bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of long-term treatment with antipsychotics on serum leptin levels
Authors: Herrán Andrés , García-Unzueta María Teresa , Amado José Antonio , De La Maza María Teresa , Álvarez Concepción , Vázquez-Barquero José Luis
Published: August 2002

Background

Abnormal regulation of the adipocyte-derived hormone leptin could play a role in body weight gain induced by antipsychotics.

Aims

To study the effects of long-term antipsychotic treatment on leptin levels in patients with schizophrenia.

Method

Serum leptin levels were determined in 59 out-patients with chronic schizophrenia and in the same number of healthy subjects controlled by gender, age and body mass index.

Results

Leptin levels did not differ between patients and controls. Leptin levels in patients with schizophrenia correlated with weight gain, even after controlling for current weight, but did not show any association with clinical variables. Antipsychotic class tended to exert different effects over leptin levels (among atypicals, olanzapine induced a greater increase).

Conclusions

Elevation of leptin levels induced by chronic antipsychotic treatment can be attributed to weight gain, but other mechanisms could be involved.
Antipsychotic medication and venous thrombosis
Authors: Thomassen René , Vandenbroucke Jan P. , Rosendaal Frits R.
Published: August 2002

Background

In an autopsy series, 10 out of 27 deaths in which ‘idiopathic’ pulmonary emboli were discerned as the sole cause of death had occurred in psychiatric patients.

Aims

To investigate whether antipsychotic medication is a risk factor for venous thrombosis.

Method

A description of the 10 psychiatric patients was obtained from the pulmonary emboli autopsy reports. We carried out a brief historic overview of the literature. We re-analysed data from the Leiden Thrombophilia Study (LETS), a case–control study on patients with venous thrombosis.

Results

In the autopsy reports, five out of 10 psychiatric patients with fatal pulmonary embolism had confirmed use of antipsychotic drugs. After the application of chlorpromazine and its analogues a higher incidence of venous thrombosis in psychiatric patients was described in the German literature between 1953 and 1977. In the re-analysis of the LETS case–control study, four patients used antipsychotic drugs versus none in the control group. Recent epidemiological studies of good methodological quality have confirmed these findings.

Conclusions

Venous thrombosis appears to be associated with the use of antipsychotic drugs in psychiatric patients.
Carers' and Users' Expectations of Services – User version (CUES–U): A new instrument to measure the experience of users of mental health services
Authors: Lelliott Paul , Beevor Anne , Hogman Gary , Hyslop Jon , Lathlean Judith , Ward Martin
Published: August 2002

Background

No existing instrument measures all or even most of the issues considered important by users of mental health services.

Aims

To develop and test a self-assessment instrument to enable users of mental health services to rate their experience across the range of domains that they consider to be important.

Method

Relevant domains were identified and a new instrument was drafted and field tested to examine its psychometric properties.

Results

The 17-item, self-rated Carers' and Users' Expectations of Services – User version (CUES–U) appears acceptable to most service users. Its items have reasonable test–retest reliability and a ‘total CUES–U score’ correlates significantly with a total score of the Health of the Nations Outcome Scales (Spearman's ρ=0.42; P<0.01).

Conclusions

The development and testing of CUES–U suggest that it might be feasible to apply a self-rated measure of the expectations and experience of users of mental health services.
Personality disorder
Authors: Tyrer Peter
Published: August 2002

It is now respectable to read about personality disorder. It was not always so. Despite the impossibility of practising psychiatry without being aware of the term and the subject matter it describes, it was not appropriate in good psychiatric circles to mention the subject unless presaged by a pause and pronounced with a mocking inflexion that indicated that the words were in parentheses: signposts to somewhere undesirable, usually somewhere in the jungle of forensic psychiatry (a subject about which I write very little in this piece, in an attempt ot redres the balance). I think the reason for this was that personality disorder had such a strong flavour of criticism that, even in a discipline in which stigma confronts us on every corner, its words were the ultimate derogatory label that, once attached, became virtually indelible. Or, as my Landcashire grandmother would say about all unsavoury topics, it was “not very nice and no one really wants to know.”. So research and writing on the subject became almost a samizdat topic, written about in code, discussed in quiet corners between professionals when they could not be overheard, or in proxy phrases such as ‘relationship difficulties’ or ‘patients who are difficult to place’ (Coid, 1991).
Child sexual abuse, poor parental care and adult depression: evidence for different mechanisms
Authors: Hill Jonathan , Pickles Andrew , Burnside Elizabeth , Byatt Marie , Rollinson Lynn , Davis Rachel , Harvey Katie
Published: August 2002

