bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychological interventions in self-injurious behaviour
Authors: Halliday Sabrina , Mackrell Kelvin
Published: October 2008

Background

Psychological approaches to working with people with learning disabilities who self-injure have developed over the past 30 years.

Method

The major literature is reviewed and an ecological framework is described which emphasises the importance of environmental, interpersonal and intrapersonal dynamics to understanding the multi-factorial nature of self-injury. Case examples are given.

Results

Self-injury is seen as essentially communicative and functionally adaptive; it is the person's best attempt to deal with abusive, neglecting or traumatic environments or events.

Conclusions

The persistence of self-injurious behaviour once established, requires an interdisciplinary approach which addresses comprehensively the variety of factors which have contributed to the development and maintenance of self-injury.
Randomised controlled trial of compliance therapy
Authors: Kemp Roisin , Kirov George , Everitt Brian , Hayward Peter , David Anthony
Published: October 2008

Background

A randomised controlled trial was conducted in an acute treatment setting to examine the effectiveness of compliance therapy, a brief pragmatic intervention targeting treatment adherence in psychotic disorders, based on motivational interviewing and recent cognitive approaches to psychosis.

Method

Seventy-four patients with psychotic disorders according to DSM–III–R criteria recruited from consecutive admissions to an acute in-patient unit, received 4–6 sessions of either compliance therapy or non-specific counselling, and were followed-up over 18 months. The principal outcome measures were observer-rated compliance, attitudes to treatment, insight and social functioning.

Results

Significant advantages were found for the compliance therapy group post-treatment on measures of insight, attitudes to treatment and observer-rated compliance which were retained over the follow-up period. Global social functioning improved relatively more over time in the compliance therapy group compared with the control group. Survival in the community prior to readmission was significantly longer in the compliance therapy group.

Conclusions

The results support the effectiveness of compliance therapy in improving functioning and community tenure after an acute psychotic episode.
Cost-effectiveness evaluation of compliance therapy for people with psychosis
Authors: Healey Andrew , Knapp Martin , Astin Jack , Beecham Jennifer , Kemp Roisin , David Anthony , Kirov George
Published: October 2008

Background

Non-compliance rates with antipsychotic medication can be high, and the personal and societal costs are considerable. A new psychological intervention, compliance therapy seeks to improve compliance and patient outcomes and reduce treatment costs.

Method

A randomised controlled study examined the cost-effectiveness of compliance therapy compared to nonspecific counselling over 18 months for 74 people with psychosis admitted as inpatients at the Maudsley Hospital. Bivariate and multivariate analyses were conducted to test for differences and to explore inter-patient cost variations.

Results

Compliance therapy is more effective and is no more expensive. Consequently, compliance therapy is more cost-effective than non-specific counselling at six, 12 and 18 months.

Conclusions

There are compliance, outcome and cost-effectiveness arguments in favour of compliance therapy in preference to non-specific counselling.
Amnestic people with Alzheimer's disease who remembered the Kobe earthquake
Authors: Ikeda Manabu , Mori Etsuro , Hirono Nobutsugu , Imamura Toru , Shimomura Tatsuo , Ikejiri Yoshitaka , Yamashita Hikari
Published: October 2008

Background

Emotional memory is a special category of memory for events arousing strong emotions. To investigate the effects of emotional involvement on memory retention in individuals with Alzheimer's disease we studied peoples' memories of distressing experiences during a devastating earthquake.

Method

Fifty-one subjects with probable Alzheimer's disease who experienced the Kobe earthquake at home in the greater Kobe area were studied. Memories of the earthquake were assessed 6 and 10 weeks after the disaster in semi-structured interviews, and were compared with memories of a magnetic resonance imaging (MRI) examination given after the earthquake.

Results

Forty-four (86.3%) of the subjects remembered the earthquake and 16 (31.4%) of subjects remembered the MRI experience. Factual content of the earthquake was lost in most of the subjects.

Conclusions

Fear reinforces memory retention of an episode in subjects with Alzheimer's disease but does not enhance retention of its context, despite repeated exposure to the information.
Criminal conviction after discharge from special (high security) hospital
Authors: Buchanan Alec
Published: October 2008

Background

The aim was to measure the criminal convictions received by people who leave special hospital and to test previously identified correlates of conviction.

Method

A cohort study design was used and the subjects were all 425 patients discharged from the special hospitals in 1982 and 1983. The outcome measure was a criminal conviction received within 10.5 years of discharge.

Results

Five and a half years after discharge 26% of ex-patients had been convicted of any offence, 9% of a violent offence, 5% of a sex offence and 10% of any serious offence. Ten and a half years after discharge 34% of patients had been convicted of any offence, 15% of a violent offence, 7.5% of a sex offence and 15% of any serious offence. When other variables are controlled for, gender and destination on discharge do not predict conviction. Age, a legal category of psychopathic disorder and prior criminal record do predict, but the effect is small.

