bluuebunny/crossref_metadata_2025 huggingface dataset:
Development, internal consistency and reliability of the Verona Service Satisfaction Scale – European Version
Authors: Ruggeri Mirella , Lasalvia Antonio , Dall'Agnola Rosa , Van Wijngaarden Bob , Knudsen Helle Charlotte , Leese Morven , Gaite Luis , Tansella Michele ,   EPSILON Study Group
Published: August 2002

Background

Satisfaction with mental health services is an important quality and outcome variable. The Verona Service Satisfaction Scale (VSSS) is a well-established method for measuiring service satisfaction.

Aim

To report the development and reliability study of the European Version of the VSSS (VSSS–EU).

Method

A sample of people with schizophrenia on the case-load of local mental health services in the five European participating countries was assessed. The VSSS–EU was administered at one site in each country at two points in time. Internal consistency and test–retest reliability were assessed and compared between the five sites.

Results

The α coefficient for the VSSS–EU total score in the pooled sample was 0.96 (95% CI 0.94–0.97) and ranged from 0.92 (95% CI 0.60–1.00) to 0.96 (95% CI 0.93–0.98) across the sites. Test–retest reliability for VSSS–EU total score, pooled over sites, was 0.82 (95% CI 0.78–0.85) and ranged from 0.73 (95% CI 0.6–0.86) to 0.93 (95% CI 0.89–0.97) across the sites.

Conclusion

VSSS–EU is a reliable instrument for measuring service satisfaction in people with schizophrenia, for use in comparative cross-national research projects and in routine clinical practice in mental health services across Europe.
Quality of life in schizophrenia: development, reliability and internal consistency of the Lancashire Quality of Life Profile – European Version
Authors: Gaite Luis , Vázquez-Barquero José Luis , Arrizabalaga Andrés Arriaga , Schene Aart H. , Welcher Birgitte , Thornicroft Graham , Ruggeri Mirella , Vázquez-Bourgon Elena , Retuerto Modesto Pérez , Leese Morven ,   EPSILON Study Group
Published: August 2002

Background

This paper, part of the European Psychiatric Services: Inputs Linked to Outcome Domains and Needs (EPSILON) Study, reports the development, reliability and internal consistency of the Lancashire Quality of Life Profile – European Version (LQoLP–EU) in a representative sample of people with schizophrenia from five European sites.

Method

The LQoLP–EU was administered to a total sample of 404 patients to check its internal consistency, and a sub-sample of 294 patients was interviewed a second time within 7–15 days to verify its test–retest reliability.

Results

Internal consistency of the total domains, perceived QoL scale (Life Satisfaction Scale, LSS) was good at 0.87. Of the nine subjective QoL domains Work and Leisure showed the lowest internal consistency (0.30 and 0.56 respectively), the values of the remaining sub-scales ranging between 0.62 and 0.88. The pooled ICC score for LSS was 0.82, and for the nine subjective QoL domain sub-scales it ranged from 0.61 (Safety) to 0.75 (Living Situation). There were significant differences between the sites inαand ICCs for sub-scales, but not for the LSS.

Conclusion

The LQoLP-EU has good internal consistency and reliability in the five European centres.
Translation and cross-cultural adaptation of outcome measurements for schizophrenia
Authors: Knudsen Helle Charlotte , Vázquez-Barquero José Luis , Welcher Birgitte , Gaite Luis , Becker Thomas , Chisholm Daniel , Ruggeri Mirella , Schene Aart H. , Thornicroft Graham
Published: August 2002

Background

Research on the comparison of mental health services has identified the need for internationally standardised and reliable measurements.

Aims

To describe the strategies adopted in the European Psychiatric Services: Inputs Linked to Outcome Domains and Needs (EPSILON) Study for the translation and cross-cultural adaptation of five European versions of the instruments.

Method

A protocol was developed for translation of the outcome scales, describing each step in the translation procedure. Disputed items were discussed in focus groups, which faced seven tasks: a list of topics to be discussed; choosing where the group should meet; composition of participants; conducting the group; data collection; data completion afterwards; reporting results.

Results

Modifications made to instruments were: changes in the instrument structure, contents and concepts; adjustments to the instrument structure; and modifications to the instrument manual.

Conclusion

Use of focus groups is an adequate method to apply if concepts, constructs and translation issues are to be addressed; otherwise, less time-consuming methods should be considered.
Predictive value of pharmacological activity for the relative efficacy of antidepressant drugs
Authors: Freemantle N. , Anderson I. M. , Young P.
Published: August 2002

Background

There is uncertainty about the contribution of specific pharmacological properties to the efficacy of antidepressants.

Aims

To assess whether specific pharmacological characteristics of alternative antidepressants resulted in altered efficacy compared to that of selective serotonin reuptake inhibitors in the treatment of major depression.

Method

Meta-regression analysis of randomised trials that compare treatment with a selective serotonin reuptake inhibitor and an alternative antidepressant.

Results

One-hundred-and-five randomised trials were included. None of the factors identified a priori predicted a statistically significant improvement in outcome across the trials.

Conclusions

This analysis does not provide evidence that antidepressants acting at more than one pharmacological site differ in efficacy from drugs selective for serotonin reuptake in the treatment of major depression.
Violence risk prediction
Authors: Dolan M. , Doyle M.
Published: August 2002

Background

Violence risk prediction is a priority issue for clinicians working with mentally disordered offenders.

