bluuebunny/crossref_metadata_2025 huggingface dataset:
Family interventions in schizophrenia and related disorders: a critical review of clinical trials
Authors: Barbato A. , D'Avanzo B.
Published: March 2003

Objective: To update evidence from studies on family intervention in schizophrenia looking carefully at methodological issues.

Method: Twenty‐five studies were reviewed, using specific outcome criteria, and computing effect sizes whenever possible.

Results: Effect on relapse is relatively well assessed, although differences emerged particularly in comparison with poor control treatments and disappeared in recent studies. Findings on patient's symptoms, social functioning or family variables are limited and affected by methodological pitfalls. No difference between intervention models emerged, although behavioural/psycho‐educational approaches were better investigated. Patients' inclusion, greater frequency and length of treatment led to better results. The main flaws were: poor control of standard treatment, small sample sizes, failure in evaluating clinical significance in continuous outcome variables.

Conclusion: It remains unclear whether the effect depends on family treatment or on more intensive care. The failure to relate outcome to family‐mediating variables is a challenge to the rationale underlying family interventions.
Patient education in schizophrenia: a review
Authors: Merinder L‐B.
Published: March 2003

Objective: To identify and analyse methodology and results of studies of patient education in schizophrenia.

Method: A literature search was made in the databases Medline, Excerpta Medica, Psychlit and Cinahl.

Results: Most studies demonstrate that knowledge and compliance can be improved by educational interventions. Compliance seems to be most readily influenced by interventions including behavioural components. A few studies indicate that relapse and symptomatology can be influenced by educational interventions as well. No influence of the duration of interventions was found. Where educability is studied, age, medication and level of symptoms are potential predictors.

Conclusion: Due to methodological limitations and insufficient reporting the results of available studies on patient education in schizophrenia are far from conclusive. The demonstration of the efficacy of patient education in improving knowledge and compliance is most consistent.
Contacts to the health care system prior to suicide: a comprehensive analysis using registers for general and psychiatric hospital admissions, contacts to general practitioners and practising specialists and drug prescriptions
Authors: Andersen U. A. , Andersen M. , Rosholm J. U. , Gram L. F.
Published: March 2003

Objective: The purpose of this study was to describe suicides' contacts with various parts of the health‐care system.

Method: Data on 472 people who committed suicide in a Danish County (Funen) in the period of April 1 1991 to December 31 1995 were searched in the Danish Psychiatric Central Register, the National Patient Register, the National Health Insurance and Odense Pharmacoepidemiologic Database.

Results: In total, 97.5% of the suicides were recaptured in at least one of these registers. Forty‐two per cent had been hospitalized in psychiatric departments. Within the last month before death, 66% consulted a general practitioner, 13% and 7%, respectively, were discharged from a psychiatric hospital and general hospital.

Conclusion: The registers used provided a comprehensive registry‐based description of suicides' contacts with the health‐care system. The most prominent features were the high prevalence of psychiatric morbidity and the high rate of contacts with GPs close to suicide.
Death wishes in the very elderly:data from a 3‐year follow‐up study
Authors: Forsell Yvonne
Published: March 2003

Objective: The aim of this study was to study the 3‐year outcome of death wishes in an elderly population.

Method: 1099 very elderly people were examined extensively by physicians, including a structured psychiatric interview. Three years later those who had survived were re‐examined (n=683) using a similar procedure.

Results: Of the sample, 11.6% (n=128) had death wishes at the first examination and 8.9% (n=54) at the follow‐up. Of the 54, 17 have had death wishes persistently during the 3‐year period; all of them had psychiatric diagnoses. Of those having death wishes at one of the examinations 70% had psychiatric diagnoses. Attrition was more common in the group with death wishes than in the group without when age, gender, somatic disorders including dementia and disability in daily living were taken into account.

Conclusion: This study shows that there is a need for a psychiatric examination when elderly people express death wishes.
The construction of the SEDAS:a new suicide‐attitude questionnaire
Authors: Jenner J. A. , Niesing J.
Published: March 2003

Objective: Only two scales exist for measuring attitudes towards suicidal behaviour. Because of theoretical and methodological limitations of both scales, the SEDAS was constructed to offer an alternative instrument.

Method: The semantic differential scale, from which the SEDAS was devised, consisted of 36 items (pairs of adjectives) constructed to measure attitudes towards suicidal behaviour of different actors in various situations. It was administered to 142 Dutch SOS‐telephone volunteers for seven different actor/situation sets.

Results: Item analysis reduced the number of suitable items to 15. Simultaneous component analysis revealed two dimensions on which the actor/situation sets were scored: health/illness and acceptance/rejection, jointly accounting for 47% of variance. Psychometrics of the instrument in terms of internal consistency (values between 0.70 and 0.86), item–rest correlation and test–retest correlation (between 0.63 and 0.87) are acceptable to good.

Conclusion: The SEDAS may be of value in population surveys, and facilitate effect evaluation of staff training and suicide prevention programmes.
Social phobia treated as a problem in social functioning: a controlled comparison of two behavioural group approaches
Authors: Stravynski A. , Arbel N. , Bounader J. , Gaudette G. , Lachance L. , Borgeat F. , Fabian J. , Lamontagne Y. , Sidoun P. , Todorov C.
Published: March 2003

Objective: Treatments for social phobia result typically in significant anxiety and avoidance reduction; the repercussions in terms of social functioning, however, are not clear. This controlled study compared two approaches designed to improve the social functioning of social phobics.

