8

Results

We found negative lod scores for several models of affection status in families selected under stringent and relaxed criteria for the absence of male to male transmission.

Conclusions

In the family sample we have obtained, our study provides no support for the presence of a locus increasing genetic susceptibility to bipolar affective disorder in this region of the X chromosome. It is likely that our finding reflects heterogeneity of linkage for bipolar and genetically related unipolar disorder that exists in specific ethnic populations. Alternatively the X-linked subtype of the disorder may have been present only in a few of our small families resulting in loss of power to detect the Xq26.3-28 linked subtype.
Recurrence in affective disorder
Authors: Kessing Lars Vedel , Bolwig Tom Gert , Andersen Per Kragh , Mortensen Preben Bo
Published: October 2008

Background

In recent years, studies of the risk of recurrence in affective disorder in relation to the number of prior episodes have given contradictory results.

Method

Survival analysis was used to calculate the rate of recurrence after successive episodes in a case register study including all hospital admissions with primary affective disorder in Denmark during 1971–1993. A total of 20 350 first-admission patients were discharged with a diagnosis of affective disorder, depressive or manic/cyclic type.

Results

The rate of recurrence increased with the number of previous episodes in both unipolar and bipolar disorder. Initially, the two types of disorders followed markedly different courses, but later in the course of the illness the rate of recurrence was the same for the two disorders.

Conclusions

The course of severe unipolar and bipolar disorder seems to be progressive in nature despite the effect of treatment.
Treatment of severe clozapine-induced neutropenia with granulocyte colony-stimulating factor (G-CSF)
Authors: Sperner-Unterweger B. , Czeipek I. , Gaggl S. , Geissler D. , Spiel G. , Fleischhacker W. W.
Published: October 2008

Background

A 17-year-old boy suffering from a severe schizophrenic disorder of the paranoid type and mental retardation did not respond to treatment with typical antipsychotics, whereas under clozapine treatment he showed a favourable response. Discontinuation of clozapine led to an acute psychotic relapse. During clozapine treatment the patient developed severe neutropenia.

Method and Results

Due to the history of unsatisfactory response to traditional antipsychotics, clozapine treatment was continued despite white blood cell (WBC) decline. Concomitant treatment with G-CSF was followed by a rapid normalisation of WBC.

Conclusions

This case report is not intended to challenge the clinical practice of discontinuing clozapine upon the development of neutropenia/agranulocytosis, but rather to stimulate further research in the pathophysiology and clinical consequences of a clozapine rechallenge after a WBC decline, especially in patients with a rather complex symptomatology where no sufficient therapeutic results can be achieved with any other pharmacological intervention than clozapine.
Behaviour phenotype for Down's syndrome
Authors: Collacott Richard A. , Cooper Sally-Ann , Branford David , McGrother Catherine
Published: October 2008

Background

For more than a century, the idea of particular personality/behavioural characteristics being associated with people with Down's syndrome has been explored, but with inconclusive results.

Method

The Disability Assessment Schedule was used to ascertain the behavioural profiles of 360 adults with Down's syndrome and 1829 adults with learning disabilities of other aetiologies, who were the whole identified population within a defined geographical area. Comparison was made between the two total groups and additionally for the subgroups aged < 35 years and aged ⩾35 years. Comparison was also made with regards to cluster analysis findings.

Results

Despite an equal age and developmental quotient, the Down's syndrome group were less likely to demonstrate maladaptive behaviours. The behaviour characteristics of the adults with Down's syndrome remained constant in the younger and older age groups. Cluster analysis demonstrated adults with Down's syndrome to have an increased prevalence in cluster groupings with lower rates of maladaptive behaviours.

Conclusions

This study confirms there to be a behaviour phenotype among adults with Down's syndrome. The reasons for this (e.g. genetic/psychological/social) require further research. Such research may establish a better understanding of the aetiologies of maladaptive behaviours among people with learning disabilities in general.
Epilepsy and non-organic non-affective psychosis
Authors: Bredkjær Søren , Ensen Pre Ben Bo Mort , Parnas Josef
Published: October 2008

Background

This study tests the hypothesis that epilepsy increases the risk of developing schizophrenia and other non-affective functional psychoses using a nationwide sample of people with epilepsy.

Method

A record linkage study between a sample from the National Patient Register, consisting of 67 116 people with epilepsy, and the Danish Psychiatric Register identified all people with non-affective psychoses with onset after the first epilepsy diagnosis. The relation between risk of psychiatric disorder in people with epilepsy and the general Danish population was estimated.