Aims

To review the current status of violence risk prediction research.

Method

Literature search (Medline). Key words: violence, risk prediction, mental disorder.

Results

Systematic/structured risk assessment approaches may enhance the accuracy of clinical prediction of violent outcomes. Data on the predictive validity of available clinical risk assessment tools are based largely on American and North American studies and further validation is required in British samples. The Psychopathy Checklist appears to be a key predictor of violent recidivism in a variety of settings.

Conclusions

Violence risk prediction is an inexact science and as such will continue to provoke debate. Clinicians clearly need to be able to demonstrate the rationale behind their decisions on violence risk and much can be learned from recent developments in research on violence risk prediction.
Assessing effectiveness of treatment of depression in primary care
Authors: Bedi Navjot , Chilvers Clair , Churchill Richard , Dewey Michael , Duggan Conor , Fielding Katherine , Gretton Virginia , Miller Paul , Harrison Glynn , Lee Alan , Williams Idris
Published: August 2002

Background

There is a mismatch between the wish of a patient with depression to have counselling and the prescription of antidepressants by the doctor.

Aims

To determine whether counselling is as effective as antidepressants for depression in primary care and whether allowing patients to choose their treatment affects their response.

Method

A partially randomised preference trial, with patients randomised to either antidepressants or counselling or given their choice of either treatment. The treatment and follow-up were identical in the randomised and patient preference arms.

Results

There were 103 randomised and 220 preference patients in the trial. We found: no differences in the baseline characteristics of the randomised and preference groups; that the two treatments were equally effective at 8 weeks, both for the randomised group and when the randomised and patient preference groups for a particular treatment were combined; and that expressing a preference for either treatment conferred no additional benefit on outcome.

Conclusions

These data challenge several assumptions about the most appropriate treatment for depression in a primary care setting.
Patient-held shared care records for individuals with mental illness
Authors: Warner James P. , King Michael , Blizard Robert , McClenahan Zara , Tang Sylvia
Published: August 2002

Background

Few formalised shared care schemes exist within psychiatry and the evidence base for sharing psychiatric care is weak.

Aims

To evaluate the utility of patient-held shared care records for individuals with long-term mental illness.

Method

Cluster-randomised controlled parallel-group 12-month trial involving 90 patients with long-term mental illness drawn from 28 general practices.

Results

Carrying a shared care record had no significant effect on mental state or satisfaction with psychiatric services. Compared with controls, patients in the shared care group were no more likely to be admitted (relative risk 1.2, 95% CI 0.86–1.67) and attend clinic (relative risk 0.96, 95% CI 0.67–1.36) over the study period. Uptake of the shared care scheme was low by patients and professionals alike. Subjects with psychotic illness were significantly less likely to use their records (relative risk 0.51, 95% CI 0.27–0.99).

Conclusions

Patient-held records may not be helpful for patients with long-term mental illness.
The Australian National Survey of Mental Health and Well-Being
Authors: Korten Ailsa , Henderson Scott
Published: August 2002

Background

The mental health of populations can be represented by case prevalence rates and by symptom scales. Scales have the advantage of identifying sub-syndromal levels of distress, which may be common and associated with considerable disability.

Aims

To examine the distribution of common psychological symptoms and associated disablement in the Australian population.

Method

A household sample of 10 641 individuals representative of the adult population of Australia was interviewed using the Composite International Diagnostic Interview and completed scales measuring recent symptoms and disablement.

Results

Symptom scales showed similar associations with socio-economic variables as did diagnoses, although only a small amount of variance in symptom levels was explained by these variables. Considerable disablement was associated with symptom levels indicating distress but not reaching levels for formal diagnoses of anxiety or depression.

Conclusions

Symptom scales provide parsimonious measures of psychological distress and are appropriate for use in large-scale surveys of mental health and disablement.
Time to recovery of an inception cohort with hitherto untreated unipolar major depressive episodes
Authors: Furukawa Toshiaki A. , Kitamura Toshinori , Takahashi Kiyohisa
Published: August 2002

Background

Generalisability of existing studies on the naturalistic history of major depression is undermined by overrepresentation of in-patients and tertiary care academic centres, inclusion of patients already on treatment and/or incomplete follow-up.

Aims

To report the time to recovery of an inception cohort of unipolar major depressive episodes.

Method

A multi-centre prospective follow-up study of patients with a mood disorder, who had been selected to be representative of the untreated first-visit patients at 23 psychiatric settings from all over Japan.

Results

The median time to recovery of the index episode after treatment commencement was 3 months (95% CI 2.5–3.6): 26% of the cohort reached asymptomatic or minimally symptomatic status by I month, 63% by 3 months, 85% by 12 months and 88% by 24 months.

Conclusions

Our estimate of the episode length was 25–50% shorter than estimates reported in the literature.
Association of depression and gender with mortality in old age
Authors: Schoevers R. A. , Geerlings M. I. , Beekman A. T. F. , Penninx B. W. J. H. , Deeg D. J. H. , Jonker C. , Tilburg W. Van
Published: August 2002

Background

The association between depression and increased mortality risk in older persons may depend on the severity of the depressive disorder and gender.

