bluuebunny/crossref_metadata_2025 huggingface dataset:
Child related strain and maternal mental health: a longitudinal study
Authors: Nærde A. , Tambs K. , Mathiesen K. S.
Published: March 2003

Objective: To explore how normal age‐related behaviour patterns and medical status affect maternal mental health in children aged 1.5–4 years.

Method:& Data were collected via questionnaires from a population‐based sample. Outcome variable was the Hopkins Symptom Checklist (HSCL‐25). Multiple regression analyses were used to assess the extent to which changes in the predictors (sociodemographic variables, chronic strains, negative life events, maternal somatic health and social support) explained changes in maternal distress.

Results: Changes in strain related to children and child care‐taking predicted changes in maternal mental distress stronger than the other explanatory variables. Only effects of changes in child care‐taking were significant for both time periods.

Conclusion: Changes in maternal symptoms of anxiety and depression appear to be influenced by changes associated with children's behaviour, their medical status and child care‐taking arrangements.
Apolipoprotein E genotype and schizophrenia: further negative evidence
Authors: Sáiz P. A. , Morales B. , G‐Portilla M. P. , Alvarez V. , Coto E. , Fernández J. M. , Bousoño M. , Bobes J.
Published: March 2003

Objective: To investigate the association between apolipoprotein E (ApoE) genotype and schizophrenia.

Method: We genotyped 106 schizophrenic out‐patients [Diagnostic Statistic Manual IV (DSM‐IV) criteria] and 250 healthy volunteers (hospital staff and blood donors) from Asturias (Northern Spain). The ApoE genotypes (ϵ2, ϵ3, ϵ4 – alleles) were determined after polymerase chain reaction (PCR) amplification, followed by digestion with the restriction enzyme CfoI and electrophoresis on a 4% agarose gel.

Results: No significant differences in ApoE‐allele frequencies between patients and controls was found, although an increased ϵ4‐frequency was recorded in patients compared with controls [9.0% vs. 6.2%, P=0.124; odds ratio (OR)=1.49; 95% confidence interval (CI)=0.82–2.70]. ApoE‐genotype frequencies did not differ between both groups. The mean age of onset for schizophrenic patients that carried the ϵ4‐allele was not significantly different from that of patients without this allele.

Conclusion: Variation in the ApoE gene was not associated with the development of schizophrenia in our population. ApoE‐genotypes did not modify the age of onset of the disease.
Do cenesthesias and body image aberration characterize a subgroup in schizophrenia?
Authors: Röhricht Frank , Priebe Stefan
Published: March 2003

Objective: To identify and characterize a subgroup of schizophrenia patients with marked and dominating bodily sensations (cenesthesias and body image aberration).

Method: We assessed cenesthesias and different aspects of body image aberration systematically along with common (general, positive and negative symptoms) and ego‐psychopathology in 60 patients with acute paranoid schizophrenia. Cluster analysis was applied to identify subgroups. Psychopathology scores of the clusters were compared at admission and after 2 weeks of hospital treatment.

Results: One of the three clusters comprised of 14 patients (23.3%) with marked disturbances of body experience (underestimation of lower extremities, desomatization, boundary loss and diminution). The subgroup was further characterized by significantly higher ego‐psychopathology scores at admission. Some of the differences held true over a 2‐week period.

Conclusion: The findings from the present study suggest that cenesthesias and body image aberration might represent an additional dimension of psychopathology that might be used for defining a nosological subtype of schizophrenia.
Age, period and cohort effects on suicide rates in Australia, 1919–1999
Authors: Snowdon J. , Hunt G. E.
Published: March 2003

Objective: To examine age, period and cohort effects on Australian suicide rates.

Method: Male suicide rates for successive 5‐year periods between 1919 and 1998, and for 1999 were displayed graphically to examine interactions between age, period and cohort effects.

Results: There has been a pronounced period effect on male suicide rates in all age groups over the last few decades, with lower rates in wartime and peak rates for most cohorts in the 1960s. Peak rates of all adult female 5‐year age cohorts occurred in the 1960s or early 1970s.

Conclusion: Most so‐called cohort effects appear to be associated with environmental changes that may not be a function of the cohort itself. While much attention has focused on the rising suicide rates in young males in Australia, local media and health authorities have given little emphasis to the high rates found in elderly males.
Quality of life in schizophrenia measured by the MOS SF‐36 and the Lancashire Quality of Life Profile: a comparison
Authors: Meijer C. J. , Schene A. H. , Koeter M. W. J.
Published: March 2003

Objective: To compare two Quality of Life (QoL) instruments on reliability, feasibility and conceptual overlap in a group of schizophrenic out‐patients.

Method: The Lancashire Quality of Life Profile (LQoLP) and the MOS SF‐36 were used to assess the QoL of 143 schizophrenic out‐patients.

Results: Feasibility and reliability for both instruments were satisfying. Second order factor analysis on 10 LQoLP and eight MOS SF‐36 scales resulted in three factors: one health related QoL factor and two general QoL factors; an internal and an external factor.

