bluuebunny/crossref_metadata_2025 huggingface dataset:
Dysthymia in Clinical Practice
Authors: Akiskal Hagop S. , Costa e Silva Jorge Alberto , Frances Allen , Freeman Hugh L. , Keller Martin B. , Lapierre Yvon D. , Ibor Juan José Lopez , Paykel Eugene S. , Stabl Max ,   The WPA Dysthymia Working Group
Published: October 2008

Background

Dysthymia has been reconceptualised in recent years from a personality disorder to a chronic affective disorder. It is incorporated into both the DSM and ICD diagnostic systems. Method. The members of the WPA Dysthymia Working Group combined the results of their manual literature searches with a search using Medline.

Results

Available data are summarised under the headings of classification, epidemiology, validity, comorbidity, course and outcome, pharmacotherapy and psychotherapy. The coexistence of major depressive disorder, constituting ‘double depression’ is of particular importance.

Conclusions

Improved knowledge of this disorder has led to a more positive approach to treatment, in which antidepressants can usefully be complemented by psychosocial measures. A high proportion of cases remain unrecognised in most populations, leading to prolonged morbidity and distress, much of which is now treatable.
Symptoms of Psychoses
Authors: Kitamura Toshinori , Okazaki Yuji , Fujinawa Akira , Yoshino Masahiro , Kasahara Yomishi
Published: October 2008

Background

The literature on the statistical analysis of symptoms of psychoses was limited to positive and negative symptoms in schizophrenia. The present study explored the relationship between positive and negative symptoms as well as affective symptoms in a wider category of psychotic disorders.

Method

The symptoms of 584 psychiatric patients, consecutively admitted to any of the 95 mental hospitals in Japan, were studied. They manifested at least one of the following: (a) delusions, (b) hallucinations, (c) formal thought disorder, (d) catatonic symptoms, or (e) negative (defect) symptoms.

Results

Factor analysis yielded five factors interpretable as (a) manic symptoms, (b) depressive symptoms, (c) negative (defect) symptoms and formal thought disorders, (d) positive (psychotic) symptoms, and (e) catatonic symptoms.

Conclusion

These results suggest that although major symptoms seen among psychotic patients can be categorised into positive, negative, manic, and depressive groups, corresponding to current knowledge of phenomenology, catatonic symptoms constitute a discrete syndrome, while formal thought disorders merge into the negative syndrome.
[18F]FDG PET Study in Obsessive–Compulsive Disorder
Authors: Perani Daniela , Colombo Cristina , Bressi Sergio , Bonfanti Annamaria , Grassi Franco , Scarone Silvio , Bellodi Laura , Smeraldi Enrico , Fazio Ferruccio
Published: October 2008

Background

We used [18F]FDG and PET in patients with obsessive–compulsive disorder (OCD) to evaluate cerebral metabolic involvement before and after treatment with serotonin-specific reuptake inhibitors.

Method

In 11 untreated, drug-free adults, regional cerebral metabolic rate for glucose (rCMRglu) was compared with that of 15 age-matched normal controls.

Results

rCMRglu values were significantly increased in the cingulate cortex, thalamus and pallidum/putamen complex. After treatment a significant improvement in obsessive–compulsive symptoms on the Y-BOC scale (t= 3.59,P< 0.01) was associated with a significant bilateral decrease of metabolism in the whole cingulate cortex (P< 0.001). Clinical and metabolic data were significantly intercorrelated (Kendall'sτ= 0.65;P< 0.01).

Conclusions

These findings indicate that OCD is associated with functional hyperactivity of a selected neuronal network and that treatment to reduce symptoms may have a selective neuromodulatory effect on cingulate cortex.
The Charles Bonnet Syndrome: A Large Prospective Study in the Netherlands
Authors: Teunisse Robert J. , Cruysberg Johan R. M. , Verbeek André , Zitman Frans G.
Published: October 2008

Background

The aims were to determine the prevalence of the Charles Bonnet syndrome (CBS) in low-vision patients and analyse possible associated ophthalmic and sociodemographic factors.

Method

A semi-structured interview on visual hallucinations was given to 300 adult low-vision patients and 200 elderly general ophthalmic patients. Positive cases were examined with the Geriatric Mental State Schedule and the Mini Mental State Examination. Diagnostic criteria were as follows: complex, persistent, or repetitive visual hallucinations; full or partial retention of insight; no hallucinations in other modalities; and no delusions. Ophthalmic and sociodemographic data were gathered for all patients.

Results

The prevalence of CBS in low-vision patients was 11%. CBS was significantly associated with an age over 64 years and a visual acuity in the best eye of 0.3 or less. No significant associations with ophthalmic diagnoses, patient sex, marital status, or social circumstances were found.

Conclusion

Our findings support association of CBS with sensory deprivation and advanced age.
Adolescent Psychiatry Services
Authors: Jaffa Tony
Published: October 2008

Background

The way in which psychiatric services for adolescents in the UK are developing will be affected by recent changes in the organisation of the National Health Service.

Method

The history of these services, and the different opportunities for development are reviewed.

Results

Ways in which high-quality clinical care can still be provided are indicated.

