bluuebunny/crossref_metadata_2025 huggingface dataset:
Suicides in Hong Kong, Taiwan and Beijing
Authors: Yip Paul S. F.
Published: October 2008

Background

Differences and similarities were examined of suicide in Hong Kong, Beijing and Taiwan, the populations of which are all ethnically Chinese and share some characteristics of culture but which have very different social and political environments.

Methods

The official death statistics were used for the periods 1981–94 (Hong Kong and Taiwan) and 1987–94 (Beijing).

Results

Hong Kong has experienced a slight increase in suicide rate, whereas a significant decline was observed in Taiwan and Beijing. The suicide rates in all three increased with age, the rate among the elderly being four to five times the average. A relatively low male:female ratio (1.0–1.9) was also observed. Jumping and hanging were the most common methods of suicide in Hong Kong and Taiwan, respectively. Hong Kong had the most years of potential life lost.

Conclusions

Despite the remarkable economic growth in all three places during the study period, the differences in suicide trends suggest that the social and political environments may be more important than the economic environment in suicide. In Hong Kong the suicide rate is likely to remain high or even to increase.
Limbic Dysfunction in Schizophrenia and Mania
Authors: Al-Mousawi Adil H. , Evans Noel , Ebmeier Klaus P. , Roeda Dirk , Chaloner Fiona , Ashcroft George W.
Published: October 2008

Background

Diagnostic classes (derived from catego) can be correlated with regional brain metabolism in patients with major psychiatric disorders.

Method

Seventeen patients with schizophrenia, 15 with mania, 10 with depression and 10 healthy volunteers were examined with positron emission tomography (PET) and 18F-labelled fluorodeoxyglucose, as a marker for glucose metabolism. The number of possible comparisons of regions of interest was reduced by principal-components analysis, and differences in factor scores were determined between diagnostic groups.

Results

Four independent factors, representing distributed brain systems, emerged: an anterior–posterior (1), a left–right temporal (2), a temporofrontal (3), and a mediofrontal (4) system, of which (1), (2) and (3) were abnormal in schizophrenia, (1) and (2) in mania, and (1) in depression.

Conclusions

Abnormal patterns of metabolism could be detected, in decreasing order, in schizophrenia, mania and depression. Some of these abnormalities are likely to be due to medication, but others will be associated with structural or functional abnormalities of the frontolimbic system in the diagnostic groups.
First-Contact Incidence Rates of Schizophrenia in Trinidad and One-Year Follow-up
Authors: Bhugra Dinesh , Hilwig Marcel , Hossein Bill , Marceau Helene , Neehall John , Leff Julian , Mallett Rosemarie , Der Geoff
Published: October 2008

Background

Incidence rates of schizophrenia among UK African–Caribbeans have been reported as high. Various explanations including selective migration and genetic vulnerability have been proposed.

Method

In one calendar year, all new cases of psychosis presenting to various psychiatric services in two clearly defined geographical catchment areas in Trinidad – one in the rural south and the other an urban area – were studied. Standardised diagnostic instruments were applied and information collected using WHO screening and measurement instruments.

Results

A total of 56 cases were collected, giving an incidence rate of 2.2/1000 of broad schizophrenia with a rate of 1.6 for S+ schizophrenia.

Conclusion

These rates are similar to those from the WHO study in Honolulu and Aarhus, and much lower than the rates for African–Caribbeans in London. The cases were followed up for one year and the poor outcome rate for schizophrenia was 19%. The findings are discussed in a cross-cultural context and suggestions for future research made.
Cognitive Therapy and Recovery from Acute Psychosis: a Controlled Trial
Authors: Drury Val , Birchwood Max , Cochrane Ray , MacMillan Fiona
Published: October 2008

Background

The application of cognitive therapy (CT) to psychosis is currently being developed in the UK. This paper reports a trial of CT in acute psychosis with the objective of hastening the resolution of positive symptoms and reducing residual symptoms.

Method

Of 117 patients with acute non-affective psychosis, 69 satisfied inclusion criteria and 40 proceeded to stratified randomisation. The experimental intervention involving individual and group CT was compared with a group receiving matched hours of therapist input providing structured activities and informal support; routine pharmacotherapy was provided by clinicians blind to group allocation. Patients were monitored weekly using self-report and mental state assessments during admission and over the subsequent nine months.

Results

Both groups showed a decline in positive symptoms but this was more marked in the CT group (P < 0.001). At 9 months 5% of the CT group, v. 56% of the control group, showed moderate or severe residual symptoms.

Conclusion

CT appears to be a potent adjunct to pharmacotherapy and standard care for acute psychosis. Issues concerning internal and external validity of the study and opportunities for further research are discussed.
Seasonal Variation in Bipolar Disorder
Authors: Partonen Timo , Lönnqvist Jouko
Published: October 2008

Background

In patients with bipolar disorder, admissions for manic and depressive episodes frequently display a seasonal pattern. We examined this variation and compared the patterns with the seasonal admission rates for schizophrenia.