Conclusion: QoL measures in schizophrenia studies are not exchangeable. Validity of a specific QoL instrument depends upon the purpose of the study. The LQoLP allows suggestions for specific improvements in mental health care for long‐term psychiatric patients. The SF‐36 is a good choice when comparison with other patient groups on health related QoL is relevant.
Demographic, family, and occupational characteristics associated with major depression: the Harvard study of moods and cycles
Authors: Harlow B. L. , Cohen L. S. , Otto M. W. , Liberman R. F. , Spiegelman D. , Cramer D. W.
Published: March 2003

Objective: This study assesses the extent to which women with and without major depression differ by demographic, familial, and occupational characteristics.

Method: From a community‐based sample, the authors identified 332 women with and 644 women without current or past major depression based on Structured Clinical Interviews for DSM‐IV. Demographic and background interviews were conducted in‐person.

Results: Depressed women were more likely to have gained ≥35 lbs between age 18 and study enrolment (OR=1.6, 95% CI 1.1–2.5), experienced divorce (OR=2.0, 95% CI 1.4–2.8), or changed occupations (OR=1.5, 95% CI 1.1–2.1) compared with non‐depressed women. Compared with women with no brothers, those with ≥1 brothers were less likely to have a history of depression (OR=0.8, 95% CI 0.6–1.1), whereas compared with women with no sisters, those with ≥1 sisters were more likely to have current or past depression (OR=1.4, 95% CI 1.0–1.9). These findings were not influenced by family sibship size.

Conclusion: These results illustrate demographic differences between women with and without major depression and that sibship gender rather than size may also influence risk.
Obstetrical complications, parenting practices and risk of criminal behaviour among persons who develop major mental disorders
Authors: Hodgins S. , Kratzer L. , McNeil T. F.
Published: March 2003

Objective: The present study examined whether socio‐economic status (SES) of the family of origin, inadequate parenting, and pre and perinatal factors are antecedents of criminality among men and women who develop a major mental disorder.

Method: The sample included the 82 men and 79 women from the 1953 Stockholm birth cohort who developed a major mental disorder by age 30. Information was extracted from obstetric files, health, social and work records and official criminal records.

Results: Among males, neonatal complications increased the risk of offending two‐fold, the risk of violent offending 2.5 times, and the risk of early start offending 3 times. Neither pregnancy or birth complications, inadequate parenting, or SES of the family of origin increased the risk for offending. Among females, none of the factors that were examined were associated with offending.

Conclusion: Complications in the neonatal period are associated with offending among men who develop major mental disorders.
Social desirability and eating disorders. A community study of an Italian school‐aged sample
Authors: Miotto P. , De Coppi M. , Frezza M. , Rossi M. , Preti A.
Published: March 2003

Objective: To explore the links between social desirability and eating disorders in a sample of adolescents in a north‐east area of Italy.

Method: A mixed male–female sample of 1000 school‐aged adolescents, corresponding to 10% of the young population aged 15–19 years living in the district, were investigated with self‐reported questionnaires, including the Eating Attitudes Test (EAT), the Bulimic Investigatory Test of Edinburgh (BITE), the Body Attitudes Questionnaire (BAT), and an Italian version of the Marlowe–Crowne Social Desirability Scale (MC‐SDS).

Results: Females scored higher than males at all eating disorder inventories. In both genders there was a negative relationship (in all cases P < 0.01) between scores at the eating disorder inventories and those at the MC‐SDS. When analysing eating disorder `caseness', as measured by cut‐off, `cases' reported significantly lower scores than `non‐cases' at the MC‐SDS in both genders.

Conclusion: Personality traits measured by the MC‐SDS, such as defensiveness, self‐esteem, and dependence from approval, might contribute to the development of abnormal eating patterns at risk of eating disorders.
Panic attacks in psychosis
Authors: Goodwin Renee , Davidson Larry
Published: March 2003

Objective: To determine the prevalence, psychiatric comorbidity and suicidal ideation associated with co‐occurring non‐affective psychosis and panic attacks, compared with non‐affective psychosis without panic attacks, in the general population.

Method:Data were drawn from the National Comorbidity Survey (n=8098). Statistical analyses were used to identify differences in sociodemographic characteristics, psychiatric comorbidity, suicidal ideation, and familial psychopathology between those with non‐affective psychoses with and without panic, as well as to identify correlates of non‐affective psychosis and panic.

Results:Co‐occurring panic attacks and non‐affective psychosis, compared with non‐affective psychosis without panic, was associated with elevated psychiatric comorbidity and increased odds of suicidal ideation.

Conclusion:Consistent with clinical findings, these data suggest that panic attacks commonly co‐occur with psychosis in the community. Results indicate that the co‐occurrence of panic and psychosis is associated with increased likelihood of psychiatric comorbidity and suicidality. These findings need replication.
The European Schizophrenia Outpatient Health Outcomes (SOHO) study: rationale, methods and recruitment
Authors: Haro J. M. , Edgell E. T. , Jones P. B. , Alonso J. , Gavart S. , Gregor K. J. , Wright P. , Knapp M. ,   on behalf of the SOHO Study Group
Published: March 2003

Objective:  The objective of the European Schizophrenia Outpatient Health Outcomes (SOHO) study is to understand the comparative costs and outcomes of antipsychotic drug treatment, with specific focus on olanzapine. The study will also provide a large database for research into the treatment and outcome of schizophrenia. The role of observational studies in the assessment of the effectiveness of antipsychotic agents is reviewed, and the rationale, design and recruitment issues surrounding the SOHO study are presented.

