bluuebunny/crossref_metadata_2025 huggingface dataset:
Cost-effectiveness of antidepressant treatment reassessed
Authors: Woods Scott W. , Rizzo John A.
Published: October 2008

Background

A recent simulation concluded that the serotonin-specific reuptake inhibitor (SSRI) paroxetine was more cost-effective than the tricyclic antidepressant (TCA) imipramine, despite substantially higher medication acquisition costs.

Method

We replicated the previous model and revised key assumptions which drove the results. The revised model was subjected to sensitivity analysis.

Results

Most scenarios in the revised model showed that the TCA is equally or more cost-effective than the SSRI. Model revision producing these results were changes in assumptions about switched treatment success rates, treatment length and initial treatment success. The revised model appears sensitive to drug acquisition and delivery costs and costs of treatment failure.

Conclusions

Based on the model, a policy of using TCAs as first-choice antidepressant treatment, with SSRIs reserved for those patients not doing well initially, appears more cost-effective than the reverse sequence. Given limitations in current knowledge about key parameters to include in a simulation model, large prospective random-assignment cost-effectiveness studies are needed.
The use of seclusion and emergency medication in a hospital for people with learning disability
Authors: Rangecroft M. E. H. , Tyrer S. P. , Berney T. P.
Published: October 2008

Background

The management of disturbed behaviour in facilities for those with learning disabilities involves a spectrum of approaches including the prescription of emergency medication, restraint and seclusion. The use of these techniques has recently come under close scrutiny.

Method

All incidents requiring emergency medication or seclusion that occurred in a large hospital for those with learning disabilities were studied over a six-months period. The precipitating factors, course and outcome of those who had received emergency medication or seclusion were then examined.

Results

In all, 286 incidents involving 72 individuals occurred during the study period. The episodes requiring seclusion comprised 19% of all incidents. Two-thirds of the patients involved were male but six female patients accounted for 36% of all incidents. During the second part of the study, when the staff knew that the treatments used were being monitored, there was a significant reduction in use of restraint and emergency drugs given intramuscularly. Patients receiving seclusion were judged to have a better outcome one hour after the onset of the incident compared with those who received medication.

Conclusions

Despite concerns about the use of seclusion, the results of this survey suggest that procedures that remove the patient from the environment contributing to the disturbance may have certain advantages in this population.
The treatment of sexually dysfunctional men without partners: A controlled study of three behavioural group approaches
Authors: Stravynski Ariel , Gaudette Giles , Lesage Alain , Arbel Nira , Petit Pascale , Clerc Doris , Fabian José , Lamontagne Yves , Langlois Robert , Lipp Olivier , Sidoun Paul
Published: October 2008

Background

Models of sex therapy for sexual dysfunction in single men are available, but their value is not well established. This controlled study compared three approaches to the treatment of sexually dysfunctional single men.

Method

Sixty-nine single men diagnosed as sexually dysfunctional were randomly assigned to treatments focusing on either their sexual dysfunction, their interpersonal problems, a combination of both or a waiting list; 51 completed treatment and 50 the one-year follow-up. Treatment was administered in small groups in 15 weekly sessions and four six-weekly sessions during the first six months of a year-long follow-up.

Results

No clinically meaningful change was observed during the waiting period. In contrast, a significant and equivalent improvement was observed in all treatment groups by the end of treatment. However, differences between them were in evidence at 6 and 12 months' follow-up.

Conclusions

Both treatments paying attention to the patients' interpersonal difficulties resulted in significantly better outcomes overall than the approach that concentrated on problems in sexual functioning alone.
Controlled efficacy study of fluoxetine in dysthymia
Authors: Vanelle Jean-Marie , Attar-Levy Dominique , Poirier Marie-France , Bouhassira Myriam , Blin Patrick , Olié Jean-Pierre
Published: October 2008

Background

There have been very few controlled studies of antidepressants in dysthymia, particularly in samples diagnosed reliably and with an adequate length of follow-up. In this investigation, we measured the long-term outcome in a large group of patients meeting DSM – III -R criteria for dysthymia. This study was designed to investigate whether fluoxetine is effective in the treatment of dysthymia.

Method

This randomised study, including 140 patients, compared fluoxetine (91 patients) and placebo (49 patients) on a double-blind basis in two distinct phases: a short-term end-point (3 months with 20 mg/day fluoxetine) and a medium-term end-point (6 months) where the initial responders continued double-blind treatment unchanged and non-responders received an additional treatment of 20 mg/day fluoxetine.

Results

After three months of treatment, response was seen more frequently in the fluoxetine group (42/72) than in the placebo group (14/39, P <0.0001). Improved patients at 3 months were still improved at 6 months. Furthermore, 50% of the non-responders at 3 months improved and rated as responders at 6 months, after fluoxetine was increased to 40 mg daily.

Conclusions

This study showed the significant and persistent action of fluoxetine on dysthymia. The finding that 50% of the non-responders at 3 months were improved at 6 months, after fluoxetine dosage was increased to 40 mg daily, argues in favour of treating dysthymic patients for at least 6 months, and with a higher dosage if the initial doses are ineffective.
Anxiety, depression and PTSD in asylum-seekers: Assocations with pre-migration trauma and post-migration stressors
Authors: Silove Derrick , Sinnerbrink Ingrid , Field Annette , Manicavasagar Vijaya , Steel Zachary
Published: October 2008

Background

Research into the mental health of refugees has burgeoned in recent times, but there is a dearth of studies focusing specifically on the factors associated with psychiatric distress in asylum-seekers who have not been accorded residency status.