Results

The incidences of the spectrum of non-organic non-affective psychosis, non-affective psychosis and schizophrenia were significantly increased both for men and women, even after exclusion of people diagnosed as suffering from a learning disability or substance misuse.

Conclusion

This study supports the notion of an association between epilepsy and the risk of subsequent non-affective psychosis.
Multivariate genetic analysis of the causes of temperance board registrations
Authors: Kendler Kenneth S. , Karkowski Laura M. , Prescott Carol A. , Neale Michael C. , Pedersen Nancy L.
Published: October 2008

Background

The Temperance Boards in Sweden registered individuals for three reasons: public drunkenness, driving under the influence of alcohol and committing a crime in connection with alcohol. We wanted to ascertain whether these three forms of alcohol-related problems result from similar or different genetic and environmental risk factors.

Method

We conducted a trivariate twin analysis of these three causes of registration in all male-female twin pairs of known zygosity born in Sweden, 1926–1949 (n=5177 twin pairs).

Results

Prevalences of registration for public drunkenness, drink-driving and alcohol-related crime were, respectively, 9.0, 3.6 and 4.0%. The best-fitting model had one general genetic and one general familial – environmental factor with specific genetic risk factors for drink-driving and specific familial – environmental risk factors for alcohol-related crime.

Conclusions

The three causes for alcohol registration in Sweden largely reflect the same genetic and environmental risk factors. Estimated heritabilities were similar for the three forms of registration. However, specific genetic risk factors exist for drink-driving and specific familial – environmental risk factors for alcohol-related crime. Genetic factors are somewhat less important and familial –environmental factors more important for public drunkenness than for drink-driving and alcohol related crime.
Prefrontal cortex activity in people with schizophrenia and control subjects
Authors: Spence Sean A. , Hirsch Steven R. , Brooks David J. , Grasby Paul M.
Published: October 2008

Background

Hypo-activation of the left dorsolateral prefrontal cortex is inconsistently found in neuroimaging studies of schizophrenia. As the left dorsolateral prefrontal cortex is involved in the generation of action, disordered function in this region may be implicated in schizophrenic symptomatology.

Method

We used H215O positron emission tomography to study dorsolateral prefrontal cortical function in men with schizophrenia (n=13) and male control subjects (n=6) performing joystick movements on two occasions, 4–6 weeks apart. The patients were initially in relapse. To clarify dorsolateral prefrontal cortical function we also scanned another group of control subjects (n=5) performing mouth movements.

Results

The control subjects performing hand or mouth movements activated the left dorsolateral prefrontal cortex to a maximum when the movements were self-selected. The men with relapsed schizophrenia exhibited left dorsolateral prefrontal cortical hypo-activation, which remitted with symptomatic improvement.

Conclusions

Hypofrontality in these patients is a dynamic phenomenon across time, possibly related to current symptomatology. The most appropriate question about the presence of hypofrontality in schizophrenia may be when, rather than whether, it will occur.
Outcomes of Depression International Network (ODIN)
Authors: Dowrick Christopher , Casey Patricia , Dalgard Odd , Hosman Clemens , Lehtinen Ville , Vázquez-Barquero José-Luis , Wilkinson Greg
Published: October 2008

Background

ODIN aims (a) to provide data on the prevalence, risk factors and outcome of depressive disorders in rural and urban settings within the European Union (EU) based on an epidemiological sampling frame; and (b) to assess the impact of two psychological interventions on the outcome of depression and on service utilisation and costs.

Method

Five centres across the EU are participating in ODIN. The centres are linked electronically and members meet regularly for training and strategic reviews. Urban and rural areas have been identified in each centre. The sampling frame is of adults aged 18–64, identified via primary care databases or electoral registers. Potential cases of depressive disorders are identified using the Beck Depression Inventory. SCAN II and other validated measures are used to assign caseness against DSM–IV and ICD–10 criteria; assess comorbidity, disability, genetic/familial susceptibility, psychosocial stressors, personality traits and cognitive factors; and utilisation of local health care services. A randomised controlled trial of individual problem-solving treatment and a group educational programme is undertaken for respondents identified as cases of depressive disorder. Individuals are followed-up at six and 12 months.