Method

Patients with bipolar disorder or schizophrenia were identified from the Finnish Hospital Discharge Register of in-patient admissions to all psychiatric hospitals during the years 1969–91. They were included in the analysis if the first admission had occurred before 30 years of age. A total of 295 bipolar patients were found and a sample of 295 schizophrenic patients was randomly selected for comparison.

Results

There was no seasonal variation among all hospital admissions for bipolar disorder or schizophrenia However, the first admission for a depressive compared with a manic episode of bipolar disorder occurred significantly more often in the autumn (33% v. 21% respectively). The peak difference occurred during the week after the autumnal equinox in September.

Conclusion

Our findings suggest that there is no seasonal variation in bipolar disorder, although in some patients the clinical course might be influenced by the autumn, as far as the likelihood of a first admission for depression is concerned.
Maternal Psychopathology and Prediction of Outcome Based on Mother-Infant Interaction Ratings (BMIS)
Authors: Hipwell A. E. , Kumar R.
Published: October 2008

Background

Very little is known about the adequacy and safety of maternal parenting behaviour in the context of severe postpartum psychiatric illness, about specific difficulties in relation to different types of mental illness, or about the potential for improvement over the course of an episode of illness. The Bethlem Mother–Infant Interaction Scale (BMIS) was thus developed as an aid to assessment on a specialist psychiatric Mother and Baby Unit.

Method

Nurses' ratings of the quality of mother–infant interaction using the BMIS were collected throughout the consecutive admissions of 78 in-patient pairs. The ratings from three points during the admissions were examined according to the mothers' RDC diagnoses and also according to the eventual outcome of the admission.

Results

The nature of the mother's illness was associated with the quality of her infant care-taking using the BMIS ratings. The nurses' ratings during the second week of admission together with maternal psychiatric diagnosis, were strongly predictive of the eventual outcome of the admission. The majority of women who were separated from their infants on discharge or who required formal supervision belonged to the schizophrenic group.

Conclusions

The results suggest that the BMIS can be used in this in-patient setting to aid clinical decisions about the safety of parenting by individual mothers with severe mental illness in the postpartum period.
Validation of the Arabic versions of the Thirty- and Twelve-Item General Health Questionnaires in Primary Care Patients
Authors: El-Rufaie Omer E. F. , Daradkeh Tewfik K.
Published: October 2008

Background

The aim of this study was to investigate the validity of the Arabic versions of the GHQ–30 and GHQ–12 in a sample of primary health care (PHC) patients in Al Ain, United Arab Emirates.

Method

A randomly selected sample (n=157) of patients attending a PHC centre in Al Ain was screened using the Arabic version of the GHQ–30, the first 12 items of which constitute the GHQ–12. Then a standardised clinical interview using the Clinical Interview Schedule (CIS) was conducted with all screened patients. The receiver operating characteristic analyses of the Arabic versions of both GHQ–30 and GHQ–12 were compared and their correlation coefficients with the weighted total score of the CIS and the overall severity rate were estimated. Discriminant functional analysis was also performed to assess the discriminatory powers of both the GHQ–30 and GHQ–12.

Results

Using the simple Likert scoring method, the best cut-off point of the GHQ–30, that balances between sensitivity and specificity, was 31/32 with a sensitivity of 0.83 and specificity of 0.83, and that of the GHQ–12 was 12/13 with a sensitivity of 0.83 and specificity 0.80. The total discriminatory powers of the GHQ–30 and GHQ–12 were approximately 93 and 86%, respectively. Both versions of the GHQ were found to have a significant concurrent validity.

Conclusion

The Arabic versions of both GHQ–30 and GHQ–12 are valid psychiatric screening instruments, with almost similar performance, for Arabic-speaking PHC patients.
The Demand for Eating Disorder Care
Authors: Turnbull Sue , Ward Anne , Treasure Janet , Jick Hershel , Derby Laura
Published: October 2008

Background

An epidemiological study of anorexia nervosa and bulimia nervosa in primary care was performed using the General Practice Research Database (GPRD).

Method

The GPRD was screened between 1988 and 1994 for newly diagnosed cases of anorexia nervosa and bulimia nervosa. The validity of the computer diagnosis was established by obtaining clinical details from a random sample of the general practitioners (GPs).

Results

Incidence rates for detection of cases by GPs in 1993 was 4.2 per 100 000 population for anorexia nervosa and 12.2 per 100 000 for bulimia nervosa The relative risks of females to males was 40:1 for anorexia nervosa and 47:1 for bulimia nervosa A threefold increase in the recording of bulimia nervosa was found from 1988 to 1993. Eighty per cent of anorexia nervosa cases and 60% of bulimia nervosa cases were referred to secondary care.

Conclusion

There is a continuing expansion of service need for bulimia nervosa The majority of cases of eating disorders are referred to secondary services. There is scope for more effective management of bulimia nervosa in primary care.
Cardiovascular and Respiratory Risk Factors and Symptoms among General Practice Patients with Long-Term Mental Illness
Authors: Kendrick Tony
Published: October 2008

Background

In the past psychiatric in-patients suffered increased cardiovascular and respiratory mortality. The present study investigated whether increased risks persist among patients in the community and are being addressed in general practice.

Method

A survey of 101 long-term mentally ill adults in 16 general practices in the South Thames (West) Region.