Method

Forty consecutive asylum-seekers attending a community resource centre in Sydney, Australia, were interviewed using structured instruments and questionnaires.

Results

Anxiety scores were associated with female gender, poverty, and conflict with immigration officials, while loneliness and boredom were linked with both anxiety and depression. Thirty subjects (79%) had experienced atraumatic event such as witnessing killings, being assaulted, or suffering torture and captivity, and 14 subjects (37%) met full criteria for PTSD. A diagnosis of PTSD was associated with greater exposure to pre-migration trauma, delays in processing refugee applications, difficulties in dealing with immigration officials, obstacles to employment, racial discrimination, and loneliness and boredom.

Conclusions

Although based on correlational data derived from a convenient'sample, our findings raise the possibility that current procedures for dealing with asylum-seekers may contribute to high levels of stress and psychiatric symptoms in those who have been previously traumatised.
Grey matter correlates of syndromes in schizophrenia
Authors: Chua S. E. , Wright I. C. , Poline J.-B. , Liddle P. F. , Murray R. M. , Frackowiak R. S. J. , Friston K. J. , McGuire P. K.
Published: October 2008

Background

Symptoms in schizophrenia duster into syndromes, each of which may be associated with a particular pattern of cerebral blood flow. We sought to investigate whether these syndromes are also related to neuroanatomical changes.

Method

A semi-automated method was used to examine structural magnetic resonance images in 12 patients with schizophrenia. The relationship between the relative regional grey matter volume and ratings of the syndromes of psychomotor poverty, disorganisation and reality distortion was investigated.

Results

There was a significant negative correlation between psychomotor poverty score and the relative volume of the left ventro-medial prefrontal grey matter, and a significant positive correlation between disorganisation and the relative volumes of the hippocampus, and the parahippocampal/fusiform gyrus bilaterally.

Conclusion

The correlation between psychomotor poverty and left prefrontal grey matter volume resembles that previously seen with prefrontal blood flow in the same patients, suggesting that this functional abnormality is related to an underlying anatomical change.
EEG coherence and syndromes in schizophrenia
Authors: Norman R. M. G. , Malla A. K. , Williamson P. C. , Morrison-Stewart S. L. , Helmes E. , Cortese L.
Published: October 2008

Background

Frith et al (1995) and others have hypothesised that disruptions in the connection between left frontal and temporal areas of the brain are a central deficit in schizophrenia. In this paper we examine whether such connectivity as assessed by EEG coherence is related to level of symptoms in patients with schizophrenia.

Method

For 73 patients with schizophrenia, assessments of the EEG coherence between frontal and temporal regions were carried out under conditions of activation by a mathematical task, and between frontal and occipital regions when performing a visuo-spatial task. We then examined the relationship between these coherence measures and the reality distortion, disorganisation and psychomotor poverty dimensions of symptomatology.

Results

Only left frontal -temporal connectivity was found to have a significant negative relationship to symptomatology. This relationship was, however, specific to reality distortion rather than to symptoms of disorganisation or psychomotor poverty, and may be more characteristic of males than females.

Conclusions

Disruption of frontaltemporal connectivity appears to have a specific relationship to reality distortion symptoms in schizophrenia.
Conventional versus atypical neuroleptics: subjective quality of life in schizophrenic patients
Authors: Franz M. , Lis Stefanie , Plüddemann K. , Gallhofer B.
Published: October 2008

Background

The effectiveness of anti-psychotic drugs against positive psychotic symptoms has been demonstrated in many studies, but their effects on quality of life have yet to be clarified. The impact of different neuroleptic therapies on the subjective quality of life of schizophrenic patients is evaluated in a cross-sectional open study.

Method

During a four-month period a standardised quality of life interview for schizophrenic patients was applied on day 10 after admission; 33 patients on atypical neuroleptics (AAP) were compared with 31 matched patients on conventional neuroleptics (CAP).

Results

The AAP group had significantly higher scores in general quality of life as well as in different life domains: physical well-being, social life and everyday life. In separate comparisons of the AAP group, patients on clozapine and risperidone were found to have a higher quality of life score than patients on CAP or zotepine.

Conclusions

The pharmacological profile of clozapine and risperidone may provide a basis for explaining the higher subjective quality of life found in this study. The lower quality of life of the CAP group may possibly be related to intrinsic effects of the conventional antipsychotics.
Uptake of 99mTc-exametazime shown by single photon emission computed tomography before and after lithium withdrawal in bipolar patients: Associations with mania
Authors: Goodwin Guy M. , Cavanagh Jonathan T. O. , Glabus M. F. , Kehoe R. F. , O'Carroll R. E. , Ebmeier K. P.
Published: October 2008

Background

Early manic relapse following lithium discontinuation offers an important opportunity to investigate the relationship between symptoms, effects of treatment and regional brain activation in bipolar affective disorder.