Results and Conclusions

ODIN has already stimulated the development of an effective international research partnership.
Home self-assessment of obsessive-compulsive disorder
Authors: Marks Isaac M. , Baer Lee , Greist John H. , Park Je-Min , Bachofen Martin , Nakagawa Akiko , Wenzel Keith W. , Parkin J. Richard , Manzo Peter S. , Dottl Susan L. , Mantle Julia M.
Published: October 2008

Background

Two studies tested whether subjects with obsessive-compulsive disorder could successfully use BT STEPS, a computer-aided system, to perform self-assessment for self-treatment of obsessive-compulsive disorder by exposure and ritual prevention.

Method

Subjects were given a self-guiding manual and could use a touch-tone telephone to access computer-controlled Interactive Voice Response interviews at their convenience from home. Using the BT STEPS system, patients rated themselves and worked out a plan for individually tailored self-exposure therapy.

Results

Outcomes were similar in the two studies. Of the 63 subjects who used BT STEPS, 84% completed the self-assessment module. Most calls were made outside usual office hours. As expected, subjects did not improve merely by completing self-assessment. However, completion of self-assessment predicted later improvement with self-exposure therapy.

Conclusions

Most subjects successfully completed self-assessment using BT STEPS from their homes.
Post-traumatic stress disorder in children and adolescents following road traffic accidents
Authors: Mirza K. A. H. , Bhadrinath B. R. , Goodyer Ian M. , Gilmour Carol
Published: October 2008

Background

Post-traumatic stress disorder (PTSD) can be a persistent and disabling psychiatric disorder. There is little systematic research into the psychiatric consequences of road traffic accidents (RTAs) in children and adolescents.

Method

A consecutive sample of 8–16-year-olds attending an accident and emergency department following RTAs were screened for PTSD. Potential cases and their parent(s) were interviewed with semi-structured research instruments about six weeks and six months after the accident.

Results

Fifty-three (45%) of the 119 subjects fell above PTSD cut-off on the Frederick's Reaction Index. Thirty-three (75%) of the 44 cases met DSM–IV criteria for PTSD. In half of these other psychiatric disorders were present, including major depressive disorder and anxiety disorders. Being female, involvement in car accidents and pre-existing depression and anxiety were associated with developing PTSD. Seventeen per cent of the sample continued to be symptomatic six months after the accident.

Conclusions

PTSD is a common consequence of RTAs. Liaison with accident and emergency departments would enhance the early detection and follow-up of children at risk of developing PTSD.
Home-based versus hospital-based care for serious mental illness
Authors: Knapp Martin R. J. , Marks Isaac M. , Wolstenholme Jane , Beecham Jennifer K. , Astin Jack , Audini Bernard , Connolly Joseph , Watts Vik
Published: October 2008

Background

The Daily Living Programme (DLP) offered intensive home-based care with problem-centred case management for seriously mentally ill people facing crisis admission to the Maudsley Hospital, London. The cost-effectiveness of the DLP was examined over four years.

Method

A randomised controlled study examined cost-effectiveness of DLP versus standard in/out-patient hospital care over 20 months, followed by a randomised controlled withdrawal of half the DLP patients into standard care. Three patient groups were compared over 45 months: DLP throughout the period, DLP for 20 months followed by standard care, and standard care throughout. Bivariate and multivariate analyses were conducted (the latter to standardise for possible inter-sample differences stemming from sample attrition and to explore sources of within-sample variation).

Results

The DLP was more cost-effective than control care over months 1–20, and also over the full 45-month period, but the difference between groups may have disappeared by the end of month 45.

Conclusions

The reduction of the cost-effectiveness advantage for home-based care was perhaps partly due to the attenuation of DLP care, although sample attrition left some comparisons under-powered.
Establishing the limits of normal cerebral ageing and senile dementias
Authors: Ritchie Karen
Published: October 2008

Cognitive deterioration is so commonly observed in the elderly that it is considered by many to be an inevitable feature of the ageing process. Some researchers have proposed that the senile dementias are the inevitable end-point of this process, should the person live long enough. The differentiation of normal cerebral ageing from disease process is important in the selection of control groups for research, and also for clinical decision-making. In the latter context it is important to ask at what level of dysfunction intervention should occur, and whether this should be active or palliative. Cognitive change in the elderly is here considered from biological, neuropsychological and epidemiological viewpoints. Current research suggests that senile dementia is the result of the interplay of genetically determined disease processes, ageing-related decline which may be regulated at a cellular level, and neuronal repair and compensation mechanisms. Therefore, to debate whether dementia is simply an extension of a normal ageing process or not is probably too simplistic an approach.
Pindolol augmentation of antidepressant therapy
Authors: McAskill Robyn , Mir Shameem , Taylor David
Published: October 2008

Background

Antidepressant therapy is not always effective and is slow to take effect. In theory, these shortfalls may be caused by induction of neuronal negative feedback via pre-synaptic 5-HTIA receptors. Pindolol, an antagonist at somatodentritic pre-synaptic 5-HTIA receptors has been investigated as a potential accelerator and augmenter of antidepressant response.

