bluuebunny/crossref_metadata_2025 huggingface dataset:
The public health impact of anxiety disorders: a WHO perspective
Authors: Costa e Silva J. A.
Published: November 2007

Anxiety disorders, which may constitute anywhere from one quarter to one half of all mental illnesses in the community. are most commonly seen in the primary care sector. Despite their significant impact on the functioning of individual patients, the plethora of unnecessary medical procedures to which these sufferers are subjected, and the large indirect economic burden, these disorders continue to be grossly underdiagnosed and undertreated in this sector. Effective treatments for anxiety disorders have been available for at least two decades. Concerted efforts by the World Health Organization (WHO), the World Psychiatric Association and similar organizations are needed to change this picture.
Comorbidity as a fundamental feature of generalized anxiety disorders: results from the National Comorbidity Study (NCS)
Authors: Judd L. L. , Kessler R. C. , PauIus M. P. , Zeller P. V. , Wittchen H.‐U. , Kunovac J. L.
Published: November 2007

Generalized anxiety disorder (GAD) is a relatively commun mental disorder in the general population, afflicting approximately 3% of community residents during their lifetime. It is not a benign condition, since significantly increased disability and dysfunction are found in GAD subjects compared to non‐GAD subjects. For decades GAD has frequently been observed in the context of other mental and substance abuse disorders. Initially the weight of clinical opinion indicated that GAD was a residual disease which should only be diagnosed when other mental disorders are not present. More recently there has been a growing recognition that comorbidity is a fundamental characteristic of the course and nature of GAD. In a series of secondary analyses conducted in subjects in the National Comorbidity Study database, we found that 8 out of 10 subjects with lifetime GAD also had a comorbid mood disorder during their lifetime. We found unipolar disorders to be four times more common in GAD than bipolar disorders (67% vs. 17%), providing indirect support for the previously reported observation that GAD and major depression may share a common genetic diathesis. In addition, our analyses support the conclusion that when comorbid mood disorders are present in GAD, a significant increase in associated disability and dysfunction is also found. Thus this comorbid relationship has important implications for clinical course and outcome.
Generalized anxiety disorder and its comorbidities: disputes at the boundaries
Authors: Maser J. D.
Published: November 2007

This theoretical paper reviews the status of generalized anxiety disorder (GAD) and the Axis I and Axis II disorders with which it is often comorbid. Differences in comorbidity between the epidemiological and clinical literatures are discussed. Special attention is given to panic disorder, the symptoms of which are similar to those of GAD. The boundaries of GAD and its relationship to other Axis I disorders and to Axis II disorders raise important implications for its classification.
DSM‐IV and beyond: what is generalized anxiety disorder?
Authors: Barlow D. H. , Wincze J.
Published: November 2007

With the advent of DSM‐III in the USA (1), a new disorder termed generalized anxiety disorder (GAD) was established separately from panic disorder. Because GAD was relegated to a residual category, it soon became a confusing diagnosis. Although revisions in DSM‐III‐R (2) removed GAD as a residual category, they also complicated the clinical examination necessary to arrive at a GAD diagnosis. With the publication of DSM‐IV (3). GAD has been further refined in an attempt to improve the reliability and discriminability of the disorder. However, it continues to be controversial. and a number of issues remain unresolved.
Psychic and somatic anxiety: worries, somatic symptoms and physiological changes
Authors: Hoehn‐Saric R.
Published: November 2007

Contrary to self‐reports, patients with generalized anxiety disorder exhibit increased muscle tension but not autonomic hyperarousal. Under stress they tend to react autonomically in a less flexible manner than normal controls. There is only a weak relationship, and in some instances a desynchrony, between physiological changes and perception of change. The inconsistencies between self‐reports of physiological states and physiological recordings can be explained by alterations of body sensations through psychological factors, predominantly expectations of and attention to bodily states, that lead to perceptual distortions.
Toward a definition of generalized anxiety disorder as an anxious temperament type
Authors: Akiskal H. S.
Published: November 2007

Generalized anxiety disorder (GAD) is defined as an uncontrollable disposition to worry about one's welfare and that of one's immediate kin. Associated manifestations include arousal, vigilance, tension, irritability, unrestful sleep and gastrointestinal distress. There is growing evidence for the lifelong nature of this condition among many of its sufferers. This and other evidence reviewed in the present paper provide further support for the thesis that the chronic disposition to worry should probably be classified under constitutional or trait anxiety. GAD is best considered an exaggeration of a normal personality disposition that can be named‘Generalized anxious temperament’ (GAT). Despite some overlap with anxious‐phobic, inhibited and avoidant‐sensitive temperaments, GAT seems to have a distinct profile with altruistic overtones; on the other hand, GAT is less easily distinguished from harm‐avoidant and obsessive traits. That worrying would increase upon relaxation is not a paradox at all, and is understandable in an ethological perspective as subserving the defensive function of being vigilant of ever present yet uncertain external dangers ‐ to oneself and one's kin ‐ in day‐to‐day living. GAT can thus be considered as ‘altruistic anxiety’, subserving hypothetically the survival of one's extended phenotype in a ‘kin selection’ paradigm. Only when extreme does worrying manifest in a clinical context, impairing one's interpersonal life and functioning at work, and increasing use of general health care resources. Furthermore, generalized anxiety appears to predispose to and is often associated with depression, and a spectrum of phobic disorders, as well as alcohol and sedative use. These considerations place GAD (and the putative GAT) in the limelight and underscore the need for more research into its fundamental characteristics. Towards this aim, a self‐rated GAT measure under development in our center is provided in an appendix to this paper.
Animal models sensitive to anti‐anxiety agents
Authors: Martin P.
Published: November 2007