Method:  SOHO is a 3‐year, prospective, observational study of the health outcomes associated with antipsychotic treatment in Europe.

Results:  Over 10 000 patients have been recruited from 10 countries. Baseline evaluation included measures of clinical status, social functioning, quality of life, service use and pharmacological treatment. Patients will be followed for 3 years.

Conclusion:  The SOHO study will complement randomized controlled trial findings on the treatment of schizophrenia and will address relevant clinical and policy research questions.
Prevalence of mental disorders among 15–17‐year‐old male adolescent remand prisoners in Denmark
Authors: Gosden N. P. , Kramp P. , Gabrielsen G. , Sestoft D.
Published: March 2003

Objective: To determine the past year prevalence of mental disorders of 15–17‐year‐old adolescent remand prisoners in east Denmark.

Method: One hundred 15–17‐year‐old boys from east Denmark consecutively remanded during 1 year were interviewed with diagnostic instruments to obtain ICD‐10 diagnoses. All were screened in The Danish Psychiatric Case Register and The Danish Criminal Register.

Results: Past year prevalence of ‘any mental disorder’ was 69%, substance use disorders 41%. Two per cent had schizophrenia and 2% schizotypal disorder. Thirty‐six per cent had ‘probable personality disorder’. Conduct disorder was found in 31% and 1% had a hyperkinetic disorder. Ten per cent had previous registered psychiatric contact.

Conclusion: The prevalence of mental disorders was found substantially higher compared with literature of population‐based samples. With an association between mental disorders and violence, early detection and treatment of mental disorders in adolescent delinquents is of importance in the prevention of violence.
Asperger's disorder: a case report of repeated stealing and the collecting behaviours of an adolescent patient
Authors: Chen P. S. , Chen S. J. , Yang Y. K. , Yeh T. L. , Chen C. C. , Lo H. Y.
Published: March 2003

Objective: To discuss special behavioural problems shown by a patient with Asperger's disorder from adolescence onward.

Method: The case and treatment of a 21‐year‐old male patient is described.

Results: A 21‐year‐old male developed obstinate stealing behaviours when he was 17 years old. He was regarded as a schizophrenic at first, and was suspected of kleptomania later. Asperger's disorder was diagnosed after we reconsidered the relationship between the schizoid psychopathy in childhood and the stealing behaviours which occurred in adolescence.

Conclusion: A wide variety of bizarre behaviours and so‐called borderline behaviours occur in late adolescence and adult life of patients with Asperger's disorder. But classic schizophrenia is very rare. Psychiatrists unacquainted with the clinical diagnosis/context may find it difficult to evaluate ‘concrete’, ‘childish’, or ‘bizarre’ symptoms in patients with Asperger's disorder, and thus are prone to misdiagnose them as having schizophrenia disorders or other similar disorders.
Functional and dysfunctional impulsivity: contribution to the construct validity
Authors: Caci H. , Nadalet L. , Baylé F. J. , Robert P. , Boyer P.
Published: March 2003

Objective:Impulsivity has been found to be an important trait of personality, whose consequences are not always negative although available questionnaires focused on its ‘dysfunctional’ aspect.

Method:Dickman's Functional and Dysfunctional Impulsivity questionnaire has been translated into French, and filled out by students. The tetrachoric correlation matrices were factor analysed.

Results:The psychometric properties are very close to those of the English version, and we recovered both factors in males and females. The factor similarities between the genders (in our sample) and between the languages (English vs. French) are very good. The Dysfunctional scale is correlated with the Motor Impulsivity subscale of the Barratt Impulsiveness Scale, and both scales are grossly independent from Spielberger's Trait‐Anxiety Inventory.

Conclusion:Our results support a two‐factor solution similar to the English one. Nevertheless, the validity of the functional factor remains to be investigated in further studies.
Emotional reactivity to daily life stress in psychosis and affective disorder: an experience sampling study
Authors: Myin‐Germeys I. , Peeters F. , Havermans R. , Nicolson N. A. , DeVries M. W. , Delespaul P. , Van Os J.
Published: March 2003

Objective:  To investigate the emotional reactivity to small disturbances in daily life in patients with non‐affective psychosis (NAP), bipolar disorder (BD) and major depression [major depressive disorder (MDD)].

Method:  Forty‐two patients with NAP, 38 with BD, 46 with MDD, and 49 healthy controls were studied with the experience sampling method to assess (i) appraised subjective stress of small disturbances in daily life and (ii) emotional reactivity, reflected in changes in positive affect (PA) and negative affect (NA).

Results:  Multilevel regression analyses showed an increase in NA in MDD, a decrease in PA in BD and both an increase in NA and a decrease in PA in NAP in association with the subjectively stressful situations, compared with the control subjects.

