bluuebunny/crossref_metadata_2025 huggingface dataset:
Adolescent Girls II Background Factors in Anxiety and Depressive States
Authors: Monck Elizabeth , Graham Philip , Richman Naomi , Dobbs Rebecca
Published: October 2008

Background

This study investigated the prevalence and background variables associated with anxiety and depressive disorders occurring in a community population of older teenage girls.

Method

Girls aged 15–20 years (n = 529) whose names were drawn from general practitioner age/sex registers completed self-report Great Ormond Street Mood Questionnaires. From this sample, 143 girls (69 with high self-report scores and 74 controls) were intensively interviewed. Information was obtained on confiding/supportive relationships, family arguments and rows, quality of marital relationship, and degree of parental control. Psychiatric state was assessed by use of the Clinical Interview Schedule to provide a Total Weighted Score. A modified form of the Bedford Life Events and Difficulties Schedule was applied.

Results

The estimated one-year prevalence rate for psychiatric disorder was 18.9%, and 16.9% for depression and anxiety disorders. Using a logit analysis, it was shown that maternal distress (P < 0.02) and the quality of the mother's marriage (P < 0.02) were independently associated with the presence of depression and anxiety disorders.

Conclusions

About 17% of girls in a community sample living at home showed a depression or anxiety disorder. Even in late adolescence, the presence of a mood disorder is closely linked to the quality of family relationships within the home.
Post-Mortem Antipsychotic Drug Concentrations and Unexplained Deaths
Authors: Jusic Nedzara , Lader Malcolm
Published: October 2008

Background

The relationship between antipsychotic drug treatment and sudden unexplained death remains unclear. The estimation of post-mortem blood drug concentrations should be helpful.

Method

Eight medico-legal cases were reviewed with respect to behaviour of patient, type and dosage of drug treatment, mode of death, post-mortem findings and drug concentrations.

Results

The problems of evaluating such drug levels are discussed. Five of the eight patients had probably toxic concentrations of antipsychotic and/or antidepressants, which caused death, usually involving cardiac arrhythmias.

Conclusions

In cases of sudden unexpected death, a sample of blood from a peripheral vein should be obtained immediately death is pronounced or the body discovered, and sent for analysis. To minimise such fatalities, the patient should be monitored carefully, with ECG if feasible, and electrolyte balance checked. The drug regimen used should be kept simple and large doses of antipsychotics and/or antidepressants avoided wherever possible.
Comparison of Long-Term Benzodiazepine Users in Three Settings
Authors: Hawley C. J. , Tattersall M. , Dellaportas C. , Hallstrom C.
Published: October 2008

Background

Most studies of chronic benzodiazepine users consider selected populations which may be unrepresentative. This study was undertaken to examine possible differences between groups.

Method

Subjects chosen were benzodiazepine users in general practice, a hospital clinic, and attending TRANX trials. Descriptive data were collected on characteristics and outcome.

Results

RANX trial patients had the best outcome (P = 0.027). Hospital cases used high doses of anxiolytic benzodiazepines; concomitant mental disorder, including schizophrenia, was common. General practice cases were older and mainly used hypnotics (P < 0.05).

Conclusions

Because groups of benzodiazepine users are different, there cannot be one single management approach. Cases require individual medical assessment.
Coping with Chronic Pain
Authors: Elton Naomi H. , Hanna Magdi M. H. , Treasure Janet
Published: October 2008

Background

A multi-dimensional approach was used to examine coping in chronic pain. The following hypotheses were tested: (a) patients who cope maladaptively also cope generally in a similar way; (b) patients' maladaptive coping is associated with childhood adversity.

Method

Cross-sectional and retrospective data were collected from 68 consecutive patients (aged 18–70) at a pain clinic where their disease was non-systemic and the pain had lasted for at least three months. Sixty-one patients were interviewed using the Structured Clinical Interview for DSM–III–R, and the Measure of Parental Care in Childhood. All patients completed questionnaires on their pain and personality.

Results

Two coping styles emerged from factor analysis. One was associated with chronicity, psychiatric morbidity, harm avoidance, immature defence style and reporting parental indifference.

Conclusion

Patients may be predisposed to cope maladaptively after the experience of parental indifference in early life. Such coping is likely to reflect more general patterns.
Confinement of Winter Birth Excess in Schizophrenia to the Urban-born and its Gender Specificity
Authors: O'Callaghan Eadbhard , Cotter David , Colgan Karen , Larkin Conall , Walsh Dermot , Waddington John L.
Published: October 2008

Background

The season of birth phenomenon in schizophrenia was reexamined in relation to place of birth, in order to test the hypothesis that a seasonal factor might operate preferentially among those who were urban-born.

Method

The seasonal distribution of births was examined among 3253 patients in two case registers having an ICD–9 diagnosis of schizophrenia and compared with the distribution of births among the normal population born in those catchment areas over the same period; those subjects born in population centres greater than 50 000 were defined as urban-born.

Results

Patients who were urban-born showed an excess of winter births relative to controls that was absent among their rural-born counterparts. On comparing patient groups, those who were urban-born were more likely to be born in the winter, while those who were rural-born were more likely to be born in the spring; this urban–rural distinction was confined essentially to female patients.