Method: Sixty‐eight socially phobic patients were randomly assigned to two treatments focused on improving interpersonal relationships either with or without social skills training or a waiting list; 60 completed treatment and 59 a 1‐year follow‐up. Treatment was administered in small groups, 14 sessions altogether.

Results: No clinically meaningful change was observed during the waiting period. A statistically significant and equivalent improvement obtained in both treatment conditions.

Conclusion: Both treatments resulted in reduced anxiety, avoidance, general psychopathology and better social functioning that maintained over follow‐up. Continuing improvement in remission rates was noted; fully 60% of the patients no longer fulfilled criteria for social phobia at the end of 1‐year follow‐up.
The relationship between insight and medication adherence in severely mentally ill clients treated in the community
Authors: Trauer Thomas , Sacks Tobie
Published: March 2003

Objective: To study the relationship between aspects of insight and medication adherence and elements of psychopathology.

Method: Clients completed insight and adherence measures in interview; doctors and case managers independently completed ratings of adherence and psychopathology. Other client information was obtained from the clinical file.

Results: The subscale structure of the insight scale was well reproduced. Clients endorsed items relating to need for treatment more than items relating to relabelling of symptoms and awareness of illness. Self‐reported insight was lower in those clients for whom either the treating doctor or the case manager or both thought the client was non‐adherent. Insight was related positively to clinician ratings of depressed mood, and negatively to clinician ratings of personal functioning.

Conclusion: Our data support the subscale structure of the insight questionnaire used, and previous suggestions that insight is positively related to depressive affect, and inversely related to impaired psychosocial functioning.
Psychotropic interactions with warfarin
Authors: Sayal K. S. , Duncan‐McConnell D. A. , McConnell H. W. , Taylor D. M.
Published: March 2003

Objective: Improving knowledge about the cytochrome p450 system means that potential drug interactions can be predicted. Interactions involving warfarin may be thus avoidable. As many patients who have suffered from a stroke or other thromboembolic events may also develop psychiatric disorder, knowledge about possible interactions with psychotropics is essential for prescribers.

Method: A Medline and hand search of published literature was complemented by contacting manufacturers.

Results: The antidepressants citalopram, nefazodone and sertraline have relatively low interaction potential with warfarin; fluoxetine and fluvoxamine relatively high. Carbamazepine appears to reduce warfarin's anticoagulant effect. Other antipsychotics, antidepressants and anxiolytics have only a theoretical risk of interaction. Lithium, gabapentin, sulpiride and amisulpride are predominantly renally excreted and so are not likely to interact with warfarin.

Conclusion: Many psychotropics are involved in predictable interactions with warfarin. Drugs with a known low interaction potential should be chosen instead of those known or predicted to interact.
The Collaborative Longitudinal Personality Disorders Study: baseline Axis I/II and II/II diagnostic co‐occurrence
Authors: McGlashan Thomas H. , Grilo Carlos M. , Skodol Andrew E. , Gunderson John G. , Shea M. Tracie , Morey Leslie C. , Zanarini Mary C. , Stout Robert L.
Published: March 2003

Objective: To describe baseline diagnostic co‐occurrence in the Collaborative Longitudinal Personality Disorders Study.

Method: Six hundred and sixty‐eight patients were reliably assessed with diagnostic interviews for DSM‐IV Axis I and II disorders to create five groups: Schizotypal (STPD), Borderline (BPD), Avoidant (AVPD), Obsessive‐Compulsive (OCPD) and Major Depressive Disorder (MDD) without personality disorder (PD).

Results: Mean number of Axis I lifetime diagnoses was 3.4; STPD and BPD groups had more diagnoses than AVPD, OCPD, and MDD groups. Significant Axis I co‐occurrences emerged for Social Phobia/AVPD, PTSD/BPD and Substance Use/BPD. Mean number of co‐occurring PDs was 1.4; STPD had more than BPD group which had more than AVPD and OCPD groups. Significant PD co‐occurrence emerged for: STPD/ Paranoid and Schizoid PDs, BPD with Antisocial and Dependent PDs, and lower frequency for OCPD/Antisocial PD.

Conclusion: Diagnostic co‐occurrences generally followed base rates, while significant departures resemble those of controlled literature.
In‐patient suicide in psychiatric hospitals
Authors: Deisenhammer E. A. , DeCol C. , Honeder M. , Hinterhuber H. , Fleischhacker W. W.
Published: March 2003

Objective: In‐patient suicides continue to be a matter of concern in hospital psychiatry. In‐patients at risk for suicide need to be identified.

Method: In‐patient suicides in two psychiatric hospitals were assessed over a time‐span of 8 years. Cases were detected by comparing police suicide data with the hospitals' admission and discharge records. Further information was then gathered from patients' records.