Conclusion:  Individuals with NAP, MDD and BD display differences in emotional stress reactivity. Type of mood disorder may exert a pathoplastic effect on emotional reactivity in individuals with MDD and BD. Individuals with NAP may be most vulnerable to the effects of daily life stress.
Change of immunoglobulins and complement factors in patients with self‐injurious behaviour
Authors: Moe T. J. , Mykletun A. , Matre R. , Skovlund E. , Bassøe C‐F. , Dahl A. A.
Published: March 2003

Objective:  As stress activates the inflammatory response system, and attempted suicide is connected with severe stress, we hypothesized that patients hospitalized for self‐injurious behaviour have changed immunocompetence.

Method:  The concentration of immunoglobulins IgG, IgA, IgM, and the complement components C3 and C4 in 73 patients hospitalized for self‐injurious behaviour was compared with those of 122 healthy controls. The immunoglobulins and complement were quantified by nephelometric technique.

Results:  The levels of IgG and IgM were significantly lower, and the complement C3 and C4 were significantly higher in self‐injurious patients compared with controls. This was valid in both genders and the effects did not interact with gender.

Conclusions:  This controlled study showed that the concentrations of immunoglobulins were reduced and complement components were increased in patients who are admitted to hospital for self‐injurious behaviour.
Taking cognizance of mental illness in schizophrenics and its association with crime and substance‐related diagnoses
Authors: Munkner R. , Haastrup S. , Jørgensen T. , Andreasen A. H. , Kramp P.
Published: March 2003

Objective:  To analyse how committed crimes and substance‐related diagnoses are associated with the age on the first contact with the psychiatric hospital system and the age at diagnosing of schizophrenia among schizophrenics.

Method:  In a register‐based study including all Danes diagnosed with schizophrenia born after November 1, 1963, data on criminality, substance‐related diagnoses and contacts with the psychiatric hospital system were analysed.

Results:  Compared with the non‐convicted schizophrenics the convicted were older on first contact with the psychiatric hospital system and older when the diagnosis of schizophrenia was first given. In contrast, having a substance‐related diagnosis was associated with a younger age on first contact but did not influence the age at which the diagnosis of schizophrenia was given.

Conclusion:  It is important that both psychiatrists and the judicial system are aware of possible psychotic symptoms in criminal and abusing individuals to enable earlier detection and treatment.
Cerebral tissue alterations and daily life stress experience in psychosis
Authors: Marcelis M. , Myin‐Germeys I. , Suckling J. , Woodruff P. , Hofman P. , Bullmore E. , Delespaul P. , Van Os J.
Published: March 2003

Objective: To examine whether the total volumes of cerebrospinal fluid (CSF), cerebral grey matter and white matter were correlated with the experience of environmental stress in daily life situations.

Method: Twenty‐seven patients with psychosis underwent magnetic resonance imaging scanning and a random time‐sampling self‐assessment technique (Experience Sampling Method) to determine subjective daily life stress experiences. Total cerebral tissue volumes were derived from an automated segmentation procedure.

Results: CSF volume was positively associated with daily life event‐related stress (β=0.016, P=0.002), while the association with total white matter was negative (β=−0.013, P=0.005). The effects were independent of each other and of total cerebral volume and other confounders. No large or significant association was found with grey matter volume.

Conclusion: Subjective stress experience in daily life is associated with increased CSF and reduced white matter volumes in patients with psychosis, suggesting functional significance of these cerebral measures.
Are patients with pituitary adenomas at an increased risk of mental disorders?
Authors: Korali Z. , Wittchen H. U. , Pfister H. , Höfler M. , Oefelein W. , Stalla G. K.
Published: March 2003

Objective: Retrospective clinical studies suggest that patients with pituitary adenoma (PA) have an increased risk of mental disorders. However, empirical evidence for this hypothesis is deficient because of out‐dated methodology. Therefore, we investigated the occurrence of mental disorders in 93 patients with PA within a limited time frame of 2 years.

Method: Patients were subjected to a comprehensive, standardized lifetime and cross‐sectional psychopathological symptom and diagnostic assessment, including an evaluation of psychosocial conditions and life events (CIDI, SCL‐90) during the past years.

Results: We could not find an increased risk of mental disorders as compared with a representative population sample of 481 subjects matched by age and gender.

Conclusion: As for our random sample, neither suffering from any type of PA nor the extent of the pituitary deficiency represent factors having significant effect on the risk of the subject to develop psychopathology as compared with the general population.
Does extra staff change clinical practice? A prospective study of the impact of extra resources in mental health teams
Authors: Kent A. , Fiander M. , Burns T.
Published: March 2003

Objective: To compare patterns of clinical activity amongst existing staff in two inner‐city community mental health teams before and after their enhancement with extra resources using a new activity schedule containing 11 comprehensive and mutually exclusive practice categories.

Method: Patterns of clinical activity amongst existing members of two inner‐London community mental health teams were compared before and after the addition of extra resources.

Results: The amount of time spent in face‐to‐face contact with patients and carers showed no meaningful change following team enhancement. Patterns of clinical activity amongst team members remained relatively static.

Conclusion: Adding resources to community mental teams without considering how to target the time released amongst existing staff may reduce their capacity to work more innovatively.
Methodological pitfalls in early detection studies – the NAPE Lecture 2002
Authors: Friis S. , Larsen T. K. , Melle I. , Opjordsmoen S. , Johannessen J. O. , Haahr U. , Simonsen E. , Rund B. R. , Vaglum P. , McGlashan T.
Published: March 2003

Objective: To identify and discuss methodological pitfalls that may help explain why many questions around early detection (ED) and duration of untreated psychosis (DUP) are still unsolved.