Method

A Medline search was conducted in November 1997.

Results

Six open-label studies and six controlled studies were identified for review Conclusions Open-label studies strongly suggest that pindolol may accelerate and augment antidepressant response, but controlled studies do not wholly support these findings: only three of six studies clearly demonstrate benefit. Larger, well-designed, controlled trials are needed to determine definitively the effectiveness of pindolol in this context.
Methods used for suicide by farmers in England and Wales
Authors: Hawton Keith , Fagg Joan , Simkin Sue , Harriss Louise , Malmberg Aslög
Published: October 2008

Background

Farmers in the UK have an elevated risk of suicide. It has been suggested that this may be related to their ease of access to dangerous means for suicidal behaviour. The extent to which farmers use these means and changes in their use may be relevant to suicide prevention.

Method

Data on 719 deaths in farmers of both genders in England and Wales between 1981 and 1993 in which a verdict of suicide or undetermined cause (open verdict) was recorded were analysed.

Results

Of 702 deaths in male farmers, farms were involved in 40.0%, hanging in 29.6%, carbon monoxide in 16.4%, poisoning in 8.0% (over half of which involved agricultural or horticultural poisons) and other methods in 6.1%. There was a considerable excess of deaths due to firearms compared with the distribution of methods of suicide and open verdict deaths in males in the general population. Hanging was also somewhat more frequent. During the study period there was a reduction in firearm death rates, particularly after 1989 when there was national legislation on firearm ownership, registration and storage. There were also fewer farming suicides after this date. By the end of the study period hanging was more frequent than deaths involving firearms.

Conclusions

Farmers who commit suicide tend to use methods to which they have easy access. Restriction of the ready availability of such methods, particularly in farmers known to be depressed or otherwise at risk, might prevent some suicides.
Rationale and design
Authors: Thornicroft Graham , Strathdee Geraldine , Phelan Michael , Holloway Frank , Wykes Til , Dunn Graham , McCrone Paul , Leese Morven , Johnson Sonia , Szmukler George
Published: October 2008

Background

This paper sets out the rationale for the PRiSM Psychosis Study, and the research design used. Nine accompanying papers present the main results. The questions addressed by the PRiSM Psychosis Study are: can the gains of experimental studies which have demonstrated benefits arising from treatment by community mental health teams be translated to routine settings? If so, are the benefits diluted in ordinary clinical practice? What are the costs?

Method

A prospective non-randomised controlled trial of two types of community mental health service, in two phases: case identification followed by patient interviews. For the case identification the research team conducted the complete ascertainment of all prevalent cases of psychosis in the two study catchment areas in the index year (1991–1992). From all 514 patients with psychotic disorders thus identified, 302 were randomly allocated for interview, along with a key informant clinician and a carer. Interviews were undertaken at two time points, two years apart.

Results

This paper presents the socio-demographic, clinical and ethnic characteristics of the patients.

Conclusions

The people with psychosis interviewed for the PRiSM Psychosis Study are representative of the whole epidemiologically based patient population identified.
Utilisation and costs of community mental health services
Authors: McCrone Paul , Thornicroft Graham , Phelan Michael , Holloway Frank , Wykes Til , Johnson Sonia
Published: October 2008

Background

The costs and the effectiveness of mental health services need to be evaluated if provision is to be efficient. Service use and costs are described for two geographical areas in south London.

Method

Service use was measured comprehensively for clients in both sectors for two six-month time periods using the Client Service Receipt Interview This information was combined with unit costs to calculate service costs. The ‘hidden’ costs of informal care and unsupported accommodation were also calculated.

Results

At baseline significantly more intensive sector clients had in-patient stays but by the follow-up this difference had disappeared. There was significantly more use of supported accommodation in the intensive sector during both time periods. Baseline and follow-up total service costs were significantly higher for the intensive sector. Costs were spread disproportionately and a small number of services accounted for a large proportion of cost.