Conclusion

Adolescent psychiatric services should be judged on their ability to provide such care, not merely on their ability to survive.
Anxiety Disorders After Stroke: Results from the Perth Community Stroke Study
Authors: Burvill P. W. , Johnson G. A. , Jamrozik K. D. , Anderson C. S. , Stewart-Wynne E. G. , Chakera T. M. H.
Published: October 2008

Background

The prevalence of anxiety disorders in 294 patients who survived to four months in the Perth Community Stroke Study (Perth, Australia), and a follow-up of these patients at 12 months, are presented.

Method

Diagnoses are described both in the usual DSM hierarchic format and by a non-hierarchic approach. Adoption of the hierarchic approach alone greatly underestimates the prevalence of anxiety disorders.

Results

Most cases were of agoraphobia, and the remainder were generalised anxiety disorder. The prevalence of anxiety disorders alone was 5% in men and 19% in women; in community controls, it was 5% in men and 8% in women. Adopting a non-hierarchic approach to diagnosis gave a prevalence of 12% in men and 28% in women. When those who showed evidence of anxiety disorder before stroke were subtracted, the latter prevalence was 9% in men and 20% in women.

Conclusion

One-third of the men and half of the women with post-stroke anxiety disorders showed evidence of either depression or an anxiety disorder at the time of the stroke. At 12 month follow-up of 49 patients with agoraphobia by a non-hierarchic approach, 51 % had recovered, and equal proportions of the remainder had died or still had agoraphobia. The only major difference in outcome between those with anxiety disorder alone and those with comorbid depression was the greater mortality in the latter.
Effectiveness of Zuclopenthixol Compared with Haloperidol in the Treatment of Behavioural Disturbances in Learning Disabled Patients
Authors: Malt Ulrik F. , Nystad Roy , Bache Torkel , Noren Ole , Sjaastad Mary , Solberg Knut Ove , T⊘nseth Sverre , Zachariassen Peter , Mæhlum Eli
Published: October 2008

Background

We compared the efficacy of two neuroleptics with different receptor profiles (zuclopenthixol and haloperidol) in learning disabled patients with behavioural disturbance.

Method

A double-blind crossover study (2×8 weeks; n = 34), interrupted by a two-week single-blind washout period, was employed. Assessments included the Schedule for Handicaps, Behaviour, and Skills (SHBS) and Clinical Global Impression (CGI).

Results

The SHBS score was significantly reduced for the zuclopenthixol cohort only. End-point analysis between the two drugs also showed an enhanced effect for zuclopenthixol over haloperidol. CGI scores did not reveal significant differences between the two drugs.

Conclusion

Zuclopenthixol may be superior to haloperidol for the treatment of behavioural disturbances in mentally retarded subjects.
Post-Viral Onset of Anorexia Nervosa
Authors: Park R. J. , Lawrie S. M. , Freeman C. P.
Published: October 2008

Background

The pathogenesis of anorexia nervosa (AN) is controversial.

Method

A retrospective case series was studied to investigate the post-viral onset of AN.

Results

Four consecutive in-patients with severe restrictive AN spontaneously volunteered histories of ‘glandular fever’-like illnesses immediately before the onset of their eating disorder. This association has not previously been described. Possible pathogenic pathways include both non-specific and specific viral disruptions in central homeostasis, particularly involving corticotrophin-releasing hormone (CRH) regulation.

Conclusion

Such mechanisms are speculative, but biologically and historically plausible.
Neuropsychiatry and SPECT of an Acute Obsessive–Compulsive Syndrome Patient
Authors: Simpson Steve , Baldwin Bob
Published: October 2008

Background

A 71-year-old man with no previous psychiatric history presented with an acute onset of obsessive–compulsive disorder (OCD) symptoms associated with a right inferior parietal infarct. There were no abnormal neurological signs. There were no noteworthy abnormalities on neuropsychological testing.

Method

Whereas a computerised tomography scan showed only a right inferior parietal infarct, a single photon emission computerised tomography (SPECT) scan revealed that in addition to the infarct there was decreased regional cerebral blood flow in the right basal ganglia and temporal areas. There was higher activity in the right orbitofrontal area than in the left.

Results

The patient improved with standard drug therapy and psychotherapy.

Conclusions

SPECT is effective in the diagnosis of neuropsychiatric disorders such as OCD, and the pathological changes in brain metabolism detected by SPECT may be reversed by both drug therapy and psychotherapy.
Child and Adolescent (Juvenile Onset) Schizophrenia
Authors: Hollis Chris
Published: October 2008

Background

The study tests the hypothesis that juvenile-onset schizophrenia is associated with premorbid developmental impairments. It was predicted that the pattern of developmental impairments would vary with age of onset and with gender.

Method

A case-control design was used to examine developmental impairments in 61 consecutive juvenile-onset (age 7–17) referrals with ICD-9 schizophrenia; 61 non-psychotic psychiatric controls were matched on age and gender. Cases and controls were divided into childhood-onset (age 7–13) and adolescent-onset (age 14–17).

Results

The schizophrenic cases had a significantly higher risk of premorbid social (χ2 = 9.1, P<0.005), motor (χ2 = 9.1, P<0.005) and language impairments (χ2 = 10.1, P<0.005). Specific impairments of language production and comprehension were associated with childhood-onset schizophrenia and were independent of gender.