Method: This paper concentrates on pitfalls in the following areas: sampling, measurement and data analyses.

Results: The main problems seem to be: Sampling: Referral bias, exclusion of patients, patient refusal, and patients lost to follow‐up. Measurement: Reliability, which is particularly cogent for multisite investigations, and validity, which includes: Start of illness, start of psychosis, diagnoses, start of treatment, the relationship between ED and DUP and choice of outcome measures.

Data analyses:  Overlooking threshold effects of DUP, improper control for baseline scores, and lack of control for confounders.

Conclusion: Methodological pitfalls may bias ED studies. Several pitfalls are unavoidable, but proper design and quality assurance can reduce their impact. Researchers ought to identify the pitfalls, and to estimate and discuss their influence.
Event-related potentials and white matter lesions in bipolar disorder
Authors: Vuurman E. F. P. M. , Honig A. , Lamers T. H. , Wiersma J. , Krabbendam L. , Hofman P. A. M. , Nolen W. A. , Jolles J.
Published: March 2003

Objectives:

To investigate neurophysiological parameters which possibly distinguish subtypes I and II of patients with a bipolar disorder, and contrast the findings with observations from a group of schizophrenic patients and a group of healthy controls.

Methods:

Sixty-six volunteers underwent a MRI scan to determine the number and location of white matter lesions (WSL). A electrophysiological registration was made while all volunteers performed a auditory ‘oddball’ task, and the amplitude of the resulting P300 wave was compared.

Results:

Earlier reports of higher numbers of WSL in bipolar disorder were not replicated in this study. Subtypes I and II showed a different P300 amplitude and subtype I resembled the results of the schizophrenia group.

Conclusion:

Bipolar patients in remission have a functional brain disorder that is expressed by a change in physiological response to external stimuli.
Psychobiology and treatment of borderline personality disorder
Authors: Cloninger C. Robert
Published: March 2003

Borderline personality disorder can be characterized in terms of a profile of abnormal deviations on multiple personality dimensions using the temperament and character inventory (TCI). Borderline patients show poor character development, including low TCI self-directedness (irresponsible, blaming) and low TCI cooperativeness (hostile, intolerant). Their temperament is explosive or unstable due to a combination of high TCI harm avoidance (anxious, shy), high TCI novelty seeking (impulsive, quick-tempered), and low reward dependence (cold, aloof). Consequently they are usually dysthymic with an admixture of anxiety and anger, and regulate their social problems and intense emotions in immature ways. Genetic and psychobiological studies have led to identification of biological correlates of each of the TCI dimensions of personality, including individual differences in regional brain activity, psychophysiological variables, neuroendocrine abnormalities and specific gene polymorphisms. Each dimension of personality involves complex non-linear interaction of multiple genetic and environmental factors and, in turn, each personality dimension interacts with the others in influencing the way an individual directs and adapts to his or her life experiences. Systematic clinical trials have shown that these personality variables predict the response to pharmacological and psychotherapeutic treatments. For example, high harm avoidance and low self-directedness predict slower response and more rapid relapse with both antidepressants and cognitive-behavioral therapy. Treatment with drugs and/or psychotherapy can be individually matched to the patient's profile of temperament and character traits, rather than treating a heterogeneous group of patients as if they had a discrete, homogeneous illness. Fundamental change in cognitive schemas depends on attention to all aspects of character, especially self-transcendence, which has previously been neglected in cognitive-behavioral therapy. Personality integration requires non-resistance to our natural intuitive awareness, rather than intensified intellectual and emotional defenses.
Serotonin, personality and borderline personality disorder
Authors: Hansenne M. , Pitchot W. , Ansseau M.
Published: March 2003

Serotonin is one of the neurotransmitters implicated in normal personality. Many psychobiological models of personality include some dimensions related to serotonin. For instance, the harm avoidance dimension of the biosocial model developed by Cloninger is related to serotonergic activity. Higher scores on the harm avoidance dimension should theoretically reflect increased serotonergic activity. However, correlation studies related serotonin activity to harm avoidance dimension have not yielded consistent findings. These controversial results are probably related to the complexity of the neurotransmitter systems, and the different assessment techniques used in these studies. Finally, recent genetic studies have examined the association between personality dimensions and serotonergic receptor polymorphisms with mixed results. Serotonin is not only related to some dimensions of normal personality. Several psychopathological disorders are associated with serotonergic dysfunction. More particularly, borderline personality disorder (BPD) can be defined by many of the symptoms associated with serotonergic dysregulation, including affective lability, suicidal behaviours, impulsivity and loss of impulse control. Indeed, several reports have demonstrated the efficacy of selective serotonin re-uptake drugs in treating the depressive and impulsive symptoms of patients with BPD. Moreover, some challenge studies have reported a lower serotonergic activity in BPD. Because these challenges are not specific, we have assessed the serotonergic activity in BPD with the flesinoxan challenge. Preliminary results showed that the prolactine responses to flesinoxan were significantly lower in BPD patients compared to those observed in controls.
Pathophysiology of autism: current opinions
Authors: Croonenberghs J , Deboutte D , Maes M
Published: March 2003