Conclusions

These findings might be accommodated most readily in terms of a spatially as well as seasonally varying environmental factor that is associated with urbanicity and to which female offspring are more vulnerable.
Placebo-Controlled Trial of Lithium Augmentation of Fluoxetine and Lofepramine
Authors: Katona Cornelius L. E. , Abou-Saleh Mohammed T. , Harrison Deborah A. , Nairac Bertrand A. , Edwards Denzil R. L. , Lock Toni , Burns Robert A. , Robertson Mary M.
Published: October 2008

Background

This study was designed to establish whether (as suggested in a number of open and relatively small controlled trials) lithium augmentation is more effective than continued antidepressant alone, where response to a standard course of antidepressant treatment has been absent or partial.

Method

Lithium or placebo was added on a double-blind basis for six weeks to the drug regime of 62 patients with major depressive illness (in both hospital and primary care settings) who had failed to respond to a controlled trial of fluoxetine or lofepramine. Response was defined as a final Hamilton Depression Rating Scale (HDRS) score of < 10.

Results

Response was seen more frequently in patients taking lithium (15/29) than in those remaining on antidepressant alone (8/32; P < 0.05). Rapid response to lithium augmentation (LA) was not consistently observed in this cohort. Mean HDRS scores after six weeks were significantly lower (P < 0.01) in the lithium group after excluding those who had not achieved significant exposure to lithium (arbitrarily defined as two or more lithium levels ≥ 0.4 mmol/1). No differences in the efficacy of LA were apparent between fluoxetine and lofepramine.

Conclusions

Our results confirm that LA is a useful strategy in the treatment of antidepressant-resistant depression. Partial response was, however, frequently observed with continued antidepressant treatment alone, and the superiority of LA appears to depend on achieving adequate serum lithium levels.
Long-Term Effects of Behavioural Treatment for Panic Disorder with Agoraphobia
Authors: Fava Giovanni A. , Zielezny Maria , Savron Gianni , Grandi Silvana
Published: October 2008

Background

There are few long-term follow-up studies of panic disorder treatments, particularly when patients have been treated by behavioural methods only and have recovered.

Method

110 consecutive patients satisfying the DSM–III–R criteria for panic disorder with agoraphobia were treated in an out-patient clinic with behavioural methods based on exposure. After 12 sessions of psychotherapy, 81 patients became panic-free. A 2–9 year follow-up was available. Survival analysis was employed to characterise the clinical course of patients. Regular assessments by a clinical psychologist were based on the Clinical Interview for Depression.

Results

The estimated cumulative percentage of patients remaining in remission was 96.1% for at least two years, 77.6% for at least five years, and 67.4% for at least seven years. These outcomes greatly improved in the absence of a personality disorder or residual agoraphobia after treatment.

Conclusions

The findings suggest that, even though one patient in four is unable to complete treatment or does not benefit sufficiently from it, exposure treatment can provide lasting relief for the majority of patients. Disappearance of residual and subclinical agoraphobic avoidance, and not simply of panic attacks, should be the aim of exposure therapy.
The Korsakoff Syndrome
Authors: Kopelman Michael D.
Published: October 2008

Background

Investigations of the Korsakoff syndrome by researchers from different disciplines have proliferated in recent years, making it apposite to review the various findings.

Method

This review is based on the author's knowledge of reports in the major clinical and neuropsychological journals, supplemented by Medline searches to update particular subtopics.

Results

The Korsakoff syndrome is defined as a disproportionate impairment in memory, relative to other aspects of cognitive function, resulting from a nutritional (thiamine) depletion. The initial manifestations of the disorder are variable, and a persistent memory impairment can result from a non-alcoholic aetiology, although this seems to happen much less commonly than in the past – presumably because of generally higher standards of nutrition. Although there is agreement on the underlying neuropathology, the critical lesion sites for memory disorder have been debated. Recent evidence suggests that the circuit involving the mammillary bodies, the mammillo-thalamic tract and the anterior thalamus, rather than the medial dorsal nucleus of the thalamus, is particularly critical in the formation of new memories. The relationship of these deficits to thiamine depletion remains a topic of current investigation, as does the purported role of neurotransmitter depletions in the cholinergic, glutamate/GABA and catecholamine and serotonergic systems. Neuro-imaging studies have confirmed autopsy findings of more widespread structural and metabolic abnormalities, particularly involving the frontal lobes.

Conclusions

The relationship of these neuropathological, neurochemical, and metabolic abnormalities to cognitive functioning, with particular reference to specific aspects of memory processing, has been considered in some detail. Whereas structural and/or neurochemical abnormalities within the limbic/diencephalic circuits account for anterograde amnesia, some other factor, such as frontal lobe dysfunction, must underlie the severe retrograde memory loss which is characteristically found in this syndrome.
Psychotic States Arising in Late Life (Late Paraphrenia)
Authors: Almeida Osvaldo P. , Howard Robert J. , Levy Raymond , David Anthony S.
Published: October 2008

Background

This study explored the association between ‘late paraphrenia’ and various risk factors such as female gender, sensory impairment, marital status, positive family history of psychoses, and the presence of abnormal neurological signs. It was hypothesised that patients would show significantly more abnormal neurological signs than controls.