Method

Fourteen stable bipolar patients on lithium were examined with neuropsychological measures, clinical ratings and single photon emission computed tomography (SPECT) before and after acute double-blind withdrawal of lithium. Brain perfusion maps were spatially transformed into standard stereotactic space and compared pixel-by-pixel. A parametric analysis was used to examine the change in brain perfusion on lithium withdrawal, and the relationship between symptom severity and brain perfusion separately both between and within subjects.

Results

Lithium withdrawal was associated with an important redistribution of brain perfusion, with increases in inferior posterior regions and decreases in limbic areas, particularly anterior cingulate cortex. Seven of the 14 patients developed manic symptoms during the placebo phase, correlating with relative increases in perfusion of superior anterior cingulate and possibly left orbito-frontal cortex.

Conclusions

The important effect of lithium withdrawal on brain perfusion implies that after withdrawal of lithium, the brain develops an abnormal state of activity in limbic cortex. The structures involved did not co-localise with those apparently modulated by manic symptoms.
The Bentham Unit: A pilot remand and assessment service for male mentally disordered remand prisoners
Authors: Weaver Tim , Taylor Fiona , Cunningham Barbara , Maden Anthony , Rees Sian , Renton Adrian
Published: October 2008

Background

Findings are presented from an evaluation of a pilot remand and assessment service - the Bentham Unit, The aims of the Bentham Unit are to provide rapid assessment, identify mentally disordered remand prisoners, and speed their transfer from prison to NHS care, where a need is indicated.

Method

The number, rate and speed of referral, assessment and transfer to NHS care of offenders remanded to Wormwood Scrubs prison during periods before and after the Bentham Unit opened were compared.

Results

The service attracted a large volume of referrals. Between the two periods, significant increases in the numbers of referrals and hospital disposals, and major reductions in the interval between reception on remand into the prison, NHS assessment and transfer to NHS care, were observed.

Conclusions

The aims of the unit were met. Implications for service configurations are discussed.
Post-traumatic stress disorder and depression
Authors: Bleich Avi , Koslowsky Meni , Dolev Aliza , Lerer Bernard
Published: October 2008

Background

We examined psychiatric morbidity following war-related psychic trauma, with a special focus on the depressive comorbidity of post-traumatic stress disorder (PTSD).

Method

Subjects consisted of 60 Israeli veterans who sought psychiatric treatment 4–6 years after having been exposed to war trauma. PTSD and psychiatric comorbidity were diagnosed using the Structured Interview for PTSD and the Schedule for Affective Disorders and Schizophrenia.

Results

Both lifetime (100%) and current (87%) PTSD were the most prevalent disorders. Comorbidity was extensive, with major depressive disorder (MDD) most prevalent (95% lifetime, 50% current), followed by anxiety disorders, minor affective disorders, and alcoholism or drug misuse.

Conclusions

Within post-traumatic psychiatric morbidity of combat origin, PTSD and MDD are the most prevalent disorders. In addition it appears that PTSD, although related to post-traumatic MDD beyond a mere sharing of common symptoms, is of the same time differentiated from it as an independent diagnostic category.
An open trial of clozapine in neuroleptic-resistant childhood-onset schizophrenia
Authors: Turetz M. , Mozes T. , Toren P. , Chernauzan T. , Yoran-Hegesh R. , Mester R. , Wittenberg N. , Tyano S. , Weizman A.
Published: October 2008

Background

Studies performed with schizophrenic adults who were resistant to classical neuroleptics showed improvement in 30% of the patients when treated with clozapine. Very early onset schizophrenic patients benefit only partially from conventional antipsychotics and are at increased risk of developing extrapyramidal symptoms; clozapine may offer an alternative treatment for these patients.

Method

Eleven neuroleptic-resistant children (< 13 years) with schizophrenia were treated with clozapine. Improvement was monitored during the first 16 weeks using the Brief Psychiatric Rating Scale, Positive and Negative Syndrome Scale and Clinical Global Impression. The mean clozapine dosage was 227.3 (s.d. 34.4) mg/day at the end of the 16 weeks.

Results

There was an overall statistically significant reduction in all parameters, especially positive symptoms, implying a favourable outcome. Most of the improvement occurred during the first 6 to 8 weeks. The major side-effects were somnolence and drooling (no agranulocytosis).

Conclusion

Clozapine may be a promising drug for the treatment of resistant childhood-onset schizophrenia.
Predictive power and construct validity of the Level of Expressed Emotion (LEE) scale
Authors: Gerlsma Coby , Hale William W.
Published: October 2008

Background

The Level of Expressed Emotion scale (LEE) is a questionnaire designed to measure the perception of expressed emotion, an important predictor of the course of several psychiatric disorders.

Method

In this study, the scales predictive and construct validity were examined in a sample of 26 clinically depressed out-patients and their partners, and in a sample of 40 couples from the general community

Results

In the sample of depressed out-patients, the LEE was predictive of depression improvement at six-month follow-up. With regard to the construct validity, results in both samples showed quite strong relationships between the LEE and depressive symptomatology, relational dissatisfaction, and coping styles.