Background

Child sexual abuse (CSA) and poor parental care (neglect and institutional care) are associated with depression in adult life. Little is known about possible mechanisms underlying these associations.

Aims

To examine the role of adult intimate-love relationships as differential mediators or moderators of the associations between CSA, poor parental care and adult depression.

Method

Sampling was carried out in two phases. In the first, questionnaires were sent to women aged 25–36 years in five primary care practices. Second-phase subjects for interview (n=198) were drawn from three strata defined on the basis of childhood adversities. Recalled childhood experiences and recent adult relationships and depression were assessed and rated independently. Frequencies of predictor and response variables, effect estimates and their confidence intervals were weighted back to the general population questionnaire sample.

Results

The risk for depression associated with CSA was unaffected by quality of adult relationships, while the risk associated with poor parental care was substantially altered.

Conclusions

There may be different pathways linking CSA and poor parental care to adult depression.
Family settings and children's adjustment: differential adjustment within and across families
Authors: O'Connor Thomas G. , Dunn Judy , Jenkins Jennifer M. , Pickering Kevin , Rasbash Jon
Published: August 2002

Background

Children in stepfamilies and single-parent families exhibit elevated levels of behavioural and emotional problems compared with children in intact (biological) families, but there is variation within and across these family types.

Aims

To examine the sources of variation in children's behavioural and emotional problems across diverse family settings.

Method

Levels of behavioural and emotional problems in children from diverse stepfamilies and single-parent families were compared with children living with both biological parents. Psychosocial risks were measured at the individual child and family levels.

Results

Behavioural and emotional problems were elevated in children in stepmother/complex stepfamilies and single-parent families, but not in simple stepfather families, relative to ‘biological’ families. Psychopathology associated with family type was explained by compromised quality of the parent–child relationship, parental depression and socio-economic adversity. Sibling similarity in behavioural and emotional problems was most pronounced in high-risk family settings.

Conclusions

Family type is a proxy for exposure to psychosocial risks; the extent of family-wide influence on children's development may be strongest in high-stress settings.
Genetic moderation of environmental risk for depression and anxiety in adolescent girls
Authors: Silberg Judy , Rutter Michael , Neale Michael , Eaves Lindon
Published: August 2002

Background

There is huge individual variation in people's response to negative life events.

Aims

To test the hypothesis that genetic factors moderate susceptibility to the environmentally mediated risks associated with negative life events.

Method

The Virginia Twin Study of Adolescent Behavioral Development (VTSABD) was used to study the effects of independent life events (assessed from maternal interview) on depression/anxiety (assessed from child interview) in 184 same-gender female twin pairs, aged 14–17 years, measured on two occasions.

Results

There was no genetic effect on the independent negative life events studied. A significant gene–environment interaction was found using structural equation modelling. There was no effect of independent life events on adolescents' depression in the absence of parental emotional disorder, but a significant effect in its presence.

Conclusions

There is an environmentally mediated effect of life events on depression/anxiety. Genetic factors play a significant role in individual differences in susceptibility to these environmentally mediated risks.
Approaches to gene mapping in complex disorders and their application in child psychiatry and psychology
Authors: Asherson Philip J. , Curran Sarah
Published: August 2002

Background

Twin studies demonstrate the importance of genes and environment in the aetiology of childhood psychiatric and neurodevelopmental disorders. Advances in molecular genetics enable the identification of genes involved in complex disorders and enable the study of molecular mechanisms and gene–environment interactions.

Aims

To review the role of molecular genetics studies in childhood behavioural and developmental traits.