Conclusions

While the cost at Time 2 was significantly greater in the intensive sector, this was largely due to the high use of supported accommodation. There was some convergence in cost between the sectors over time.
User perspective on needs and satisfaction with mental health services
Authors: Leese Morven , Johnson Sonia , Slade Mike , Parkman Sue , Kelly Frank , Phelan Michael , Thornicroft Graham
Published: October 2008

Background

Measurement of the impact of different types of service provision on the views of service users is important in planning mental health services.

Method

Needs (met and unmet) and satisfaction with services, were assessed. People with psychosis (n=131) were interviewed before (Time 1) and after (Time 2) the introduction of two community mental health services in south London. One was intensive, with two specialist teams, the other standard. Outcomes were compared at Time 2, controlling for the Time 1 values.

Results

Overall, 70% of needs were met and mean satisfaction was between ‘mixed’ and ‘mainly satisfied’. There was evidence for higher met needs in the intensive sector, but no evidence for lower unmet needs in the intensive sector or for differences in satisfaction. The additional needs met by the intensive service were associated with aspects of basic living situation. Satisfaction was negatively correlated with both unmet and met needs.

Conclusions

Both services were reasonably successful, with little difference from the user perspective. The intensive service provided benefits in terms of met needs, but this has to be balanced against a possible increase in unmet needs.
Family burden of schizophrenia and depressive illness
Authors: Jenkins Janis H. , Schumacher John G.
Published: October 2008

Background

The burdens experienced by relatives of mentally ill persons are substantial.

Aims

To study the relationship between family burden and sociocultural context.

Method

A comparative study of Euro-Americans and Latinos ascertained whether dimensions of family response are (a) non-specific to diagnostic groups; and/or (b) variable across cultural settings.

Results

Regardless of diagnosis or ethnicity, patient misery was found most burdensome and distressing. However, considerable difference in shades of meaning and nuance across groups appears in relation to what is classed similarly as ‘misery’. Only gender was significantly associated with social performance (males reported to have greater deficits). A complex cultural – ecological effect was observed among the Latino–schizophrenia group.

Conclusions

Findings suggest similarities and differences in levels of family burden in relation to socio-cultural factors across cultural and diagnostic groups. The specificity of results by objective and subjective measures, types of burden, gender, ethnicity, diagnosis, and living situation confirm the importance of context and heterogeneity in understanding family burden and distress.
Genetic basis of attention deficit and hyperactivity
Authors: Thapar Anita , Holmes Jane , Poulton Kay , Harrington Richard
Published: October 2008

Background

Hyperkinetic disorder or attention-deficit hyperactivity disorder (ADHD) is an important clinical condition.

Aims

The research evidence for a genetic contribution to ADHD is reviewed.

Method

Measurement of the phenotype, the extent to which attention deficit and hyperactivity are heritable and molecular genetic findings are discussed. Future research directions are also considered.

Results

ADHD is a familial disorder. Available adoption evidence suggests genetic influences are important. Twin studies have primarily focused on trait measures which have consistently been found to be highly heritable. Molecular genetic studies of clinical disorder so far have suggested the involvement of the dopamine DRD-4 receptor gene and dopamine transporter gene (DATI). However, these findings await further replication.

Conclusions

Advances in psychiatric genetics and current research interest in the genetics of ADHD should improve our understanding of aetiological factors and have an impact on treatment.
Prevalence of substance misuse in first-episode psychosis
Authors: Cantwell Roch , Brewin John , Glazebrook Cristine , Dalkin Tim , Fox Richard , Medley Ian , Harrison Glynn
Published: October 2008

Background

Reports suggest a high prevalence of substance misuse in psychotic disorders but few studies examine comorbidity at onset of psychosis.

Aims

To identify the prevalence and pattern of substance use and misuse in first-episode psychosis, and relationships with diagnosis, mode of presentation and demographic variables.

Method

Consensus diagnoses for 168 subjects presenting with first-episode psychosis were made using ICD–10 diagnostic criteria. Information on substance use and misuse was obtained from multiple sources. We examined associations between substance misuse, diagnosis and demographic factors.

Results

Criteria for drug use, drug misuse or alcohol misuse were met by 37% of the sample. One-year prevalence rates were 19.5% (drug misuse) and 11.7% (alcohol misuse). Thirteen subjects (8.4%) received a primary diagnosis of substance-related psychotic disorder; a significant increase compared with an earlier cohort from the same catchment area. Drug misuse was associated with younger age of onset of psychosis, male gender and non–African–Caribbean ethnicity.