Research on the neurochemical aspects of the pathophysiology of autism is still increasing and publications are abundant. In this paper we reviewed significant data from the last decade and recent research results from our center. We focused on molecules influencing the central nervous system (CNS) and consecutively responsible for typical autistic behavior. We highlighted the mutual relationship between the serotonergic, immunological and endocrinological system and the interaction of these three pivotal systems with predisposing (genetic)and external (pre-, peri- and postnatal) conditions and xenobiotics. We stressed the influence of age, pubertal stage, sex, race and IQ on biological data. There is growing evidence that the complexity and variability of those interactions might be responsible for the heterogeneity of behavioral phenotypes and biological findings in Autism. Genetic, neuroanatomical and neurophysiological data were mentioned according their relevance to neurochemical opinions.
Low IQ scores in schizophrenia: primary or secondary deficit?
Authors: van Beilen M. , Withaar F. , van Zomeren A. H. , van den Bosch R.
Published: March 2003

Background:

Schizophrenia is consistently associated with lower IQ compared to the IQ of control groups, or estimated premorbid IQ. It is not likely that the IQ scores deteriorate during the prodromal phase or first psychotic episode; they are already present before the onset of the prodromal phase and have been detected in childhood.

Methods:

We investigated cognitive functioning and IQ levels in a group of 36 patients with schizophrenia or other psychotic disorders.

Results:

The IQ scores in our sample were lower than average. The IQ showed a relation with attention, memory, speed of information processing and some aspects of executive functioning. However, when IQ scores were corrected for processing speed, they were no longer below average.

Conclusions:

These findings are important in considering the value of intelligence levels in schizophrenia. IQ scores should be judged in combination with cognitive functioning and school career to assess a patients capabilities in society. Cognitive functions and other variables might have a considerable influence on IQ scores. This rises the question of whether the low IQ scores are a primary or secondary deficit. Schizophrenia patients may have normal IQs, but could be less capable of making an IQ-test.
Chronic fatigue syndrome in the psychiatric practice
Authors: Van Duyse A. , Mariman A. , Poppe C. , Michielsen W. , Rubens R.
Published: March 2003

Background:

Chronic fatigue syndrome (CFS) is a complex syndrome with a psychiatric comorbidity of 70–80%. A psychiatric interview is necessary in order to exclude psychiatric illness and to identify psychiatric comorbidity. Studies have demonstrated that in general medical practice and in the non-psychiatric specialist practice, physicians tend to underdiagnose psychopathology in patients with CFS. There are many questions unanswered about the treatment of CFS

Aim:

Typical issues for the psychiatric practice are reviewed: psychiatric comorbidity, dysregulation of the PHA-axis and the treatment of CFS.

Conclusions:

Depression, somatization, sleeping disorders and anxiety disorders are the most important psychopathological symptoms found in CFS patients. CFS should not be regarded as a masked (somatoform) depression. Although the results from neuroendocrinological studies assessing the hypothalamic–pituitary–adrenal axis (HPA-axis) are inconsistent, they suggest that there is a subgroup of CFS patients suffering from a discrete dysregulation of the HPA-axis resulting in basal hypocortisolaemia. These findings, however, do not reveal a causal relationship. Antidepressants do not seem to have a positive influence on the symptom of fatigue, but appear to be beneficial in alleviating the symptoms of depression and social functioning. Cognitive behaviour therapy and graded exercise show a significant improvement on fatigue and other symptoms and are the only treatments available for CFS patients.
Stress in the brain: implications for treatment of depression
Authors: de Kloet Er
Published: March 2003

A fundamental question in stress research is when the glucocorticoid stress hormone (cortisol in man) stops being neuroprotective and becomes harmful to the brain with negative consequences for cognition and mood. To address this question Section 1 focuses on the action mechanism of glucocorticoids. These hormones act via high and low affinity nuclear receptors, which regulate gene transcription in a coordinate manner. The receptors are expressed abundantly in hippocampus, amygdala and frontal cortex involved in cognitive processes. In Section 2 hypercortisolism is considered a potential disease factor for about 50% of the patients suffering from major depression. Recent data show that these patients recover within a few days when excess cortisol action is blocked with high doses of an antiglucocorticoid. Section 3 concerns animal models with ‘depression-like’ features of hypercorticism generated by manipulation of gene X environment inputs. Using gene expression profiling technology in the hippocampal transcriptome of these animals we identified about 700 potential targets for antidepressants out of 30 000 detectable gene products. One of our models is based on early life programming of the stress system. Rats exposed as pups to maternal deprivation display at senescence an enhanced individual difference in cognitive performance. The maternally deprived senescent animals age either successfully or become senile, at the expense of the average performance of non-deprived controls. The essay is concluded with the notion that the new generation of antidepressants ameliorates specific psychic dysfunctions (e.g. cognitive performance) linked to aberrant stress hormone action in discrete brain regions.
Which depressions are related to life stress?
Authors: Paykel E. S.
Published: March 2003