Conclusion

The rate of conviction of patients leaving special hospital has fallen over the past 20 years; this is the case for crime in general and for serious crimes in particular. The change in rates of conviction over time for patients of different legal categories, previously thought to be different, is the same. The low predictive power of the variables examined here suggests that actuarial methods are of limited value in predicting offending in this group.
Commentary on: Randomised, double-blind, placebo-controlled trial of fluoxetine and graded exercise for chronic fatigue syndrome†
Authors: Deale Alicia , Chalder Trudie , Wessely Simon
Published: October 2008

A variety of treatments for chronic fatigue syndrome (CFS) have been proposed but few have been systematically evaluated. The publication of this well-designed, double-blind, randomised controlled trial is therefore a welcome contribution to the literature.
Oral olanzapine versus oral haloperidol in the maintenance treatment of schizophrenia and related psychoses
Authors: Tran Pierre V. , Dellva Mary Anne , Tollefson Gary D. , Wentley Anita L. , Beasley Charles M.
Published: October 2008

Background

Three studies compared olanzapine and haloperidol given orally in maintenance therapy for schizophrenia and related psychoses.

Method

Data were from double-blind extensions of acute studies. The subjects met criteria for schizophrenia, schizophreniform disorder or schizoaffective disorder. Subjects had responded to acute therapy (Brief Psychiatric Rating Scale total score decreased $ 40% from baseline (Studies 1, 2, and 3) or was $ 18 (Studies I and 2)) and were out-patients at their last acute phase visit. Relapse was defined as hospitalisation for psychopathology. Subjects treated with olanzapine in the three studies were pooled to form the olanzapine group and subjects treated with haloperidol were pooled to form the haloperidol group.

Results

Olanzapine-treated subjects experienced less relapse (P=0.034). The Kaplan-Meier estimated one-year risk of relapse was 19.7% with olanzapine and 28% with haloperidol.

Conclusion

Olanzapine was superior to haloperidol in the maintenance therapy of schizophrenia and related psychoses.
Nithsdale Schizophrenia Surveys 17
Authors: Kelly Ciara , McCreadie Robin , MacEwan Tom , Carey Stephen
Published: October 2008

Background

In recent years there has been a shift to ‘community care’ and the introduction of several ‘atypical’ antipsychotic drugs. We report the impact of these changes.

Method

In Nithsdale, Dumfries and Galloway, Scotland, the population of patients with schizophrenia was identified in 1996. This census replicated a study carried out in 1981. The population with schizophrenia were compared on clinical and social variables. The whereabouts in 1996 of the 1981 population was determined.

Results

In comparison with the 1981 population, more patients in 1996 had positive, negative and non-schizophrenic symptoms. More showed tardive dyskinesia. Social adjustment had not changed. They had spent less time in hospital; fewer (13%) were living with their parents; and fewer (8%) were employed. By 1996, 35% of the 1981 cohort had died (standardised mortality rate male – 154, female – 162).

Conclusions

The mental health of a community of people with schizophrenia living in a rural area in 1996 was poorer than in 1981.
Genetic epidemiology of binging and vomiting
Authors: Sullivan Patrick F. , Bulik Cynthia M. , Kendler Kenneth S.
Published: October 2008

Background

Bulimia nervosa is typically defined as the combination of the behaviours of binging and vomiting. We sought to clarify the relationship of these behaviours from a genetic epidemiological perspective.

Method

Using data on the lifetime history of binging and vomiting from a personally interviewed population-based sample of female twins (n = 1897), we applied bivariate twin modelling to estimate the sources of variation for these traits.

Results

The association between having ever binged (23.6%) and having ever induced vomiting (4.8%) was very strong (odds ratio=8.78, P < 0.0001). The best-fitting model indicated that lifetime binging and vomiting were both heritable (46% and 72%) and influenced by individual-specific environmental factors (54% and 28%). The overlap between the genetic (ra = 0.74) and individual-specific environmental factors (re = 0.48) for the two traits was substantial. No violations of the equal environment assumption were evident.

Conclusions

Including binging and vomiting under the rubric of bulimia nervosa appears to be appropriate. Our data are consistent with the identification of binging and vomiting as complex traits resulting from the interplay of multiple genes and individual-specific environmental influences. In contrast to ‘environmentalist’ theories, our results suggest that genetic influences may be of particular relevance to the aetiology of binging and vomiting.
Severe personality disorder — whose responsibility?
Authors: Cawthra Richard , Gibb Robert
Published: October 2008

Should personality disordered individuals receive treatment within today's mental health services? The debate often follows episodes of aggression towards staff or patients by personality disordered individuals receiving treatment in hospital, and more recently where the general public have been affected. The subjects of personality disorder and psychopathy in particular have long evoked strong emotions which make clarity of thought difficult and psychiatry unclear of its position.
Loss of consciousness and post-traumatic stress disorder
Authors: O'Brien Maureen , Nutt David
Published: October 2008