Results

Twenty-six patients were found to be obese (body mass index > 30 kg/m2), 53 were current smokers and 11 were hypertensive (mean systolic blood pressure > 160 mmHg or mean diastolic blood pressure > 100 mmHg, or both). Twenty-one reported daily cough and sputum, 24 shortness of breath, 11 wheezing and seven chest pain on exertion. These rates were significantly higher than population rates in a contemporary national survey. Nearly all the risk factors were recorded in the general practice records but few attempts to intervene were apparent.

Conclusions

Long-term mentally ill patients remain at increased risk of cardiovascular and respiratory problems in the community. Primary care teams should make special efforts to tackle risk factors among this group.
Sick-Leave due to Psychiatric Disorder: Higher Incidence among Women and Longer Duration for Men
Authors: Hensing Gunnel , Alexanderson Kristina , Allebeck Peter , Bjurulf Per
Published: October 2008

Background

Women take sick-leave more often than men, both in general and because of psychiatric disorders. The aim of the present study was to introduce the new dimension of sick-leave duration in the analysis of gender differences in minor psychiatric disorders.

Method

A population-based register was used which included all sick-leave spells exceeding seven consecutive days, 1985–1987, in a Swedish county.

Results

Sick-leave duration was longer for men. The greatest gender differences were found in the youngest and oldest age-groups. Women had higher incidence also in the longest spells. An increase in duration over the three years was found among women, leading to decreased gender differences.

Conclusions

Contrary to other studies on minor psychiatric disorders, small gender differences were found. It is suggested that sick-leave duration can be used as a quantitative measure of health-related working capacity.
Effects of Electroconvulsive Therapy on Peripheral Adrenoceptors, Plasma, Noradrenaline, MHPG and Cortisol in Depressed Patients
Authors: Werstiuk Eva S. , Coote Margaret , Griffith Lauren , Shannon Harry , Steiner Meir
Published: October 2008

Background

The mechanism of the antidepressant action of electroconvulsive therapy (ECT) remains unknown. Based on previous work with antidepressant drugs and their effects on the noradrenergic system, we undertook this study to further determine the effects of ECT on selected indices of peripheral adrenoceptor function in depressed patients.

Methods

Binding parameters (Bmaxand Kd) of plateletα2- and leukocyteβ2-adrenoceptors, plasma noradrenaline (NA), 3-methoxy-4-hydroxy-phenylglycol (MHPG) and cortisol levels were determined in 18 patients, prior to treatment and 14 days after the last of a series of ECTs, and compared with samples obtained from 18 matched control subjects.

Results

Plateletα2-adrenoceptor sites were significantly elevated in untreated patients compared with controls (P< 0.03), but leukocyteβ2-adrenoceptor numbers did not differ. Treatment with ECT led to a significant reduction in plateletα2-adrenoceptor numbers, whereas leukocyteβ2-adrenoceptor densities increased. Pre-ECT plasma NA, MHPG, and cortisol levels were elevated in patients, compared with controls, and decreased following ECT, but these differences were not statistically significant. Post-ECT plasma NA andβ2-adrenoceptor numbers were significantly, negatively correlated (P< 0.05).

Conclusions

These results suggest that plateletα2-adrenoceptors are supersensitive in depressed patients and treatment with ECT results in down-regulation of these receptors, which may be interpreted as a primary therapeutic, ‘normalising’ effect. The post-ECT changes in leukocyteβ2-adrenoceptors are probably only secondary to the lower circulating plasma NA levels.
Nithsdale, Nunhead and Norwood: Similarities and differences in prevalence of schizophrenia and utilisation of service sin rural and urban areas
Authors: McCreadie Robin G. , Leese Morven , Tilak-Singh Deepa , Loftus Linda , MacEwan Tom , Thornicroft Graham
Published: October 2008

Background

The prevalence of schizophrenia is known to be greater in urban than in rural areas. Less studied are differences between the patients themselves and, more specifically, their use of psychiatric services.

Method

The prevalence of schizophrenia was determined in rural Nithsdale in Scotland and urban Nunhead and Norwood in South London. Information about patients' psychiatric history, use of services during the study year and global assessment of functioning were obtained from case records and staff.

Results

There were no significant differences in prevalence rates between Nithsdale patients, all White (2.78 per 1000 general population), Nunhead (3.46 per 1000) and Norwood (2.24 per 1000) Whites; rates were significantly higher among the non-Whites in Nunhead (7.36 per 1000) and Norwood (5.53 per 1000), who were mainly Black Caribbeans. Nithsdale patients were at a higher level of functioning and made substantially more use of psychiatric services. During the study year, 42% of Nithsdale patients used more than one of three principal community services, namely day, out-patient and community psychiatric nursing care.

Conclusions

The prevalence of schizophrenia is no different in rural Nithsdale and inner-city Nunhead and Norwood, when only White patients are considered. Nithsdale patients were at a higher level of functioning and made more use of available psychiatric services.
Problems in conducting economic evaluations alongside clinical trials
Authors: Gray Alastair , Marshall Max , Lockwood Austin , Morris Joan
Published: October 2008

Background

Case management has become the statutory basis of community care in the UK for people with long-term mental disorders, although a randomised controlled trial found no important improvements over standard care. Here we compare the costs and cost consequences of this intervention with standard care.