Method

Inclusion criteria for the diagnosis of late paraphrenia were fulfilled by 47 patients, including in-patients, out-patients, day-patients, and those living in the community. Thirty-three age-, sex-, education-, and premorbid IQ-matched elderly controls were recruited from luncheon clubs in Southwark and Lambeth (London, UK). A scale for the assessment of neurological soft and hard signs was developed for this study. The Abnormal Involuntary Movement Scale (AIMS) and the Tardive Dyskinesia Rating Scale (TDRS) were also used.

Results

There was a high female-to-male ratio (42:5), and a fourfold increase in the risk of patients having hearing impairment (odds ratio = 4.15, Clodds= 1.36 to 12.63). There was no difference between the two groups in visual difficulties nor in marital status. Patients were approximately ten times more likely to be living on their own (odds ratio = 10.61; Clodds= 3.59 to 31.33) and 16 times more likely to be considered socially isolated (odds ratio = 16.65; Clodds= 5.39 to 51.40). There was no difference between patients and controls in frequency of schizophrenia-like family history. Patients were more likely than controls to exhibit neurological soft signs (z = 4.70;P< 0.001; Cld= 4.61 to 9.63). The presence of abnormal involuntary and tardive dyskinesia movements was associated with the use of antipsychotic medication.

Conclusion

Women appear to run a greater risk of developing late paraphrenia, especially those who are socially isolated and present with associated hearing impairment. The increased presence of neurological soft signs among patients indicates that brain disease may be a critical factor in the development of psychotic symptoms in late life.
The Influence of Nietzsche on Freud's Ideas
Authors: Chapman A. H. , Chapman-Santana Mirian
Published: October 2008

Background

The striking analogies between the ideas of Freud and Friedrich Nietzsche, whose works were published from one to three decades before those of Freud, have been commented upon, but no previous systematic correlation of the ideas of Nietzsche and Freud has been made.

Method

The major works of Nietzsche were read, and each possible analogy to an idea later broached by Freud was correlated by a systematic review of his works. Any references to Nietzsche in Freud's writings and reported conversation were culled.

Results

Concepts of Nietzsche which are similar to those of Freud include (a) the concept of the unconscious mind; (b) the idea that repression pushes unacceptable feelings and thoughts into the unconscious and thus makes the individual emotionally more comfortable and effective; (c) the conception that repressed emotions and instinctual drives later are expressed in disguised ways (for example, hostile feelings and ideas may be expressed as altruistic sentiments and acts); (d) the concept of dreams as complex, symbolic “illusions of illusions” and dreaming itself as a cathartic process which has healthy properties; and (e) the suggestion that the projection of hostile, unconscious feelings onto others, who are then perceived as persecutors of the individual, is the basis of paranoid thinking. Some of Freud's basic terms are identical to those used by Nietzsche.

Conclusion

Freud repeatedly stated that he had never read Nietzsche. Evidence contradicting this are his references to Nietzsche and his quotations and paraphrases of him, in casual conversation and his now published personal correspondence, as well as in his early and later writings.
The Future of Adolescent Psychiatry
Authors: Parry-Jones William Ll.
Published: October 2008

Background

Appraisal of the future of adolescent psychiatry is required urgently, in view of the increasing scrutiny of mental health service priorities and the need for informed planning of psychiatric training and manpower requirements.

Method

Future developments are set in the context of the changing concept and connotations of adolescence, the history and present position of adolescent psychiatry, and the rationale for separate services.

Results

Predictions are derived using trend extrapolation, in relation to a number of factors likely to determine the future. These include the social value attached to adolescence and youth, the status of adolescent medicine, the definition of clinical boundaries, the upper age-limit of services, investment in prevention, postgraduate training, research, the evaluation and marketing of adolescent psychiatry and, finally, its recognition as a separate sub-speciality.

Conclusions

Predictions suggest that adolescent psychiatry will assume an expanding clinical role and increasing academic influence in the 21st century.
Late-Life Depressive Disorder in the Community
Authors: Ojen Rob Van , Hooijer Chris , Bezemer Dick , Jonker Cees , Lindeboom Jaap , Tilburg Willem Van
Published: October 2008

Background

In previous studies, dementia was linked to a family history of dementia and Down's syndrome. This study tested the hypothesis that late-life depression accompanied by cognitive impairment in elderly individuals with no history of psychiatric illness is also associated with these family histories.

Method

We investigated an age-stratified sample of 4051 elderly people in the community aged 65–84 (AMSTEL). The relationship between family history (CAMDEX questionnaire) and depression (GMS-AGECAT diagnosis) was studied.

Results

A family history of mental health problems was associated with all subtypes of depression. Family history of dementia was associated with depression in subjects with a psychiatric history, but a family history of Down's syndrome was only associated with the combination of depression and cognitive impairment in subjects with no history of psychiatric illness.

Conclusions

The heritability pattern confirms the concept of a dementia-related subtype of late-life depression.
Cultural Dimensions of Psychiatric Diagnosis
Authors: Weiss Mitchell G. , Raguram R. , Channabasavanna S. M.
Published: October 2008

Background

Cross-cultural research to examine the cultural validity of diagnostic categories and underlying concepts requires methods that integrate epidemiological and anthropological frameworks.