Post-traumatic stress disorder (PTSD) is a condition that appears to be becoming increasingly prevalent in psychiatric and general practice. Davidson (1992) reports a lifetime prevalence of 1–9% in the community, with high levels of chroniciry and comorbidity. It routinely features in the general as well as medical literature following major traumas such as the Herald of free enterprise disaster. PTSD is also growing more important in medicolegal terms, as the recent police attempt to obtain compensation for their experiences in the Hillsborough tragedy demonstrates. Despite the high profile of the condition and the repeated descriptions of its development and (partial) resolution after every major disaster, there is very little research into the most effective means of preventing or treating PTSD. The usual approach of debriefing has been shown to be without effect (Deahl et al, 1994) and a recent review of drug treatments revealed only a few small-scale studies, none of which would be suitable tor [he licensing of a drug for this disorder (Davidson, 1992). This may be because most drug treatments are initiated well after the trauma, which may be too late to prevent the laying down of immutable brain traces for the memories, behaviours and affect that trauma causes and which develop into PTSD.
Burden of disease
Authors: Andrews Gavin , Sanderson Kristy , Beard John
Published: October 2008

Background

The Global Burden of Disease studies are important because they encompass morbidity as well as mortality. Burden due to morbidity is calculated from incidence, duration and disability. There is a dearth of epidemiological measurements of disability.

Method

Data from a quasi-community sample (n=1364) were analysed. Diagnoses of mental and physical disorders, and reports of disability, were based on established methods.

Results

The disabilities reported in mental and physical disorders were comparable. Disability was correlated with comorbidity. The disability in mental disorders was examined by three methods: pure disorders, main problem and regression. It appears that major depression and substance disorder weights were overestimated, and anxiety disorder weights were underestimated in the Global Burden of Disease studies.

Conclusions

A method for disentangling the effects of concurrent comorbidity is presented. The size of burden attributed to mental disorders is of potential benefit for funding mental health services. It is important that we get the estimates right.
Brain changes in schizophrenia
Authors: Sharma Tonmoy , Lancaster Eric , Lee David , Lewis Shôn , Sigmundsson Thordur , Takei Noriyoshi , Gurling Hugh , Barta Patrick E. , Pearlson Godfrey , Murray Robin M.
Published: October 2008

Background

Structural brain abnormalities have been reported in schizophrenia. We tested the hypothesis that these abnormalities represented a marker for the genetic liability to schizophrenia in a sample of people with schizophrenia and their relatives from families multiply affected with the disorder.

Method

We compared 31 people with schizophrenia, 57 relatives and 39 unrelated control subjects. Volumetric measurement of brain structures was carried out using stereological principles from three-dimensional reconstructed magnetic resonance images.

Results

Subjects with schizophrenia had larger lateral ventricles than their relatives and the normal control subjects. Relatives who were ‘presumed obligate carriers' had larger left lateral ventricles than other relatives and the control subjects. Subjects with schizophrenia showed smaller whole brain and cerebellar volumes and larger lateral ventricles than their age–and gender-matched unaffected siblings.

Conclusions

In families multiply affected with schizophrenia lateral ventricular enlargement distinguishes people with schizophrenia and presumed obligate carriers from other relatives and unrelated control subjects. These changes may be a marker for a genetic liability to schizophrenia.
‘Pfropfschizophrenie’ revisited
Authors: Doody Gillian A. , Johnstone Eve C. , Sanderson T. L. , Owens David G.C. , Muir W J.
Published: October 2008

Background

It is reported that people with mild learning disability have a higher point prevalence of schizophrenia than the normal population, the reasons for which are unclear.

Method

Thirty-nine subjects with mild learning disability and schizophrenia, 34 control subjects with schizophrenia and 28 control subjects with mild learning disability were seen. Interviews with relatives and carers were also conducted. Assessments were made of clinical variables, psychopathology, neurological ‘soft'signs, IQ, memory and family history. Blood was taken for karyotypic analysis from comorbid subjects.

Results

The comorbid group had more negative symptoms, episodic memory deficits, soft neurological signs, epilepsy and receive more community supports than control subjects with schizophrenia. Comorbid subjects had a tendency to belong to multiply affected families and show high rates of chromosomal variants on routine karyotypic testing.

Conclusions

Future work on the generality of schizophrenia should include people with premorbid learning disability, as a discrete subtype from whom valuable genetic aetiological clues may be obtained.
Substance use, health and social problems of service users at 54 drug treatment agencies
Authors: Gossop Michael , Marsden John , Stewart Duncan , Lehmann Petra , Edwards Carolyn , Wilson Alison , Segar Graham
Published: October 2008

Background

The National Treatment Outcome Research Study (NTORS) is the first large-scale, prospective, multi-site treatment outcome study of drug users in the UK.

Method

Substance use, health and social problems of 1075 service users were assessed at intake to 54 agencies chosen to be representative of the main national drug treatment modalities.