This paper examines the relationship of recent life events to specific kinds of depression using published studies and the author's own work. An overall effect of life events on depression has been found consistently and is moderate in degree. In suicide attempts there are stronger and more immediate effects than in depression. Life events precede both non-melancholic and melancholic depressions. It is only in recurrent depressions that life events are less common with melancholic pictures. Life events influence bipolar disorder as well as unipolar. Mania may be preceded by life events, particularly those involving social rhythm disruption, but it is harder to rule out events which are consequences of insidious development of illness. There are strong effects of life events and social support in postpartum depressions but in postpartum psychoses these effects are absent. Events precede depression comorbid with other disorders as well as pure depression. The course of depression is also influenced by life stress with less remission where negative events occur after onset and better outcome where earlier adverse events are neutralized. Relapse is related to immediately preceding life events. However, where depressions are both severe and recurrent life stress effects weaken and as the number of episodes increases preceding life events lessen. These findings suggest that some kinds of depression are more related to psychosocial causation and some are more biological in origin.
Neuroticism, alexithymia, negative affect and positive affect as predictors of medically unexplained symptoms in primary care
Authors: De Gucht V.
Published: March 2003

Background:

Somatization has been defined in a number of ways. Despite their differences, these definitions have one element in common, namely the presence of somatic symptoms that cannot be explained (adequately) by organic findings.

Objective:

The primary objectives of the dissertation were to gain a better insight into the concept of somatization, and to study (prospectively) the relationship between neuroticism and alexithymia, two personality traits that have been shown to be related to somatization, the affective state dimensions positive and negative affect (or psychological distress) and medically unexplained symptoms.

Method:

A selective review was conducted regarding conceptual and methodological issues related to somatization. A total number of 318 patients, presenting to their primary care physician with medically unexplained symptoms, participated in the prospective study. Both at baseline and at 6-month follow-up a number of measures were filled out with respect to somatization, neuroticism, alexithymia, negative and positive affect, anxiety and depression.

Results:

The concept of somatization was clarified, thereby making use of the distinction between presenting and functional somatization. The personality traits neuroticism and alexithymia were found to have an indirect influence on symptom reports. Both the cross-sectional and follow-up data pointed to the importance of positive and negative affect as determinants of (changes in) number of symptoms (over time). Negative affect, together with the alexithymia dimension measuring difficulty identifying feelings, predicted symptom persistence.

Conclusions:

The theoretical as well as therapeutic implications of the present paper may give an impetus to new research in the domain of somatization.
The clinical application of the stress concept
Authors: Koerselman F.
Published: March 2003

Background:

Knowledge on fundamental aspects of the influence of ‘stress’ on animal and human organisms is accumulating. In clinical situations, however, psychiatrists still do not use apropriate instruments to recognize and handle the impact of daily life stress. DSM-IV is insufficient in this respect.

Objective:

A different approach is sketched for clinicians to be able to integrate knowledge from research more effectively.

Method:

Application of a ‘broad’ biological view may reveal the significance of interpretation, emotion, impulse and reaction as stages of a ‘mental tract’, which is involved in processing the input of stressful situations.

Result:

This may lead to a more rational ‘targeting’ of pharmacological and psychotherapeutic strategies in clinical practice.

Conclusion:

A re-orientation of clinical psychiatry from mere classification towards a ‘broad’ biological approach may pave the way for a more rational and purposeful application of research findings to therapy.
Clinical models of stress
Authors: Hoes Mjajm
Published: March 2003

Background:

Here we propose a stress model with disease-specific aspects and aspecific factors. The latter are subdivided into load (perception, psychic defence mechanisms), strain (psychophysiological responses) and stress sensu strictu (biological and behavioural compensation). Insufficiently compensated strain will result in being sick and precipitation of a specific disease according to one's predisposition. In the clinical practice, multiconditionality requires a multidimensional analysis, the the five-axial DSM-system being designed especially for this purpose. Multidisciplinary treatment is then organized accordingly, i.e. Axis I: case management, medication; Axis II, (focal) psychotherapy; Axis III, somatic specialists; Axis IV, social worker; Axis V, psychotherapy for coping deficits.

Objective:

To test the efficacy of this multimethodical approach.

Method:

In a 1-year prospective study of 257 admissions in a department of psychiatry in a general hospital, the General Health Questionnaire (30 items) was filled out at admission, discharge and first polyclinical visit post-discharge.

Results:

The 213 evaluable questionnaires at admission did not show differences (17–18.9) between the four groups, mood disorders (62%), alcoholism (17%), psychoses (15%) and anxiety disorders (6%). At discharge all four groups had reached the cut-off value for ‘not-sick’ (< 6), this remaining so at follow-up; the three measurements differed significantly throughout the patient groups. Hospitalization was definitely 28.2 days shorter than the Dutch mean of 42 days.

Conclusions:

Working to the proposed clinical model for multiconditionalty is effective on intensity and duration of disorders, sustained improvement is attained.
Lack of effect of eicosapentaenoic acid in the Porsolt forced swimming test model of depression
Authors: Shaldubina Alona , Nemets Boris , Bersudsky Yuly
Published: March 2003

Background:

Eicosapentaenoic acid (EPA) is one of the major components of fish oils. Omega-3 fatty acids, particularly EPA, have been hypothesized to play a role in the etiology, pathogenesis and treatment of mood disorders. Clinical studies have shown beneficial effects of omega-3 fatty acids in major depression, bipolar disorder and other psychiatric disorders.