Results: During the period under investigation 44 in‐patients committed suicide, the majority of them being diagnosed with affective disorders (45.4%) or schizophrenia (27.3%). The most commonly used method was ‘jumping in front of a vehicle’ (34.1%); 79.5% were treated in an open ward at the time of their suicide, 15.9% in a locked unit. The majority of open ward suicides happened outside the hospital; 39.4% of patients had left the ward without giving notice.

Conclusion: Additional cautionary measures are warranted especially for patients in open wards.
Fatal antidepressant overdose among drug abusers and non‐drug abusers
Authors: Oyefeso Adenekan , Valmana Anton , Clancy Carmel , Ghodse Hamid , Williams Hugh
Published: March 2003

Objective: This study examined the predictors, extent and patternof fatal antidepressant overdose (FAO) in all psychoactivedrug‐related deaths and compared these in drug abusers and non‐drugabusers.

Method: Inquest data on 491 psychoactive drug‐related cases in England and Wales were analysed. We examined predictors of FAO relative to other drug‐related deaths in drug abusers and non‐abusers using logistic regression, and compared the relative fatality of different antidepressant classes using the Proportionate Fatality Index (PFI).

Results: The overall FAO prevalence ratio was 10% (male=7.1%, female=18.5%). FAO was twice as likely to occur among cases aged 45 years and over than in younger cases (MOR=2.6, 95% CI=1.4–4.9), and eight times more likely to occur in cases with no history of drug abuse (MOR=8.2, 95% CI=4.0–18.4). Ingestion of prescribed antidepressants is the only common predictor of FAO among drug abusers and non‐abusers, and co‐ingestion of a combination of antidepressants of two different classes is a potent risk for FAO in the cases studied.

Conclusion: The results highlight the need to develop appropriate therapeutic strategies for managing treatment‐resistant depression.
The relationship between cognitions and panic attack intensity
Authors: Hedley Liv Margaret , Hoffart Asle , Dammen Toril , Ekeberg Øivind , Friis Svein
Published: March 2003

Objective: To investigate the relationship between panic attack intensity, catastrophic belief and cognitions.

Method: Data from 540 panic diaries were collected from 42 patients with panic disorder with agoraphobia.

Results: When we controlled for individual variation, effects of treatment and number of symptoms, catastrophic belief contributed significantly to more intense panic attacks (r2change=0.10, P<0.0001). There were no significant differences in panic attack intensity between primary and secondary cognitions.

Conclusion: Our results indicate that catastrophic belief is a reliable predictor of panic attack intensity.
CAMCOG as a screening instrument for dementia: the Odense Study
Authors: Lolk A. , Nielsen H. , Andersen K. , Andersen J. , Kragh‐Sørensen P.
Published: March 2003

Objective: The Cambridge Cognitive Examination (CAMCOG) score is correlated with age and sociodemographic variables. The aim of the study was to determine an individualized CAMCOG cut‐off score for dementia, taking such correlates into account.

Method: From the general population 150 people aged 65–84 years were examined with CAMDEX which includes CAMCOG, and a neuro‐psychological test battery. Data from 130 non‐demented people were entered in setwise multiple regression analyses to identify variables predicting the CAMCOG score.

Results: The variables age, social class, matrimonial status, general knowledge and intellectual level explained 66% of the variance of the CAMCOG scores. A cut‐off defined as a difference between actual and predicted CAMCOG score −4.41 resulted in a sensitivity of 88.2% and a specificity of 89.2% for very mild to moderate dementia.

Conclusion: It is possible to determine an individualized CAMCOG cut‐off score for dementia in its early stages.
Progressive deterioration of soft neurological signs in chronic schizophrenic patients
Authors: Chen Eric Y. H. , Kwok Carol L. , Au Joyce W. Y. , Chen Ronald Y. L. , Lau Benjamin S. T.
Published: March 2003

Objective: Neurological signs are found to be increased in schizophrenia in cross‐sectional studies. Whether they progress with time is an important issue in addressing the course of the illness.

Method: The current study investigated different groups of neurological signs in 43 stable chronic schizophrenic patients over a 3‐year period using an operationalized instrument.

Results: While symptoms and medication have remained largely unchanged in the 3‐year period, significant increase in soft neurological signs (SNS) (‘motor coordination’, ‘sensory integration’ and ‘disinhibition’) has been observed. This contrasted with the stability of ‘pyramidal’, ‘extrapyramidal’, ‘dyskinesia’ and ‘catatonia’ signs. The increase in SNS appears not to be related to age, illness duration, symptoms or medication.

Conclusion: This finding suggests that SNS represent a marker sensitive to a possible late deterioration process in the course of a schizophrenic illness.
Differences between patients with identified and not identified psychiatric disorders in primary care
Authors: Karlsson Hasse , Joukamaa Matti , Lehtinen Ville
Published: March 2003

Objective: The aim of this study was to discover the differences between the primary care patients with a psychiatric disorder whose illness was detected and the patients whose disorder was not detected.

Method: We collected 1000 randomly selected PC patients. We used SCL‐25 as a screening method and PSE as a diagnostic tool.

Results: Ninety‐one (89.2%) of the interviewed patients received a psychiatric diagnosis. The physicians detected a disorder in 36 (36.9%). A larger part of the undetected group belonged to the highest social groups. Also the SCL‐25 mean scores differed significantly, indicating that the symptoms of the undetected cases were milder. The detected cases had higher levels of anxiety and depression, but the difference in anxiety symptoms was greater between the groups. Detection was associated with treatment.