Aims

To investigate the association between major and mild depressive syndromes and excess mortality in community-living elderly men and women.

Method

Depression (Geriatric Mental State AGECAT) was assessed in 4051 older persons, with a 6-year follow-up of community death registers. The mortality risk of neurotic and psychotic depression was calculated after adjustment for demographic variables, physical illness, cognitive decline and functional disabilities.

Results

A total of 75% of men and 41% of women with psychotic depression had died at follow-up. Psychotic depression was associated with significant excess mortality in both men and women. Neurotic depression was associated with a 1.67-fold higher mortality risk in men only.

Conclusions

In the elderly, major depressive syndromes increase the risk of death in both men and women, but mild depression increases the risk of death only in men.
Impact of emotion on memory
Authors: Kazui Hiroaki , Mori Etsuro , Hashimoto Mamoru , Hirono Nobutsugu , Imamura Toru , Tanimukai Satoshi , Hanihara Tokiji , Cahill Larry
Published: August 2002

Background

In an earlier study we showed that a powerful emotional experience (the Kobe earthquake) reinforced memory retention in patients with Alzheimer's disease, but we could not control factors other than the emotional impact of the earthquake.

Aims

To test our previous findings in a controlled experimental study.

Method

Recall tests consisting of two short stories were administered to 34 patients with Alzheimer's disease and 10 normal subjects. The two stories were identical except for one passage in each story: one was emotionally charged (arousing story) and the other (neutral story) was not.

Results

In both groups, the emotionally charged passage in the arousing story was remembered better than the counterpart in the neutral story. In addition, the extent of the memory improvement was similar in the subjects and in the controls.

Conclusions

The results provide further evidence that emotional arousal enhances declarative memory in patients with Alzheimer's disease, and give a clue to the management of people with dementia.
Nithsdale Schizophrenia Surveys 20
Authors: Kelly C. , Sharkey V. , Morrison G. , Allardyce J. , McCreadie R. G.
Published: August 2002

Background

Cognitive deficits are a core aspect of schizophrenia but there has been no study of cognitive function in a catchment-area-based population of patients with schizophrenia.

Aims

To assess cognitive function in a population of patients with schizophrenia, and relate it to community functioning.

Method

All patients with schizophrenia in Nithsdale, south-west Scotland, were identified (n=182). Measures of assessment were: National Adult Reading Test (NART), Mini-Mental State Examination (MMSE), Rivermead Behavioural Memory Test (RBMT), Executive Interview (EXIT), FAS Verbal Fluency and Health of the Nation Outcome Scales (HoNOS).

Results

We assessed 138 patients, mean age 48 years (standard deviation (s.d.) 15). Only 14% were in-patients. The mean premorbid IQ as assessed by NART was 98 (s.d. 14); 15% of patients had significant global cognitive impairment (MMSE); 81% had impaired memory (RBMT); 25% had executive dyscontrol (EXIT); and 49% had impaired verbal fluency (FAS). Scores on the functional impairment sub-scale of HoNOS correlated with all measures of cognitive impairment.

Conclusions

Cognitive dysfunction is pervasive in a community-based population of patients with schizophrenia.
Third ventricle enlargement and developmental delay in first-episode psychosis: preliminary findings
Authors: Fannon Dominic , Tennakoon Lakshika , Sumich Alex , O'Ceallaigh Seamus , Doku Victor , Chitnis Xavier , Lowe Jennifer , Soni William , Sharma Tonmoy
Published: August 2002

Background

Third rather than lateral ventriculomegaly may be a more specific finding in psychosis. The relevance of ventricular abnormality remains unclear.

Aims

To investigate the developmental correlates of ventricular enlargement.

Method

Information on childhood development and magnetic resonance images in 1.5-mm contiguous sections were collected on 21 patients experiencing a first episode of psychosis.

Results

Patients (n=21) had significantly less whole brain volume and enlarged third and lateral ventricles compared to controls (n=25). Third ventricle (r=0.48,P< 0.03) and lateral ventricle (r=0.65,P< 0.01) volumes correlated with developmental score. Patients with developmental delay had significantly larger third and lateral ventricles than those without.

Conclusions

Enlargement of both third and lateral ventricles is found in first-episode psychosis and is related to developmental delay in childhood. Insult to periventricular areas is relevant to the neurobiology of the disease. These findings support the view that schizophrenia involves disturbance of neurodevelopmental processes in some patients.
Psychosocial and psychiatric risk factors for suicide
Authors: Cheng Andrew T. A. , Chen Tony H. H. , Chen Chwen-Chen , Jenkins Rachel
Published: August 2002

Background

Few studies of suicide have simultaneously examined the individual and combined effects of psychosocial and psychiatric risk factors.

Aims

To do so in a representative sample of suicides.

Method

A case-control psychological autopsy was conducted among 113 consecutive suicides and 226 living controls matched for age, gender, ethnicity and area of residence inTaiwan.

Results

Five major risk factors (loss event, suicidal behaviour in first-degree relatives, ICD–10 major depressive episode, emotionally unstable personality disorder and substance dependence) were found to have independent effects on suicide from multivariate conditional logistic regression analysis.