Conclusions

Juvenile-onset schizophrenia is associated with a range of developmental antecedents. There may be a specific link between cases with a very early onset and an impairment in the processes underlying the development of language.
Increased Risk of Affective Disorders in Males after Second Trimester Prenatal Exposure to the Dutch Hunger Winter of 1944–45
Authors: Brown Alan S. , Susser Ezra S. , Lin Shang P. , Neugebauer Richard , Gorman Jack M.
Published: October 2008

Background

Prenatal and perinatal factors have been linked to affective disorders. We therefore undertook an exploratory study to determine whether prenatal exposure to severe famine was associated with an increased risk of affective disorders.

Method

Monthly birth cohorts that were exposed and unexposed to the Dutch Hunger Winter of 1944–45 were identified. The cumulative incidences of affective psychoses and neurotic depression (ICD–9 criteria) were compared between exposed and unexposed cohorts during each trimester of gestation.

Results

The relative risk (RR) of affective psychosis (broad and restricted definitions) among persons exposed to famine during the second trimester was significantly increased (broad: RR (95% confidence interval) = 1.62 (1.19, 2.20); restricted: 1.59 (1.14, 2.21)). Separate analysis by gender showed a significant association among males (broad: 2.26 (1.43, 3.57); restricted: 2.40 (1.49, 3.89)), but not females (broad: 1.28 (0.84, 1.94); restricted: 1.17 (0.73, 1.86)). The risk of neurotic depression was not increased after prenatal famine exposure.

Conclusions

These results suggest a possible relationship between prenatal famine during the second trimester and affective psychosis, lending plausibility to reports that have associated affective psychoses with prenatal exposures. Further studies of this relationship are warranted.
A Brief Mental Health Outcome Scale
Authors: Jones Steven H. , Thornicroft Graham , Coffey Michael , Dunn Graham
Published: October 2008

Background

The Global Assessment of Functioning (GAF) is a quick and simple measure of overall psychological disturbance. However, there is little research on the reliability and validity of this measure in severely mentally ill populations.

Method

Multidisciplinary keyworkers assessed 103 patients at monthly intervals over a 6-month period. Overall GAF scores were obtained, with additional separate ratings for symptoms and disability. These were compared with changes in antipsychotic medication and support needs over the same period.

Results

Satisfactory reliability was obtained for total GAF score and for symptom and disability measures, in spite of raters having only one brief training session. All GAF scores were associated with current support needs of patients. Symptom and disability scores were associated with changes in antipsychotic medication in the previous month. Only symptom score was associated with increases in antipsychotic medication at time of rating.

Conclusion

AF proved to be a reliable and, within the limits of the indicators used, a valid measure of psychiatric disturbance in our sample of the severely mentally ill. Differences in relationships between the three GAF scores and medication/support needs indicate the usefulness of obtaining all three scores for monitoring levels and type of psychiatric disturbance in this population.
Dependency and Community Care in Presenile Alzheimer's Disease
Authors: Newens Andrew J. , Forster Donald P. , Kay David W. K.
Published: October 2008

Background

In a study of patients with presenile dementia of Alzheimer type (PDAT), we aimed to investigate functional dependency in relation to the time since diagnosis and place of residence. Use of community and support services and the time between diagnosis and entry to permanent residential care were also studied.

Method

Interviews with 109 cases of PDAT (diagnosed before age 65) and their carers.

Results

The need for assistance in activities of daily living (ADL) was progressive with time from diagnosis. Five years after diagnosis, 57% of patients remained at home, 20% of whom required some assistance in each of six areas of ADL. The need for assistance in each ADL category was significantly greater for cases in permanent residential care than for those at home. There were no significant differences between the Mini-Mental State Examination (MMSE) scores of patients at home and those of patients in permanent care. Incontinence and the relationship of the carer to the patient were the strongest predictors of permanent residential care. Respite care had been offered in 63% of cases; 71% of these offers had been accepted.

Conclusions

Patients with PDAT who have a living relative are cared for at home for a considerable period of time despite severe cognitive impairment and loss of independence measured by ADL. The reports of carers suggest there is scope for improvement in supportive services to meet this community need.
A Clinical Study of Chronic Fatigue Syndrome
Authors: Shanks M. F. , Ho-Yen D. O.
Published: October 2008

Background

This study examines the hypothesis that more recently ill patients with chronic fatigue syndrome (CFS) might have different characteristics from more chronic patients in tertiary referral centres.

Method

Sixty-four patients who fulfilled strict diagnostic criteria for CFS had detailed medical, viral, immunological and psychiatric assessment. Patients were advised to remain within their energy limits. Patient and doctor monitored progress using a scoring system.

Results

Using the Schedule for Affective Disorders and Schizophrenia, patients were placed into four groups: group A (no psychiatric disorder, 35 patients), group B (psychiatric disorder before onset of CFS, 7 patients), group C (coincident psychiatric disorder and CFS, 11 patients), and group D (psychiatric disorder after onset of CFS, 11 patients). There were no viral or immunological differences between the groups. Patients in groups B, C and D had more severe illness than those in group A (P< 0.05), but patients in group A had more muscle pain (P< 0.05) than patients in group C. Counselling resulted in 52 patients becoming better; nine remained the same and three became worse.