Animal models of anxiety serve two primary purposes in psycho‐pharmacological research. (i) The pharmacological profile observed in the model provides a basis which, depending on its predictive validity, permits an estimation of clinical activity. (ii) Insofar as the ‘anxiety’ occurring in the animal model is homologous to human anxiety disorders, it is possible to investigate the underlying cellular and molecular mechanisms. The most commonly used laboratory procedures for the identification of anxiolytic effects of drugs are described in this paper.
A Finnish validation study of the SCL‐90
Authors: Holi M. M. , Sammallahti P. R. , Aalberg V. A.
Published: November 2007

The Symptom Check‐List‐90 (SCL‐90) is a widely used psychiatric questionnaire which has not yet been validated in Finland. We investigated the utility of the translated version of the SCL‐90 in the Finnish population, and set community norms for it. The internal consistency of the original subscales was checked and found to be good. Discriminant function analysis, based on the nine original subscales, showed that the power of the SCL‐90 to discriminate between patients and the community is good. Factor analysis of the items of the questionnaire yielded a very strong unrotated first factor, suggesting that a general factor may be present. This together with the fact that high intercorrelations were found between the nine original subscales suggests that the instrument is not multidimensional. The SCL‐90 may be useful in a research setting as an instrument for measuring the change in symptomatic distress, or as a screening instrument. The American community norms should be used with caution, as the Finnish community sample scored consistently higher on all subscales.
Mental health problems among homeless adolescents
Authors: Sleegers J. , Spijker J. , Van Limbeek J. , Van Engeland H.
Published: November 2007

This paper reviews 18 surveys of mental health problems among homeless adolescents and reports on a pilot study of the same topic conducted in Amsterdam. Sampling methods and measures of mental health are discussed. The reported estimates of mental health problems vary greatly, very probably because of methodological differences. Despite the different methods used, there seems to be considerable research evidence to support a high prevalence of mental disorders among homeless adolescents. The results of the pilot study of 50 homeless adolescents in Amsterdam are consistent with the surveys reviewed. A highly structured interview was conducted at all four services sites for homeless adolescents in Amsterdam. Of the homeless adolescents interviewed, 78% had at least one lifetime DIS/DSM‐III‐R diagnosis, and 64% had at least one 1‐month diagnosis.
Quality of life in schizophrenia and dysthymia
Authors: Gupta S. , Kulhara P. , Verma S. K.
Published: November 2007

Quality of life (QOL) was assessed in three groups of patients, consisting of 30 schizophrenic patients with duration of illness < 2 years, 30 schizophrenic patients with duration of illness ≥2 years and 30 dysthymic patients. The diagnoses were made according to ICD‐10. Two scales of quality of life were used, one of which was specific for schizophrenia, while the other was generic for all patients. On inter‐group comparison the two schizophrenia groups did not show significant differences in quality of life, but on comparing schizophrenic and dysthymic patients, significant differences emerged. Dysthymic patients were significantly less satisfied than schizophrenic patients with duration of illness < 2 years in the domain of physical health. In the domains of satisfaction with medication and leisure‐time activities, both schizophrenic groups were significantly more satisfied than the dysthymic group. Comparison of the quality of life ratings of our patients with those of a well‐known study from Sweden revealed some significant differences which relate to the domains of work, contacts, inner experience and leisure‐time activities. Cultural factors are invoked to account for these differences. The need for refinement of assessment of quality of life in multi‐racial and multi‐ethnic contexts is stressed.
Validation of the self‐report questionnaire DIP‐Q in diagnosing DSM‐IV personality disorders: a comparison of three psychiatric samples
Authors: Bodlund O. , Grann M. , Ottosson H. , Svanborg C.
Published: November 2007