Conclusions

The LEE may be a useful tool in the study of interpersonal processes and depression, both in clinical and research settings.
Mental health in primary care
Authors: Vázquez-Barquero José Luis , Garcia José , Simón Jesús Artal , Iglesias Celso , Montejo Javier , Herrán AndréS , Dunn Graham
Published: October 2008

Background

The main objectives of the survey were: (a) to analyse the sociological, clinical and illness-related correlates of mental illness in primary care; (b) to study, during one-year follow-up, outcome and use of health resources.

Method

The survey comprised a two-phase cross-sectional study. In the first phase patients were classified using the GHQ-28 or by the general practitioner (GP). In the second phase they were assessed by the SCAN system.

Results

The prevalence rate of mental illness (in attenders) using the GHQ was 33.2%. The corresponding rate for the GP was 14.1%, and for the SCAN 31.5%. Mental illness mainly comprised depression, anxiety and alcohol-related diagnoses. The presence of mental illness and the use of health resources during follow-up were dependent on demographic characteristics and on their original psychiatric status.

Conclusions

In primary care, mental illness constitutes a major health problem. Despite this fact. GPs do not recognise a substantial proportion of these health problems.
The effect of physical ill health on the course of psychiatric disorder in general practice
Authors: Kisely S. R. , Goldberg D. P.
Published: October 2008

Background

The aim of this study was to determine the effect of physical morbidity on the outcome of patients with psychiatric disorder, and to compare the effects of non-medically and medically explained symptoms.

Method

One hundred and fifty psychiatric cases were recruited using a two-stage design from 1620 consecutive patients attending their GP. Subjects were assessed at the time of screening, and one year subsequently, using the Composite International Diagnostic Instrument adapted for use in primary care (CIDI - PHC) and the Groningen Social Disability Schedule (GSDS). Assessments of psychiatric morbidity were also obtained from GPs.

Results

Medically explained somatic symptoms were strongly related to psychological outcome one year later. Whereas just over a half of patients with no medically explained symptoms had recovered from a psychiatric disorder, the percentage recovery fell to 41% in those with 1 −4 medically explained symptoms, and only 21% in patients with five or more medically explained symptoms.

Conclusions

Physical ill-health has been shown to make an independent contribution to psychological outcome. The specific needs of these patients should receive greater attention.
Prolactin response to d-fenfluramine in obsessive-compulsive patients, and outcome of fluvoxamine treatment
Authors: Monteleone Palmiero , Catapano Francesco , Martino Stefania Dl , Ferraro Ciro , Maj Mario
Published: October 2008

Background

Although several studies have directly explored serotonin (5-HT) transmission in patients with obsessive compulsive disorder (OCD), their results have been inconsistent and their clinical relevance is doubtful

Method

According to a double-blind placebo-controlled design, plasma prolactin (PRL) response to a specific serotonergic probe, d-fenfluramine, was measured in 20 drug-free obsessive compulsive patients and in 20 matched healthy controls. After the neuroendocrine test, 5 patients completed a lO-week treatment with fluvoxamine. Psychopathological assessment was performed before and after therapy.

Results

PRL response in OCD patients was blunted under the drug-free condition; correlated inversely with pretreatment ratings of obsessive-compulsive and depressive symptomatology; and correlated inversely with the improvement in obsessive-compulsivescore observed after fluvoxamine treatment.

Conclusions

These results support the idea of a dysfunction of 5-HT transmission in OCD, and suggest that the greater this impairment, the better the response to drugs which selectively block the reuptake of 5-HT.
Predicting PTSD in trauma survivors: prospective evaluation of self-report and clinician-administered instruments
Authors: Shalev Arieh Y. , Freedman Sara. , Peri Tuvia , Brandes Dalia , Sahar Tali
Published: October 2008

Background

This study examined the ability of commonly used questionnaires and a structured clinical interview to predict PTSD in recent trauma survivors.

Method

Horowitz's Impact of Event Scale (IES), Speilberger's State Anxiety (SANX) and the Peri Traumatic Dissociation Questionnaire (PDEQ) were administered one week post-trauma to 239 traumatised individuals recruited from a general hospital emergency room. The IES, the SANX, the civilian version of the Mississippi Scale for Combat Related PTSD (MISS), and the Clinician Administered PTSD Scale (CAPS) were administered one month and four months post-trauma. Receiver operator characteristic (ROC) analysiswas used with these data.

Results

All questionnaires were better than chance at predicting PTSD. The so called PTSD questionnaires (IES and MISS) were not better than the more general ones. No difference in predictive value was found when questionnaires were carried outone week or one month after a trauma. Recovery was better predicted than PTSD, and the CAPS was better than the questionnaires.

Discussion

The use of psychometrics and clinical interviews to predict PTSD should be guided by clinical relevance and by the availability of resources.
Subjective experience of persistent schizophrenia and depression among US Latinos and Euro-Americans
Authors: Jenkins Janis Hunter
Published: October 2008

Background

The aims were to investigate cross-culturally the subjective experience of long-term psychiatric patients to determine whether or not they would define their current life situation predominantly in terms of illness.

Method

The design is a two-by-two comparison by ethnicity (Latino and Euro-American) and diagnosis (schizophrenia and unipolar depression) of 80 subjects for DSM–III–R criteria according to the SADS. Patients were interviewed using a semi-structured interview (Context of Illness Experience) yielding data coded for qualitative and quantitative analyses.