Conclusions

This study confirms high rates of substance misuse at onset of psychosis. There is evidence for an increase in diagnosis of substance-related psychotic disorders over time. Those most at risk of substance misuse are young males.
Neurobehavioural symptoms one year after a head injury
Authors: Deb Shoumitro , Lyons Ita , Koutzoukis Charis
Published: October 2008

Background

Neurobehavioural symptoms are common immediately after a minor head injury but have not been studied one year after the injury.

Aims

To estimate the rate and pattern of neurobehavioural symptoms one year after a head injury of varying severity.

Method

Adults who had been hospitalised after a head injury (n=196, 164 of whom had a face-to-face interview) and showed indirect evidence of brain assault were assessed for the presence of neurobehavioural symptoms with the help of a behaviour rating scale.

Results

About 40% had three or more symptoms. Individual symptoms varied among 3% (social disinhibition), 15% (lack of initiative) and 35% (irritability) of the cohort. Premorbid factors such as lower social class and lower educational achievement, head-injury-related factors such a low Glasgow coma score, and outcome-related factors such as the presence of a disability according to the Edinburgh Rehabilitation Status Scale and psychiatric caseness according to the Clinical Interview Schedule–Revised, significantly influenced the rate and the pattern of behavioural symptoms. The pattern of symptoms varied between age groups and according to the severity of the head injury.

Conclusions

A significant proportion of patients with varying degrees of severity of head injury showed behavioural symptoms after one-year of head injury.
Health of the Nation Outcome Scales for Elderly People (HoNOS 65+)
Authors: Burns Alistair , Beevor Anne , Lelliott Paul , Wing John , Blakey Andrew , Orrell Martin , Mulinga John , Hadden Stuart
Published: October 2008

Background

Health of the Nation Outcome Scales (HoNOS) have been developed to measure outcomes in people with mental health problems.

Aims

The particular physical and cognitive problems affecting older people requires a specific scale for their measurement. We describe the development of such a scale, named HoNOS 65+.

Method

Pilot, validity and reliability studies were carried out on an amended scale. Validity was assessed by comparison with existing scales reflecting depression, cognitive function, psychiatric symptomatology, activities of daily living and functional abilities. Reliability was measured in two centres.

Results

HoNOS 65+ was successfully amended to include specific aspects of mental health problems in older people including the phenomenology of depression, delusions occurring in the presence of dementia, incontinence and agitation/restlessness. HoNOS 65+ was able to discriminate between people suffering from organic and functional illnesses. Correlations with other scales indicated reasonable validity. Reliability was satisfactory.

Conclusions

Aversion of HoNOS 65+ is presented (see pp. 435–438, this issue) which is appropriate for use in elderly people with mental health problems.
Durability of the effects of cognitive–behavioural therapy in the treatment of chronic schizophrenia: 12-month follow-up
Authors: Tarrier Nicholas , Witttkowskj Anja , Kinney Caroline , McCarthy Eilis , Morris Juue , Humphreys Lloyd
Published: October 2008

Background

Persistent drug-resistant psychotic symptoms are a pervasive problem in the treatment of schizophrenia.

Aims

To evaluate the durability of the treatment effects of cognitive–behavioural therapy for chronic schizophrenia one year after treatment termination.

Method

A comparison of clinical outcomes was made at one-year follow-up from a randomised trial of cognitive–behavioural therapy, supportive counselling and routine care alone in the treatment of chronic schizophrenia.

Results

Seventy out of the 72 patients (97%) who completed treatment were assessed at follow-up. There were significant differences between the three groups when positive and negative symptoms were analysed by means of ANCOVAs. Between-group comparisons indicated significant differences between cognitive–behavioural therapy and routine care at follow-up for positive symptoms. There was a trend towards significance for both cognitive–behavioural therapy and supportive counselling to be superior to routine care alone on negative symptoms.

Conclusions

At 12-month follow-up the significant advantage of cognitive– behavioural therapy compared to routine care alone remained.
Venlafaxine and paroxetine in treatment-resistant depression
Authors: Poirier M.-F. , Boyer P.
Published: October 2008

Background

About one-third of patients fail to respond to initial antidepressant therapy, which suggests a need for more effective drugs.

Aims

To compare the efficacy and safety of venlafaxine and paroxetine in 122 patients with non-chronic treatment-resistant depression.