Method

Molecular approaches to complex disorders are reviewed, with examples from autism, reading disability and attention-deficit hyperactivity disorder (ADHD).

Results

The most robust finding in ADHD is the association of a variable number tandem repeat polymorphism in exon 3 of the DRD4 gene. Other replicated associations with ADHD are outlined in the text. In autism, there is a replicated linkage finding on chromosome 7. Linkage studies in reading disability have confirmed a locus on chromosome 6 and strongly suggest one on chromosome 15.

Conclusions

In the next 5–10 years susceptibility genes for these disorders will be established. Describing their relationship to biological and behavioural function will be a far greater challenge.
Hyperphagic short stature and Prader–Willi syndrome: A comparison of behavioural phenotypes, genotypes and indices of stress
Authors: Gilmour Jane , Skuse David , Pembrey Marcus
Published: August 2002

Background

The clinical features of hyperphagic short stature (HSS) include short stature secondary to growth hormone insufficiency, excessive appetite (hyperphagia) and mild learning disabilities. Affected children characteristically live in conditions of high psychosocial stress. Symptoms resolve when the child is removed from the stressful environment. Family studies indicate a genetic predisposition.

Aims

To compare the behavioural and stress profiles of HSS with those of Prader–Willi syndrome (PWS), and to test the hypothesis that the genetic locus that predisposes to HSS co-inherits with the PWS locus at 15q11–13.

Method

Twenty-five children with HSS, mean age 9.1 (s.d. 3.8) years, 28% female, were compared with 30 children with PWS, mean age 8.8 (s.d. 2.8) years, 33% female.

Results

The clinical profiles were largely similar across the conditions, but no evidence was found in HSS of co-inheritance of the PWS critical region.

Conclusions

Hyperphagic short stature is one of the very few behavioural diseases associated with a pathognomonic physiological abnormality. Investigations of the suggested genetic dysregulation, which is so sensitive to environmental influences, may well be of importance in a broader context.
Neuropsychological analyses of impulsiveness in childhood hyperactivity
Authors: Rubia K. , Taylor E. , Smith A. B. , Oksannen H. , Overmeyer S. , Newman S.
Published: August 2002

Background

Neuropsychological analyses of impulsiveness are needed to refine assessment of attention-deficit hyperactivity disorder (ADHD).

Aims

To investigate specific impairments in hyperactive children in a neuropsychological task battery of impulsiveness, the Maudsley Attention and Response Suppression (MARS) task battery, and to identify the neural substrates.

Method

Impulsiveness was assessed using different tasks of inhibitory control and time management (MARS) in 55 children with ADHD, other diagnoses and controls. Functional magnetic resonance images were obtained from adolescents with and without ADHD during three of the tasks.

Results

Children with ADHD, but not psychiatric controls, were impaired on tests of response inhibition, but not of motor timing. Reduced right prefrontal activation was observed in hyperactive adolescents during higher level inhibition and delay management, but not during simple sensorimotor coordination.

Conclusions

Attention-deficit hyperactivity disorder is characterised by specific deficits in tasks of motor response inhibition, but not motor timing, and by dysfunction of frontostriatal brain regions.
Autonomic reactivity and psychopathology in middle childhood
Authors: Boyce W. Thomas , Quas Jodi , Alkon Abbey , Smider Nancy A. , Essex Marilyn J. , Kupfer David J. ,   MacArthur Assessment Battery Working Group of the MacArthur Foundation Research Network on Psychopathology and Development
Published: August 2002

Background

Better indicators are needed for identifying children with early signs of developmental psychopathology.

Aims

To identify measures of autonomic nervous system reactivity that discriminate children with internalising and externalising behavioural symptoms.

Method

A cross-sectional study of 122 children aged 6–7 years examined sympathetic and parasympathetic reactivity to standardised field-laboratory stressors as predictors of parent— and teacher-reported mental health symptoms.

Results

Measures of autonomic reactivity discriminated between children with internalising behaviour problems, externalising behaviour problems and neither. Internalisers showed high reactivity relative to low-symptom children, principally in the parasympathetic branch, while externalisers showed low reactivity, in both autonomic branches.