Results

While significant ethnic differences were observed, nearly half the sample did not include illness in their description of their life situation. Other domains (e. g. activities, events) and the extent to which patients perceived themselves as in- or out-of-step with the “rhythm of life” were identified as central patient concerns.

Conclusions

Empirical research on the subjective experiences and representations of the life situation of patients offers clues to the course and treatment of persistent psychiatric disorder.
Intensive in-patient and community intervention versus routine care after attempted suicide
Authors: Van Der Sande Rob , Van Rooijen Liesbeth , Buskens Erik , Allart Esther , Hawton Keith , Van Der Graaf Yolanda , Van Engeland Herman
Published: October 2008

Background

A randomised clinical trial was carried out in suicide attempters to assess clinical efficacy of an intensive psychosocial intervention compared with treatment as usual.

Method

Two hundred and seventy-four suicide attempters presenting for medical treatment were randomly assigned to either intensive psychosocial treatment or ‘care as usual’. Intensive psychosocial treatment consisted of brief admission to a special crisis-intervention unit and problem-solving aftercare. ‘Care as usual’ included any form of treatment the assessing clinicians thought appropriate. Psychological well-being was evaluated by the SCL–90 and the Hopelessness Scale at 3, 6 and 12 months following entry in the study.

Results

No differences in outcome were found. The probability of repeat suicide attempts in the 12-month follow-up was 0.17 for patients in the experimental group and 0.15 for the control group. There were no differences in ratings on the SCL–90 and the Hopelessness Scale. Patients in the experimental group attended significantly more out-patient treatment sessions.

Conclusions

General implementation of an intensive in-patient and community intervention programme for suicide attempters does not seem justified.
Family planning needs and STD risk behaviours of female psychiatric out-patients
Authors: Coverdale John H. , Turbott Sarah H. , Roberts Helen
Published: October 2008

Background

There are few studies concerning the family planning needs of female chronic psychiatric patients. We aimed to determine the contraceptive needs and sexually transmitted disease (STD) risk-behaviours of female psychiatric out-patients.

Method

Sixty-six female out-patients with major psychiatric disorders, including schizophrenia, bipolar disorder and mood disorders, completed a semi-structured interview (response rate=63%) and were individually matched for age and ethnicity with 66 women who had never been treated for psychiatric illness. They answered questions on child-rearing and on their methods of contraception in relation to their attitudes towards pregnancy, as well as on their risk for STDs.

Results

Compared with controls, the female patients reported having had significantly more induced abortions and were significantly more likely to have given up their own children for others to raise. Heterosexually active psychiatric patients were significantly more likely than controls to have had more than one male sexual partner, to have been pressured into unwanted sexual intercourse, and to report having had sexual intercourse with a suspected bisexual over the preceding year.

Conclusions

These results underscore the priority for developing programmes that reduce female psychiatric patients' risk for unwanted pregnancies and STDs.
Randomised controlled trial of psychological debriefing for victims of acute burn trauma
Authors: Bisson Jonathan I. , Jenkins Peter L. , Alexander Julie , Bannister Carol
Published: October 2008

Background

Psychological debriefing (PD) is widely used following major traumatic events in an attempt to reduce psychological sequelae.

Method

One hundred and thirty-three adult burn trauma victims entered the study. After initial questionnaire completion, participants were randomly allocated to an individual/couple PD group or a control group who received no intervention; 110 (83%) were interviewed by an assessor blind to PD status three and 13 months later.

Results

Sixteen (26%) of the PD group had PTSD at 13-month follow-up, compared with four (9%) of the control group. The PD group had higher initial questionnaire scores and more severe dimensions of burn trauma than the control group, both of which were associated with a poorer outcome.

Conclusions

This study seriously questions the wisdom of advocating one-off interventions post-trauma, and should stimulate research into more effective initiatives.
Eye movement desensitisation and reprocessing versus exposure in vivo
Authors: Muris Peter , Merckelbach Harald , Van Haaften Hans , Mayer Birgit
Published: October 2008

Background

Eye movement desensitisation and reprocessing (EMDR) is a relatively new therapeutic technique that has been proposed as a treatment for post-traumatic stress disorder and other anxiety complaints.

Method

We compared the efficacy of EMDR with that of exposure in viv. in the treatment of a specific phobia. Twenty-two spider-phobic children who met the DSM – III – R criteria for specific phobia participated in the study. Children were treated with one session of exposure in viv. and one session of EMDR in a crossover design. Treatment outcome was evaluated by self-report measures, a behavioural avoidance test and a physiological index (skin conductance level).

Results

Results showed positive effects of EMDR, but also suggest that it is especially self-report measures that are sensitive to EMDR. Improvement on a behavioural measure was less pronounced, and exposure in viv. was found to be superior in reducing avoidance behaviour. With regard to skin conductance level, EMDR and exposure in viv. did not differ.