Method

Resource-use data were collected over a six-month baseline period and for 14 months after randomisation on all patients in the trial.

Results

At 14 months the ratio of control group to treatment group weekly costs was 1.09 (95% CI 0.86–1.38) for total costs; 1.12 (0.76–1.65) for state benefits, and 1.21 (0.61–2.42) for health care costs. Costs were thus lower in the treatment group, but these differences were not significant.

Conclusions

Retrospective power calculations indicated that the trial could have detected differences of 30% in total cost, but would have required 700 patients per arm to detect a 20% difference in health care costs. Hence this study, which had adequate power to detect clinically meaningful differences, was found to be far too small to detect large differences in costs. Funding agencies increasingly request that clinical trials include economic alongside clinical end-points: these findings may have important lessons for that policy.
The impact of the Symptoms of dementia on caregivers
Authors: Donaldson Catherine , Tarrier Nicholas , Burns Alistair
Published: October 2008

Background

The symptoms of dementia are the most obvious stressors to which caregivers are exposed and many studies have investigated the association of such symptoms with the adverse consequences of caring. The present paper represents the only dedicated review of this literature.

Method

Manual and computer (MEDLINE) literature searches were performed.

Results

Seventeen empirical studies were found.

Conclusions

Variability in conceptual and methodological approaches and inconsistencies in the reported findings have prevented firm conclusions from being drawn. However, the literature provided support for a relationship between non-cognitive features in dementia and psychological problems in caregivers, and suggested possible associations between cognitive deficits and some negative care-giver outcomes. New methodological and conceptual approaches are required if decisive evidence is to be forthcoming. This information is a prerequisite for investigations into the causal mechanisms that sustain these relationships, and for rationally designed interventions.
Hyperekplexia: abnormal startle response due to glycine receptor mutations
Authors: Andrew Martin , Owen Michael J.
Published: October 2008

Background

Hyperekplexia is a rare but well-delineated clinical syndrome of pathological startle response and neonatal hypertonia. Many cases result from mutations in the α1subunit of the glycine receptor (GLRA 1).

Method

The clinical features, management and recent genetic studies of hyperekplexia are reviewed.

Results

Diagnosis of the disorder should not be difficult, if one is aware of the syndrome. The treatment of first choice is with the benzodiazepine drug clonazepam, which often causes a dramatic although incomplete diminution of startle. Both recessive and dominant mutations in GLRA 1 have been found in affected individuals. The study of mouse mutants with startle phenotypes suggests that the remainder of cases may well be due to mutations in the β subunit of the glycine receptor.

Conclusions

Hyperekplexia is the first human disease shown to result from mutations within a neurotransmitter gene. The demonstration of both dominant and recessive inheritance resulting from different mutations in the same gene is of considerable interest, as other neuropsychiatric disorders may result from mutations in ligand-gated ion channels. Mutation analysis of GLRA 1 is also likely to be useful as an aid to genetic counselling and in diagnostic evaluation of neonatal hypertonia.
Prenatal and neonatal risk factors for schizophrenia
Authors: Hultman Christina M. , Öhman Arne , Cnattingius Sven , Wieselgren Ing-Marie , Lindström Leif H.
Published: October 2008

Background

The present study examines the effects of independent, single pre- and perinatal risk factors and rates of obstetric complications upon the subsequent development of schizophrenia.

Method

This study was based on prospectively recorded birth records of 107 cases (82 with schizophrenic disorders and 25 with other psychotic reactions) and 214 controls, individually matched by gender and time and place of birth. Variables univariately associated with significantly elevated risk were entered in a logistic regression model.

Results

A high non-optimality summary score (> or = 7 complications of 34 possible) was a significant risk estimate for the total index group (OR 4.58, 95% CI 1.74–12.03) and the 82 schizophrenic patients (OR 3.67, CI 1.30–10.36). Patients with 2–6 complications also had an increased, although lower, risk (OR 1.67, CI 1.02–2.75). A disproportionate birth weight for body length (OR 3.57, CI 1.77–7.19) and a small head circumference (OR 3.93, CI 1.32–11.71) were the strongest independent risk factors.

Conclusions

A contribution of obstetric complications to the risk of schizophrenia was confirmed. Only aberrations in physical size remained as individual independent risk factors.
Neuropsychological correlates of syndromes in schizophrenia
Authors: Norman Ross M. G. , Malla A. K. , Morrison-Stewart S. L. , Helmes E. , Williamson P. C. , Thomas J. , Cortese L.
Published: October 2008

Background

On the basis of Liddle's three-syndrome model of schizophrenia, it was predicted that: (1) symptoms of psychomotor poverty would be particularly correlated with impaired performance on neuropsychological tests likely to reflect functioning of the dorsolateral prefrontal cortex; (2) disorganisation would be particularly correlated with impaired performance on tests sensitive to medio-basal prefrontal functioning; and (3) reality distortion would be particularly correlated with measures sensitive to temporal lobe functioning.