Conclusion: The GPs should also be aware of psychiatric morbidity in patients with a higher social status, a good level of education and milder symptoms.
The perception of needs for care in staffand patients in community‐based mental health services. The South‐Verona Outcome Project 3
Authors: Lasalvia Antonio , Ruggeri Mirella , Mazzi Maria Angela , Dall'Agnola Rosa Bruna
Published: March 2003

Objective: The present study aims to assess needs for care rated by patients and staff and their agreement on needs assessment in a community‐based mental health service by using the Camberwell Assessment of Need (CAN).

Method: The Italian version of the CAN was used in a sample of 247 patient–staff pairs.

Results: Patients and staff showed poor agreement on both the presence of a need and on whether need had been met or not. Higher disability predicted a higher number of patient‐rated needs, while higher disability, higher number of service contacts and patient unemployment predicted a higher number of staff‐rated needs. Lower global functioning predicted higher disagreement in patients and staff ratings of needs.

Conclusion: Patients and staff show different perceptions of needs for care and therefore multiple perspectives should be taken into account for planning and providing effective needs‐led mental health care.
Social networks and functional status in patients with psychosis
Authors: Howard Louise , Leese Morven , Thornicroft Graham
Published: March 2003

Objective: To investigate whether large social networks are associated with better functional outcome in psychotic disorders.

Method: A prospective cohort study of epidemiologically representative patients with psychosis was analysed to examine the relationship between social networks and functional outcome. Standardized validated measures were used for diagnosis, social networks and outcome.

Results: There was strong evidence of cross‐sectional associations between the size of the social network and the number of active interactions, and functional outcome. Structural equation modelling found weak evidence of an additional longitudinal association.

Conclusion: There was consistent evidence of a positive correlation between the total size of patients' social networks and the number of active interactions, and functional outcome. The direction of causality cannot be determined by this analysis, although it is suggested that the effect of social networks on functioning is stronger than vice versa. Patients' functioning may improve with interventions that improve social networks.
Prolactin and beta‐endorphin serum elevations after ECT in manic patients
Authors: Chaudhry Haroon R. , Hofmann Peter , Loimer Norbert , Kotter Mark , Quehenberger Franz , Fueger Gerhard
Published: March 2003

Objective: Alterations in prolactin and β‐endorphin serum levels after ECT are well‐established findings in depression. The present study focuses on electroconvulsive therapy (ECT) response patterns of the mentioned parameters in patients suffering from acute mania.

Method: Following the first three ECTs of a treatment series in 19 patients diagnosed according to DSM‐III‐R criteria as suffering from mania, blood samples were drawn before, and 20, 30 and 40 minutes after ECT. Serum prolactin and β‐endorphin levels were established in order to gain information about the effects of ECT on different neurotransmitter systems.

Results: A significant transient increase in serum prolactin after ECT was found. Furthermore, in females but not males, Δmax prolactin diminished over the course of treatment as prolactin baseline levels increased. β‐endorphin levels showed a stable transient increase after ECTstimulus regardless from sex or treatment.

Conclusion: The reported findings reflect those established in depression. This suggests that they are epiphenomenal to ECT.
Premorbid performance IQ deficit in schizophrenia
Authors: Amminger G. P. , Schlögelhofer M. , Lehner T. , Looser Ott S. , Friedrich M. H. , Aschauer H. N.
Published: March 2003

Objective: Performance IQ (PIQ) is often lower than verbal IQ (VIQ) in schizophrenic patients. Whether PIQ<VIQ precedes psychotic symptoms in schizophrenia remains uncertain.

Method: We investigated premorbid IQ scores in 63 subjects assessed at a child and adolescent psychiatric unit (mean age 13.1 years, SD 3.2), who at follow‐up in adulthood (mean age 30.9 years, SD 3.9) received a lifetime RDC diagnosis of schizophrenia‐related psychosis, affective disorder, or no psychiatric disorder.

Results: Premorbid PIQ<VIQ significantly differentiated the groups with schizophrenia‐related psychosis and no psychiatric disorder. Subjects with schizophrenia‐related psychosis had a significantly lower mean value for premorbid PIQ, but not VIQ, compared to subjects who developed affective disorder or subjects without psychiatric disorder.

Conclusion: Our results emphasize premorbid intellectual deficits in schizophrenia. Those deficits might largely be in consequence of an impairment on the PIQ scale.
Prevalence of dissociative disorders in psychiatric in‐patients: the impact of study characteristics
Authors: Friedl Monica , Draijer Nel , De Jonge Peter
Published: March 2003

Objective: Prevalence rates for dissociative disorders among psychiatric in‐patients vary widely. The aim of this meta‐analysis is to offer an explanation for these differences.

Method: Prevalence studies using a clinical diagnostic interview among psychiatric in‐patients were included. Hypotheses concerning the impact of blind versus not blind designs, choice of diagnostic instrument and continental background were tested.

Results: Nine studies met the inclusion criteria. In blind studies the prevalence rate for dissociative disorders was significantly lower (but not for DID). Studies using the SCID‐D (compared to the DDIS) and European studies had significantly lower prevalence rates for both dissociative disorders as well as for DID.