The DSM‐IV section of the DSM‐IV and ICD‐10 Personality Questionnaire (DIP‐Q) was used to screen for personality disorders in 448 subjects from three clinical samples (general and forensic psychiatric patients and candidates for psychotherapy) and a sample of 139 healthy volunteers. Differences between the samples with regard to patterns of personality pathology in relation to concurrent Axis I disorders and sociodemographic variables were analysed. The prevalence of personality disorders according to DIP‐Q was 14% among the healthy volunteers, compared to 59% in the general psychiatric sample, 68% in the forensic psychiatric sample and up to 90% among psychotherapy candidates. Moreover, from a dimensional perspective (i.e. the number of fulfilled Axis II criteria), all clinical groups differed significantly from the control group in all specified personality dimensions and clusters. Dimensional DIP‐Q cluster scores also discriminated significantly between the three clinical samples. Unexpectedly, the odds ratio for an Axis II disorder was nearly five times higher among psychotherapy applicants than among general psychiatric patients, independent of concomitant Axis II disorders, gender or age. The strongest association between DIP‐Q score and Axis I disorders was found for depressive disorders, which more than doubled the odds ratio for a personality disorder diagnosis. This association could result from high true comorbidity, but could also be due to the fact that a concomitant depressive state can increase self‐reported personality difficulties. The high prevalence among psychotherapy candidates may to some extent reflect help‐seeking exaggeration of problems. These are aspects to consider when using the DIP‐Q, which overall appears to discriminate well between different samples.
Suicidal ideation and parasuicide in the Finnish general population
Authors: Hintikka J. , Viinamäki H. , Tanskanen A. , Kontula O. , Koskela K.
Published: November 2007

In a sample of the Finnish general population (n= 4868), 2.4% of women and 2.3% of men reported having thought about suicide during the preceding 12 months. The prevalence of parasuicide was correspondingly 0.9% in women and 1.1% in men, higher figures than have previously been found or estimated. Most suicidal individuals (85%) had contacted general practitioners or other primary care services during the previous 12 months, and a minority (20%) had made contact with psychiatric services. General practitioners and other primary care services are thus in a key position to identify suicidal behaviour in the Finnish general population.
High delinquency, disability and mortality — a register study of former adolescent psychiatric in‐patients
Authors: Kjelsberg E. , Dahl A. A.
Published: November 2007

A Norwegian population of 1276 former adolescent psychiatric in‐patients was followed up 15 to 33 years after hospitalization by record linkage to the national registers of criminality, disability benefits and causes of death. In total 1095 patients (53.7% males), representing 85.8% of the original sample, could be traced. On the basis of the hospital records all patients were rediagnosed according to DSM‐IV. At follow‐up, 52.0% of those investigated had engaged in criminal activity, 38.5% had received disability benefits, and 13.6% had died. The delinquency, disability and mortality rates were significantly increased compared to those for the general population. In total, 22.9% of the population were not found in any of the above registers and were considered to have a good outcome.
Changes in regional brain activity in major depression after successful treatment with antidepressant drugs
Authors: Ogura A. , Morinobu S. , Kawakatsu S. , Totsuka S. , Komatani A.
Published: November 2007

Relative regional cerebral blood flow was measured with single photon emission computed tomography (SPECT) using 99mTc‐hexamethyl‐propyleneamine oxime (99mTc‐HMPAO) in 16 patients with major depression while they were in the depressed state as well as in remission. All patients were closely matched with regard to medication status. In the depressed state, significant reductions in tracer uptake were found in the left superior frontal, bilateral parietal and right lateral temporal cortex. During remission, significant increases in uptake were found in the left superior frontal, right parietal and right lateral temporal cortex. There were no significant differences in tracer uptake between patients in remission and controls. These findings suggest that the regional decreases in tracer uptake observed in the depressed state might be a state‐related abnormality.
Amisulpride, an atypical antipsychotic, in the treatment of acute episodes of schizophrenia: a dose‐ranging study vs. haloperidol
Authors: Puech A. , Fleurot O. , Rein W. ,   Amisulpride Study Group
Published: November 2007

This 4‐week, double‐blind, randomized study was undertaken to determine the dose‐response relationship of amisulpride in 319 patients with acute exacerbation of schizophrenia. Fixed doses of amisulpride (400, 800 and 1200 mg/day) and haloperidol (16 mg/day) were compared to amisulpride, 100 mg/day, as a potentially subtherapeutic dose. Efficacy data (BPRS total score and PANSS positive subscale) in the amisulpride groups generated a bell‐shaped dose‐response curve, with 400 mg/day and 800 mg/day being the most effective treatments for positive symptoms. Parkinsonism did not increase significantly between baseline and endpoint with amisulpride 400, 800 and 1200 mg/day compared to the amisulpride 100 mg/day group, whereas the difference was significant for haloperidol (P<0.05). It is concluded that amisulpride 400 mg and 800 mg/day is highly effective in treating the positive symptoms of schizophrenia, with less extrapyramidal side‐effects than haloperidol 16 mg/day.
Prolactogenic effects of risperidone in male patients — a preliminary study
Authors: Shiwach R. S. , Carmody T. J.
Published: November 2007

This preliminary study describes a case of a male patient who developed gynaecomastia and sexual difficulties whilst taking risperidone for chronic paranoid schizophrenia. Laboratory tests showed raised prolactin levels and depressed testosterone levels which were reversed on cessation of medication. A small study was subsequently conducted on male psychotic patients to compare the prolactogenic effects of risperidone (n= 14) with traditional antipsychotic medication (n= 15). The results showed a greater but non‐significant prolactogenic effect of risperidone.
Prevention of disturbed eating behaviour: a prospective intervention study in 14‐ to 19‐year‐old Swiss students
Authors: Buddeberg‐Fischer B. , Klaghofer R. , Gnam G. , Buddeberg C.
Published: November 2007