Conclusions

School-age children with mental health symptoms showed a pattern of autonomic dimorphism in their reactivity to standardised challenges. This observation may be of use in early identification of children with presyndromal psychopathology.
Timing of initial exposure to maternal major depression and children's mental health symptoms in kindergarten
Authors: Essex Marilyn J. , Klein Marjorie H. , Miech Richard , Smider Nancy A.
Published: August 2002

Background

Little is known about the influence on child mental health symptoms of the timing of initial exposure to maternal major depression or whether the timing is associated with ‘pure’ or co-occurring internalising and externalising symptoms.

Aims

To address these issues, while also taking account of child gender and family socio-economic status.

Method

In a prospective community-based study, 421 kindergarten teachers rated children's symptoms. Previous assessments of maternal major depression indicated whether children were first exposed during infancy, in the toddler/pre-school period, or never.

Results

Exposure during infancy was associated with high internalising symptoms, especially when co-occurring with high externalising symptoms. Initial exposure in the toddler/pre-school years increased the risk of ‘pure’ externalising symptoms among girls.

Conclusions

The association of child mental health symptoms with the timing of initial exposure to maternal depression highlights the need for effective prevention and intervention strategies addressed to the developmental issues of each period.
Influence of psychiatric disorder on the controlling behaviour of mothers with 1-year-old infants
Authors: Stein Alan , Woolley Helen , Murray Lynne , Cooper Peter , Cooper Sandra , Noble Fiona , Affonso Nicky , Fairburn Christopher G.
Published: August 2002

Background

Certain styles of parental controlling behaviour influence child development. Work with mothers with eating disorders suggests that they may be particularly controlling of their infants.

Aims

To examine the nature and specificity of maternal controlling behaviour in mothers with eating disorders compared with mothers who had experienced postnatal depression and a healthy comparison group.

Method

Mothers with eating disorders (n=34), postnatal depression (n=39) and a healthy comparison group (n=61) and their 12-month-old infants were observed during play and mealtimes, and blind ratings made of verbal and non-verbal control exerted by the mother.

Results

Mothers in the eating disorder group used more verbal control, especially strong control. There were no differences between the groups on gentle verbal control and physical contact. Maternal dietary restraint was the one feature of eating disorder psychopathology associated with the use of verbal control. Marital criticism was also associated with the extent of verbal controlling behaviour.

Conclusions

Aspects of maternal control of infants were found to be specific to maternal eating disorder psychopathology.
Use of sertraline, paroxetine and fluvoxamine by nursing women
Authors: Hendrick Victoria , Fukuchi Alan , Altshuler Lori , Widawski Mel , Wertheimer Amy , Brunhuber Martina V.
Published: August 2002

Background

The pharmacological treatment of depression in nursing women requires information on the magnitude of medication exposure to the infant that may occur through breast milk.

Aims

To examine serum concentrations of antidepressants in infants exposed to these medications through breast-feeding.

Method

Maternal and infant serum concentrations of sertraline, paroxetine and fluvoxamine were determined with high-performance liquid chromatography (limit of detections=1 ng/ml).

Results

No detectable medication was present in any infant exposed to paroxetine (n=16) or fluvoxamine (n=4). Among infants exposed to sertraline (n=30), detectable medication was present in 24% of serum samples. A significant negative correlation was found between infant age and infant serum concentration. Sertraline was significantly more likely to be detected in an infant if the mother's daily dose was 100 mg or higher. No adverse sequelae occurred in any infant.

Conclusions

This study shows that paroxetine, fluvoxamine and sertraline produce minimal exposure to infants when taken by nursing mothers.
Association of autonomic dysfunction and clozapine
Authors: Cohen Hagit , Loewenthal Uri , Matar Michael , Kotler Moshe
Published: August 2002

Background

Antipsychotic medications cause a wide range of adverse effects and have been associated with sudden death in psychiatric patients.

Aims

To supply power spectral analysis of heart rate variability as a tool to examine the arrythmogenic effects of neuroleptics.

Method

Heart rate analysis was carried out in patients with schizophrenia on standard doses of neuroleptic monotherapy − 21 were on clozapine, 18 on haloperidol and 17 on olanzapine – and in 53 healthy subjects.