Conclusions

Effective intervention and management for loss event and major depressive episode among emotionally unstable subjects with a family tendency of suicidal behaviour, frequently also comorbid with alcohol or other substance dependence, may prove to be most effective for suicide prevention in different populations.
Seasonal variation in suicides: diminished or vanished
Authors: Yip Paul S. F. , Chao Anne , Chiu Calvin W. F.
Published: August 2002

Background

Seasonal variation in suicidal death has been observed in many countries. In particular, a cyclic variation was found for both men and women in England and Wales in the 1960s and 1970s. Men showed a single 12-month cycle whereas women showed two cycles.

Aims

To re-examine the seasonal variation in suicides in England and Wales for the period 1982–1996.

Method

A harmonic analysis was used to detect the seasonality of the suicide data.

Results

The seasonal effect on suicide is greatly diminished in England and Wales. This is shown by the reduced amplitude and smaller proportion of variance accounted for by the season.

Conclusions

The seasonal effect on suicide has either diminished or vanished.
Focus on psychiatry in Poland
Authors: Balicki Marek , Leder Stefan , Piotrowski Andrzej
Published: August 2002

The German occupation of Poland in 1939 was accompanied by the destruction of the existing medical system, and the first victims of the Nazi terror were psychiatric patients in hospitals – around 15 000 were exterminated and about 10 000 died as a result of malnourishment.
Future therapeutic targets in mood disorders: the glucocorticoid receptor
Authors: McQuade Richard , Young Allan H.
Published: August 2002

Background

The hypercortisolaemia and dysfunction of the hypothalamic–pituitary–adrenal (HPA) axis associated with mood disorders have been attributed to a breakdown in the glucocorticoid-receptor-mediated negative feedback mechanism regulating HPA activity. Reinstating normal feedback may be therapeutic in mood disorders.

Aims

To review the evidence for the involvement of the glucocorticoid receptor in the pathogenesis and treatment of mood disorders.

Method

Medline and hand searches were carried out, selecting literature relevant to psychiatrists and psychopharmacologists.

Results

A dysfunction in glucocorticoid receptors is integral to the HPA abnormalities of mood disorders. Antidepressant and mood-stabilising drugs can up-regulate glucocorticoid receptors, restoring glucocorticoid function. Preliminary clinical studies targeting the glucocorticoid receptor are encouraging.

Conclusions

Drugs designed specifically to up-regulate glucocorticoid receptors may be integral to future strategies in treating mood disorders.
Mental health literacy
Authors: Jorm A. F.
Published: August 2002

Background

Although the benefits of public knowledge of physical diseases are widely accepted, knowledge about mental disorders (mental health literacy) has been comparatively neglected.

Aims

To introduce the concept of mental health literacy to a wider audience, to bring together diverse research relevant to the topic and to identify gaps in the area.

Method

A narrative review within a conceptual framework.

Results

Many members of the public cannot recognise specific disorders or different types of psychological distress. They differ from mental health experts in their beliefs about the causes of mental disorders and the most effective treatments. Attitudes which hinder recognition and appropriate help-seeking are common. Much of the mental health information most readily available to the public is misleading. However, there is some evidence that mental health literacy can be improved.

Conclusions

If the public's mental health literacy is not improved, this may hinder public acceptance of evidence-based mental health care. Also, many people with common mental disorders may be denied effective self-help and may not receive appropriate support from others in the community.
Immediate effects of risperidone on cortico–striato–thalamic loops and the hippocampus
Authors: Liddle Peter F. , Lane Carol J. , Ngan Elton T. C.
Published: August 2002

Background

Functional imaging studies indicate that delusions and hallucinations in schizophrenia are associated with overactivity of the left hippocampus and ventral striatum. Hippocampal neuronal firing modulates feedback to cortex via cortico–striato–thalamic loops.

Aims

To test the hypothesis that recovery from psychosis is associated with decrease in activity in cortico–striato–thalamic circuits, and, furthermore, that reduction in hippocampal activity predicts the degree of alleviation of delusions and hallucinations.

Method

Positron emission tomography (PET) was used to measure the effects of the atypical antipsychotic, risperidone, on glucose metabolism in eight first-episode schizophrenia patients.

Results

A single dose of risperidone produced decreases in metabolism in ventral striatum, thalamus and frontal cortex. The magnitude of decreases in left hippocampus predicted subsequent reduction in delusions and hallucinations. After six weeks' treatment with risperidone, the decreases in frontal metabolism were more extensive.

Conclusions

The mechanism of antipsychotic action of risperidone entails reduction of hippocampal activity together with reduced feedback via cortico–striato–thalamic loops.
Striatal and extra-striatal D2/D3 dopamine receptor occupancy by quetiapine in vivo
Authors: Stephenson C. M. E. , Bigliani V. , Jones H. M. , Mulligan R. S. , Acton P. D. , Visvikis D. , Ell P. J. , Kerwin R. W. , Pilowsky L. S.
Published: August 2002

Background

Selective action at limbic cortical dopamine D2-like receptors could mediate atypical antipsychotic efficacy with few extrapyramidal side-effects.

Aims

To test the hypothesis that quetiapine has ‘limbic selective’ D2/D3 receptor occupancy in vivo.