Subsequent to an epidemiological study on eating behaviour in adolescents, a prospective study was carried out to examine the effect of health promotion lessons on disturbed eating behaviour. From the original sample (t1, n=1944), a subgroup of 314 students of both sexes, 14–19 years of age, was selected. Participants came from a total of 20 classes in which a high percentage of students exhibited disturbed eating behaviour. Ten classes were then randomly selected to receive health promotion lessons (intervention group, high‐risk; IGHR), while the other 10 classes served as controls (control group, high‐risk; CGHR). The Eating Attitudes Test (EAT‐26), the Giessen Physical Complaint List for Children and Adolescents (GSCL‐C) and the Self‐Report Symptom Check‐List (SCL‐90‐R) were administered shortly before (t2) and 3 months after (t3) the interventions. The three health promotion lessons dealt with issues concerning beauty ideals, gender differences in psychosexual maturation and body awareness, healthy eating behaviour, physiology of nutrition, early symptoms of eating disorders and therapeutic approaches. The data analyses revealed an improvement on all three symptom scales for both groups between t2 and t3, but there were no significant differences between the IGHR and CGHR groups. When data from high‐scoring female participants only were analysed (HRf‐IGHR and HRf‐CGHR), the multivariate analysis revealed a significant interaction between time and group (15.2% of variance explained). Our experiences in implementing health promotion lessons that conveyed knowledge about eating disorders and addressed physical and psychological issues in a more general way indicated that these interventions can be carried out in schools, and may contribute to increases in physical and psychological well‐being in a high‐risk population of adolescents.
Mental health expectancy: an indicator to bridge the gap between clinical and public health perspectives of population mental healtha
Authors: Gispert R. , Ritchie K. , Rajmil L. , Rué M. , Glutting J. P. , Roset M.
Published: November 2007

Mental health indicators generally used in public health are derived from mortality statistics, but they do not reflect the impact that disability due to mental disorders has on population health. The present study proposes a global indicator of population mental health which combines both mortality and morbidity data. The data used were the results of a Health Interview Survey, including the 12‐item version of the General Health Questionnaire, mortality life‐tables for the general population, and data from a two‐step epidemiological study used to assign the probability of case status. The results are calculated for the Catalonia region in north‐east Spain. Life expectancy and mental health expectancies at all ages were found to be higher for women than for men. Men were found to have a higher total life expectancy in good mental health. The feasibility and potential areas of application of this generic mental health index are discussed.
Depressive disorders among somatizing patients in primary health care
Authors: Posse M. , Hällström T.
Published: November 2007

Unrecognized, untreated and undertreated depressive disorders incur inordinate human and economic costs, despite the availability of an exclusive array of clinical interventions. The aim of this study was to identify cases of masked depression in primary health care, employing a two‐stage design. In the first stage, involving a study of 442 patients, the prevalence of recognized depression was 1.8%. In the second step, 62 patients from stage 1 were investigated further because of their high score on somatization tendency. In total, 41 of the 62 patients were found to have a mood disorder according to DSM‐III‐R, i.e. a major depressive disorder or dysthymia. Two patients were found to have already had a diagnosis of major depression assigned to them in stage 1, but they were joined by 13 more patients. A further 26 patients were found to be suffering from dysthymia, nine had adjustment disorders with depressed mood, and 12 patients showed no signs of depressed mood. For the group suffering from a current episode of major depression or dysthymia, the prevalence rate increased to 11.7% in the initial total population after stage 2. The diagnostic category with the highest rate of depressed patients was ‘musculoskeletal diseases’. Patients with masked depression had higher scores for alexithymia and psychasthenia than depressed patients who were directly diagnosed.
A comparison of the performance of rating scales used in the diagnosis of postnatal depression
Authors: Thompson W. M. , Harris B. , Lazarus J. , Richards C.
Published: November 2007

The results of a study looking into the association between thyroid status and depression in the postpartum period were reanalysed to explore the psychometric properties of the rating scales employed. The performance of the Edinburgh Postnatal Depression Scale was found to be superior to that of the Hospital Anxiety and Depression Scale in identifying RDC‐defined depression, and on a par with the observer‐rated Hamilton Rating Scale for Depression, which it also matched for sensitivity to change in mood state over time. The anxiety subscale of the Hospital Anxiety and Depression Scale performed well, reflecting the fact that anxiety represents a prominent symptom in postnatal depression.
Postnatal depression: a hidden illness
Authors: Bågedahl‐Strindlund M. , Börjesson K. Monsen
Published: November 2007