Method

The Explanatory Model Interview Catalogue (EMIC) and Structured Clinical Interview for DSM–III–R (SCID) were used to study 80 psychiatric out-patients with depressive neurosis at a clinic in south India.

Results

kappa values of 0.75 for the EMIC and 0.68 for the SCID confirmed inter-rater reliability. Comparison of patient explanatory models and SCID diagnoses showed that patients emphasised somatic experience while clinicians emphasised depressive diagnoses. More than half the patients (55%) received a non-specific or dual diagnosis.

Conclusions

These findings raise questions about the distinctiveness of depressive, anxiety, and somatoform (DAS) disorders for this population.
Characteristics of Fire-Setters a Study and Proposed Multiaxial Psychiatric Classification
Authors: Puri B. K. , Baxter R. , Cordess C. C.
Published: October 2008

Background

The study set out to review the relationship between mental disorder and fire-setting.

Method

Sociodemographic, psychiatric, and medical data were retrospectively obtained from case notes of a group of 36 fire-setters referred to the North West Thames Forensic Psychiatry Service over a four-year period.

Results

Of the sample, 28% were female and one-third had no mental illness; 28% had a previous medical history of possible relevance. Psychoactive substance abuse was common. There was a significant disturbance of interpersonal relationships. Eighty-five per cent lived alone, and 44% of the female fire-setters had a history of sexual abuse.

Conclusion

On the basis of this study, a multiaxial classification system of fire-setting is proposed.
Cognitive Therapy with Obsessive–Compulsive Disorder
Authors: James Ian A. , Blackburn Ivy-Marie
Published: October 2008

Background

People with obsessive–compulsive disorders (OCD) are widely treated with a combination of medication and behavioural techniques. The success rate is 50–85%, but both relapse and drop-out rates appear high. The use of cognitive therapy (CT) for the treatment of OCD has been suggested. The empirical evidence supporting the use of CT for OCD is examined.

Method

A manual and computer (Medline) literature search was performed.

Results

Fifteen empirical studies were found: ten non-controlled, and five controlled.

Conclusions

There are few controlled CT studies, and these show little evidence of improvement when CT is added to existing therapeutic techniques.
Quality of Life in Liaison Psychiatry
Authors: Gater R. A. , Kind P. , Gudex C.
Published: October 2008

Background

This exploratory study investigates the performance of the Health Measurement Questionnaire (HMQ), as compared with the Psychiatric Assessment Schedule (PAS) and the Nottingham Health Profile (NHP), and compares self- and observer-completed measures.

Method

A total of 138 medical patients scoring over the screening threshold for probable psychiatric illness completed the HMQ, NHP and PAS, and were rated by a psychiatrist on Rosser disability and distress.

Results

HMQ disability correlated well with NHP and PAS physical health items, while HMQ distress correlated well with the NHP emotional reactions and PAS Index of Definition. There was significant correlation between self-report and psychiatrist ratings, the latter being more sensitive to distress.

Conclusion

The HMQ is a useful measure of generic health status in liaison psychiatry settings.
Psychiatric and Social Outcome of Liver Transplantation
Authors: Collis Ian , Burroughs Andrew , Rolles Keith , Lloyd Geoffrey
Published: October 2008

Background

This study measures psychiatric morbidity, quality of life, and cognitive function after liver transplantation.

Method

We undertook a cross-sectional study, with a longitudinal subgroup. The setting was a tertiary referral centre for liver transplantation. The subjects were 30 post-liver-transplantation patients, including 11 also interviewed before the operation. The main outcome measures were the Clinical Interview Schedule (CIS), the General Health Questionnaire (GHQ), the Nottingham Health Profile (NHP), and the Mini-Mental State Examination (MMSE).

Results

Of the patients, 8/30 were CIS cases, and 7/30 were GHQ cases. NHP scores were higher than a previous postal study indicated, with less impairment after than before transplant. MMSE scores were 24–30. Median GHQ was 7.0 before operation and 1.0 after operation (P= 0.03), with no significant change in CIS score.

Conclusion

Liver transplantation improves quality of life, but not to the level of the general population; post-transplantation patients have a prevalence of psychiatric morbidity comparable with that of general medical patients.
Light Therapy for Seasonal Affective Disorder the Effects of Timing
Authors: Meesters Y. , Jansen J. H. C. , Beersma D. G. M. , Bouhuys A. L. , Van Den Hoofdakker R. H.
Published: October 2008

Background

Sixty-eight patients with seasonal affective disorder participated in a 10 000-lux light treatment study in which two questions were addressed: do response rates differ when the light is applied at different times of the day and does short-term rank ordering of morning and evening light influence response rates?

Method

Three groups of patients received a 4-day light treatment: (I) in the morning (8.00–8.30 a.m., n = 14), (II) in the afternoon (1.00–1.30 p.m., n = 15) or (III) in the evening (8.00–8.30 p.m., n = 12). Two additional groups of patients received two days of morning light treatment followed by two days of evening light (IV, n = 13) or vice versa (V, n = 14).