Conclusions

A lower incidence of psychiatric disorder may characterise patients who are more recently ill, as may the type of associated emotional disorder and better outcome.
A Darwinian Approach to the Origins of Psychosis
Authors: Crow T. J.
Published: October 2008

Background

The onset of psychotic illness in the reproductive phase of life with a decrease in fecundity (and approximately constant incidence across populations) requires an evolutionary explanation. What is the survival value of the predisposing gene or genes?

Method

Evolutionary theories, including the author's, are reviewed and critically compared.

Results

Some theories (e.g. Huxleyet al, 1964) postulate an advantage outside the nervous system: such theories fail to explain either the characteristic age distribution or constant incidence. More plausible are theories that relate the advantage to diversity of personality structure or social ability, or even to general intelligence, i.e. to the areas of function in which the phenomena of psychosis arise.

Conclusions

It is argued that psychosis arises as the boundary of a distribution of variation in cerebral structure generated in the course of hominid evolution. Language played a central role, with the critical changes taking place on the basis of a mutation that allowed the two cerebral hemispheres to develop with a degree of independence. Sexual selection (differing criteria in females and males in choosing a mate) acting on this genetic innovation has generated a dimension of competence in social interaction in relation to which there has been a progressive increase in cerebral size by delayed maturation (neoteny). A sexual dimorphism in cerebral asymmetry and the sex difference in age of onset of psychosis can be parsimoniously explained if a gene regulating the relative growth of the two hemispheres is X–Y homologous.
Psychological and Sexual Symptoms Associated with the Menopause and the Effects of Hormone Replacement Therapy
Authors: Pearce Jane , Hawton Keith , Blake Fiona
Published: October 2008

Background

There is considerable inconsistency in the results of studies of the psychological and sexual sequelae of the menopause and their treatment.

Method

A search of the literature on Medline was made of studies of psychological symptoms in women who were either naturally or surgically menopausal or who were receiving hormone replacement therapy for menopausal symptoms.

Results

There is evidence of a small increase in psychological morbidity (not usually amounting to psychiatric disorder) preceding the natural menopause and following the surgical menopause. Psychosocial as well as hormonal factors are relevant. While the response of psychosocial symptoms to hormone replacement therapy with oestrogens is variable and most marked in the surgical menopause, in some studies the effect is little greater than that for placebo. Where sexual symptoms are present, there is more consistent evidence that hormone replacement therapy is effective.

Conclusions

In the light of the available evidence, the current use of hormone replacement therapy to treat psychological symptoms detected at the time of (but not necessarily therefore due to) the natural menopause must be questioned. It does appear that oestrogen therapy ameliorates psychological symptoms after surgical menopause.
Medium-Term Course of Disaster Victims
Authors: Duggan C. , Gunn J.
Published: October 2008

Background

Our aim was to describe the medium-term course (2–3 years) in a series of victims who had experienced severe trauma.

Method

We selected a consecutive series of 31 trauma victims and applied a structured clinical schedule (CAPS-2) to their psychiatric evaluations prepared for the court on two separate occasions approximately one year apart.

Results

Post-traumatic stress disorder and depression were the commonest diagnoses, occurring in 39% and 16% of the victims respectively when they were first assessed. Most had improved between the assessments and this was especially the case for the re-experiencing of the trauma and over-arousal, but less so for avoidance; 20% of subjects showed no improvement, often being handicapped by secondary psychiatric illness.

Conclusion

Traumatised victims generally showed recovery in the 2–3 years after the trauma, but this was slow and was not universal.
A Follow-up Study of Seasonal Affective Disorder
Authors: Thompson Christopher , Raheja Sunil K. , King Elizabeth A.
Published: October 2008

Background

The long-term course of seasonal affective disorder has not been well studied.

Method

Using the Structured Clinical Interview for DSM–III–R, we interviewed 75% of a sample of 124 subjects diagnosed from five to eight years previously as fulfilling DSM–III–R criteria for recurrent major affective disorder, seasonal pattern.

Results

In the follow-up period, 38% of the sample continued to fulfil DSM–III–R criteria for seasonal illness; 28% had recurrent major depressive disorder, but no longer displayed a seasonal pattern; 18% were completely well with no further depression; 6% had subsyndromal symptoms; and 5%, although not meeting DSM–III–R criteria for seasonal illness, were still displaying constant periodicity. A short duration of index episode and a high frequency of illness predicted a continuing seasonal course of illness.

Conclusion

Diagnostic criteria for seasonal affective disorder need to be further refined, possibly restrictively, if they are to be used to predict the future course of seasonal illness.
Neuropsychological Slowness in Obsessive–Compulsive Patients
Authors: Galderisi Silvana , Mucci Armida , Catapano Francesco , D'amato Alessandro Colucci , Maj Mario
Published: October 2008

Background

Although it is acknowledged that obsessive-compulsive (OC) patients may be slower than healthy controls in performing neuropsychological tests, speed has usually been treated as a confounding variable. It is possible, however, that the slower performance of OC patients is itself the result of a dysfunction of specific neural circuits (in particular of fronto-subcortical systems).

Method

A neuropsychological battery including tests sensitive to fronto- and temporo-subcortical dysfunction was administered to a group of OC patients and a group of healthy controls. Each test provided independent indices of accuracy and speed.

Results

OC patients were significantly slower than controls only when performing tasks involving the fronto-subcortical systems, whereas they did not differ from controls with respect to accuracy indices.