Results

Heroin dependence was the most frequently reported problem often with poly-drug and alcohol problems. Most service users injected drugs and & quarter of the injectors shared injecting equipment. Poly-drug use and heavy drinking were more common among service users admitted to residential treatments. High criminality rates were reported Psychological and physical health problems were common and many service users had prior contact with psychiatric and medical services.

Conclusions

The range and severity of problems adversely affect individual users, their families, and present & challenge to addiction treatment services. These problems create costs for the health care, social service and criminal justice system responses.
Objectivity in psychoanalytic judgements
Authors: Hobson R. Peter , Patrick Matthew P. H. , Valentine John D.
Published: October 2008

Background

There is widespread scepticism concerning the reliability and validity of psychoanalytic judgements of patient–therapist transactions. We predicted that (a) in reviewing the initial part of 14 videotaped assessment interviews with borderline and dysthymic subjects, dynamic psychotherapists would agree in their ratings of psychoanalytically relevant characteristics of subjects' interpersonal relations; (b) inter-correlations among the ratings would conform with those expected from psychoanalytic descriptions of ‘paranoid-schizoid’ and ‘depressive position’ states of mind; and (c) these ratings would differentiate between borderline and dysthymic groups.

Method

Six trained psychotherapists who were blind to the design of the study, independently rated qualities of interpersonal relatedness during the first 30 minutes of each interview, on & 30-item ‘personal relatedness profile’

Results

There was satisfactory interrater reliability in judgements among the raters, and evidence that the items were interrelated. There was also & significant difference between the two subject groups.

Conclusions

It is possible to make reliable psychoanalytic judgements about qualities of interpersonal relatedness. Moreover, there is evidence that paranoid–schizoid and depressive positive aspects of psychological functioning do constitute & meaningful constellation of clinically grounded phenomena.
Specific fears and phobias
Authors: Curtis George , Magee William J. , Eaton William W. , Wittchen Hans-Ulrich , Kessler Ronald C.
Published: October 2008

Background

Data on eight specific fears representing DSM–III–R simple phobia were analysed to evaluate: (a) their prevalence and (b) the validity of subtypes of specific phobia defined by DSM–IV.

Method

A modified version of the Composite International Diagnostic Interview was administered to a probability sample of 8098 community respondents. Correlates of responses to questions concerning these fears were analysed.

Results

The most prevalent specific fears were of animals among women, and of heights among men. Slight evidence was found for specific phobia subtypes. Number of fears, independent of type, powerfully predicted impairment, comorbidity, illness course, demographic features, and family psychopathology.

Conclusion

Number of specific fears may mark a general predisposition to psychopathology. More detailed information is needed to resolve the question of specific phobia subtypes.
Temporal relationships between physical symptoms and psychiatric disorder
Authors: Hotopf Matthew , Mayou Richard , Wadsworth Michael , Wessely Simon
Published: October 2008

Background

Physical symptoms and psychiatric disorder are associated. We aimed to investigate which comes first.

Methods

Data from the Medical Research Council National Survey of Health and Development, a population-based birth cohort study were used at two time points: 36 and 43 years. Six physical symptoms were reported at both time points. The Present State Examination and Psychiatric Symptom Frequency interviews were administered at 36 and 43 years respectively. Odds ratios corrected for a variety of confounders were used to describe the associations between physical symptoms and psychiatric disorder across these two time points.

Results

Psychiatric disorder increased the odds of reporting symptoms 3–7-fold. The relationship strengthened when the outcome was defined as suffering from multiple symptoms. Population attributable risk of psychiatric disorder and subsyndromal disorder in causing multiple somatic symptoms was 40.3%. Prospectively, psychiatric disorder at 36 years was a predictor for five of the six physical symptoms. Three physical symptoms at 36 years predicted new onset of psychiatric symptoms at 43 years.

Conclusions

Psychiatric disorder is strongly related to physical symptoms. The direction of causality may operate in both directions. Assuming a causal relationship, psychiatric disorder (including subthreshold disorders) could account for at most 40% of cases of multiple physical symptoms.
Psychological treatment of depression in children and adolescents
Authors: Harrington Richard , Whittaker Jane , Shoebridge Philp
Published: October 2008

Background

This paper reviews research on the psychological treatment of depression in children.

Method

Manual and computer literature searches were performed.

Results

The most promising psychological interventions for depression in children are individual rather than family therapies. Cognitive – behavioural therapy seems to be an effective treatment for depressive symptoms and mild depressive disorders. It may also be a useful preventive intervention, though this remains to be conclusively demonstrated. There have been no systematic studies comparing psychological treatments with medication.

Conclusions

Studies comparing psychological treatments and medication are now required.
Neuroimaging in autism
Authors: Deb Shoumitro , Thompson Bill
Published: October 2008

Background

Childhood autism is a developmental disorder with distinctive clinical features and characteristic cognitive deficits. Neuroimaging techniques have been extensively used in the study of autism and related disorders.

Method

Recent important literature reported on structural and functional neuroimaging in autism was reviewed and discussed in the context of other neurobiological research findings.