Results

Response rates for groups I, II and III were 69, 57 and 80% respectively, with no significant differences between them. Response rates for groups IV and V were 67 and 50% respectively; this difference was not significant and these percentages did not differ significantly from those of groups I and III.

Conclusions

The results indicate that the timing of light treatment is not critical and that short-term rank ordering of morning and evening light does not influence therapeutic outcome.
Life Events and Senile Dementia Affective Symptoms
Authors: Orrell Martin , Bebbington Paul
Published: October 2008

Background

Previous research in the elderly has linked threatening life events with depression. Dementia sufferers are known to be sensitive to stressful changes in their daily life such as relocation. This study investigates whether threatening life events are associated with depressive symptoms in dementia sufferers.

Method

Using the Life Events and Difficulties Schedule, this study examined life events before admission in a group of 70 dementia patients compared with two control groups: dementia sufferers in the community and mentally fit elderly people matched for age and sex.

Results

Life events with severe threat were not significantly more frequent in the dementia patients than in two control groups. However, depressive symptoms in the dementia sufferers were significantly associated with independent severe life events. This strong association was maintained when a multivariate analysis was used to control for the effects of other social factors and severity of cognitive impairment. This association appears to be specific to the threat aspect of life events since there was no association between depressive symptoms and events relating to change in the social environment.

Conclusion

In dementia sufferers, threatening life events are associated with depressive symptoms. This means that dementia sufferers are responsive to stress in the same way as cognitively intact individuals, and clinicians need to be more aware of the social influences on them.
Expressed Emotion Trait or State?
Authors: Schreiber Judith L. , Breier Alan , Pickar David
Published: October 2008

Background

This exploratory study addresses the question of whether expressed emotion (EE) is a response characteristic of the parent (trait) or a parental response to specific circumstances or persons (state).

Method

Seventeen parents participated in two audiotaped interviews, using modified versions of the Camberwell Family Interview. One interview concerned the child with chronic schizophrenia and the other a well sibling. Subsequent ratings of the EE variables of critical comments (CC), emotional overinvolvement (EOI) and warmth were completed and compared.

Results

E response patterns directed towards patients, as compared with towards siblings, were significantly different on two measures: EOI (P=0.01) and warmth (P=0.02). The parents showed significantly more emotional overinvolvement with the child with schizophrenia and significantly more warmth towards the well child.

Conclusions

These data suggest that the EE variables of EOI and warmth are related to the state of child, and the lack of a significant difference in CC suggests that this is a parental trait.
Long-Term Fluoxetine Treatment of Bulimia Nervosa
Authors: Goldstein David J. , Wilson Michael G. , Thompson Vicki L. , Potvin Janet H. , Rampey Alvin H. ,   The Fluoxetine Bulimia Nervosa Research Group
Published: October 2008

Background

A large collaborative 8-week study has shown fluoxetine to be effective and safe in treating patients with bulimia nervosa. The present study evaluated fluoxetine over 16 weeks.

Method

Fifteen US out-patient psychiatry clinics conducted a double-blind parallel study in men and women with DSM–III–R bulimia nervosa (483 patients entered, 398 randomised [3:1 ratio, fluoxetine 60 mg/day or placebo], 225 completed). Outcome measures included change in vomiting and binge-eating episodes per week, Eating Disorder Inventory, Clinical Global Impressions and Patient's Global Impression.

Results

Compared with placebo, fluoxetine treatment resulted in significantly greater reductions in vomiting (F [1,360] = 14.73, P< 0.0001) and binge-eating (F [1,360] = 14.39, P=0.0002) episodes per week at endpoint and improvement in other outcome measures. Adverse event, vital sign and laboratory analyses indicated that fluoxetine was safe.

Conclusion

Fluoxetine appeared to be safe and effective in patients with bulimia nervosa for up to 16 weeks.
Antecedents of Schizophrenia and Affective Illness Obstetric Complications
Authors: Sacker Amanda , Done D. John , Crow Timothy J. , Golding Jean
Published: October 2008

Background

This exploratory study seeks to generate new hypotheses about the relationship between obstetric complications and schizophrenia.

Method

The British Perinatal Mortality Survey represents 98% of all births during one week in March 1958 in Great Britain. Present State Examination (PSE), Catego diagnoses of narrowly defined schizophrenia (n = 49), broadly defined schizophrenia (n = 79), affective psychosis (n = 44) and neurosis (n = 93) were derived from case notes for all cohort members. The remainder of the cohort, surviving the perinatal period, acted as controls (n = 16 812). Variables in the British Perinatal Mortality Survey were grouped into five categories: the physique/lifestyle of the mother (including demographic characteristics), her obstetric history, the current pregnancy, the delivery and the condition of the baby.

Results

There were 7/17 significant differences in maternal physique/lifestyle and obstetric history between the births of schizophrenics and controls, compared to 4/40 comparisons of somatic variables relating to pregnancy, birth and the condition of the baby. This compares with 4/17 and 7/40 for affective psychotics and a total of 4/57 differences for all categories of variables when neurotics were contrasted with controls.