Method

The high-affinity D2/D3 ligand [123I]-epidepride and single photon emission tomography were used to estimate D2/D3 specific binding and an index of relative percentage D2/D3 occupancy in striatal and temporal cortical regions for quetiapine-treated patients (n=6). Quetiapine-, and previously studied typical-antipsychotic- and clozapine-treated patients were compared.

Results

Mean (s.d.) relative percentage D2/D3 receptor occupancy by quetiapine was 32.0% (14.6) in striatum and 60.1% (17.2) in temporal cortex (mean daily dose 450 mg: range 300–700 mg/day). Quetiapine treatment resulted in limbic selective D2/D3 blockade similar to clozapine and significantly higher than typical antipsychotics.

Conclusions

Preliminary data suggest that limbic selective D2/D3 receptor blockade is important for atypical drug action.
Non-psychotic psychiatric disorder and subsequent risk of schizophrenia
Authors: Lewis Glyn , David Anthony S. , Malmberg Aslög , Allebeck Peter
Published: August 2002

Background

Those with schizophrenia often give a history of premorbid non-psychotic psychiatric disorder.

Aims

To investigate the association between non-psychotic psychiatric disorders and the later development of schizophrenia.

Method

Men aged 18 or 19 years, conscripted to the Swedish army in 1970 (n=50 054) were linked to the Swedish National Psychiatric Case Register.

Results

There was an increased risk of schizophrenia in those with ICD–8 diagnoses of neurosis (OR=4.6,95% CI 3.2–6.9), personality disorder (OR=8.2, 95% CI 5.4–12.3), alcohol abuse (OR=5.5, 95% CI 1.7–17.5) or substance abuse (OR=14.0, 95% CI 7.8–25.0) at age 18. Of those who developed schizophrenia, 38% (95% CI 32–45) received a diagnosis of non-psychotic psychiatric disorder at age 18. Only those with personality disorder had a significantly increased risk of schizophrenia (OR=2.4, 95% CI 1.1–5.2) with onset after age 23.

Conclusions

Personality factors could represent an underlying vulnerability to schizophrenia. Other diagnoses occurring before schizophrenia may reflect a prodromal phase of the illness.
Ten-year outcome: patients with schizoaffective disorders, schizophrenia, affective disorders and mood-incongruent psychotic symptoms
Authors: Harrow Martin , Grossman Linda S. , Herbener Ellen S. , Davies Elizabeth W.
Published: August 2002

Background

It is unclear whether outcome in schizoaffective disorders is more similar to schizophrenia or affective disorders.

Aims

To provide longitudinal data on clinical course and outcome in schizoaffective disorders versus schizophrenia and affective disorders, and determine whether mood-incongruent psychotic symptoms have negative prognostic implications.

Method

A total of 210 patients with schizoaffective disorders, schizophrenia, bipolar manic disorders and depression were assessed at hospitalisation and then followed up four times over 10 years.

Results

At all four follow-ups, fewer patients with schizoaffective disorders than with schizophrenia showed uniformly poor outcome. Patients with mood-incongruent psychotic symptoms during index hospitalisation showed significantly poorer subsequent outcome (P< 0.05).

Conclusions

Schizoaffective outcome was better than schizophrenic outcome and poorer than outcome for psychotic affective disorders. Mood-incongruent psychotic symptoms have negative prognostic implications. The results could fit a symptom dimension view of schizoaffective course.
Effects of behavioural family management on family communication and patient outcomes in schizophrenia
Authors: Bellack Alan S. , Haas Gretchen L. , Schooler Nina R. , Flory Janine D.
Published: August 2002

Background

Family interventions for schizophrenia have proved to be highly effective in preventing relapse, but it is not clear how they work or how they should be structured.

Aims

To examine the effects of a behavioural family intervention and a family support programme on communication, problem solving and outcome in order to determine the impact of structured communication training.

Method

Patients and family members participating in the Treatment Strategies in Schizophrenia study were videotaped engaging in 10-minute problem-solving conversations at baseline and after the conclusion of the family intervention. Tapes were subsequently evaluated for changes in communication patterns.

Results

The intensive behavioural intervention did not produce differential improvement in communication, and change in communication was unrelated to patient outcomes.

Conclusions

The data suggest that intensive behavioural family interventions may not be cost efficient, and that change in family communication patterns may only be important for a subset of families.
Effects of cognitive therapy on psychological symptoms and social functioning in residual depression
Authors: Scott Jan , Teasdale John D. , Paykel Eugene S. , Johnson Anthony L. , Abbott R. , Hayhurst H. , Moore R. , Garland A.
Published: August 2002

Background

About 30% of psychiatric out-patients with major depression demonstrate partial remission.

Aims

To explore whether the addition of cognitive therapy (CT) had any differential effect on residual symptoms or social adjustment.

Method

Patients with residual symptoms of major depression (n=158) were randomised to receive clinical management (CM) alone, or CM plus 18 sessions of CT. Subjects' depressive symptoms and social functioning were assessed regularly over 16 months.

Results

The addition of CT produced statistically significant differential effects on: two out of four measures of overall severity of depression; specific psychological symptoms (guilt, self-esteem and hopelessness); and social functioning (including dependency, interpersonal behaviour and friction).