Conclusion

It may be that neuropsychological slowness of OC patients is not merely an epiphenomenon of meticulous concern for correct test execution or intrusion of obsessive thoughts, but reflects the dysfunction of fronto-subcortical systems.
Does Rational Role-play Enhance the Outcome of Exposure Therapy in Dysmorphophobia?
Authors: Cromarty Paul , Marks Isaac
Published: October 2008

Background

Dysmorphophobia may improve after a variety or combination of treatments, but which elements of a treatment are useful is usually not certain.

Method

In a single out-patient case study rational role-play (‘paradoxical discourse’) was added to exposure plus cognitive restructuring (CR) for a dysmorphic delusion study comprised of 20-minute sessions one week apart.

Results

Previous exposure plus attempted CR had improved anxiety, phobias, work and social leisure, but not dysmorphic belief. Added brief rational role-play was followed by resolution of the dysmorphic belief. All measures remained much improved at 18-month follow-up.

Conclusions

Rational role-play deserves a controlled trial in dysmorphophobia and other problems and exploration of its mechanism of action.
Antipsychotic Drug-Induced Dysphoria
Authors: King D. J. , Burke M. , Lucas R. A.
Published: October 2008

Background

Dysphoric reactions to antipsychotic medication are well recognised in association with akathisia, but can also occur independently.

Method

Fifty-one healthy volunteers were given haloperidol 5 mg in two consecutive pharmacokinetic studies.

Results

Dysphoria occurred in about 40% of the subjects on both occasions, but akathisia was only detected in 8% (first study) and 16% (second study). All adverse effects were transient and were abolished in nine of the ten subjects given procyclidine.

Conclusions

While dysphoria is a well-recognised reaction in healthy volunteers, it is probably insufficiently recognised in patients, particularly if it occurs in the absence of akathisia. Better detection could improve compliance in patients.
Recurrent Brief Episodes with Psychotic Features in Adolescence: Periodic Psychosis of Puberty Revisited
Authors: Abe Kazuhiko , Ohta Mikio
Published: October 2008

Background

There are many reports of adolescents with periodic episodes each followed by complete remission within 2 weeks, but the nosology and long-term prognosis of such cases have not been elucidated.

Method

A prospective follow-up study on 11 cases (nine girls and two boys) meeting predetermined criteria is reported.

Results

The first several episodes were found to meet ICD–10 symptomatic criteria for recurrent depressive disorder in all cases, and, except for two cases, showed psychotic features. The episodes were linked to one phase of the menstrual cycle in only two of six girls with regular menses. There were no recurrences while on lithium in eight of nine cases. Of eight patients followed up 5–14 years after the first onset, three had been well, three had become bipolar and two were still suffering from brief depressive episodes.

Conclusions

Recurrent brief episodes in adolescence tend to show a near-monthly rhythm and psychotic features. Most of them appear to be manifestations of affective illness and may be treated and prevented as such.
Validation of a French Version of an Informant-Based Questionnaire as a Screening Test for Alzheimer's Disease
Authors: Law Samuel , Wolfson Christina
Published: October 2008

Background

Development of informant-based screening tests for dementia is an emerging field. The reliability and validity of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), an instrument that screens for dementia in general, have been established. We conducted a study to validate a French version of the IQCODE as a screening test for Alzheimer's dementia in the elderly living in the community.

Method

In the Canadian Study of Health and Aging, subjects were screened in their own homes using the Modified Mini-Mental State Exam (3-MS). Those who screened positive, along with a sample of subjects who screened negative, were referred for a complete clinical examination. In Quebec, an informant was asked to complete the French version, IQCODE (F), at that time. Based on the final clinical diagnoses, performances of the IQCODE (F) and Mini-Mental State Examination (MMSE, converted from 3-MS) in screening for Alzheimer's disease were evaluated.

Results

Of the 237 subjects, the mean IQCODE (F) score was 3.4 (s.d. = 0.6), on a 5-point scale (1 = improvement in condition over the past 10 years, 5 = marked deterioration, 3 = no change). The mean MMSE score was 23.1 (s.d. = 4.5). The scores on the two scales were correlated (r = –0.44, P < 0.001). The IQCODE (F) scores were unrelated to education (r = –0.07, P > 0.3) in contrast to the MMSE scores (r = 0.28, P < 0.001). With respect to a diagnosis of probable Alzheimer's disease, the IQCODE (F) (cut-off point 3.6) had a sensitivity of 75% and a specificity of 95.6%. The sensitivity and specificity of the MMSE (cut-off point 23) were 70% and 82.3% respectively.

Conclusion

The findings of the IQCODE (F) are consistent with those of the English version in correlation with the MMSE and apparent freedom from educational bias. The IQCODE is superior to the MMSE as a screening test for probable Alzheimer's disease in the elderly living in the community. It may be a useful addition to the screening tests already available, especially for the less well educated.
Prevalence of Psychiatric Morbidity Among Remand Prisoners in Scotland
Authors: Davidson Mark , Humphreys Martin S. , Johnstone Eve C. , Owens David G. Cunningham
Published: October 2008

Background

Determining the prevalence of psychiatric disorders among remand populations has been made a priority in England and Wales. Differences in legal process and psychiatric services in Scotland make similar research there important.