Results

Various abnormalities of brain structure and function have been proposed, but no focal defect has been reliably demonstrated. Important findings, so far, include increased brain volume, structural abnormality in frontal lobe and corpus callosum in a proportion of autistic individuals. Functional neuroimaging findings emphasised the imbalance in interregional and inter-hemispheric brain metabolism and blood flow as well as abnormality in the anterior cingulate gyrus.

Conclusion

The research to date has been hindered by methodological difficulties. However, hypothesis-driven research, particularly involving activation studies and neurotransmitter/neuroreceptor activities, using functional neuroimaging will be very useful in unravelling the enigma associated with this intriguing and distressing condition.
Mortality in schizophrenia
Authors: Waddington John L. , Youssef Hanafy A. , Kinsella Anthony
Published: October 2008

Background

Although increased mortality is one of the most consistent and accepted epidemiological findings in schizophrenia, a high rate of suicide appears unable to account fully for this burden which remains poorly understood.

Method

A cohort of 88 in-patients was followed prospectively over a 10-year period and predictors of survival sought among demographic, clinical and treatment variables.

Results

Over the decade, 39 of the 88 patients (44%) died, with no instances of suicide. Reduced survival was predicted by increasing age, male gender, edentulousness and time since pre-terminal withdrawal of antipsychotics; additionally, two indices of polypharmacy predicted reduced survival: maximum number of antipsychotics given concurrently (relative risk 2.46, 95% C1 1.10-5.47; P=0.03) and absence of co-treatment with an anticholinergic (relative risk 3.33, 95% C1 0.99-11.11; P=0.05).

Conclusions

Receiving more than one antipsychotic concurrently was associated with reduced survival, in the face of little or no systematic evidence to justify the widespread use of antipsychotic polypharmacy. Conversely, over-cautious attitudes to the use of adjunctive anticholinergics may require re-evaluation.
Utilisation of mental health services and costs of patients with schizophrenia in three areas of Spain
Authors: Haro Josep Maria , Salvador-Carulla Luis , Cabasés Juan , Madoz Vicente , Vázquez-Barquero José Luis ,   PSICOST Group
Published: October 2008

Background

The analysis of the costs of schizophrenia and its treatment under different mental health care structures will facilitate the improved allocation of the limited resources available for the treatment of schizophrenia. The research we present compares health service use and total health care costs of three cohorts of subjects with schizophrenia which are representative of three areas of Spain (Burlada in Navarra, Cantabria and the Eixample of Barcelona).

Method

We selected first-time contacts with any psychiatric service who received a diagnosis of schizophrenia. Subjects were evaluated in the third year after onset.

Results

The mean number of out-patient visits per patient per year was 10.7 and the mean in-patient days were 9.5. The mean direct cost per patient in the third year of treatment was US$2243. Costs were higher for single subjects and for people who had a relapse. Costs of subjects with better functioning were lower than costs of subjects with a worse state.

Conclusions

Direct costs of care in Spain were lower than the reported figures from other western European countries. Costs were greater in the two centres with greater community mental health service development. Some of the findings may be explained by service availability.
Long-term pharmacokinetics of clozapine
Authors: Kurz Martin , Hummer M. , Kemmler G. , Kurzthaler I. , Saria A. , Fleischhacker W. W.
Published: October 2008

Background

Previous studies of clozapine pharmacokinetics have shown a wide intra- and inter-individual variability of plasma levels in patients on stable clozapine doses. We investigated dose-plasma level relationships and intra-individual variability of plasma levels during maintenance treatment with clozapine.

Method

Forty-one patients on clozapine were followed for 26 weeks with repeated plasma level measurements and assessments of co-medication and clinical symptoms. In a second step, 15 patients on stable clozapine doses between treatment Weeks 12 and 52 were followed in the same way. Coefficient of variation was used as a parameter of plasma level deviation.

Results

Dose-plasma level correlations stayed significant from Week 6 to Week 26 (n=41). The group of patients followed up to Week 52 showed a mean intra-individual coefficient of variation of 52.8% (s.d. =20.6), and remained stable psychopathologically.

Conclusions

Even though clozapine plasma levels may show a significant degree of variation, this is not necessarily reflected in a change in psychopathology.
Evolving service interventions in Nunhead and Norwood
Authors: Becker Thomas , Holloway Frank , McCrone Paul , Thornicroft Graham
Published: October 2008

Background

Service evaluation requires a detailed understanding of the services studied.

Method

Community mental health services evaluated in the PRiSM Psychosis Study in south London are described. The intensive sector and standard sector services are contrasted.

Results

The intensive sector had two teams with extended opening hours: a psychiatric acute care and emergency (PACE) team, and a psychiatric assertive continuing care (PACT) team focusing on care for people with chronic illness. In the standard sector there was a generic community team providing office-hour assessments, case management of the severely mentally ill and close liaison with in-patient services. The team made use of the local psychiatric emergency clinic and of other local resources. The intensive sector was characterised by: more admissions to fewer beds, more non-hospital residential places, extended hours, on-call rota, wider range of interventions, more medical and nursing staff, a lower nursing grade mix and higher staff turnover. The standard sector had a less highly resourced generic community psychiatric service.