Conclusions

EMDR has no additional value in treatment of this type of animal phobia, for which exposure in viv. is the treatment of choice.
Increased rate of psychosis among African–Caribbeans in Britain is not due to an excess of pregnancy and birth complications
Authors: Hutchinson G. , Takei N. , Bhugra D. , Fahy T. A. , Gilvarry C. , Mallett R. , Moran P. , Leff J. , Murray R. M.
Published: October 2008

Background

It has been suggested that the increased rate of psychotic illness among African–Caribbeans living in Britain is due to an excess of pregnancy and birth complications (PBCs).

Method

We therefore compared the frequency of PBCs in a group of White psychotic patients (n=103) and a comparable group of patients of African–Caribbean origin (n=61); the latter consisted of 30 first-generation (born in the Caribbean) and 31 second-generation (born in Britain) individuals.

Results

White psychotic patients were more than twice as likely to have a history of PBCs as their African–Caribbean counterparts (odds ratio=2.34, 95% confidence interval (CI) 0.88–6.47, P=0.062). The same trend was observed among patients with a DSM–III diagnosis of schizophrenia (odds ratio=l.65, 95% CI 0.56–4.97, P=0.32). The rate of PBCs was similar among the first- and second-generation Caribbean psychotic patients.

Conclusions

The increased rate of psychotic illness that has been reported among the African–Caribbean population in Britain is not due to an increased prevalence of PBCs.
Incidence and risk factors for severe tardive dyskinesia in older patients
Authors: Caligiuri Michael P. , Lacro Jonathan P. , Rockwell Enid , McAdams Lou Ann , Jeste Dilip V.
Published: October 2008

Background

Severe tardive dyskinesia (TD) represents a serious and potentially disabling movement disorder, yet relatively little is known about the incidence of and risk factors for severeTD.

Method

We report the results of a longitudinal prospective incidence study of severeTD in 378 middle-aged and elderly neuropsychiatric patients. Psychiatric, neuropsychological, pharmacological and motor variables were obtained at intake and at regular intervals for 36 months.

Results

The cumulative incidence of severeTD was 2.5% after one year, 12.1% after two years, and 22.9% after three years. Individual univariable Cox regression analyses were conducted to identify demographic, psychiatric, motor and pharmacological predictors of severeTD. Results indicated that higher daily doses of neuroleptics at study entry, greater cumulative amounts of prescribed neuroleptic, and greater severity of worsening negative symptoms were predictive of severeTDConclusionsThese findings suggest that conventional neuroleptics may be prescribed to older patients only when necessary and at the lowest effective dosage. Additional caution is recommended in patients exhibiting negative symptoms.
Plasma noradrenaline response to electroconvulsive therapy in depressive illness
Authors: Kelly C. B. , Cooper S. J.
Published: October 2008

Background

Abnormalities of catecholaminergic function have been hypothesised to cause depressive illness. Plasma noradrenaline can be used as a marker of central noradrenergic activity. It is of interest to examine the change in resting plasma noradrenaline in patients with depressive illness over a course of electroconvulsive therapy (ECT) and relate this to their clinical state.

Method

Patients referred for ECT who suffered from DSM – III – R major depressive disorder or dysthymia were recruited. Blood samples were taken before and after each treatment, during a course of ECT, to measure plasma noradrenaline and Cortisol. Clinical ratings were carried out weekly during the course of ECT.

Results

Plasma noradrenaline fell significantly in those patients with melancholic/psychotic depressions but increased in those with non-melancholic depressive illness. There was a strong trend indicating that a fall in plasma noradrenaline was associated with improvement in depression ratings in the melancholic/psychotic patients only.

Conclusions

Electroconvlusive therapy decreases plasma noradrenaline in melancholic/psychotic depressive illness and this shows a trend associated with clinical improvement.
Closing the gap between research and practice
Authors: Geddes John R. , Harrison Paul J.
Published: October 2008

Has Mrs A got schizophrenia? Would Mr B do better with a tricyclic or a selective serotonin reuptake inhibitor? Is Miss C likely to be recovered in six months time? Is St John's wort an effective antidepressant? Clinical psychiatry involves making difficult decisions about diagnosis, therapy and prognosis. Sometimes we may be entirely confident about our decisions, but often we are uncomfortably aware that we are making a choice without being sure there is convincing evidence to justify it. Maybe we don't know or have forgotten what the evidence is, or perhaps there isn't any.
Effects of level of socio-economic development on course of non-affective psychosis
Authors: Varma Vijoy K. , Wig N. N. , Tripathi B. M. , Misra Arun K. , Khare C. B. , Phookun Hemen R. , Menon D. K. , Brown Alan S. , Susser Ezra S.
Published: October 2008

Background

This study explored the relation of level of socio-economic development to the course of non-affective psychosis, by extending the analysis of urban/rural differences in course in Chandigarh, India.

Method

The proportion of ‘best outcome cases between urban (n=110) and rural (n=50) catchment areas were compared at two-year follow-up, separately for CATEGO S+ and non-S+ schizophrenia.