Method

In-patients or out-patients satisfying DSM – III – R criteria for major depression in evolution for less than eight months, having a baseline HAM–D score 18 and a HAM – D Item 3 score < 3 were eligible. Patients were required to have a history of resistance to two previous antidepressant treatments and a CGI improvement score of 3 at the beginning of treatment. Doses were adjusted to 200–300 mg/day for venlafaxine and 30–40 mg/day for paroxetine.

Results

For the observed-case analysis, the response rate was 51.9% for venlafaxine and 32.7% for paroxetine (P=0.044), and a remission was achieved in 42.3% of venlafaxine-treated and 20.0% of paroxetine-treated patients (P=0.01). The incidence of adverse effects was comparable between treatment groups.

Conclusions

Venlafaxine showed some evidence of superiority to paroxetine in this difficult-to-treat patient population.
Reducedin vivobinding to the serotonin transporter in the cerebral cortex of MDMA (‘ecstasy’) users
Authors: Semple David M. , Ebmeier Klaus P. , Glabus Michael F. , O'Carroll Ronan E. , Johnstone Eve C.
Published: October 2008

Background

The use of MDMA (‘ecstasy’) is common among young people in Western countries. Animal models of MDMA toxicity suggest a loss of serotonergic neurons, and potentially implicate it in the development of significant psychiatric morbidity in humans.

Aims

To test whether long-term use of MDMA can produce abnormalities in cerebral serotonin, but not dopamine, transporter binding measured by single photon emission computed tomography (SPECT)

Method

Ten male regular ecstasy users and 10 well-matched controls recruited from the same community sources participated in SPECT with the serotonin transporter (SEPT) ligand [123I]-CIT. Dopamine transporter binding was determined from scans acquired 23 hours after injection of the tracer.

Results

Ecstasy users showed a cortical reduction of SERT binding, particularly prominent in primary sensory-motor cortex, with normal dopamine transporter binding in lenticular nuclei.

Conclusions

This cross-sectional association study provides suggestive evidence for specific, at least temporary, serotonergic neurotoxicity of MDMA in humans.
Psychological autopsy study of suicides by people aged under 35
Authors: Appleby Louis , Cooper Jayne , Amos Tim , Faragher Brian
Published: October 2008

Background

In the past two decades the suicide rate in young people has risen in the UK and other countries.

Aims

To identify the characteristics of people aged under 35 who commit suicide.

Method

Psychological autopsy study with case–control design. Cases were 84 suicides and probable suicides (open verdicts). Controls were 64 age- and gender-matched non-suicides obtained through the general practices of the matched cases. Main variables: social, including employment status, marital status and living circumstances; life events and interpersonal difficulties; clinical, including current psychiatric disorder, alcohol and drug misuse, previous self-harm and personality disorder.

Results

A large number of highly significant social, interpersonal and clinical differences between suicides and controls was found. Factor analysis identified two groups of variables within each of the social, interpersonal and clinical domains which were independently linked to suicide, corresponding to: acute, severe mental disorder and chronic disorder of behaviour; rootlessness and social withdrawal; chronic and recent interpersonal problems.

Conclusions

A broad prevention strategy is needed to reverse the recent rise in the suicide rate in young people.
Route of discharge for special (high-security) hospital patients with personality disorder
Authors: Davison Sophie , Jamieson Elizabeth , Taylor Pamela J.
Published: October 2008

Background

A considerable proportion of patients with personality disorder are discharged directly to the community from special (high-security) hospitals.

Aims

To examine whether patients with personality disorder discharged directly to the community are more likely to be re-convicted than those transferred to psychiatric hospitals of lesser security.

Method

Re-conviction data for a f ive-to nine-year follow-up were collected for a four-year (1988–1991) special hospital discharge cohort of patients with personality disorder.

Results

Individuals discharged directly to the community were not significantly more likely to be re-convicted than those transferred to less secure psychiatric hospitals. However, patients discharged to the community without formal conditions of supervision were more likely to be re-convicted than those discharged to the community with conditions or those transferred to other psychiatric hospitals.

Conclusions

Formal supervision after discharge may be more important than actual destination in influencing the likelihood of re-conviction.
Suicide in young people
Authors: Hawtdn Keith , Houston Kelly , Shepperd Rosie
Published: October 2008

Background

Suicide rates in youngmales in the UK have risen markedly in recent years.

Aims

To investigate the characteristics of a series of consecutive suicides in under-25-year-olds.

Method

We studied coroners' inquest notes, general practitioners' records and psychiatric case notes of 174 individuals (148 males and 26 females) whose deaths received a verdict of suicide or an open or accidental verdict (excluding traffic accidents) where the circumstances strongly suggested suicide.