Conclusions

Change in services has been more marked in the intensive sector.
Frequency and predictors of adverse events
Authors: Johnson Sonia , Leese Morven , Brooks Liz , Clarkson Paul , Guite Hilary , Thornicroft Graham , Holloway Frank , Wykes Til
Published: October 2008

Background

Community care has been criticised as a hazardous policy associated with high rates of adverse events. There is little research evidence as to the truth of this claim.

Method

Best available evidence from public records, interviews, case notes, key workers and general practitioners was assembled to establish: (a) which of the 514 subjects initially identified as having psychotic illnesses had died during an average follow-up of 4.9 years; (b) care currently received by all 286 subjects originally selected for interview; and (c) rates of major adverse events and of admission for these 286 individuals.

Results

Twenty-eight natural and 11 unnatural deaths had occurred. Among subjects still living at the end of the follow-up, 84% were in contact with specialist mental health services and 11% only with primary care services. Rates of serious violence, imprisonment and homelessness were relatively low. Forty-one per cent had been admitted at least once during a mean follow-up of 3.2 years and 20% at least once under the Mental Health Act. After adjustment, there were no significant differences between standard and intensive care sectors.

Conclusions

Rates of adverse events and slipping through the net’ are relatively low among individuals receiving community-based services, whether intensive or standard care.
Care-giving and the impact on carers of a community mental health service
Authors: Szmukler George I. , Wykes Til , Parkman Sue
Published: October 2008

Background

We examined: care-giving activities in a population-based sample of carers of sufferers from psychotic disorders; putative determinants of care-giving; and changes in care-giving in an intensive community psychiatric service.

Methods

In the PRiSM interview sample 170 people had a carer; 124 were interviewed. Care-giving activities, dissatisfaction with these, and carers General Health Questionnaire (GHQ) scores were measured. Patient and illness characteristics were examined as predictors of the carer measures. The carer measures were reassessed for 62 carers after two years in two service sectors, one with an intensive community service, the other with a standard service.

Results

Overall, 36% of carers were engaged in no, or only occasional care-giving activities. Fifty per cent expressed no dissatisfaction with their care-giving role. Patient and illness characteristics predicted care-giving poorly. Carers in the intensive community treatment sector did not experience significantly different care-giving demands or distress than those in the standard sector.

Conclusions

A significant proportion of carers of sufferers from psychosis do not engage in common care-giving activities, and are not dissatisfied with their role. An intensive community service did not affect the impact of the illness on carers.
Impact of community mental health services on users' social networks
Authors: Becker Thomas , Leese Morven , McCrone Paul , Clarkson Paul , Szmukler George , Thornicroft Graham
Published: October 2008

Background

Social networks are important for people with severe mental illness, and services need to assess whether they succeed in improving social contacts.

Method

In a prospective controlled study, social network data were obtained in an epidemiologically representative sample of people with psychotic disorders both before (Time I) and two years after (Time 2) the introduction of two sectorised community mental health services in south London (one intensive service with two specialist teams, one standard service with a generic team).

Results

There were significant baseline differences between sectors with social networks being smaller in the sector later served by the intensive service. Social network size increased within the intensive service sector, but not in the standard service sector. There was a significant sector effect for the network component of relatives (intensive > standard) and in the other (‘non friends’) component (standard > intensive) after adjusting for baseline differences.

Conclusions

The findings suggest that the intensive sector community mental health service enhanced peoples social networks with their relatives, relative to the standard service. The reverse is the case for other contacts.
Quality of life outcomes for intensive versus standard community mental health services
Authors: Taylor Ruth E. , Leese Morven , Paul Clarkson , Holloway Frank , Thornicroft Graham
Published: October 2008

Background

We report the impact on the quality of life (QOL) of people with psychosis of an intensive compared with a standard model of community care.

Method

People with psychosis, in two sectors in south London, were interviewed with a variety of measures at baseline, and at two-year follow-up (n=138). After baseline, services within one sector were reorganised, and a more intensive model of community care was introduced. QOL was measured using the Lancashire Quality of Life Profile.

Results

The two overall QOL measures, global QOL and the average of the domain-specific scores, were remarkably stable over time. There was weak evidence for an improvement in living situation domain in the intensive sector; this may be accounted for by a large drop in in-patient admissions. In both sectors objective QOL was poor, and there was little change in any of the objective indicators except in-patient admissions, and a suggestion of increased social activity in the intensive sector.