Method

The above hypotheses were tested on 87 subjects with a confirmed diagnosis of schizophrenia. Patients' symptoms were scored for each of the three syndromes. Patients completed six neuropsychological tests designed to measure impairment in specific areas of the brain.

Results

There was no support for the first two hypotheses. There was, however, evidence of a specific relationship between reality distortion and neuropsychological performance usually considered to be related to left temporal lobe functioning.

Conclusions

Although not directly supporting the first two hypotheses; the results are, in general, consistent with there being different cortical-subcortical circuits associated with each of psychomotor poverty and disorganisation. Temporal lobe functioning appears to have particular significance for the reality distortion syndrome.
Phenomenological differences appearing with repetitive behaviours in obsessive-compulsive disorder and Gilles de la Tourette's syndrome
Authors: Miguel Euripedes C. , Baer Lee , Coffey Barbara J. , Rauch Scott L. , Savage Cary R. , O'Sullivan Richard L. , Phillips Katharine , Moretti Cara , Leckman James F. , Jenike Michael A.
Published: October 2008

Background

Obsessive–compulsive disorder (OCD) is heterogeneous, with some forms related to Gilles de la Tourette's syndrome (GTS). This is a phenomenological study designed to investigate the nature of these possible OCD subtypes and the relationship between OCD and GTS.

Method

We evaluated 20 adult outpatients with OCD, 21 with GTS, and 20 with OCD plus GTS using a semi-structured interview designed to assess cognitive, sensory and autonomic phenomena preceding repetitive behaviours.

Results

More cognitions and autonomic anxiety and fewer sensory phenomena were reported in OCD than in GTS. Like the GTS group, the OCD plus GTS group reported more sensory phenomena and fewer cognitions than the OCD group.

Conclusions

The presence or absence of cognitions, sensory phenomena, and autonomic anxiety distinguishes repetitive behaviours in patients with OCD from those with OCD plus GTS, and GTS. These subjective experiences may be useful in subtyping OCD and may represent valid predictors of prognosis and treatment response.
HIV infection in psychiatric patients: An unlinked anonymous study
Authors: Ayuso-Mateos José L. , Montañés Francisco , Lastra Ismael , De La Garza Juan J. Picazo , Ayuso-Gutiérrez José L.
Published: October 2008

Background

Recent surveys suggest that psychiatric patients are at increased risk of being infected with HIV, although very little information is available concerning the seroprevalence of HIV infection among this population outside the US. The aim of this study is to determine the seroprevalence of HIV-I among patients admitted to a psychiatric in-patient unit and to gather linked anonymous risk-factor information.

Method

An unlinked serosurvey was made, using HIV-1 antibody testing of remnant blood specimens collected for routine medical purposes, of patients consecutively admitted to an acute psychiatric unit in Madrid.

Results

Blood was obtained from 390 of the 477 eligible patients (81.8%). The prevalence of HIV was 5.1% (20/390). Patients aged between 18 and 39 accounted for 63.4% of the admissions and 75% of the positive results. Of the 29 patients who presented with injecting drug use, 14 were HIV-infected (48.3%; 95% CI 29.4 67.5). Of the 51 patients for whom any risk behaviour was noted on the admission chart, 18 were HIV-infected (35.3%; 95% CI 22.4 49.9).

Conclusions

This study demonstrates that there is a substantial prevalence of HIV infection in psychiatric patients admitted to an acute in-patient unit. History of injecting drug use was strongly associated with seropositivity. Clinicians recognised risk factors for HIV infection in the majority of the HIV-infected cases.
The Nottingham Acute Bed Study: Alternatives to acute psychiatric care
Authors: Beck A. , Croudace T. J. , Singh S. , Harrison G.
Published: October 2008

Background

Although modern psychiatric services seek alternatives to hospitalisation wherever appropriate, the national trend toward higher bed occupancies on acute psychiatric wards has refocused attention on community-based alternatives and methods of assessing reed for acute care.

Method

We surveyed key decision makers in a community-oriented district service with a low acute psychiatric bed to population ratio, in order to examine alternatives to hospitalisation in a cohort of consecutive admissions over a six-month period.

Results

Alternatives to acute ward hospitalisation were identified for 29% of admissions, and for 42% of those with an admission duration of more than 60 days. Residential options were chosen more often than intensive community support. Simulated bed day savings were considerable.

Conclusions

In a community-oriented service, key decision-makers could identify further alternatives to acute ward hospitalisation, although relatively few non-residential, community support options were chosen. Although this methodology has limitations, data based upon keyworker judgements probably have greater local ‘ownership’, and the option appraisal process itself may challenge stereotyped patterns of resource use.
Mental health review tribunals
Authors: Myers D. H.
Published: October 2008

Background

Mental health legislation allows for treatment needs to override civil liberty. Mental health review tribunals act as a counterbalance. This study examines the long-term outcome of patients reviewed by a tribunal, and in particular whether the tribunal, in its concern for civil liberty, might be discharging patients prematurely.

Method

All non-offender patients from a defined catchment area reviewed by the tribunal between the inception of the 1983 Mental Health Act and 31 December 1991 were followed-up until 31 May 1993.

Results

Those discharged by the tribunal did not differ significantly from those refused discharge in subsequent survival period in the community, in readmission rate or in final outcome.