Conclusion: The choice of diagnostic instrument and cultural differences in interpretation of symptoms are major explanations for differences in prevalence of dissociative disorders and DID. Comparative, blind research using both DDIS and SCID‐D in the assessment of dissociative disorders is advised.
Relapse prevention in major depressive disorder after successful ECT: a literature review and a naturalistic case series
Authors: Wijkstra Jaap , Nolen Willem A. , Algra Ale , Van Vliet Irene M. , Kahn René S.
Published: March 2003

Objective: Medication‐resistance in major depressive disorder (MDD) may be related to high relapse rates after successful ECT when continued medication (C‐MED) is used to prevent relapse. An alternative could be to continue ECT (C‐ECT).

Method: Patients with medication‐resistant MDD responding to ECT were offered C‐ECT without medication. Follow‐up was 6 months. Publications from a literature search were screened against prespecified criteria.

Results: With C‐ECT the 6‐month relapse‐rate was 50% (6/12, 95%CI:21–79) in our medication‐resistant group. In the review we found with C‐ECT 29% (7/24,CI:13–51) in ‘unknown’ medication resistance and no data about medication‐resistant depression. With C‐MED at 6 months: no data were found concerning medication‐resistant depression, 28% (35/124,CI:20–36) in ‘unknown’ resistance and 13% (2/15,CI:2–41) in non‐resistance. With C‐MED at 12 months, 73% (16/22,CI:50–90), 50% (16/32,CI:32–68) and 27% (8/30,CI:12–46) were found, respectively.

Conclusion: The efficacy of C‐MED is related negatively to medication resistance before ECT. This may also be the case for C‐ECT. Further studies with C‐ECT are urgently needed.
Risperidone in treating behavioural disturbances of Prader‐Willi syndrome
Authors: Durst R. , Rubin‐Jabotinsky K. , Raskin S. , Katz G. , Zislin J.
Published: March 2003

Objective: This paper reports the results of risperidone treatment in seven patients (six adults and one adolescent) diagnosed as suffering from Prader‐Willi syndrome (PWS) accompanied by severe behavioural disturbances. Risperidone was chosen following the failure of these patients to respond to other acknowledged modes of treatment for the psychiatric manifestations of PWS.

Method: This was a prospective open‐label study. Measures of Clinical Global Impression Scale (CGIS), Retrospective Overt Aggression Scale (ROAS), Aggression Score (AS) and weight were obtained during two baseline visits and again following 37 weeks of treatment with risperidone.

Results: Low dosages (1–3 mg/day; 1.6 mg/day on average) of risperi‐done brought about notable clinical improvement with no apparent adverse side effects. All measures evaluated — general behaviour, CGIS, OAS and weight — reacted favourably to the treatment protocol.

Conclusion: The preliminary results presented here suggest that risperidone is useful in treating PWS due to its positive effect on the disruptive behavioural symptoms that accompany it.
Prevalence and background factorsof depression in first admittedschizophrenic patients
Authors: Bottlender R. , Strauß A. , Möller H. J.
Published: March 2003

Objective: The aim of this study was to investigate the prevalence and background factors of depression in first admitted schizophrenic patients.

Method: The study is an analysis of 998 consecutively admitted schizophrenic patients with their first hospitalization. Patient's characteristics were prospectively assessed using standardized instruments at the time of first admission and discharge.

Results: High prevalence rates of depressive symptoms were found. Depressed schizophrenic patients were more likely to have suicidal tendencies, were older, more frequently married, less frequently single and unemployed and had more family members with psychiatric disorders other than schizophrenia than the non‐depressed patients. Positive, negative and extrapyramidal symptoms do not have a substantial influence on depression in these patients.

Conclusions: The study suggests that depression represents a distinct psychopathological dimension of the acute illness in first admitted schizophrenic patients. In particular, in light of the suicidal tendencies, recognition and treatment of depression is an important clinical task.
Association between oestradiol and puerperal psychosis
Authors: Riecher‐Rössler A.
Published: March 2003

Objective: Postpartum psychiatric disorders with long‐lasting adverse sequelae are common during the childbearing years. These disorders can be severe and resistant to conventional psychiatric treatment methods. We present two consecutive cases with puerperal psychosis who were refractory to conventional treatment methods but responded successfully to oestrogen therapy.

Method: Serum oestradiol concentration was measured by radioimmunoassay and the documented oestradiol deficiency replaced with physiological oestradiol sublingually. The treatment effect was evaluated by the Brief Psychiatric Rating Scale.

Results: In both cases the baseline oestradiol concentration was low (28 and 69 pmol/L). During the treatment with oestradiol, there was a concomitant elevation of the concentration of serum oestradiol, which coincided with the decline in psychotic symptoms.

Conclusion: The observation of low serum oestradiol together with psychotic symptoms and successful treatment with oestradiol suggests that oestradiol may have a causal relevance to puerperal psychosis and significance in the treatment of this condition.
Specific characteristics of suicide in China
Authors: Qin P. , Mortensen Preben Bo
Published: March 2003

Objective: The aims of this paper are (i) to describe the specific characteristics of suicide in China and compare it with that in a western country, Denmark; and (ii) to discuss the accuracy of suicide data and the possible explanations for suicide behaviour in China.