Conclusions

We failed to find an effect of intensive community care on QOL in people with psychosis. This may indicate an insensitivity to change in QOL measures, or that the intervention failed to produce the kind of changes in mental health and functioning which would be reflected in improved QOL.
Epidemiology of self-injurious behaviour in adults with learning disabilities
Authors: Collacott Richard A. , Cooper Sally-Ann , Branford David , McGrother Catherine
Published: October 2008

Background

There have been few epidemiological studies of the disabling and poorly understood disorder self-injurious behaviour among adults with learning disabilities.

Method

Interviews were undertaken with the carers of adults known to the Leicestershire Learning Disabilities Register (n=2277). The Disability Assessment Schedule was used and information was also collected on demographic characteristics, developmental and physical status.

Results

Self-injurious behaviour was present in 17.4% of the population. In 1.7% self-injurious behaviour occurred frequently and was severe. There was no gender difference between those with and without self-injurious behaviour. Both the chronological age and developmental quotient of individuals with self-injurious behaviour were lower than those of individuals without self-injurious behaviour. Autistic symptoms were more common among those with self-injurious behaviour. The association of self-injurious behaviour with a wide range of other maladaptive behaviours was highly significant. Logistic regression analysis retained age, developmental quotient, hearing status, immobility and number of autistic symptoms as explanatory variables for self-injurious behaviour.

Conclusions

Self-injurious behaviour is a prevalent and disabling disorder among adults with learning disabilities.
Incidence, risk and prognosis of acute and chronic fatigue syndromes and psychiatric disorders after glandular fever
Authors: White P. D. , Thomas J. M. , Amess J. , Crawford D. H. , Grover S. A. , Kangro H. O. , Clare A. W.
Published: October 2008

Background

The role of viruses in the aetiology of both chronic fatigue syndrome (CFS) and depressive illness is uncertain.

Method

A prospective cohort study of 250 primary care patients, presenting with glandular fever or an ordinary upper respiratory tract infection (URTI).

Results

The incidence of an acute fatigue syndrome was 47% at onset, after glandular fever, compared with 20% with an ordinary URTI (relative risk 2.3, 95% CI 1.3–4.1). The acute fatigue syndrome lasted a median (interquartile range) of eight weeks (4–16) after glandular fever, but only three weeks (2–4) after an URTI. The prevalence of CFS was 9–22% six months after glandular fever, compared with 0–6% following an ordinary URTI, with relative risks of 2.7–5.1. The most conservative measure of the incidence of CFS was 9% after glandular fever, compared with no cases after an URTI. A conservative estimate is that glandular fever accounts for 3113 (95% C11698–4528) new cases of CFS per annum in England and Wales. New episodes of major depressive disorder were triggered by infection, especially the Epstein – Barr virus, but lasted a median of only three weeks. No psychiatric disorder was significantly more prevalent six months after onset than before.

Conclusions

Glandular fever is a significant risk factor for both acute and chronic fatigue syndromes. Transient new major depressive disorders occur close to onset, but are not related to any particular infection if they last more than a month.
Psychiatric disorders in adolescents in primary care
Authors: Kramer Tami , Garralda M. Elena
Published: October 2008

Background

Little is known about psychiatric disorders in adolescents who attend primary care.

Method

Prospective study of 13- to 16-year-olds consecutively attending general practice. Information was obtained from adolescents, parents and general practitioners, using questionnaires and research interviews.

Results

136/200 (68%) of adolescent attenders took part. Two per cent presented with psychiatric complaints. From research interviews with adolescents, psychiatric disorder in the previous year was found in 38%, with moderate impairment of functioning in over half (according to Children's Global Assessment Scale scores). Most disorders (42/50, 84%) were emotional (‘internalising’) disorders. Psychiatric disorders were significantly associated with high levels and intensity of physical symptoms and with increased health risks. General practitioner assessment of psychiatric disorders was low on sensitivity (20.8%) but high on specificity (90.7%). Doctors identified most severely affected adolescents.

Conclusions

Depressive and anxiety disorders are common among adolescent general practice attenders and linked to increased physical symptoms; general practitioner recognition is limited.
Olanzapineversushaloperidol in the treatment of schizoaffective disorder
Authors: Tran Pierre V. , Tollefson Gary D. , Sanger Todd M. , Lu Yili , Berg Paul H. , Beasley Charles M.
Published: October 2008

Background

The effectiveness of antipsychotic monotherapy in schizoaffective disorder is limited, and further constrained by safety concerns.

Aims

We aimed to compare the efficacy, tolerability and safety profile of the new pharmaceutical, olanzapine, with haloperidol.

Method

Data were assessed from 300 DSM – III – R schizoaffective subjects from a larger double-blind prospective international study. Subjects were randomly allocated to six weeks of olanzapine (5–20 mg) or haloperidol (5–20 mg) treatment; responders were followed for up to one year of double-blind, long-term maintenance therapy.

Results

Olanzapine-treated patients achieved a statistically significant greater improvement than haloperidol-treated patients on overall measures of efficacy, including clinical response. Significantly fewer olanzapine patients left the study early, and fewer adverse events were observed among those receiving olanzapine. During maintenance, olanzapine-treated patients continued to experience additional improvement, with fewer EPS but more weight gain than those on haloperidol.