Conclusions

In patients showing only partial response to antidepressants, the addition of CT produced modest improvements in social and psychological functioning. The implications for research on the mechanisms of action of CT are discussed.
Effects of acute tryptophan depletion on mood and suicidal ideation in bipolar patients symptomatically stable on lithium
Authors: Hughes J. H. , Dunne F. , Young A. H.
Published: August 2002

Background

Previous studies suggest that brain serotonin neurotransmission may mediate the actions of lithium carbonate. Acute tryptophan depletion reduces brain serotonin and allows the study of this neurotransmitter in patient groups.

Aims

To examine the effects of acute tryptophan depletion on mood and suicidal ideation in bipolar patients who were symptomatically stable on lithium.

Method

Nineteen subjects satisfying DSM–IV criteria for bipolar I disorder participated in a within-subject, double-blind, placebo-controlled random-order crossover study. Symptoms were evaluated following acute tryptophan depletion, which was induced by a 100 g amino acid drink following an overnight fast.

Results

Plasma tryptophan fell significantly after the depleting drink, but not after the control drink (P < 0.05, paired t-test, mean reduction 83%). No significant changes in mood or suicidality scores were recorded after acute tryptophan depletion.

Conclusions

Acute tryptophan depletion does not reverse lithium's effects on mood and suicidality in bipolar disorder.
Psychiatric symptoms in adults with learning disability and challenging behaviour
Authors: Moss Steve , Emerson Eric , Kiernan Chris , Turner Steve , Hatton Chris , Alborz Alison
Published: August 2002

Background

In people with learning disability one of the most frequent reasons for psychiatric referral is challenging behaviour.

Aims

To determine what proportion of people with challenging behaviour actually have psychiatric symptoms.

Method

Using an instrument specifically designed for use by informants, a sample of 320 people with administratively defined learning disability, with and without challenging behaviour, was surveyed for the presence of psychiatric symptoms.

Results

Increasing severity of challenging behaviour was associated with increased prevalence of psychiatric symptoms, depression showing the most marked association. Anxiety symptoms were associated with the presence of self-injurious behaviour.

Conclusions

There is clearly the potential for reducing challenging behaviour by improved identification and treatment of coexisting psychiatric disorders. The possibility of modifying diagnostic criteria for depression in people with learning disability, by including aspects of challenging behaviour, merits attention.
Personality disorders and normal personality dimensions in obsessive-compulsive disorder
Authors: Samuels Jack , Nestadt Gerald , Bienvenu O. Joseph , Costa Paul T. , Riddle Mark A. , Liang Kung-Yee , Hoehn-Saric Rudolf , Grados Marco A. , Cullen Bernadette A. M.
Published: August 2002

Background

Little is known about personality disorders and normal personality dimensions in relatives of patients with obsessive-compulsive disorder (OCD).

Aims

To determine whether specific personality characteristics are part of a familial spectrum of OCD.

Method

Clinicians evaluated personality disorders in 72 OCD case and 72 control probands and 198 case and 207 control first-degree relatives. The self-completed Revised NEO Personality Inventory was used for assessment of normal personality dimensions. The prevalence of personality disorders and scores on normal personality dimensions were compared between case and control probands and between case and control relatives.

Results

Case probands and case relatives had a high prevalence of obsessive-compulsive personality disorder (OCPD) and high neuroticism scores. Neuroticism was associated with OCPD in case but not control relatives.

Conclusions

Neuroticism and OCPD may share a common familial aetiology with OCD.
Effect of death of Diana, Princess of Wales on suicide and deliberate self-harm
Authors: Hawton Keith , Harriss Louise , Appleby Louis , Juszczak Edmund , Simkin Sue , McDonnell Ros , Amos Tim , Kiernan Katy , Parrott Hilary
Published: August 2002

Background

The death of the Princess of Wales in 1997 was followed by widespread public mourning. Such major events may influence suicidal behaviour.

Aims

To assess the impact of the Princess's death on suicide and deliberate self-harm (DSH).

Method

Analysis, using Poisson regression, of the number of suicides and open verdicts (suicides’) in England and Wales following the Princess's death compared to the 3 months beforehand, and the equivalent periods in 1992–1996. Similar analysis on DSH presentations to a general hospital.

Results

Suicides increased during the month following the Princess's funeral (+ 17.4%). This was particularly marked in females (+33.7%), especially those aged 25–44 years (+45.1%). Suicides did not fall in the week between the death and the funeral. Presentations for DSH increased significantly during the week following the death (+44.3%), especially in females (+65.1%). Examination of case notes suggested that the influence of the death was largely through amplification of personal losses or exacerbation of existing distress.

Conclusions

The death of a major public figure can influence rates of suicidal behaviour. For DSH, the impact may be immediate, but for suicide it may be delayed.
Gender differences in depression
Authors: Piccinelli Marco , Wilkinson Greg
Published: August 2002

Background

With few exceptions, the prevalence, incidence and morbidity risk of depressive disorders are higher in females than in males, beginning at mid-puberty and persisting through adult life.

Aims

To review putative risk factors leading to gender differences in depressive disorders.

Method

A critical review of the literature, dealing separately with artefactual and genuine determinants of gender differences in depressive disorders.