Method

Demographic data were collected on 389 prisoners, the Clinical Interview Schedule was completed and cognitive function assessed.

Results

The prevalence of major psychiatric disorders was low. Less severe symptoms were more common. The sample was of average IQ, but low educational attainment. Reported drug abuse was high.

Conclusions

Few of those interviewed required hospital care, but other symptoms and drug-related problems may place heavy demands on prison medical and psychiatric services.
Crisis in Admission Beds
Authors: Powell Robin B. , Hollander Doris , Tobiansky Robert I.
Published: October 2008

Background

This study was carried out to measure bed occupancy in Greater London's psychiatric units, in response to the apparent shortage of admission beds.

Method

The bed occupancy of London's 54 National Health Service (NHS) acute psychiatric units within 29 districts was ascertained by telephone on 16 bank holidays covering the period 1990–93.

Results

The mean occupancy level for all London over the 4 years was 97.54% (95% CI = ±0.94%). The number of beds occupied in inner London was significantly greater (99.79 ± 1.11%) than in outer London (95.1 ± 1.49%) (t = 3.85, d.f. = 462, P < 0.001). Bed occupancy for inner London units was ≥ 100% on over 49% of occasions. There has been a steady decline in the number of beds over the four-year period. There was a clear correlation between occupancy levels and the Jarman UPA8 Underprivilege Score (r = 0.504) and between bed provision and the UPA8 (r = 0.67).

Conclusion

Occupancy rates have become unacceptably high and require careful monitoring. Corrective action may be required in order to prevent a breakdown in services.
Psychological Consequences of the Kegworth Air Disaster
Authors: Gregg W. , Medley I. , Fowler-Dixon R. , Curran P. , Loughrey G. , Bell P. , Lee A. , Harrison G.
Published: October 2008

Background

The study sought to quantify psychiatric morbidity among survivors of a major air crash and to identify aetiological factors linked with post-traumatic stress disorder (PTSD).

Method

Sixty-eight of the 79 survivors (86%) were assessed at a clinical interview within one year of the disaster. The majority also completed the General Health Questionnaire, the Impact of Events Scale (IES) and the Zung Anxiety and Depression Scales.

Results

Fifty-four of the study group (79%) met DSM–III–R criteria for a psychiatric disorder within one year of the disaster, of whom 27 (50%) had PTSD. Those who saw injured or dead people at the scene, or had sustained less severe injuries as measured by their Injury Severity Scores, or were under 35 years old, were significantly more likely to develop PTSD.

Conclusions

High rates of psychiatric morbidity are found in survivors of transportation disasters. Further studies are needed to identify those at most risk and to evaluate the benefits of psychological intervention.
Mental Health of Preschool Children and their Mothers in a Mixed Urban/Rural Population
Authors: Sonuga-Barke Edmund , Stevenson Jim , Thompson Margaret J. J.
Published: October 2008

Background

The extent to which certain maternal, child and family characteristics are associated in families with a 3-year-old child were examined.

Method

A total population of families with a 3-year-old child and living in the New Forest were identified. Measures of child behaviour and the maternal GHQ-30 were obtained.

Results

Whereas behaviour problems were found to be significantly associated with all maternal and family factors (except social class), difficult temperament was only related to mother's recall of their own childhood as unhappy and overactivity was only significantly associated with maternal disturbance.

Conclusions

The results are consistent with maternal disturbance and difficult temperament acting independently and additively to influence the development of behaviour problems in preschool children.
Mental Health of Preschool Children and their Mothers in a Mixed Urban/Rural Population
Authors: Stevenson Jim , Thompson Margaret J. J. , Sonuga-Barke Edmund
Published: October 2008

Background

There is a lack of clear and explicit models of the way various family and social influences on children's behaviour interact with factors such as temperament to produce behaviour disturbance in young children.

Method

The following measures had been obtained on a total population sample of 1047 families with a 3-year-old child: the child's perceived cuddliness, difficult temperament, mother's unhappy childhood, maternal disturbance, social class, behaviour problems and overactivity. A latent variable analysis using the LISREL 7 program was applied to the data.

Results

A model that allowed the latent variables child ‘temperament’ and ‘mother's mental state’ to have separate additive effects on ‘child adaptation’ proved an excellent fit (goodness of fit index = 0.956). This model suggests that there is a common factor (‘child adaptation’) underlying behaviour problems and overactivity. Using this model 72% of child adaptation in boys could be explained. For girls however temperament and mother's mental state accounted for only 30% of the variance in child adaptation.

Conclusion

There is a need to investigate different mechanisms for the origins of behaviour problems in preschool boys and girls.
Enhancement of the Prolactin Response to d-Fenfluramine in Drug-Naive Schizophrenic Patients
Authors: Abel Kathryn M. , O'Keane Veronica , Murray Robin M.
Published: October 2008

Background

We wished to investigate central serotonergic function in untreated schizophrenia.

Method

Thirteen drug-naive, DSM–III–R schizophrenic patients were compared with sex, race, age, weight and menstrual phase matched controls. Plasma prolactin and cortisol responses to a specific serotonergic probe, d-fenfluramine, were measured along with BPRS ratings.

Results

Prolactin responses were enhanced in schizophrenic patients compared to controls (P < 0.05) and were correlated positively with BPRS items for depression, anxiety and guilt. Baseline cortisol was also raised in those with schizophrenia (P < 0.001).