Method: Data for the study are obtained from the World Health Statistics Annual based on official records in China and the Danish Cause‐of‐Death Register, and standardized according to the age‐specified population of China in 1990.

Results: The specific characteristics of suicide in China differed strikingly from the general pattern of suicide in other western countries as well as in Denmark: suicide rates in females were higher than in males; rural rates were more than three times higher than urban rates; suicide rates peaked for those aged 75+ years, but with a minor peak in females for those aged 15–24 years old.

Conclusion: These specific characteristics of suicide in China may possibly be interpreted in terms of traditional culture, social forces, political environment and economic status.
Bright light therapy of subsyndromal seasonal affective disorder in the workplace: morning vs. afternoon exposure
Authors: Avery D. H. , Kizer D. , Bolte M. A. , Hellekson C.
Published: March 2003

Objective: Bright light therapy in seasonal affective disorder (SAD) has been studied extensively. However, little attention has been given to subsyndromal seasonal affective disorder (SSAD) or the use of bright light in the workplace. Many patients using bright light boxes complain of the inconvenience of use. Much of this inconvenience involves the often‐recommended early timing of the bright light therapy. Patients, who already have difficulty awakening, often have difficulty using the bright light therapy soon after awakening before going to work. If bright light could be used effectively in the workplace, the treatment would be more convenient; the improved convenience would probably improve compliance. In this study, we studied the effectiveness of bright light therapy in subjects with SSAD in the workplace, comparing morning bright light with afternoon bright light.

Method: Morning and afternoon bright light treatment (2500 lux) were compared in 30 subsyndromal seasonal affective disorder patients using the bright light therapy in the workplace. Hamilton Depression Ratings and subjective measures of mood, energy, alertness and productivity were assessed before and after 2 weeks of light therapy.

Results: Both morning and evening bright light significantly decreased the depression ratings and improved the subjective mood, energy, alertness and productivity scores. However, there were no significant differences between the two times of administration of the bright light treatment. Both bright light treatments were well tolerated.

Conclusion: Bright light given in the workplace improves subjective ratings of mood, energy, alertness and productivity in SSAD subjects. Morning and afternoon bright lights resulted in similar levels of improvement.
The genetics of autism
Authors: Lauritsen M. , Ewald H.
Published: March 2003

Objective: To review systematically the empirical evidence for the involvement of genetic risk factors in infantile autism.

Method: We aimed at including all relevant papers written in English. We conducted a Medline search in September 2000. In addition we searched the reference lists of related papers.

Results: A relatively small number of reports including family and twin studies, comorbidity, cytogenetic and molecular genetic studies were reviewed.

Conclusion: As well family, twin, cytogenetic and molecular genetic studies supported the importance of genetic risk factors in infantile autism. In most individual cases probably at least a few gene variants simultaneously determine the genetic risk. Presently the most interesting chromosome regions concerning the aetiology of autism are chromosomes 7q31–35, 15q11–13 and 16p13.3 which have been suggested by different lines of genetic research.
Reasoning about the optimal duration of prophylactic antipsychotic medication in schizophrenia: evidence and arguments
Authors: Bosveld‐van Haandel L. J. M. , Slooff C. J. , Van Den Bosch R. J.
Published: March 2003

Objective: To review evidence‐based literature regarding the necessary duration of antipsychotic relapse prevention in schizophrenia and related psychoses.

Method: A computerized search was performed on Medline, Embase Psychiatry and PsycLIT which covered the period 1974–99. We also used cross‐references.

Results: Although schizophrenia refers mainly to an intrinsic biological vulnerability, only maintenance studies with a follow‐up of 2 years at most are available. Relapses appear unpredictable and occur even after long‐term successful remission during antipsychotic treatment.

Conclusion: Since rehabilitation efforts have effects only after long‐term endeavours, antipsychotic relapse prevention should be maintained for long periods. It is reasonable to treat patients suffering from schizophrenia and related psychoses for longer periods than indicated by the current guidelines.
Subclinical suspiciousness as a risk factor for depressive episodes
Authors: Messias Erick , Kirkpatrick Brian
Published: March 2003

Objective: Previous studies suggest suspiciousness is associated with an increased risk of major depressive episodes in psychotic patients. We tested the hypothesis that this relationship would extend to nonpsychotic groups.

Method: Data came from the Epidemiological Catchment Area (ECA) study, a longitudinal population‐based study conducted at five sites in the United States. Baseline clinical and demographic features were used to predict the onset of episodes of depression at 1‐year follow‐up in subjects without psychotic symptoms.

Results: Subclinical suspiciousness was associated with an increased risk of new episodes of depression after accounting for demographic variables. However, three of six subclinical delusion‐like experiences were also associated with an increased risk of depressive episodes. None of the subclinical hallucination‐like experiences predicted subsequent risk.

Conclusion: Subclinical suspiciousness appears to increase the risk of depression in the general population. Some other delusion‐like experiences may do the same.
Ward atmosphere in acute psychiatric in‐patient care: patients' perceptions,ideals and satisfaction
Authors: Middelboe Thomas , Schjødt Torben , Byrsting Karin , Gjerris Annette
Published: March 2003

Objective: To investigate the relationship between patients' perception of the real and ideal ward atmosphere and their satisfaction.