Conclusions

The purported increased risk of obstetric complications in schizophrenics may result from the physique/lifestyle of their mothers.
Chronic Fatigue Syndrome in the Community Prevalence and Associations
Authors: Lawrie S. M. , Pelosi A. J.
Published: October 2008

Background

Chronic fatigue syndrome (CFS) is a poorly understood condition, apparently related to both psychiatric disturbance and infectious illness. Little progress has been made in identifying aetiology, owing to a lack of epidemiological studies using case-definition criteria.

Method

A community postal survey of a random sample of over 1000 patients registered at a local health centre comprised a fatigue questionnaire and the 12-item General Health Questionnaire (GHQ).

Results

Total fatigue scores were modestly higher in women than men. Fatigue was most frequently attributed to psychosocial factors. Fatigue and GHQ scores were strongly correlated. Two men and two women satisfied British criteria for CFS, a prevalence of 0.56% (95% CI 0.16–1.47%); three were probable psychiatric cases.

Conclusions

Previously reported sociodemographic associations of CFS may reflect medical referral patterns. A strong association exists with psychological morbidity, but relabelling CFS as a psychiatric disorder is not justified.
The Social Disablement of Men in Hostels for Homeless People II. a Comparison with Patients from Long-stay Wards
Authors: Hamid Walid Abdul , Wykes Til , Stansfeld Stephen
Published: October 2008

Background

Some authors have argued that hostels for homeless people are increasingly taking over the role of psychiatric long-stay wards, and that this creates a problem. We set out to test this hypothesis.

Method

The social disablement of a random sample of 101 homeless men, described in Part 1, was compared with that of a sample of 66 psychiatric patients from a long-stay ward.

Results

The study sample rated significantly lower for social disablement than the long-stay ward sample. Thirteen subjects of the hostel sample had psychotic social behaviour problems. These had no history of being long-stay psychiatric patients.

Conclusions

The hostel sample differ significantly in their social disablement from the chronic psychiatric patients. There is a small proportion of severely disturbed residents who might have been over-represented in previous non-random surveys.
Is There a Seasonal Pattern of Relapse in Bipolar Affective Disorders? a Dual Northern and Southern Hemisphere Cohort Study
Authors: Silverstone Trevor , Romans Sarah , Hunt Neil , McPherson Heather
Published: October 2008

Background

Admission statistics for mania frequently show an increase in the summer. The present two-centre study was designed to test the hypothesis, in a representative sample of bipolar patients, that manic and depressive relapses show a seasonal pattern.

Method

Two cohorts of bipolar I patients, one in London, England (n = 86), the other in Dunedin, New Zealand (n = 58), were tracked retrospectively during 1985–88 and prospectively during 1989–91, with the onset of all relapses being carefully dated.

Results

In the London cohort there were 221 episodes of mania and 76 of depression; in the Dunedin cohort there were 201 of mania and 61 of depression. No consistent seasonal pattern of mania was detected in either centre. There was an autumn preponderance of depressive episodes in both centres.

Conclusions

Relapse of bipolar depression, but not of mania, appears to be determined in part by seasonal factors.
Does Imagined Exposure to the Consequences of Not Ritualising Enhance Live Exposure for OCD? a Controlled Study
Authors: De Araujo L. A. , Ito L. M. , Marks I. M. , Deale A.
Published: October 2008

Background

This randomised controlled study tested whether adding imagined to live exposure plus ritual prevention would enhance gains in obsessive-compulsive disorder (OCD).

Method

Out-patients with OCD were randomly allocated to either have nine sessions of daily live self-exposure and ritual prevention to external cues alone (Ex) (n = 23) or to have, in addition to Ex, daily self-exposure to the imagined internal cues of the consequences of not ritualising (group Exi) (n = 23). All patients had the same sessional exposure time of 1 h 30 min (Exi 1 h live, 30 min imagined; Ex 1 h 30 min live), and had to practise either Exi or Ex daily for the same duration and to keep diaries of that self-exposure homework throughout treatment. Patients were followed up to week 32. Outcome measures were YBOCS for rituals and obsessions, compulsion checklist, target rituals and obsession, general anxiety, depression (Beck, Hamilton), work and social disability, clinical global impression (CGI).

Results

At weeks 4, 9, 20 and 32 the two groups improved similarly with no significant difference between them, neither for washers nor for checkers. Imagined exposure was more difficult to do than live exposure and there were more drop-outs.

Conclusions

Daily imagined exposure to internal cues did not enhance exposure to external cues. Perhaps longer imagined exposure would have been more enhancing.
Does Imagined Exposure to the Consequences of Not Ritualising Enhance Live Exposure for OCD? a Controlled Study
Authors: Ito L. M. , Marks I. M. , De Araujo L. A. , Hemsley D.
Published: October 2008

Background

This study tested whether adding imagined exposure to live exposure would increase the concordance between behavioural and subjective improvement in obsessive–compulsive disorder (OCD).

Method

46 OCD out-patients were randomly allocated to 9 weekly sessions of either combined live + imagined exposure/ritual prevention (Exi, n = 23), or only live exposure/ritual prevention (Ex, n = 23). Patients were asked to do 90 min of daily self-exposure at home (corresponding to Exi or Ex). Measures were: (A) behavioural; (B) subjective; (C) clinical global impression (CGI).