Conclusions

Central serotonergic tone may be raised in acute, drug-naive schizophrenia and may be associated with the presence of affective symptomatology.
Relationships Among Negative, Positive, and Depressive Symptoms in Schizophrenia and Psychotic Depression
Authors: Sax Kenji W. , Strakowski Stephen M. , Keck Paul E. , Upadhyaya Vidya H. , West Scott A. , McElroy Susan L.
Published: October 2008

Background

We examined relationships among positive, negative, and depressive symptoms in schizophrenia and major depression with psychosis.

Method

Patients with schizophrenia (n = 17) and major depression and psychotic features (n = 25), with no prior psychopharmacologic treatment were assessed on scales measuring positive psychotic, negative, and depressive symptoms.

Results

Analyses revealed that depressive symptoms positively correlated with anhedonia/asociality and avolition/apathy in both patient groups. Positive psychotic symptoms significantly correlated with depressive symptoms in the schizophrenic group.

Conclusions

Several specific symptoms used in defining both depressive and negative syndrome constructs appear to be shared. The relationship between positive symptoms and depression in schizophrenia and not psychotic depression suggests the severity of depression may be involved in this relationship.
The Borderline Syndrome Index: a Validation Study using the Personality Assessment Schedule
Authors: Marlowe M. J. , O'Neill-Byrne K. , Lowe-Ponsford F. , Watson J. P.
Published: October 2008

Background

This study examines the validity and screening properties of the Borderline Syndrome Index – BSI (developed in the USA) for categories of the Personality Assessment Schedule – PAS (developed in the UK).

Method

Patients were recruited by case control sampling. Chance corrected agreement between instruments and screening properties of the BSI were calculated.

Results

The BSI proved a moderately sensitive but non-specific screen. Questionnaire scores were highly correlated with symptom measures.

Conclusions

The results do not support the validity of the BSI or its use as a screening instrument. BSI scores may be distorted by current symptoms.
Sequential Treatment for Bulimia Nervosa Incorporating A Self-Care Manual
Authors: Treasure Janet , Schmidt Ulrike , Troop Nicholas , Tiller Jane , Todd Gill , Turnbull Susan
Published: October 2008

Background

The aim of this study was to evaluate the effectiveness of a stepped care approach to the treatment of bulimia nervosa: a self-care manual followed, if necessary, by a course of attenuated cognitive behavioural treatment (CBT) in comparison with standard CBT.

Method

One hundred and ten patients, presenting at a tertiary referral centre with ICD–10 bulimia nervosa or atypical bulimia nervosa, were randomly assigned to one of two treatment conditions; a) a sequential treatment group: 8 weeks with a self-care manual followed by up to eight sessions of CBT (if still symptomatic) or b) 16 sessions of CBT.

Results

Bulimic symptoms improved significantly in both groups with no significant differences between the two groups on any of the measures at the end of treatment or at 18 months follow-up. At end of treatment 30% (95% CI: 18–46%) of the sequential group and 30% (95% CI: 17–47%) of the standard treatment group were free from all bulimic symptoms. Sixteen of those in the sequential group improved significantly with self-care and did not require additional treatment. The median number of sessions taken by the sequential group was three (95% CI: 0–6). At 18 months follow-up 40% (95% CI: 23–59%) of the sequential group and 41% (95% CI: 25–59%) of the CBT group were symptom free.

Conclusions

A sequential approach to the treatment of bulimia may be as effective as standard CBT and can considerably reduce the amount of therapist contact required.
Longitudinal Cognitive, Electroencephalographic and Morphological Brain Changes in Ageing and Alzheimer's Disease
Authors: Förstl Hans , Sattel Herbert , Besthorn Christoph , Daniel Sabine , Geiger-Kabisch Claudia , Hentschel Frank , Sarochan Manfred , Zerfaß Rainer
Published: October 2008

Background

The natural course of cognitive performance, electrophysiological alterations and brain atrophy in ageing and Alzheimer's disease (AD) has been investigated in numerous studies, but only few attempts have been made to examine the relationship between clinical, electroencephalographic (EEG) and morphological changes with quantitative methods prospectively over longer periods of time.

Method

Fifty-five patients with clinically diagnosed AD and 66 healthy elderly controls were examined biannually using a cognitive test (CAMCOG), EEG band power and volumetric estimates of brain atrophy.

Results

On average cognitive performance deteriorated by 28 points on the CAMCOG in the AD group, the alpha/theta ratio decreased by 0.2, and the proportion of intracranial cerebrospinal fluid volume increased by 3.5% during a 2-year period. Similar changes were observed after a second 2-year interval. A multiple regression model demonstrated a significant influence of age on cognition and atrophy and a significant influence of the estimated duration of symptoms on cognition, alpha/theta ratio and brain atrophy at the initial examination. Cognitive performance at the first examination exerted significant effects on the performance and also on brain atrophy at re-examination after 2 or 4 years, whereas the EEG and neuroimaging findings at the previous examination were exclusively related to the corresponding findings at the follow-up examinations. In the control group no significant cognitive, EEG and morphological changes were observed after 2 and 4 years.