Results

The proportion of subjects with ‘best outcome’ ratings at the urban and rural sites, respectively, was similar for CATEGO S+ schizophrenia (29 v. 29%), but significantly different for non-S+ psychosis (26 v. 47%)

Conclusions

The fact that in rural Chandigarh, psychoses have a more favourable course than in the urban area may be explained in large part by psychoses distinct from ‘nuclear’ schizophrenia.
Efficacy and safety of two new methods of rapid intravenous detoxification in heroin addicts previously treated without success
Authors: Seoane Albert , Carrasco Genís , Cabré Lluís , Puiggrós Ana , Hernández Eustaqui , Álvarez Miguel , Costa Josep , Molina Ricard , Sobrepere Gaudi
Published: October 2008

Background

New methods of rapid opiate detoxification, under intravenous sedation, can detoxify heroin-addicted patients in 24 hours. Their clinical application has been limited by the lack of studies establishing both efficacy and safety.

Method

In a randomised, controlled study, 300 treatment-refractory, heroin-addicted patients received rapid intravenous detoxification treatment (naloxone infusion, 0.06–0.08 mg/kg, then oral naltrexone 50 mg/day) under either monitored light intravenous sedation or unmonitored deep intravenous sedation.

Results

All patients were successfully detoxified and 93% remained abstinent one month later. Severity of withdrawal, according to the Wang Scale modified by Loimer, was 4.9 (s.d. 3.0) points in the light sedation group and 4.8 (s.d. 2.9) in the deep sedation group (P=0.26). Two patients (1.3%) in the light sedation group and four (2.6%) in the deep sedation group required tracheal intubation (P=0.31). There was only one severe complication, a case of nosocomial aspirative pneumonia which improved with antibiotic treatment.

Conclusions

Successful rapid intravenous detoxification can be achieved using relatively light levels of sedation.
Brain blood flow in anxiety disorders
Authors: Lucey J. V. , Costa Durval C. , Adshead Gwen , Deahl Martin P. , Busatto Geraldo , Gacinovic Sveto , Travis Michael , Pilowsky Lyn S. , Ell Peter J. , Marks Isaac M. , Kerwin Robert W.
Published: October 2008

Background

We compared regional cerebral blood flow (rCBF) in three groups of patients with DSM–III–R anxiety disorders.

Method

Fifteen patients with obsessive–compulsive disorder (OCD), 15 with panic disorder with agoraphobia (PA), and 16 with post-traumatic stress disorder (PTSD) and a similar group of healthy controls were assessed on brain-dedicated high-resolution SPET.

Results

MANOVA revealed significant rCBF differences between diagnostic groups (F=4.4; d.f.=3, 57; P=0.007) and between cerebral regions (F=6.4; d.f.=1, 57; P=0.01) in OCD and PTSD compared with PA and healthy controls, limited to bilateral superior frontal cortices and right caudate nuclei. Whole brain blood flow correlated positively with anxiety (r=0.24, n=46, P=0.05). Beck depression scores correlated significantly negatively with left caudate rCBF (r= –0.24, n=46, P=0.05) and right caudate rCBF (r= –0.31, n=46, P=0.02). PTSD syndrome severity correlated significantly negatively with the left caudate (r=-0.49, n=16. P=0.03) and with right caudate rCBF (r=-0.7, n=16, P=0.001)

Conclusions

Functional rCBF differences in anxiety disorders could relate to repetitive, intrusive, distressing mental activity, prominent in both OCD and PTSD.
Strategies for preventing suicide
Authors: Lewis Glyn , Hawton Keith , Jones Peter
Published: October 2008

Background

The Health of the Nation includes a target for reducing population suicide rates. We have examined and quantified various high-risk and population-based strategies for prevention based upon a number of stated assumptions and hypothetical interventions.

Method

The published literature was used to estimate the population attributable fractions for both high-risk and population-based strategies. The number needed to treat for the high-risk strategies was calculated, assuming an intervention that reduced suicide rates by 25%

Results

Interventions that would reduce rates of suicide by 25% would reduce population rates by about 2.6% for those recently discharged from hospital and by up to 5.8% for those presenting to general hospital with deliberate self-harm. The population attributable fraction for unemployment was 10.9%

Conclusions

High-risk strategies will have only a modest effect on population suicide rates, even if effective interventions are developed. Evaluating interventions for deliberate self-harm patients seems worthwhile. The UK Government's target for suicide reduction is more likely to be achieved using population-based strategies. Reducing the availability of methods commonly used for committing suicide is the most practicable current policy, although more radical approaches, for example reducing unemployment, may also substantially reduce suicide rates.
Mental disorders among the community-dwelling elderly in Dublin
Authors: Kirby Michael , Bruce Irene , Radic Alicja , Coakley Davis , Lawlor Brian A.
Published: October 2008

Background

The prevalence of mental disorders among the community-dwelling elderly in the catchment area of a psychiatry for the elderly service in Dublin was determined.

Method

A sample of 1232 individuals aged 65 years and over, identified from general practitioner practice lists, was interviewed using the Geriatric Mental State–AGECAT package.

Results

Depression and organic disorder occurred with prevalences of 10.3 and 4.1%, respectively. Depression diagnostic cases had comorbid anxiety at case level in 17.3% and at sub-case level in a further 59.9%. Organic diagnostic cases had comorbid depressive or anxiety symptoms, at case or sub-case level, in 32%

Conclusions

Depression is the most common mental disorder among the elderly in Dublin. The frequency of anxiety symptoms in the presentation of depression may be a factor in the under-diagnosis or misdiagnosis of depression in the community-dwelling elderly. Comorbid anxiety and depression in organic disorder may represent treatable symptoms.
Subjective memory complaints in the elderly: Depressive symptoms and future dementia
Authors: Schmand B. , Jonker C. , Geerlings M. I. , Lindeboom J.
Published: October 2008

Background

Population studies indicate that subjective memory complaints by elderly people are correlated with cognitive performance. These complaints have some predictive power regarding the development of dementia. The present study attempted to replicate this finding, and investigated which variables determine subjective memory complaints.