Results

More individuals were of lower social class and unemployed than in the local population. Hanging and carbon monoxide poisoning were the most frequent methods of suicide, and co-proxamol was the drug most often used in overdoses. Previous self-harm had occurred in 44.8%, nearly half of these having carried out multiple episodes and 80% having self-harmed within the previous year. Little support was found for an earlier finding of increasing frequency of general practitioner visits shortly before death. Only 22.4% of individuals were in the care of psychiatric services.

Conclusions

Diverse strategies are required to prevent suicide in the very young.
A Jamaican psychiatrist evaluates diagnoses at a London psychiatric hospital
Authors: Hickling F. W. , McKenzie K. , Mullen R. , Murray R.
Published: October 2008

Background

Authors have suggested that the high rate of schizophrenia reported for African–Caribbeans living in the UK is due to misdiagnosis by British psychiatrists.

Aims

To compare the diagnoses made by a Black Jamaican psychiatrist with those of White British psychiatrists.

Method

All in-patients on four wards at the Maudsley hospital were approached for the study; 66 participated: 24 White, 29 Black African–Caribbeans and 13 Blacks from other countries of origin. F. W. H., a Black Jamaican psychiatrist, conducted his standard clinical assessment and performed the Present State Examination (PSE) on these patients. His diagnoses were compared with the case note diagnoses made by British psychiatrists, and with the PSE CATEGO diagnoses.

Results

Of 29 African and African–Caribbean patients diagnosed with schizophrenia, the diagnoses of the British and the Jamaican psychiatrists agreed in 16 instances (55%) and disagreed in 13 (45%). Hence, interrater reliability was poor (κ=0.45). PSE CATEGO diagnosed a higher proportion of subjects as having schizophrenia than the Jamaican psychiatrist did (χ2=3.74, P=0.052)

Conclusions

Agreement between the Jamaican psychiatrist and his UK counterparts about which patients had schizophrenia was poor. PSE CATEGO may overestimate rates of schizophrenia.
Community-based case–control study of depression in older people
Authors: Copeland J. R. M. , Chen Ruoling , Dewey Michael , McCracken C. F. M. , Gilmore Chris , Larkin B. , Wilson K. C. M.
Published: October 2008

Background

Risk factors of depression in later life, particularly for sub-cases and for psychotic and neurotic types of depression, are unclear.

Aims

To identify such risk factors.

Method

Over 5200 older people ($65 years), randomly selected from Liverpool, were interviewed using the Geriatric Mental State (GMS)and the Minimum Data Set (MDS). The computer-assisted diagnosis AGECAT identified 483 cases and 575 sub-cases of depression and 2451 with no mental problems. Logistic regression was employed to examine factors relevant to caseness.

Results

In multiple logistical regression, odds ratios (ORs) were significantly high for being female (2.04, 95% CI 1.56–2.69), widowed (2.00, 1.18–3.39), having alcohol problems (4.37, 1.40–2.94), physical disablement (2.03, 1.40–2.94), physical illness (1.98,.1.25–3.15), taking medications to calm down (10.04, 6.41 −15.71), and dissatisfaction with life (moderate 4.54, 3.50–5.90; more severe 29.00, 16.00–52.59). Good social networks reduced the ORs. If sub-cases were included as controls, the statistical significance was reduced.

Conclusions

Age was not associated with depression in later life whereas gender, physical disablement and dissatisfaction with life were. The sub-cases shared many risk factors with cases, suggesting that prevention may need to be attempted at an early stage.
Natural history of pharmacotherapy of older depressed community residents
Authors: Wilson K. C. M. , Copeland J. R. M. , Taylor S. , Donoghue J.
Published: October 2008

Background

Depression in older people is common and has a high mortality, but effective treatments exist.

Aims

To describe drug prescribing in older community residents in relation to depression status.

Method

The MRC–ALPHA community cohort aged 65 and over were interviewed using the Geriatric Mental State examination drug data collected at index interview and at two and four years.

Results

Antidepressants were used by 10.9% of the depressed population. Benzodiazepines were used frequently. Of the antidepressant users, 59.6% took low-dose antidepressants for two years, had a poor outcome and few drug changes.

Conclusions

Trends of increasing antidepressant use have cost implications for primary care groups. Benzodiazepines may be mis-prescribed for treatment of depressive symptoms. Antidepressant users have poor outcome and follow-up.