Conclusion

After 2 consecutive follow-up periods, we were able to verify significant deteriorations of cognition accompanied by neurophysiological and neuroradiological changes in AD, but not in normal ageing. In clinically diagnosed AD, cognitive performance at the follow-up examination could not be predicted by the previous alpha/theta ratio or by the previous degree of global brain atrophy, whereas the cognitive test score determined not only performance, but also structural findings at follow-up. Performance on cognitive tests appears to be a more sensitive indicator of the degenerative process than EEG band-power and morphological changes in manifest AD. Neuroimaging, neurophysiology and genetic risk markers may be more important for the early differential diagnosis than for the prediction of the course of illness.
Stress and Psychiatric Disorder in the Hindu Kush
Authors: Mumford David B. , Nazir Mohammed , Jilani Faiz-Ul-Mulk , Baig Imam Yar
Published: October 2008

Background

It is widely believed that people in remote areas of the world suffer less emotional distress and fewer psychiatric disorders. Previous studies offer contradictory evidence.

Method

First stage screening of two mountain villages in Chitral used the Bradford Somatic Inventory (BSI). Psychiatric interviews were conducted with stratified samples using the ICD–10 Diagnostic Criteria for Research.

Results

The BSI was an effective screening test, with sensitivity of 80% and specificity of 77%. At a conservative estimate, 46% of women and 15% of men suffered from anxiety and depressive disorders. Literate subjects had lower levels of emotional distress than the illiterate. Higher socio-economic status was associated with less emotional distress. Members of joint and nuclear families were similar.

Conclusions

The study offers no support for the belief that people who live in Chitral lead stress-free lives or have low rates of psychiatric morbidity. Women may suffer more anxiety and depressive disorders than in Western societies.
Ultra-Rapid and Ultradian Cycling in Bipolar Affective Illness
Authors: Kramlinger Keith G. , Post Robert M.
Published: October 2008

Background

Rapid-cycling bipolar disorder is defined as four or more affective episodes yearly. The conventionally recognised limit in episode duration is usually considered 24 hours (i.e. a cycle duration of 48 hours). We report a small series of intensively observed bipolar patients who showed much faster patterns of mood oscillation.

Methods

Detailed, systematic, longitudinal assessment of five bipolar patients during extended in-patient psychiatric evaluation were conducted, including retrospective life charting and prospective evaluation of daily mood by self and blinded observer ratings, and motor activity recording.

Results

Our data demonstrate a spectrum of cycling frequencies in rapid-cyclers, including distinct, clinically robust mood shifts that occur at frequencies faster than once per 24 hours. Affective oscillations spanned a range of cycling frequencies from four episodes per year (rapid cycling) to those occurring within the course of weeks to several days (ultra-rapid cycling), to distinct, abrupt mood shifts of less than 24 hours' duration (ultra-ultra rapid or ultradian cycling). The time of onset and duration of these ultradian affective fluctuations are highly variable and they are observed in bipolar patients without evidence of personality disorder.

Conclusions

The potential clinical and theoretical implications of these first systematic observations of ultra-rapid and ultradian cycling in the context of the evolution of otherwise classical bipolar affective illness are discussed.
Speech and Language in First Onset Psychosis Differences Between People with Schizophrenia, Mania, and Controls
Authors: Thomas Philip , Kearney Gabby , Napier Elizabeth , Ellis Elin , Leudar Ivan , Johnston Margaret
Published: October 2008

Background

Several studies have revealed linguistic differences between diagnostic groups. This study investigates the extent to which these differences are accounted for by factors such as chronicity, or disturbances in cognition associated with acute psychosis.

Method

Transcripts of interviews with patients suffering from RDC schizophrenia (n=38), mania (n=11) and controls (n=16) were examined using the Brief Syntactic Analysis (BSA). Patients were within two years of first onset of psychotic symptoms, and received tests of working memory and attention.

Results

The speech of patients with schizophrenia was syntactically less complex than that of controls. Patients with schizophrenia and mania made more errors than controls. These differences were, to some extent, related to group differences in social class, working memory and attention, although significant group differences in language persisted after the effects of covariates were removed.

Conclusions

The study confirms the existence of differences in the speech of psychiatric patients. Low complexity appears to be a particular feature of speech in schizophrenia, even in the earliest stages of the condition. The importance of this finding is discussed in relation to two recent theories of schizophrenia: Crow's evolutionary model, and Friths neuro-psychological model.
A Typology of Sub-Clinical Senescent Cognitive Disorder
Authors: Ritchie Karen , Leibovici Didier , Ledésert Bernard , Touchon Jacques
Published: October 2008

Background

Cognitive impairment without dementia is commonly observed in ageing populations. The present study aims to describe types of impairment and evolution over a one-year period.

Method

Three hundred and ninety-seven normal French elderly persons demonstrating recent, observable change in cognitive performance were examined annually using a computerised cognitive examination.

Results

Five subtypes were differentiated by cluster analysis. Two of the groups were predicted by logistic regression to be at high risk of senile dementia. Of 16 incident cases of senile dementia diagnosed in the following year, 13 were found to have derived from these two groups. The typology was also found to be useful in the description of age-associated memory impairment.

Conclusions

Subclinical cognitive impairment was found to not constitute a unitary phenomenon and heterogeneous subgroups could be differentiated. The concept of ‘normality’ in elderly cohorts is reconsidered in the light of these findings.