The main objectives of this study were (i) to find out to what extent postnatal depression (PND) in mothers was recognized at Well Baby Clinics (WBCs) in Stockholm, (ii) to study the prevalence of PND using the Edinburgh Postnatal Depression Scale (EPDS), (iii) to test the positive predictive value of the EPDS against an interview‐based Research Diagnostic Criteria (RDC) diagnosis of depression and (iv) to identify sociodemographic risk factors for PND. Case‐records of 1128 infants were reviewed at WBCs to obtain a baseline rate of PND. Two per cent of the mothers were identified in the routine service of the WBCs as being depressed during the first 3 months postpartum. During a project year, 309 Swedish‐speaking mothers completed a set of EPDS 3 months postpartum. In total, 14.5% of the women scored >12 on the EPDS and 67% of these women had a depression according to RDC. At least 8.4% of the mothers investigated had a clinical depression. A positive link was found between being single with more than one child and having PND. In conclusion, very few women with PND are identified in routine WBC care in Sweden. The use of the EPDS as a screening measure at the WBC is recommended. The scale is well accepted both by the mothers and by the nurses, and its use significantly increases the number of identified cases of PND.
Subjective quality of life and standard of living: a 10‐year follow‐up of out‐patients with schizophrenia
Authors: Skantze K.
Published: November 2007

In 1984, a study in Göteborg, Sweden, reported the quality of life of 61 outpatients with schizophrenia (DSM‐III) to be low, despite their high standard of living. The respondents used an instrument (QLS‐100) developed by the author to indicate which of 100 items they considered to be unsatisfactory. Interviews captured objective conditions of the patients' lives and their quality‐of‐life goals for each unsatisfactory item. The results of the study led during the late 1980s to deliberately individualized services, aimed at helping patients to attain their own quality‐of‐life goals. In total, 40 of the subjects took part in a 10‐year follow‐up. The 1994 study showed that the incidence of living alone in one's own home increased. Overall quality of life remained unchanged. Although still low, quality of life increased significantly in three of 14 domains, namely contacts, inner experiences, and knowledge and education. The reasons for these improvements and the maintained overall quality of life could be that patients increased their ability to interact with the environment, that they increased and/or modified their aspirations in the light of available resources and/or deficits, and that housekeeping assistance and service were provided conditional on the patients' own quality‐of‐life goals and needs.
Response to high doses of citalopram in treatment‐resistant obsessive‐compulsive disorder
Authors: Bejerot S. , Bodlund O.
Published: November 2007

We report a severe case of obsessive‐compulsive disorder (OCD) that responded to very high doses of citalopram (160mg/day) after a poor response to clomipramine 250 mg/day for several years, alone or in combination with buspirone 30 mg/day or flupenthixol 4 mg/day. The patient had previously been submitted for capsulotomy which was declined, probably due to the magical content of her obsessions, which resembled delusions.
Fluoxetine as a treatment for post‐stroke emotionalism
Authors: Brown K. W. , Sloan R. L. , Pentland B.
Published: November 2007

The effectiveness of fluoxetine compared to placebo in the treatment of post‐stroke emotionalism was investigated in 20 patients using a double‐blind protocol. A total of 19 patients completed the study, as one subject in the treatment group had to be withdrawn. The subjects receiving fluoxetine showed a statistically and clinically significant improvement in their emotionalism compared to the placebo group, which was apparent in the majority of subjects from the third day of treatment.
Distinct neurophysiological mechanisms for manic and cycloid psychoses: evidence from a P300 study on manic patients
Authors: Strik W. K. , Ruchsow M. , Abele S. , Fallgatter A. J. , Mueller Th. J.
Published: November 2007

Pathologically asymmetrical P300 fields with right lateralized peaks were described in core schizophrenia as an expression of left‐temporal functional deficits, while higher than normal amplitudes were found in cycloid psychosis. This latter finding appeared to be specific for cycloid psychosis and was explained by a generalized cerebral hyperarousal. Based on some psychopathological analogies with cycloid psychosis, and on the comparable pharmacological treatment of the acute episodes, a group of 19 manic patients was investigated immediately after remission and clinical stabilization of an episode. Patients with psychotic features were excluded to avoid overlaps with cycloid psychosis. Patients showed normal P300 amplitudes and no pathological asymmetries of the field, but more posterior positive areas compared to age‐ and sex‐matched controls. This indicates that the neurophysiological changes underlying mania are different from both core schizophrenia and cycloid psychosis. Based on previous three‐dimensional source location studies, this finding indicates that disinhibition due to reduced frontal lobe activity, and not hyperarousal, is the basic functional mechanism of manic disorders.
Risk factors associated with suicide attempt in young French people
Authors: Chastang F. , Rioux P. , Dupont I. , Baranger E. , Kovess V. , Zarifian E.
Published: November 2007