Conclusions

Olanzapine demonstrated substantial advantages over the conventional antipsychotic haloperidol in the management of schizoaffective disorder.
Economic impact of Alzheimer's disease in the United Kingdom
Authors: Souêtre E. , Thwaites R. M. A. , Yeardley H. L.
Published: October 2008

Background

While the costs associated with Alzheimer's disease have been shown to be significant, there are few data relating cost of care to severity of the disease.

Aims

We aimed to compare the costs associated with different severities of Alzheimer's disease with those incurred by control subjects over a three-month period.

Method

In this cross-sectional, multicentre, naturalistic analysis, non-institutionalised patients with Alzheimer's disease (128), their care-givers (128), and 56 matched controls were interviewed once to establish resource use over the previous three months. Patients were stratified into three severity groups according to their Mini Mental State Examination score. Costs were calculated from the perspective of society as a whole.

Results

Over the three-month period, total mean cost per control subject (£387) was minor compared with mean cost incurred by patients with mild (£6616), moderate (£10 250) and severe (£13 593) Alzheimer's disease. Indirect cost, mainly time spent by care-givers, was the main cost component in all groups (68.6%), followed by direct medical costs (24.7%)

Conclusions

The cost of care for an Alzheimer's disease patient is directly related to the severity of the patient's illness.
Cost-effectiveness analysis of a home-based social work intervention for children and adolescents who have deliberately poisoned themselves
Authors: Byford Sarah , Harrington Richard , Torgerson David , Kerfoot Michael , Dyer Elizabeth , Harrington Val , Woodham Adrine , Gill Julia , McNiven Faye
Published: October 2008

Background

Little evidence exists regarding the effectiveness or cost-effectiveness of alternative treatment services in the field of child and adolescent psychiatry.

Aims

To assess the cost-effectiveness of a home-based social work intervention for young people who have deliberately poisoned themselves.

Method

Children aged ⩽16 years, referred to child mental health teams with a diagnosis of deliberate self-poisoning were randomly allocated to either routine care (n=77) or routine care plus the social work intervention (n=85). Clinical and resource-use data were assessed over six months from the date of trial entry.

Results

No significant differences were found between the two groups in terms of the main outcome measures or costs. In a sub-group of children without major depression, suicidal ideation was significantly lower in the intervention group at the six-month follow-up (P=0.01), with no significant differences in cost.

Conclusions

A family-based social work intervention for children and adolescents who have deliberately poisoned themselves is as cost-effective as routine care alone.
Difficulties in family functioning and adolescent anorexia nervosa
Authors: Gowers Simon G. , North Clive
Published: October 2008

Background

Difficulties in family functioning are often evident when an adolescent has anorexia nervosa, and the possible causative or contributory role of such difficulties in the illness is unclear.

Aims

To elucidate the relationship between severity of anorexia nervosa and difficulties in family functioning and whether clinical improvement results in diminution of self-rated family difficulties.

Method

Thirty-five adolescents with anorexia nervosa and their mothers completed the Family Assessment Device (FAD) while clinicians administered the McMaster's Structured Interview of Family Functioning (McSIFF). Severity of anorexia nervosa was rated at baseline and at one year follow-up using the Morgan–Russell Schedule.

Results

Clinicians and patients were more critical of the families' functioning than parents. There was an inverse association between the extent of family difficulties and severity of anorexia nervosa. Over time subjects improved clinically but this was not matched by improvement in family functioning.

Conclusions

Difficulties in family functioning do not appear to be directly associated with severity of anorexia nervosa nor do these difficulties reduce with clinical improvement, in the short term.
Neurodevelopmental antecedents of early-onset bipolar affective disorder
Authors: Sigurdsson Engilbert , Fombonne Eric , Sayal Kapil , Checkley Stuart
Published: October 2008

Background

Developmental impairments have been identified as a risk factor for early-onset schizophrenia. Affective symptoms are more common in children and adolescents with disordered neurodevelopment than in healthy controls.

Aims

To test the hypothesis that severe early-onset mood disorders are associated with developmental antecedents.

Method

We retrospectively identified 38 adolescent cases (15 female, 23 male; mean age 14.4 years, range 11–18) who met ICD–10 Research Diagnostic Criteria for a manic episode, bipolar affective disorder or psychotic depression, and 41 controls (25 female, 16 male, mean age 14.2 years, range 11–18) with depression but without psychotic features.

Results

Cases were significantly more likely to have experienced delayed language, social or motor development (OR 5.5, 95% CI=1.4–21.6,P=0.01). in particular those who develop psychotic symptoms (OR 7.2, 95% CI=1.8–28.6,P=0.003).

Conclusions

Compared to early-onset unipolar depression, neurodevelopmental antecedents are over-represented in early-onset bipolar disorder. The validity of this finding was supported by contemporaneous IQ scores that are not subject to the same potential biases as case-note ratings.