Conclusions

Within the limitations of a non-experimental study, the main hypothesis was not supported. An intensive study of family and personal life in the three months after discharge would cast useful additional light on the soundness of tribunal decisions.
Generalisability of results from randomised drug trials
Authors: Licht Rasmus Wentzer , Gouliaev Georg , Vestergaard Per , Frydenberg Morten
Published: October 2008

Background

Exemplified by a randomised trial on antimanic treatment, this paper addresses the question of whether selection of patients for drug trials may limit the applicability of study results from the randomised patients to a wider population.

Method

During two-year period, all consecutively admitted patients from a defined catchment area were screened for inclusion criteria concerning age, diagnosis and severity of illness. The subsequently excluded subgroups of patients were compared with the randomised patients by multivariate data analysis.

Results

One hundred and sixty-four patients met the inclusion criteria. However, after exclusion for various reasons, only 27 (17%) patients remained for randomisation. The randomised patients and the excluded patients differed substantially.

Conclusions

The generalisability of trial results is limited. Reports of randomised drug trials should carefully describe the screening procedure for inclusion and, when possible, present relevant comparisons-between the randomised patients and the various subgroups of excluded patients.
A transcultural pattern of drug use: Qat (khat) in the UK
Authors: Griffiths Paul , Gossop Michael , Wickenden Simon , Dunworth John , Harris Ken , Lloyd Charles
Published: October 2008

Background

This study investigates patterns of qat use among 207 Somalis living in London.

Method

Subjects were recruited using privileged access interviewing. Somalian interviewers were recruited who shared the same culture as the subjects. Data were collected by means of a structured interview.

Results

One hundred and sixty-two subjects (78%) had used qat. The majority (76%) used more qat than in Somalia. Some users reported moderate dependence; a minority reported severe problems. Adverse psychological effects included sleep problems, anxiety and depression. Medical problems associated with qat use were rare.

Conclusions

Qat users who continue to use this drug when it is transplanted from a traditional context may experience difficulties. Qat use can also be seen as playing a positive role in supporting the cultural identity of the Somalian community. Severe problems were rarely reported. Qat consumption should be considered when addressing health-related topics with patients from those communities in which qat use is common.
The predictive validity of a diagnosis of schizophrenia
Authors: Mason Peter , Harrison Glynn , Croudace Tim , Glazebrook Cristine , Medley Ian
Published: October 2008

Background

Outcome is important in the validation of psychiatric diagnosis, as most disorders lack clinicopathological correlates. We describe the predictive validity of four definitions of schizophrenia (DSM-III-R, ICD-10, ICD-9 and CATEGO S+), in a representative cohort of patients selected during their first episode of psychosis.

Method

Each definition of schizophrenia was applied to 99 patients. Their respective ability to predict 13-year outcome (Global Assessment of Functioning scales) was assessed.

Results

DSM-III-Rand ICD-10 diagnoses of schizophrenia have high predictive validity for long-term outcome, and both provide relatively stable diagnoses. ICD-9 is reasonably good at predicting disability, but not symptoms, and CATEGO S+ showed no predictive validity. Adding six-month duration criteria to ICD-10, ICD-9 and CATEGO S+ improved their predictive validity, and removing the six-month duration criterion from DSM-III-R commensurately reduced predictive validity.

Conclusions

Modern diagnostic systems (DSM-III-Rand ICD-10) have high predictive validity, and are superior to ICD-9. The six-month duration criterion of DSM-III-R schizophrenia accounts for its predictive validity and stability over 13 years, but restricts its use in first-episode studies. The one-month duration criterion of ICD-10 is less restrictive, without major compromises in predictive validity or stability.
Empirically based subgrouping of eating disorders in adolescents: A longitudinal perspective
Authors: Van Der Ham Thecla , Meulman Jacqueline J. , Van Strien Din C. , Van Engeland Herman
Published: October 2008

Background

Successive DSM versions struggle with the heterogeneity of the eating disorders. Criteria were mainly based on clinical impressions and on descriptive and inferential studies.

Method

In a study of 55 eating-disordered adolescents, we investigated whether patients could be grouped on an empirical basis, using principal components analysis (PCA) with optimal scoring (scaling), i.e. PCA with no aprioriassumptions. Clustering was based on Morgan-Russell subscales, each measured four times over the course of illness.

Results

Contrary to DSM – IV criteria, patients did not cluster primarily on the basis of anorectic symptoms; the occurrence of bulimic symptoms was more dominant. Core symptomatology (preoccupation with food, disturbed body perception and inadequate sexual behaviour) did not differ between patients, either at referral or over time.

Conclusions

These results support the spectrum hypothesis of the eating disorders, which considers them as one syndrome with different manifestations.
Reasoning and delusions
Authors: Kemp Róisín , Chua Siew , McKenna Peter , David Anthony
Published: October 2008

Background

Delusions are assumed to reflect disordered reasoning, but with little empirical support. We attempted to study this in 16 relatively intelligent deluded patients and 16 normal volunteers.