Demographic data, personal and familial characteristics, as well as DSM‐III‐R‐based psychiatric diagnoses were collected in 369 adolescents and young adults aged between 15 and 29 years, referred to an Emergency Department for psychological problems. In total, 60% of them were suicide attempters. Separations before the age of 12 years and depression in the family emerged as the main features distinguishing the suicidal group from the psychiatric control group. Fifty per cent of suicide attempters were repeaters. Fostering during childhood, suicide attempts and depression in the family were found to be risk factors for repeated self‐attempts. These results support the view that significant levels of dysfunction, together with increased psychiatric morbidity, especially suicidal behaviour, characterize the families of young self‐attempters.
History of suicidal behaviour in the families of young suicides
Authors: Runeson B. S.
Published: November 2007

The prevalence of attempted or completed suicide was studied in the families of a consecutive sample of young suicide victims aged 15–29 years. In 17 of 42 (40%) of the men and 5 of 16 (31%) of the women suicidal behaviour was found to be present in first‐degree relatives. Male suicide victims with a family history of suicidal behaviour had an earlier debut of their own suicidal behaviour, longer suicidal processes, and had made more previous suicide attempts. Families in which suicidal behaviour was displayed by the victim's parents or siblings also had more frequent early separations between parent and victim and more substance abuse. Taking into account suicide by a friend or second‐degree family member, it was found that 72% of suicide victims had a history of suicidal behaviour in close relationships.
Cannabinoids: possible role in patho‐physiology and therapy of Gilles de la Tourette syndrome
Authors: Müller‐Vahl K. R. , Kolbe H. , Schneider U. , Emrich H. M.
Published: November 2007

High densities of cannabinoid receptors were found in the basal ganglia and hippocampus, indicating a putative functional role of cannabinoids in movement and behaviour. Anecdotal reports suggested beneficial effects of marijuana in Tourette's syndrome (TS). We therefore interviewed 64 TS patients with regard to use of marijuana and its influence on TS symptomatology. Of 17 patients (27%) who reported prior use of marijuana, 14 subjects (82%) experienced a reduction or complete remission of motor and vocal tics and an amelioration of premonitory urges and obsessive‐compulsive symptoms. Our results provide more evidence that marijuana improves tics and behavioural disorders in TS. It can be speculated that cannabinoids might act through specific receptors, and that the cannabinoid system might play a major role in TS pathology.
Treatment of major depression associated with smoking cessation
Authors: Vázquez F.L. , Becoνa E.
Published: November 2007

A number of clinicians have reported cases of major depression associated with smoking cessation. We report here a case of major depression in a 27‐year‐old woman who abruptly reduced cigarette consumption from 35 to 8 cigarettes per day during the baseline period. A multi‐component behavioural programme was applied to stop smoking, together with pharmacotherapy and Beck's cognitive therapy for depression. Twelve months after ending treatment, the patient was still abstaining from smoking, and she showed no signs of depressive symptomatology.
Reliability of statistics on violent death and suicide in the former USSR, 1970–1990
Authors: Wasserman D. , Värnik A.
Published: November 2007

The stability of the relationship between trends of violent deaths as a whole, suicides and death from undetermined causes was assessed by quantitative methods for the whole former USSR in the years 1970–1990 and for each of the 15 republics in the former USSR for the years 1984–1990. Semi‐structured interviews during 1989–1996 were performed with 12 professionals involved in the diagnosis and coding of causes of death in the Baltic states and Russia. The quantitative analyses showed that mortality data were reliable for the Slavic (Russia, the Ukraine and Belarus) and Baltic (Estonia, Latvia and Lithuania) republics, and also for Kazakhstan, Kirgizia and Moldova. The Central Asian and Caucasian republics showed greater variation in trends and ratios, indicating a need for further investigations of the reliability of suicide statistics in these regions. It emerged from the interviews that no instructions to falsify data were given. The only instructions given were to treat the data on suicide and murder as ‘top secret’. None the less, certain classification errors might arise in the statistics. The diagnosis ‘undetermined cause of death’ was permissible only as a preliminary diagnosis for 14 days, and there was a risk of criticism for poor‐quality work if too many deaths were classified as being due to undetermined causes. Misclassifications could also occur in cases where there was a wish to conceal murder. Negative attitudes towards suicide, especially in Muslim regions, where suicide is taboo, might also have contributed to under‐reporting of suicide.
Internal and external validity of the WHO Well‐Being Scale in the elderly general population
Authors: Heun R. , Burkart M. , Maier W. , Bech P.
Published: November 2007

The objectives of this study were (i) to evaluate the validity of the WHO Well‐Being Scale in elderly subjects and (ii) to assess the influence of demographic variables on subjective quality of life. A sample of 254 elderly subjects completed the 22‐item WHO Well‐Being Scale. The scale had an adequate internal and external validity. However, the short 10‐item and 5‐item versions were equally valid. Low scores indicating decreased well‐being were related to the presence of a psychiatric disorder or, independently, to poor living conditions. The Well‐Being Scale and their short versions would appear to be useful instruments for identifying subjects with reduced subjective quality of life.
Characteristics of psychiatric emergencies and the choice of intervention strategies
Authors: Schnyder U. , Klaghofer R. , Leuthold A. , Buddeberg C.
Published: November 2007