Method

Participants in the Amsterdam Study of the Elderly (n=2114; 65–84 years of age), who were not demented and had a normal MMSE score (> 23) at baseline, were re-examined after four years. Subjective complaints were measured using a previously developed scale. Dementia and depression were measured using the Geriatric Mental State Schedule (GMS). Premorbid intelligence was measured by the Dutch Adult Reading Test (DART)

Results

Memory complaints at baseline contributed a small but significant amount of diagnostic information with respect to the prediction of future dementia. Depressive symptoms at baseline had no predictive value when these memory complaints were accounted for. Subjective memory complaints were associated with depression, baseline MMSE score, and premorbid intelligence.

Conclusions

Subjective memory complaints are not just secondary to depression, but in part reflect realistic self-observations of cognitive decline.
Cognitive deficits in patients suffering from chronic fatigue syndrome, acute infective illness or depression
Authors: Vollmer-Conna Ute , Wakefield Denis , Lloyd Andrew , Hickie Ian , Lemon Jim , Bird Kevin , Westbrook Reginald
Published: October 2008

Background

Patients with chronic fatigue syndrome (CFS) report neuropsychological symptoms as a characteristic feature. We sought to assess cognitive performance in patients with CFS, and compare cognitive performance and subjective workload experience of these patients with that of two disease comparison groups (non-melanchonic depression and acute infection) and healthy controls.

Method

A computerised performance battery employed to assess cognitive functioning included tests of continuous attention, response speed, performance accuracy and memory. Severity of mood disturbance and subjective fatigue were assessed by questionnaire.

Results

All patient groups demonstrated increased errors and slower reaction times, and gave higher workload ratings than healthy controls. Patients with CFS and non-melancholic depression had more severe deficits than patients with acute infection. All patient groups reported more severe mood disturbance and fatigue than healthy controls, but patients with CFS and those with acute infection reported less severe mood disturbance than patients with depression.

Conclusions

As all patients demonstrated similar deficits in attention and response speed, it is possible that common pathophysiological processes are involved. The differences in severity of mood disturbance, however, suggest that the pathophysiological processes in patients with CFS and acute infection are not simply secondary to depressed mood.
Structural neuroimaging in learning disability
Authors: Deb Shoumitro
Published: October 2008

Background

Neuroimaging has proven useful in confirming diagnoses of certain neuropsychiatric conditions, but neuroimaging studies in learning disability are at an early stage.

Method

A review of recent structural neuroimaging research in relation to learning disability was carried out.

Results

Brain abnormalities can be detected in cases of idiopathic and non-idiopathic learning disability, but their significance is not clear due to discrepancies in study findings and the small cohorts involved.

Conclusion

Although the role of structural neuroimaging in the assessment of people with learning disability is not clear, new magnetic resonance imaging technology holds great promise for future research.
Outcome of anxiety and depressive disorders in primary care
Authors: Ronalds Clare , Creed Francis , Stone Kit , Webb Sarah , Tomenson Barbara
Published: October 2008

Background

Factors related to the outcome of depression and anxiety in primary care are not fully understood.

Method

Adult patients in general practice with depressive, anxiety or panic disorder (n=148; DSM–III–R criteria) were studied prospectively for six months to determine the factors most closely associated with outcome. The Psychiatric Assessment Schedule, Hamilton Depression Rating Scale, Clinical Anxiety Scale and Life Events and Difficulties Schedule interviews were performed at index consultations and repeated six months later. Variables associated with outcome were assessed by multiple regression analysis.

Results

Good outcome was predicted by mild depression at initial assessment, high educational level, and being in employment. At follow-up the most important predictor of improvement was reduction in marked difficulties over the six months. Recognition and management by the GP was most frequent in patients with severe disorder; such patients were least likely to improve because of the severity of their depression and marked social difficulties.

Conclusions

This naturalistic study helps to provide a framework for further studies with more precisely defined groups of people with depression. An effective treatment strategy for people with marked depression and ongoing social difficulties is especially needed.
Excess mortality of schizophrenia
Authors: Brown Steve
Published: October 2008

Background

This paper presents a structured review of the published information on the mortality of schizophrenia.

Method

A meta-analysis of the literature.

Results

Schizophrenia has a significantly increased mortality from natural and unnatural causes. Twenty-eight percent of the excess mortality is attributable to suicide and 12% to accidents. The rest of the excess mortality is from the same broad range of conditions which cause deaths in the general population. Further interpretation is hampered by confounding variables, wide confidence intervals and reservations about generalising from individual cohorts.

Conclusions

The available evidence suggests that schizophrenia is associated with a large increased mortality from suicide and a moderate increased mortality from natural causes. A number of possible interventions have been identified, but we do not yet have reliable means of detecting any changes in mortality which might result.