Method

Standard tests were used which required subjects to choose between logically fallacious and valid responses, both of which were plausible. The tests were: (a) conditional statements (if… then), (b) syllogisms (e.g. no A are C, some B are C, some C are not A), and (c) judgements of probability. All three tasks incorporated neutral and emotive content.

Results

Both normal and deluded subjects frequently made logical errors. With conditionals, deluded subjects tended to endorse fallacies more often than normal controls and this was accentuated when the content was emotive. Similarly, with syllogisms, the effect of emotional content on the endorsement of unbelievable responses was increased slightly in the deluded group. Finally, the deluded patients showed a trend to be less prone to the conjunction fallacy than normals, suggesting less reliance on existing schema.

Conclusions

Differences in reasoning between deluded patients and controls are surprisingly small. Patients are somewhat more prone to endorse invalid or fallacious responses, especially when emotive themes are involved.
Mental disorders and suicide in Northern Ireland
Authors: Foster Tom , Gillespie Kate , McClelland Roy
Published: October 2008

Background

The aim of this part of the Northern Ireland Suicide Study was to investigate the prevalence of DSM - III - R axis I (clinical syndrome) and axis II (personality) disorders among suicides (14 years and older) in Northern Ireland during a one-year period.

Method

A psychological autopsy study based on a variety of documentary sources and interviews with bereaved informants and health care professionals.

Results

Ninety per cent of suicides (106/118) had a current axis I and/or an axis II mental disorder. At least one current axis I disorder was diagnosed in 86% of suicides (102/118), and at least one axis II disorder was diagnosed in 44% (52/118). Suicides under 30 years (92% male) were less likely to have a current axis I disorder (68%; 26/38) than those 30 years and older (95%; 76/80). Psychiatric comorbidity was present in 55% of suicides (65/118). The time between the last contact with a health care professional and death was greater among suicides under 30 years and male suicides.

Conclusions

Notwithstanding the aetiological complexity of suicide, the prevention, recognition and treatment of mental disorder will continue to play key roles in suicide prevention.
No association between bipolar disorder and alleles at a functional polymorphism in the COMT gene
Authors: Craddock Nick , Spurlock Gillian , Mcguffin Peter , Owen Michael J. , Nosten-Bertrand Marika , Bellivier Frank , Meloni Rolando , Leboyer Marion , Mallet Jacques , Mynett-Johnson Lesley , Murphy Valerie , Mckeon Patrick , Kirov George , Powell John , Kunugi Hiroshi , Collier David , Larosa Monica , Nacmias Benedetta , Sorbi Sandro , Schwab Sibylle , Ackenheil Manfred , Maier Wolfgang ,   Biomed European Bipolar Collaborative Group
Published: October 2008

Background

There is compelling evidence for the existence of susceptibility genes for bipolar disorder. Association studies using functional DNA variations are an important approach for identifying these genes. The enzyme catechol-O-methyltransferase (COMT) plays a key role in the degradation of catecholamine neurotransmitters and is a candidate for involvement in bipolar disorder. Recently a common functional genetic polymorphism that underlies population variation in COM Tactivity has been elucidated and a simple assay developed.

Method

In a collaboration involving seven European centres, we have undertaken an association study of this functional polymorphism in 412 unrelated West European caucasian DSM - III-R bipolar patients and 368 ethnically matched controls.

Results

We found no evidence of allelic or genotypic association.

Conclusions

We can conclude that variation at this functional polymorphism does not make an important contribution to bipolar disorder in the Western European population. Future studies using this powerful experimental approach can be expected to contribute to identification of bipolar susceptibility genes.
Confusional State Evaluation (CSE): An instrument for measuring severity of delirium in the elderly
Authors: Robertsson B. , Karlsson I. , Styrud E. , Gottfries C. G.
Published: October 2008

Background

Delirium or confusional state is a common mental disorder in the elderly. To follow changes in symptoms over time and to evaluate the efficacy of treatment of delirium, a reliable and valid instrument for measuring degrees of delirium is essential.

Method

An observer's rating scale with 22 items, the Confusional State Evaluation (CSE), was developed. Scores on 12 of the items were summarised to a “confusion score”. Based on ratings of 7l demented and non-demented elderly patients with delirium, the interrater reliability and validity of the scale was studied.

Results

Agreement between two independent raters was fair to excellent (weighted kappa 0.38–0.93). The correlation between the “consfucsoion score” of the scale and the global rating by a psychogeriatrician was good (r=0.79).

Conclusions

The CSE seems to be a reliable and valid measuring instrument which can be useful in following the course of confusion in elderly patients.
Clinical specificity of prison inmates with severe mental disorders
Authors: Côté Gilles , Lesage Alain , Chawky Nadia , Loyer Michel
Published: October 2008

Background

We wished to determine whether prison inmates with severe mental disorders possess specific clinical characteristics compared with psychiatric in-patients suffering from similar problems.

Method

Under a case-control design, 69 male prison inmates suffering from a schizophrenic or major affective disorder were matched for age and diagnostic spectrum to 60 male psychiatric in-patients. Standardised interviews were used to diagnose psychiatric disorders according to DSM-111-R and social functioning criteria. Case-notes were reviewed to cull data regarding social life, criminal record and service use.