The aim of this study was to describe the sociodemographic, contextual and clinical characteristics of a consecutive sample of 3611 psychiatric emergency visits to a Swiss university general hospital, and to investigate their associations with different intervention strategies. All consultations were documented by a questionnaire covering sociodemographic and diagnostic data as well as information about the consultation and the disposition decision. In a total of 1093 cases (30.3%) no further emergency intervention was required, in 1287 cases (35.6%) patients were offered out‐patient crisis intervention, and in 1231 cases (34.1%) patients were hospitalized. Social integration and the presence of an easily recognizable precipitating stressor were associated with referral to out‐patient crisis intervention. In logistic regression analyses, referral by the police or by health professionals (in contrast to self‐referral or referral by relatives), current diagnosis of a psychotic disorder, and previous hospitalizations were the most powerful predictors of hospitalization. The presence of a precipitating stressor related to the patient's social network decreased the likelihood of hospitalization. The findings indicate a need for facilities offering brief admission, allowing for extended emergency assessments.
The treatment received by substance‐dependent male and female suicide victims
Authors: Pirkola S. P. , Isometsã E. T. , Henriksson M. M. , Heikkinen M. E. , Marttunen M. J. , Lönnqvist J. K.
Published: November 2007

Within a nation‐wide psychological autopsy study we investigated use of treatment services and recognition of substance abuse problems among male and female substance‐dependent suicide victims. Although during their final month half of the male subjects and two‐thirds of the female subjects contacted health care services, in only one‐sixth and one‐third of cases, respectively, were substance abuse problems currently recognized. During their final year, 37% of the males and 67% of the females received psychiatric care. This was associated with Axis‐I comorbid disorders among males, with lower socio‐economic status and abuse of prescribed drugs among females, and with previous suicide attempts among both sexes. Due to their high psychiatric morbidity and tendency to have contacts with psychiatric services, the recognition, treatment and follow‐up of subjects with substance use disorders in psychiatric care would appear to be of major importance for suicide prevention.
Depression Scale (DEPS) in schizophrenia
Authors: Huttunen J. , Taiminen T. , Kähkönen J. , Tuominen K. , Salokangas R. K. R.
Published: November 2007

Objective: To explore the applicability of the Depression Scale (DEPS), a screening instrument for detecting depression in primary health care, in schizophrenia.

Method The DEPS was compared with the Calgary Depression Scale (CDS) among 63 patients with schizophrenia.

Results: Using the CDS as a gold standard, the positive and negative predictive values of the DEPS for the diagnosis of depression were 41 % and 97%, respectively. The correlation between the total CDS scores and the total DEPS scores was 0.73.

Conclusion: The DEPS appears to be useful for screening depression among schizophrenic patients, but the positive diagnosis must he confirmed with a clinical interview.
Autism: not an extremely rare disorder
Authors: Gillberg C. , Wing L.
Published: November 2007

Objective: To study autism over time in order to ascertain whether there has been an increase in its prevalence in recent years. Method: All English language papers on the prevalence of autism were reviewed. Ten of the studies retrieved were not used in the final analysis because they did not meet full criteria for inclusion in the review. The remaining 20 studies, published between 1966 and 1997, were subdivided into US studies (n = 2) and non‐US studies (n= 18), and the latter group was subdivided into four 8‐year periods.

Results: The early studies yielded prevalence rates of under 0.5 in 1000 children, whereas the later ones showed a mean rate of about 1 in 1000. There was a marked difference in prevalence rates between those studies that included some children born before 1970 (low rates) and those that included only children born in 1970 and after (high rates). This is probably due to the lower rates obtained by use of criteria strictly based on Kanner's description of his syndrome. The US studies reported atypically low rates. There was a highly significant estimated increase with calendar year in the non‐US studies (3.8%, per year).

Conclusion: It is concluded that autism is considerably more common than was previously believed. The possible reasons for the higher reported rates are discussed.
Comparative effects of low and high doses of clomipramine and placebo in panic disorder: a double‐blind controlled study
Authors: Caillard V. , Rouillon F. , Viel J. F. , Markabi S.
Published: November 2007

This study was designed to explore the dose‐response relationship for clomipramine in patients with panic disorder, with or without agoraphobia. After 1 week of single‐blind placebo pretreatment, 180 such patients were assigned to a multicentre placebo‐controlled comparison of the effects of high and low doses of clomipramine, and were followed up for 8 weeks. In alleviating anxiety and panic disorder, both clomipramine doses were more efficacious than placebo for panic disorder and, to a lesser degree, for phobia. The lower dose was better tolerated and at least as effective as the higher dose, sometimes more so. These results indicate the clinically important possibility that low‐dose clomipramine is effective and well tolerated.
Changes in public attitudes towards mental illness in the Athens area (1979/1980–1994)
Authors: Madianos M. G. , Economou M. , Hatjiandreou M. , Papageorgiou A. , Rogakou E.
Published: November 2007