Method: Patients filled in the Ward Atmosphere Scale (WAS, Real and Ideal Form) and a satisfaction questionnaire. Patient characteristics were derived from clinical assessments.

Results: WAS ratings were almost independent of patient characteristics. Patients in locked wards perceived more anger and aggression and patients subjected to coercive measures perceived less autonomy and practical orientation. Patient satisfaction was predicted by higher scores on the WAS Relationship‐ and System Maintenance dimensions, explaining 41% of the variance. In particular support, order and organization predicted satisfaction. Except from the areas of anger/aggression and staff control, patients gave the ‘ideal’ ward higher ratings on all subscales. The perceived gap between the ‘ideal’ and ‘real’ ward explained 45% of variance in satisfaction.

Conclusion: Patients' perception of ward atmosphere is a clinically meaningful measure appearing to be a strong predictor of satisfaction.
Platelet serotonin transporters and the transporter gene in control subjects, unipolar patients and bipolar patients
Authors: Mellerup Erling , Bennike Bente , Bolwig Tom , Dam Henrik , Hasholt Lis , Balslev Jørgensen Martin , Plenge Per , Asger Sørensen Sven
Published: March 2003

Objective: The purpose of the present study was to relate the number of platelet serotonin transporters in unipolar and bipolar patients and in control subjects to two polymorphisms in the serotonin transporter gene: a VNTR in intron 2 and a deletion/insertion in the promoter region.

Method: Density of platelet serotonin transporters was determined by radioligand binding analysis. Genotyping was performed by PCR amplification of polymorphic regions followed by size determination of the obtained fragments.

Results: The control subjects and the two groups of patients were similar with respect to the genotype and allele distribution belonging to the two polymorphisms in the serotonin transporter gene for. An interaction between status (control, unipolar‐ or bipolar patient) and VNTR genotype regarding the number of platelet serotonin transporters was observed; unipolar patients with the genotype 12/10 had more platelet serotonin transporters than bipolar patients and controls with this genotype. No association related to the polymorphism was found in the promoter region of the serotonin transporter gene.

Conclusion: An association was observed between the polymorphism in intron 2 of the serotonin transporter gene and the number of platelet serotonin transporters. Unipolar patients with a particular genotype had more platelet serotonin transporters than the corresponding controls and bipolar patients.
A structured interview guide increases Brief Psychiatric Rating Scale reliability in raters with low clinical experience
Authors: Crippa J.A.S. , Sanches R.F. , Hallak J.E.C. , Loureiro S.R. , Zuardi A.W.
Published: March 2003

Objective: To assess the beneficial impact of a structured interview on the reliability of BPRS ratings in raters with low clinical experience.

Method: Each patient was rated once a week in two separate interviews, conducted on the same day. The first interview was conducted by a rater with low clinical experience (recruited from a group of five residents in psychiatry and one clinical psychologist in training). All second interviews were conducted by the same highly experienced psychiatrist.

Results: The number of items with full agreement between observers increased with the use of SIG. The value of intraclass correlation coefficients for individual items and the total score also increased, approaching reported studies with experienced raters.

Conclusion: These results suggest that the use of SIG reduces variability of information gathering in reliability testing of BPRS with less experienced raters.
A review of the epidemiological transition in dementia — cross‐national comparisons of the indices related to Alzheimer's disease and vascular dementia
Authors: Suh Guk‐Hee , Shah Ajit
Published: March 2003

Objective: To examine temporal changes in the prevalence of dementia and associated factors.

Method: All publications on the epidemiology of dementia were identified using a medline search for the years 1966–1999.

Results: Alzheimer's disease (AD) has become nearly twice as prevalent as vascular dementia (VaD) in Korea, Japan, and China since transition in early 1990s. Prior to this, in the 1980s, VaD was more prevalent than AD in these countries. In Nigeria, the prevalence of dementia was low. Indian studies were contradictory, with both AD and VaD being more prevalent in different studies. American and European studies consistently reported AD to be more prevalent than VaD.

Conclusion: A theoretical model of transition from low incidence–high mortality society to high incidence–high mortality society to low incidence–low mortality society may explain these findings. Rigorous testing in prospective, longitudinal and population‐based cross‐national studies using culture‐fair diagnostic instruments is required.
Prevalence of mental illness in homeless men in Munich, Germany: results from a representative sample
Authors: Fichter Manfred M. , Quadflieg Norbert
Published: March 2003

Objective: The aim of the study was a reliable assessment of the prevalence of DSM‐IV mental disorders in a representative sample of homeless men in the city of Munich.

Method: A preliminary survey yielded an estimate of 1022 single homeless men in Munich divided among three sectors (shelter users, service users and street dwellers). A random sample of 265 single homeless men was surveyed from these three sectors. An age‐matched comparison group of 178 men was selected randomly from a community register. The Structured Clinical Interview for DSM‐IV (SCID‐IV) was used for diagnostic classification.