Results

Although artefactual determinants may enhance a female preponderance to some extent, gender differences in depressive disorders are genuine. At present, adverse experiences in childhood, depression and anxiety disorders in childhood and adolescence, sociocultural roles with related adverse experiences, and psychological attributes related to vulnerability to life events and coping skills are likely to be involved. Genetic and biological factors and poor social support, however, have few or no effects in the emergence of gender differences.

Conclusions

Determinants of gender differences in depressive disorders are far from being established and their combination into integrated aetiological models continues to be lacking.
Needs assessment for mentally disordered offenders: measurement of ‘ability to benefit’ and outcome∗
Authors: Cohen Andrea , Eastman Nigel
Published: August 2002

Background

The Department of Health defines needs as “the ability to benefit from healthcare interventions”. Outcome measurement is an integral component of needs assessment because it underpins ‘ability to benefit’.

Aims

To propose a framework for addressing the measurement of outcome in relation to mentally disordered offenders (MDOs).

Method

Based on a literature search, the paper reviews the definition and measurement of outcome in general mental health care and specifically in relation to MDOs. It analyses the problems of conducting outcome research in relation to MDOs.

Results

A framework for outcome measurement in relation to MDOs is presented. Outcome is placed within a broader framework that relates to service evaluation.

Conclusions

Current measurement of outcome in relation to MDOs is inadequate. A comprehensive framework that acknowledges the multi-dimensional nature of outcome is essential. Researchers must be able to justify the dimensions they prioritise.
Recent life events, cortisol, dehydroepiandrosterone and the onset of major depression in high-risk adolescents
Authors: Goodyer I. M. , Herbert J. , Tamplin A. , Altham P. M. E.
Published: August 2002

Background

It is not clear whether cortisol or dehydroepiandrosterone (DHEA) hypersecretion increases the risk for major depression in the presence of undesirable life events.

Aims

To determine whether there is a specific pattern of psychoendocrine factors that predicts the onset of major depressive disorder.

Method

180 adolescents (73 boys, 107 girls) at high risk for psychopathology were assessed for cortisol, DHEA, depressive symptoms, life events and psychiatric disorder at entry and 12 months later.

Results

Major depression was predicted for both genders by the additive effects of: higher depressive symptoms; personal disappointments and losses only in the month before onset; one or more daily levels of cortisol at 08.00 h or DHEA at 20.00 h greater than the 80th percentile of the daily mean.

Conclusions

A subgroup of adolescents may carry a physiological risk for major depression which may be either of genetic and/or earlier psychosocial origin.
Morning cortisol as a risk factor for subsequent major depressive disorder in adult women
Authors: Harris T. O. , Borsanyi S. , Messari S. , Stanford K. , Cleary S. E. , Shiers H. M. , Brown G. W. , Herbert J.
Published: August 2002

Background

Whether individual differences in cortisol contribute to subsequent major depressive disorder (MDD) is unknown.

Aims

To determine whether premorbid levels of salivary cortisol and dehydroepiandrosterone (DHEA) were associated with subsequent MDD and how these related to psychosocial factors known to increase the risk for MDD.

Method

Adult women (n=116) were recruited from general practices. None was currently depressed; 83 were ‘psychosocially vulnerable’ to MDD, 33 were not. Salivary steroids (cortisol and DHEA at 08.00 h and 20.00 h), recent life events, current mood and social support were assessed at entry. Onset of MDD was recorded during 13 months' follow-up.

Results

There were no associations between salivary cortisol or DHEA and recent life events or vulnerability. Twenty-eight onsets of MDD occurred during the follow-up period. This was associated with: severe adverse life events and difficulties during the follow-up period; mean morning cortisol levels at entry; and the presence of any of three vulnerability factors.

Conclusions

Individual differences in morning salivary cortisol levels may represent an independent risk factor for subsequent MDD. The origin of these differences in cortisol is not yet understood.
Causes and consequences of duration of untreated psychosis in schizophrenia
Authors: Drake Richard J. , Haley Clifford J. , Akhtar Shahid , Lewis Shôn W.
Published: August 2002

Background

It is unclear what determines duration of untreated psychosis (DUP) in schizophrenia and why long DUP predicts poor outcome.

Aims

First, to test the hypothesis that specific patterns of symptoms and social functioning acting before treatment prolong DUP. Second, to clarify the mechanisms linking DUP with recovery after treatment.

Method

Two hundred and forty-eight consecutive first admissions with schizophrenia were interviewed to assess DUP, symptoms and social functioning at admission, and symptoms were re-assessed after 6–12 weeks.

Results

Median DUP was 12 weeks. Long DUP was predicted by poor insight, social isolation and preserved coping skills, but not by demographic factors. Even allowing for all these variables, long DUP predicted poor outcome.

Conclusions

Longer DUP results partly from a pattern of symptoms and social functioning which reduces concern by the sufferer and relevant others. DUP's relationship to outcome is strongest in the initial months of psychosis. This has implications for targeting early intervention.
Cognitive approach to depression and suicidal thinking in psychosis
Authors: Birchwood Max , Iqbal Zaffer , Chadwick Paul , Trower Peter
Published: August 2002

Background

Depression in schizophrenia is a rather neglected field of study, perhaps because of its confused nosological status. Three course patterns of depression in schizophrenia, including post-psychotic depression (PPD), are proposed.