Opinions about mental illness were measured, in 1994, in a probability sample consisting of 360 residents of two boroughs in greater Athens. These boroughs represent the catchment area of a community mental health centre. The aim of this study was to compare the differences in attitudes towards mental illness with a matched sample of 360 respondents drawn from the sample of the 1979/1980 attitudinal study, conducted in the same area. The instrument used was the Opinion about Mental Illness scale. which yields five factors. In all five factors statistically significant differences between the two samples were observed. The recent study sample expressed more positive attitudes towards the social integration of the mentally ill, and did not favour the social discrimination against and restriction of mental patients. These results could be explained in the context of a positive and tolerant social climate in the Athens area, strengthened by the implementation of local community mental health intervention programmes.
The concept of target features in schizophrenia research
Authors: Tsuang M. T. , Faraone S. V.
Published: November 2007

Target features are clinical or neurobiological characteristics that are expressions of the underlying predisposition to an illness. They comprise a wide range of phenomena, from the classic signs and symptoms of psychopathology to sophisticated measures of brain structure and function. For schizophrenia, many target features have been identified. These include eye tracking dysfunction, attentional impairment, allusive thinking, neurological signs, thought disorder, characteristic auditory evoked potentials, neuropsychological impairment, structural brain abnormalities and functional brain abnormalities. In their most pathological forms, thcse features are present among many schizophrenic patients, yet it is their presence among their non‐psychotic relatives that shows them to be target features. We discuss the theoretical background for target features, present examples and describe how the discovery of target features has implications for schizophrenia research.
Morbid objectivization in psychopathology
Authors: Cutting J.
Published: November 2007

The fundamental problems of schizophrenia arc wrongly formulated unless one takes heed of the major philosophical revolution which Kant initiated with the publication of theCritique of Pure Reasonin 1781. Virtually all major philosophers since then have adhered to the view that the mind objectifies whatever energy fields/atoms, etc., are ‘out there’. The thesis put forward in this lecture will be that schizophrenia is a condition in which this process proceeds too far. Evidence from the psychopathology of body, time and world is offered in support of such morbid objectivization.
Backward masking performance as an indicator of vulnerability to schizophrenia
Authors: Green M. F. , Nuechterlein K. H.
Published: November 2007

Several types of design have been used to identify neurocognitive measures that indicate vulnerability to schizophrenia rather than the presence of the illness. These designs include studies of first‐degree relatives of patients, studies of patients in symptomatic remission, and studies of subjects who are considered to be prone to psychosis. The backward masking procedure is one promising indicator of vulnerability lo schizophrenia. Backward masking is a procedure in which identification of an initial stimulus (the target) is disrupted by a later stimulus (the mask). Schizophrenic patients show performance deficits on backward masking. Unaffected siblings of patients, remitted patients, and individuals prone to psychosis also show performance deficits on backward masking. This pattern of results suggests that backward masking is a promising indicator of vulnerability to schizophrenia. It provides an alternative phenotype for schizophrenia that is separate from the disorder. The composite nature of masking procedures helps investigators to parse a performance deficit into its smallest meaningful elements and relate them to vulnerability to schizophrenia.
Abnormal neural integration related to cognition in schizophrenia
Authors: Dolan R. J. , Fletcher P. C. , McKenna P. , Friston K. J. , Frith C. D.
Published: November 2007

A striking feature of schizophrenia is the diversity of the phenomenology both within and between patients. This diversity can be contrasted with the well‐circumscribed and stable deficits seen in classic neuropsychological syndromes. The argument will be advanced that the classic lesion model, based on the notion of a segregated deficit, is inappropriate in schizophrenia. Instead the idea will be developed that a more appropriate model is one derived from concepts of neural integration across large‐scale brain networks. Empirical data derived from positron emission tomography (PET) within our laboratory that provide support fur this suggestion will be presented. One critical observation from these data is a disruption of prefrontal‐temporal interactions. under a variety of cognitive activation paradigms, in both chronic medicated and acute unmediated schizophrenic patients. Furthermore, these data indicate that both regional and interregional neuronal function, including prefrontal‐temporal interactions, can be significantly modulated by a neurochetnical perturbation of ascending dopaminergic systems. The latter observations suggest that the deficit of abnormal cortico‐cortical interactions are to some extent modifiable by neuromociulatory neurotransmitter systems.
Costs of services for schizophrenic patients in Norway
Authors: Rund B. R. , Ruud T.
Published: November 2007

Estimates of the direct costs of mental health services for patients with schizophrenia are made from a registration of all patients seen during a period of 4 weeks in all treatment units serving 6 catchment areas. The estimates were based on unit costs. The total direct costs of mental health services for Schizophrenic patients in Norway were estimated to be NOK 1158 million (US$ 164 million). In total. 74.3% of the costs are for long‐term in‐patient care, 19.7% are for acute and intermediate length in‐patient care, and 6.0% are for out‐patient and day care. The average costs of schizophrenic patients with a GAF score of 1–20 are almost twice those of patients with a GAF score of 21–40, and more than three times those of patients with a GAF score of 41–60.