Results

Inmates were more likely to suffer from delusional/NOS psychotic disorders (72%) or major depression (70%), and psychiatric in-patients from schizophrenic or bipolar disorder (62% and 71%, respectively). Comorbidity was more prevalent among inmates than among in-patients, while in-patients presented less social autonomy than did inmates.

Conclusions

The clinical specificity of prison inmates with severe mental disor ders clearly differentiates them from psychiatric in-patients, and warrants recognition of their special needs for assessment and integrated treatment approaches.
One hundred cases of attempted suicide in the elderly
Authors: Hepple Jason , Quinton Catherine
Published: October 2008

Background

Despite the high suicide rate in the elderly, there is a relative lack of information on the longer-term outcome of elderly people who have attempted suicide, particularly their psychiatric and physical morbidity and mortality.

Method

Comprehensive demographic and psychiatric data were available on 100 consecutive referrals to a liaison psychiatric service of patients over 65 years of age who attempted suicide between 1989 and 1992. Detailed follow-up in 1994 included the interviewing of survivors using GMS–AGECAT.

Results

Of the 64 women and 36 men, with a mean age of 75.8 years, 42 subjects were dead at follow-up; 12 were suspected suicides, five having died as a delayed result of their index attempt. Twelve women made a further non-lethal suicide attempt. All five male repeat attempts proved fatal.

Conclusions

Elderly people who attempt suicide have a high mortality both from completed suicide and death from other causes. The completed suicide rate is at least 1.5% per year, and the repetition rate is 5.4% per year. Those at risk of further self-harm are likely to be in contact with psychiatric services and to be suffering from persistent depression.
Common mental disorders in primary care in Harare, Zimbabwe: Associations and risk factors
Authors: Patel Vikram , Todd Charles , Winston Mark , Gwanzura Fungisai , Simunyu Essie , Acuda Wilson , Mann Anthony
Published: October 2008

Background

This study aimed to investigate the associations for common mental disorders (CMD) among primary care attenders in Harare.

Method

This was an unmatched case-control study of attenders at primary health clinics, general practitioner surgeries and traditional medical practitioner clinics; 199 cases with CMD as identified by an indigenously developed case-finding questionnaire, and 197 controls (non-cases), were interviewed using measures of sociodemographic data, disability, care-giver diagnoses and treatment, explanatory models, life events and alcohol use.

Results

CMD was associated with female gender (.=0.04) and older age (.=0.02). After adjustment for age, gender and site of recruitment, CMD was significantly associated with chronicity of illness; number of presenting complaints; beliefs in “thinking too much” and witchcraft as a causal model; economic impoverishment; infertility; recent unemployment; an unhappy childhood for females; disability; and consultations with traditional medical practitioners and religious priests.

Conclusions

Mental disorders are associated with female gender, disability, economic deprivation, and indigenous labels of distress states.
Pharmacokinetic interactions involving clozapine
Authors: Taylor David
Published: October 2008

Background

Metabolism of clozapine is complex and not fully understood. Pharmacokinetic interactions with other drugs have been described but, in some cases, their mechanism is unknown.

Method

Published trials and case reports relevant to the human metabolism of clozapine and to suspected pharmacokinetic interactions were reviewed.

Results

Metabolism of clozapine appears to be largely controlled by the function of the hepatic cytochrome p4501A2 (CYPIA2). Compounds which induce CYPIA2 activity (carbamazepine, tobacco smoke) may reduce plasma clozapine levels. Inhibitors of CYPIA2 (caffeine, erythromycin) have the opposite effect. Drugs which inhibit the hepatic cytochrome p4502D6 (CYP2D6) have also been reported to elevate plasma clozapine levels. The mechanism of this interaction is unclear.

Conclusions

The co-administration of clozapine and compounds reported to alter its metabolism should be avoided where possible. A host of other interactions can be predicted and so caution should be exercised when co-administering drugs which affect the function of CYPIA2 and CYP2D6. The pharmacokinetics of clozapine require further investigation so that its safe use can be assured.
Lithium: evidence reconsidered
Authors: Moncrieff Joanna
Published: October 2008

This review examines the evidence for the main current recommendations for lithium use in psychiatry and briefly summarises the literature on its adverse consequences, in an attempt to develop an overall evaluation of its potential role based on available evidence. An introduction to the history of lithium is given because it is suggested that in both the 19th and 20th centuries the social context in which lithium emerged, rather than the quality of the scientific evidence, was decisive in determining its adoption as a treatment.
Lithium: balancing risks and benefits
Authors: Cookson John
Published: October 2008

More than 20 years have passed since publication of the pivotal studies of efficacy upon which our use of lithium in acute mania and the prophylaxis of bipolar disorder are based. Since then, two of the most important discoveries about lithium have been the phenomenon of lithium withdrawal mania, and the recognition of permanent neurological sequelae after lithium toxicity. The use of lithium survived earlier criticism from the Institute of Psychiatry (Blackwell & Shepherd, 1968), but the new discoveries call for a reappraisal of the studies and reconsideration of whether lithium has a place in treatment, for which patients it should be recommended, what information and supervision should be given to patients on lithium, and what doctors should be expected to know of it.