Aims

We chart the ontogeny of depression and psychotic symptoms from the acute psychotic episode over a 12-month period and test the validity of the proposed course patterns.

Method

One hundred and five patients with ICD–10 schizophrenia were followed up on five occasions over 12 months following the acute episode, taking measures of depression, positive symptoms, negative symptoms, neuroleptic exposure and side-effects.

Results

Depression accompanied acute psychosis in 70% of cases and remitted in line with the psychosis; 36% developed PPD without a concomitant increase in psychotic symptoms.

Conclusions

The results provided support for the validity of two of the three course patterns of depression in schizophrenia, including PPD. Post-psychotic depression occurs de novo without concomitant change in positive or negative symptoms.
Cognitive approach to depression and suicidal thinking in psychosis
Authors: Iqbal Zaffer , Birchwood Max , Chadwick Paul , Trower Peter
Published: August 2002

Background

In paper I we reported that depression in the acute stage remitted in line with the psychosis and that 36% of patients developed post-psychotic depression (PPD).

Aims

We apply our cognitive framework to PPD and chart the appraisal of self and psychosis and their link with the later emergence of PPD.

Method

Patients with ICD–10 schizophrenia (n=105) were followed up over 12 months following the acute episode, taking measures of depression, working self-concept, cognitive vulnerability, insight and appraisals of psychosis.

Results

Before developing PPD, these patients felt greater loss, humiliation and entrapment by their illness than those who relapsed or did not become depressed, and were more likely to see their future selves in ‘lower status’ roles. Upon becoming depressed, participants developed greater insight, lower self-esteem and a worsening of their appraisals of psychosis.

Conclusions

Depression in psychosis arises from the individual's appraisal of psychosis and its implications for his/her perceived social identity, position and ‘group fit’. Patients developing PPD feel forced to accept a subordinate role without opportunity for escape. Implications for treatment are discussed.
Experience of caregiving: relatives of people experiencing a first episode of psychosis
Authors: Tennakoon Lakshika , Fannon Dominic , Doku Victor , O'Ceallaigh Seamus , Soni William , Santamaria Mar , Kuipers Elizabeth , Sharma Tonmoy
Published: August 2002

Background

There has been relatively little research on caregivers of people experiencing their first episode of psychosis.

Aims

To investigate dimensions of caregiving and morbidity in caregivers of people with first-episode psychosis.

Method

Caregivers of 40 people with first-episode psychosis were interviewed at home about their experience of caregiving, coping strategies and distress.

Results

Caregivers used emotional and practical strategies to cope with participants' negative symptoms and difficult behaviours and experienced more worry about these problems. They increased supervision when the participants displayed difficult behaviours. Twelve per cent of caregivers were suffering from psychiatric morbidity as defined by the General Health Questionnaire. Those living with the participant had more frequent visits to their general practitioner.

Conclusions

At first-episode psychosis, caregivers are already having to cope with a wide range of problems and are developing coping strategies. Caregivers worried most about difficult behaviours and negative symptoms in participants.
Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample
Authors: Goodman Robert , Ford Tamsin , Simmons Helen , Gatward Rebecca , Meltzer Howart
Published: August 2002

Background

Child psychiatric disorders are common and treatable, but often go undetected and therefore remain untreated.

Aims

To assess the Strengths and Difficulties Questionnaire (SDQ) as a potential means for improving the detection of child psychiatric disorders in the community.

Method

SDQ predictions and independent psychiatric diagnoses were compared in a community sample of 7984 5- to 15-year-olds from the 1999 British Child Mental Health Survey.

Results

Multi-informant (parents, teachers, older children) SDQs identified individuals with a psychiatric diagnosis with a specificity of 94.6% (95% CI 94.1–95.1%) and a sensitivity of 63.3% (59.7–66.9%). The questionnaires identified over 70% of individuals with conduct, hyperactivity, depressive and some anxiety disorders, but under 50% of individuals with specific phobias, separation anxiety and eating disorders. Sensitivity was substantially poorer with single-informant rather than multi-informant SDQs.

Conclusions

Community screening programmes based on multi-informant SDQs could potentially increase the detection of child psychiatric disorders, thereby improving access to effective treatments.
Unconsciousness, amnesia and psychiatric symptoms following road traffic accident injury
Authors: Mayou Richard A. , Black John , Bryant Bridget
Published: August 2002

Background

Although road traffic accident injury is the most common cause of traumatic brain injury, little is known of the prevalence of psychiatric complications or the significance of unconsciousness and amnesia.

Aims

To describe amnesia and unconsciousness following a road traffic accident and to determine whether they are associated with later psychological symptoms.

Method

Information was obtained from medical and ambulance records for 1441 consecutive attenders at an emergency department aged 17–69 who had been involved in a road traffic accident. A total of 1148 (80%) subjects completed a self-report questionnaire at baseline and were followed up at 3 months and 1 year.

Results

Altogether, 1.5% suffered major head (and traumatic brain) injury and 21% suffered minor head injury. Post-traumatic stress disorder (PTSD) and anxiety and depression were more common at 3 months in those who had definitely been unconscious than in those who had not, but there were no differences at 1 year.

Conclusions

PTSD and other psychiatric complications are as common in those who were briefly unconscious as in those who were not.