Results

After 9 weeks of treatment, improvement was greater on behavioural than subjective measures (similar for the Exi and Ex groups). At 20 weeks (3-month follow-up) each group had improved slightly more on subjective measures and slightly less on behavioural ones. Two subjective measures improved less during Exi than Ex, but this difference disappeared at follow-up. The greater difference between behavioural and subjective improvement scores in Exi than in Ex did not relate to clinical outcome at the end of treatment or follow-up.

Conclusions

Compared to live exposure alone, combined imagined plus live exposure did not enhance behavioural/subjective concordance.
Sexual Abuse in Patients with Eating Disorder, Patients with Depression, and Normal Controls
Authors: Vize Christine M. , Cooper Peter J.
Published: October 2008

Background

A history of sexual abuse has been widely reported in patients with eating disorders. However, the association does not appear to be specific, because a high rate of such abuse has also been found in other psychiatric patients.

Method

A standardised interview method was used to elicit details of sexual abuse in a psychiatrically normal control group and samples of patients with anorexia nervosa, bulimia nervosa, or depression.

Results

An equally high rate of abuse was found in all three clinical samples. Among the patients with anorexia nervosa the presence of bulimic episodes was not found to be associated with reports of abuse; and among the patients with bulimia nervosa there was no relationship between abuse and a history of anorexia nervosa. Among the patients with eating disorders, borderline personality disorder, assessed by means of self-report questionnaire, was not found to be related to reports of abuse, although there was an association between abuse and both indices of impulsive behaviour and the overall level of personality disturbance.

Conclusions

Childhood sexual abuse appears to be a vulnerability factor for psychiatric disorder in general and not eating disorders in particular. The way in which abuse interacts with other aetiological factors to produce different psychopathological trajectories remains to be elucidated.
Gender and Schizophrenia Results of an Epidemiologically-based Family Study
Authors: Kendler Kenneth S. , Walsh Dermot
Published: October 2008

Background

Gender may have a significant impact on the prevalence, age at onset, symptoms, course and outcome of schizophrenia, as well as on the pattern of psychopathology in relatives.

Method

We examined these questions in the Roscommon Family Study, in which the probands were epidemiologically sampled from a case registry and followed up an average of 15 years after onset. Face-to-face interviews were conducted with 86% of traceable living relatives.

Results

The treated lifetime prevalence of DSM–III–R schizophrenia was 0.54 ± 0.06% in men and 0.28 ± 0.04% in women. No significant differences were seen in the age at onset, symptoms, course or outcome of schizophrenia. The risks for schizophrenia, schizophrenia spectrum disorders, affective illness and alcoholism were similar in relatives of male and female schizophrenic probands.

Conclusions

Gender has little impact on the presentation and course of schizophrenia in the west of Ireland. The familial liability to schizophrenia did not differ in affected men and women. No evidence was found that schizophrenia in women, compared to men, is, from a symptomatic or familial perspective, more closely related to affective illness. The substantial gender difference in the prevalence rate of schizophrenia in Ireland cannot be explained by women having a greater resistance to the familial predisposition to illness.
Sensorimotor Cortex and Supplementary Motor Area Changes in Schizophrenia
Authors: Schröder J. , Wenz F. , Schad L. R. , Baudendistel K. , Knopp M. V.
Published: October 2008

Background

Neurological soft signs (NSS) such as a disturbed finger-to-thumb opposition are frequently found in schizophrenia. To identify the underlying cerebral changes we investigated sensorimotor cortex and supplementary motor area (SMA) activation during finger-to-thumb opposition using functional magnetic resonance imaging (fMRI).

Method

Ten DSM–III–R schizophrenics and seven healthy controls were included. All subjects were right-handed. fMRI was carried out in a resting condition followed by an activation state (finger-to-thumb opposition) and the activities in the sensorimotor cortices and SMA recorded.

Results

All subjects showed a significant activation of the SMA and both ipsilateral and contralateral sensorimotor cortices. In the controls, ipsilateral finger-to-thumb opposition was associated with a greater left than right hemispheric sensorimotor cortex coactivation. When compared with the healthy controls, the schizophrenic patients showed a decreased activation of both sensorimotor cortices and SMA, as well as a reversed lateralisation effect.

Conclusion

Sensorimotor cortex and SMA dysfunction are associated with motor disturbances in schizophrenia.
Episodes of Care for First-Ever Psychiatric Patients a Long-Term Case-Register Evaluation in a Mainly Urban Area
Authors: Tansella Michele , Micciolo Rocco , Biggeri Annibale , Bisoffi Giulia , Balestrieri Matteo
Published: October 2008

Background

Psychiatric case registers (PCRs) are particularly useful for studying patterns of care over time. Methods of ‘survival analysis’ have rarely been used for assessing such data.

Method

A longitudinal study was conducted over 10 years (1 January 1982 to 31 December 1991) on 1423 first-ever psychiatric patients, using the PCR of South Verona, Italy. The product-limit method, the log-rank test, the Cox regression model and the Poisson regression analysis were used to analyse episodes of care and relapses.