Results: The lifetime prevalence rates of mental disorders were as follows: 72.7% vs. 15.2% for alcohol dependence, 32.8% vs. 7.3% for mood disorders, 15.9% vs. 6.2% for anxiety disorders and 9.8% vs. 0.6% for psychotic disorders. Of the homeless males in Munich, 93.2% had at least one lifetime DSM‐IV axis I diagnosis, while this was the case for only 38.2% of the community controls. One‐month prevalence for all SCID DSM‐IV axis I disorders in homeless males was 73.4%.

Conclusion: Lifetime DSM‐IV axis I mental disorders were 2.4 times more frequent among homeless individuals compared to community control. Implications for health care planning are discussed.
Telepsychiatry: assessment of televideo psychiatric interview reliability with present‐ and next‐generation internet infrastructures
Authors: Yoshino Aihide , Shigemura Jun , Kobayashi Yuji , Nomura Soichiro , Shishikura Kurie , Den Ryosuke , Wakisaka Hitoshi , Kamata Shiho , Ashida Hiroshi
Published: March 2003

Objective: We assessed the reliability of remote video psychiatric interviews conducted via the internet using narrow and broad bandwidths.

Method: Televideo psychiatric interviews conducted with 42 in‐patients with chronic schizophrenia using two bandwidths (narrow, 128 kilobits/s; broad, 2 megabits/s) were assessed in terms of agreement with face‐to‐face interviews in a test–retest fashion. As a control, agreement was assessed between face‐to‐face interviews. Psychiatric symptoms were rated using the Oxford version of the Brief Psychiatric Rating Scale (BPRS), and agreement between interviews was estimated as the intraclass correlation coefficient (ICC).

Results: The ICC was significantly lower in the narrow bandwidth than in the broad bandwidth and the control for both positive symptoms score and total score.

Conclusion: While reliability of televideo psychiatric interviews is insufficient using the present narrow‐band internet infrastructure, the next generation of infrastructure (broad‐band) may permit reliable diagnostic interviews.
Increased libido in a woman treated with fluvoxamine: a case report
Authors: Hori Hiroko , Yoshimura Reiji , Nakamura Jun
Published: March 2003

Objective: The aim of this paper is to describe a case of increased libido during fluvoxamine therapy.

Method: Single case report.

Results: The patient, a 27‐year‐old married Japanese woman with borderline personality disorder, developed an increased libido with the administration of fluvoxamine. The increased libido disappeared after fluvoxamine was discontinued.

Conclusion: The present findings suggest that fluvoxamine can cause increased libido in some patients.
OCD and transvestism: is there a relationship?
Authors: Abdo Carmita Helena Najjar , Hounie Ana , De Tubino Scanavino Marco , Miguel Euripedes Constantino
Published: March 2003

Objective: There have been reports of obsessive‐compulsive disorder (OCD) patients with comorbid paraphilias. In this paper, two cases of comorbidity between OCD and transvestism are reported with the aim of discussing possible explanations for this association.

Method: Longitudinal case studies of two patients with OCD and tranvestism according to the DSM‐IV were assessed using semi‐structured interviews.

Results: Both patients presented with OCD and comorbid transvestism with different clinical features and treatment response. The case whose cross‐dressing was more egodystonic responded better to treatment.

Conclusion: It is possible that some cases of transvestism are OCD‐related while others are more related to a gender identity disorder. A dimensional approach focusing on common phenomenological and neurobiological substrates is suggested as particularly useful for clinical management and future research of both disorders.
Late‐onset bipolar disorder due to hyperthyroidism
Authors: Nath Jisu , Sagar Rajesh
Published: March 2003

Objective: Bipolar disorder starts typically in early age and late‐onset cases are rare. Late‐onset cases are more likely to have comorbid medical illnesses responsible for them. This case report highlights late‐onset bipolar disorder due to hyperthyroidism.

Method: A 65‐year‐old patient of bipolar disorder has been described.

Result: Physical examination and laboratory investigations detected presence of hyperthyroidism and the patient was treated with antithyroid and anxiolytics.

Conclusion: A thorough examination and investigation are required in late‐onset cases of bipolar disorder to rule out secondary causes. Definitive antimanic agents or mood stabilizers may not be required in such cases.
The Parma High School Epidemiological Survey: obsessive‐compulsive symptoms
Authors: Maggini C. , Ampollini P. , Gariboldi S. , Cella P. L. , Peqlizza L. , Marchesi C.
Published: March 2003

Objective: This study was undertaken to assess the prevalence of obsessive‐compulsive symptoms in a population of Italian adolescents.

Method: A sample of 2877 high‐school students, 1463 males (51%) and 1414 females (49%), aged 16–21 years were assessed with the Leyton Obsessional Inventory — Child Version (LOI‐CV). Two groups of subjects were defined as ‘positive’ on the screen: the high interference (HI) (i.e. all subjects who scored 25 or more in the interference score), and the supernormals (Sn).

Results: Females scored higher than males both on yes and interference scores. One hundred and nineteen (4.1%) and 87 (3.0%) constitute, respectively, the HI and the Sn groups. The most interfering symptoms were obsessions linked to dirt phobia, rumination and nail biting.

Conclusion: The prevalence estimates of OCD symptoms confirmed the recent data of the literature that adolescent OCD symptoms are more frequent than was believed previously. Females showed more symptoms and more interference on personal functioning than males.