Objective:

The present study design evaluates the effect of EPA in the Porsolt forced swimming test.

Results:

EPA alone did not reduce the immobility time and did not enhance the anti-immobility effect of a low dose of imipramine. Contrary to the hypothesis, EPA slightly increased the immobility time, and in some experiments tended to reduce the anti-despair effect of imipramine.

Conclusion:

The present results do not provide an animal model for the antidepressant effect of EPA as demonstrated in clinical experiments. The mechanism of EPA antidepressant action is unknown and the Porsolt forced swimming test could be non-sensitive for its antidepressant properties.
No allelic association between harm avoidance and the debrisoquine 4-hydroxylase gene
Authors: Veefkind Adriaan H , Ingenhoven Theo J M , De Groot Izaäk W
Published: March 2003

Background:

Several reports suggest that variance in personality traits is inherited, but little is known about the genes responsible. It has been suggested that there is a relationship between personality characteristics and the gene responsible for the activity of the enzyme debrisoquine 4-hydroxylase (CYP2D6).

Objective:

To examine the proportion of poor metabolizers in a group of personality disordered patients.

Methods:

Blood samples were obtained from 23 patients with a high or very high score on the dimension ‘harm avoidance’ of the Temperament and Character Inventory (TCI). The samples were genotyped for the null alleles CYP2D6*3 and*4 by performing an allele-specific polymerase chain reaction.

Results:

The frequencies of genotypes in the sample were very similar to the frequencies found in a general white population.

Conclusions:

The investigation produced no support for the idea that the CYP2D6 gene is related to personality by means of variations in the temperament dimension of harm avoidance.
Post-stroke quality of life and depression
Authors: Jaracz Krystyna , Jaracz Jan , Kozubski Wojciech , Rybakowski Janusz K
Published: March 2003

Background:

Studies on the determinants of the quality of life (QOL) after stroke bring differing results depending on the applied concept of QOL. This may lead to confusion about the contribution of various factors to the post-stroke QOL.

Objective:

The aim of the study was: (i) to investigate functional and psychological QOL in the individuals after the first ischemic stroke; (ii) to identify the most important correlates of QOL; and (iii) to examine the significance of depression among the other possible predictors of QOL.

Methods:

A hospital-based sample of 72 stroke patients was followed up to 6 months after stroke onset. QOL was assessed using the Polish version of the Quality of Life Index and the Sickness Impact Profile. A multiple regression procedure was performed to examine relationships between QOL and the study variables.

Results:

In spite of good recovery, the psychological and functional QOL of the examined patients was impaired, although the negative impact of stroke was greater on the objective QOL than on the subjective QOL. Stroke-related impairment, depression, functional disability and marital status predicted 80% of the variance in the functional QOL. Emotional support, depression and functional disability explained 38% of the variance in psychological well-being.

Conclusions:

Depression and physical disability were the most important predictors of QOL after stroke since their impact on QOL was more robust in comparison to the remaining variables. For improving QOL, a comprehensive care for patients aimed at reducing physical dependence and ameliorating depressive symptoms could be recommended.
Suppressive effect of TRH and antidepressants on human interferon-γ productionin vitro
Authors: Kubera Marta , Kenis Gunter , Basta-Kaim Agnieszka , Bosmans Eugene , Budziszewska Bogustawa , Scharpe Simone , Maes Michael
Published: March 2003

Background:

It has been established that thyrotropin-releasing hormone (TRH) affects several aspects of immunoreactivity, e.g. production of proinflammatory cytokines. It has been shown that TRH enhances the therapeutic efficiency of classical tricyclic antidepressants. Proinflammatory cytokines may play a role in the etiology of depression, whereas the therapeutic efficacy of antidepressants may be related to their negative immunoregulatory effects.

Objective:

In order to verify the hypothesis that TRH-induced increase of therapeutic efficiency of classical tricyclic antidepressants results from synergistic inhibitory effects of these agents on the secretion of proinflammatory cytokines, we determine the effect of imipramine or fluoxetine with and without TRH on the production of interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α) and interleukin-10 (IL-10) by stimulated human whole blood cells.

Methods:

Diluted whole blood of 17 volunteers was incubated with imipramine or fluoxetine (both in doses of 10−5M) with or without TRH (in a dose of 10−5M). The supernatants were collected 24 h later for the assay of TNF-α and after 72 h for the assays of IFN-γ and IL-10. The three cytokines were assayed by ELISA methods.

Results:

A significant decrease in production of IFN-γ was observed in cells stimulated with mitogens and co-incubated with imipramine or fluoxetine and TRH. Under the same conditions, TRH alone did not change the production of these cytokines, whereas imipramine alone significantly decreases IFN-γ production, and fluoxetine alone significantly decreases IFN-γ and TNF-α production.

Conclusion:

Although a significant decrease in IFN-γ production was observed after joint application of TRH and antidepressants, our data did not support the above-mentioned hypothesis. Indeed, we did not observe synergistic inhibitory effects of these agents on the secretion of proinflammatory cytokines.