Results

The duration of the episodes of care increased consistently from the first to the fifth episode. The probability of opening a new episode of care after the first one increased consistently from the second to the sixth episode. The only variable significantly associated with the length of the first episode of care was diagnosis (highest probability of having longer episodes for schizophrenic patients), while the length of the breaks following the first episode of care was associated with diagnosis, sex and occupational status (highest probability of opening a second episode of care for schizophrenic subjects and those with alcohol and personality disorders, for males, and for unemployed patients). The probability of opening a new episode of care decreased with time since last contact and increased with number of previous contacts.

Conclusions

The community psychiatric service in South Verona is fulfilling its original aim, that is, to give priority to the continuity of care for patients with chronic and severe mental illnesses. Survival analyses proved to be useful methods for assessing episodes of care.
Brain Perfusion Abnormalities in Gilles de la Tourette's Syndrome
Authors: Moriarty John , Costa Durval Campos , Schmitz Bettina , Trimble Michael R. , Ell Peter J. , Robertson Mary M.
Published: October 2008

Background

Functional brain imaging with technetium-99m d,l-hexamethyl propyleneamine oxime (HMPAO) Single Photon Emission Tomography (SPET) allows us to explore the cerebral pathophysiology of Gilles de la Tourette's Syndrome (GTS).

Method

Fifty patients and 20 controls were examined. Patients were rated for tic severity and mood. Scans were analysed quantitatively using internal ratios to the occipital cortex.

Results

Patients differed from controls on measures of relative blood flow to the left caudate, anterior cingulate cortex and the left dorsolateral prefrontal cortex. Severity of tics was related to hypoperfusion of the left caudate and cingulate and a left medial temporal region. Hypoperfusion in the left dorsolateral prefrontal region was related to mood.

Conclusions

The areas found to be hypoperfused in this study are consistent with known functions of fronto-striatal circuits. A wide range of perfusion patterns is seen, however, and no characteristic patterns for behavioural subgroups has been documented with this technique.
The Edinburgh Primary Care Depression Study: Personality Disorder and Outcome
Authors: Patience Douglas A. , McGuire Ralph J. , Scott Allan I. F. , Freeman Christopher P. L.
Published: October 2008

Background

Little is known about the impact of personality pathology on the treatment outcome of major depressive illness in primary care in the UK.

Method

Patients meeting criteria for DSM–III major depressive disorder were randomly allocated to one of four treatments each lasting 16 weeks, then followed up for 18 months. Assessments were made of depressive symptoms, personality and social functioning. Personality was assessed at maximum improvement or 16 weeks.

Results

The prevalence of personality disorder (PD) in the sample of 113 patients was 26%. Patients with a PD were significantly younger and rated more depressed at entry than patients with no personality disorder (NoPD). On completion of treatment patients with a PD were significantly more depressed and had poorer social functioning than the NoPD group. After 18 months there were no differences in ratings of depression or social functioning between the groups.

Conclusions

There was substantial improvement in both the PD and NoPD groups. The presence of personality pathology delays recovery from major depressive illness.
Effect of Exposure to Dothiepin and Northiaden in Breast Milk on Child Development
Authors: Buist Anne , Janson Helen
Published: October 2008

Background

This study looks at the outcome of infants exposed to dothiepin in breast milk in an attempt to guide clinicians on the risk-benefit ratio of breast-feeding when on antidepressants.

Method

Thirty women, who had had HDRS scores > 15 within the first five years postpartum from the same women's hospital, were assessed with their children 3–5 years postpartum; half had breast-fed while on dothiepin (study group). Thirty-six non-depressed women were also assessed. Rating scales assessed depression, anxiety, self-esteem, personality, social support, marital relationship, child behaviour and temperament. The children were assessed by the McCarthy Scale.

Results

Comparisons of the two depressed groups showed no significant differences on any measures except marital conflict and child behaviour, which were the most disturbed in the study group (P < 0.001). Overall cognitive scores for the children did not differ between the groups. Higher levels of dothiepin and northiaden were associated with higher cognitive scores on subscales (P = 0.02).

Conclusions

We are cautiously optimistic about the lack of any negative associations between cognitive development and exposure to dothiepin via breast milk.
Supportive Psychotherapy the Search for Positive Meanings
Authors: Holmes Jeremy
Published: October 2008

Background

The attempt to define psychotherapeutic skills appropriate for psychiatrists has aroused an interest in supportive psychotherapy, a previously undervalued and underdeveloped member of the psychotherapeutic family. This has been coupled with an increasing recognition of the importance of support within formal psychotherapies, especially when working with highly disturbed patients.

Method

A review of supportive psychotherapy (ST) was performed, based on a Medline literature search.

Results

It is argued that, from the perspective of attachment theory, support is an integral part of all psychotherapies. ST is also a specific mode of treatment suitable for some patients suffering from psychotic illnesses and borderline personality disorder. ST is an eclectic treatment drawing on many theoretical approaches. A common theme based on a narrative co-constructionist perspective, the search for positive meaning, is identified.

Conclusions

Supportive psychotherapy is an essential component of good psychiatric practice. Further research is needed to define its benefits and limitations.