Results

Patients with schizophrenia on clozapine had significantly higher heart rate, lower heart rate variability and lower high-frequency and higher low-frequency components compared with patients on haloperidol or olanzapine and matched control subjects. Prolonged QTc intervals were more common in patients than controls.

Conclusions

Patients treated with neuroleptic medications, especially clozapine, showed autonomic dysregulation and cardiac repolarisation changes. Physicians should be aware of this adverse reaction.
Increased first-contact rates for very-late-onset schizophrenia-like psychosis in African— and Caribbean-born elders
Authors: Reeves Suzanne J. , Sauer Justin , Stewart Robert , Granger Annabel , Howard Robert J.
Published: August 2002

Background

Studies have consistently shown a higher incidence of schizophrenia with onset in early adult life in African and Caribbean migrants to the UK.

Aims

To establish the incidence (first-contact rates) of very-late-onset (>60 years) schizophrenia-like psychosis (SLP) in south London and to test the hypothesis that this is higher among African— and Caribbean-born than indigenous elders.

Method

We identified all new referrals of SLP to the Maudsley Hospital between 1995 and 2000. Demographic details, including age, ethnicity and electoral ward (address), were obtained from case notes. Incidence was estimated using 1997 census data to determine the denominator population for each ethnic group.

Results

The incidence of SLP was significantly higher in African— and Caribbean-born than indigenous elders: 172.4 per 100 000 population (95% Cl=579–286.8) in African— and Caribbean-born males and 323.5 per 100 000 population (95% Cl 167.8–479.1) in African— and Caribbean-born females. Rates also were increased in elders from other immigrant groups, but the numbers involved were too small to reach accepted levels of significance.

Conclusions

Large-scale epidemiological studies are needed to determine both the incidence of and the coexistent risk factors for SLP among all elderly migrants, who may constitute a group with high service needs.
Specificity and heterogeneity in children's responses to profound institutional privation
Authors: Rutter Michael L. , Kreppner Jana M. , O'Connor Thomas G.
Published: August 2002

Background

The sequelae of profound early privation are varied.

Aims

To delineate the behavioural patterns that are specifically associated with institutional privation.

Method

A group of 165 children adopted from Romania before the age of 42 months were compared at 4 years and 6 years with 52 non-deprived UK children adopted in infancy. Dysfunction was assessed for seven domains of functioning. The groups were compared on which, and how many, domains were impaired.

Results

Attachment problems, inattention/overactivity, quasi-autistic features and cognitive impairment were associated with institutional privation, but emotional difficulties, poor peer relationships and conduct problems were not. Nevertheless, one-fifth of children who spent the longest time in institutions showed normal functioning.

Conclusions

Attachment disorder behaviours, inattention/overactivity and quasi-autistic behaviour constitute institutional privation patterns.
Association between behaviour at age 3 years and adult criminality
Authors: Stevenson Jim , Goodman Robert
Published: August 2002

Background

The continuity in antisocial behaviour into adulthood from middle childhood is well established but it is not clear whether this is also true of the pre-school period.

Aims

To determine whether preschool behaviour problems increase the risk of later criminal convictions and add to risk associated with family and social circumstances.

Method

The records of adult convictions were traced for a general population sample (n=828) initially assessed at age 3 years.

Results

The risk of having any adult conviction was related to soiling, daytime enuresis, activity level and management difficulties, and that of having an adult violent offence to recent-onset daytime enuresis, management difficulties and temper tantrums. The only other predictors of later convictions were the child's gender and social competence at age 3 years.

Conclusions

The presence of specific behaviour problems in the pre-school period places the child at increased risk of being convicted of an adult offence. Family and social circumstances at age 3 years did not predict later convictions.
Adolescents' self-reported problems as predictors of psychopathology in adulthood: 10-year follow-up study
Authors: Hofstra Marijke B. , Van Der Ende Jan , Verhulst Frank C.
Published: August 2002

Background

Knowledge of the course of psychopathology from adolescence into adulthood is needed to answer questions concerning origins and prognosis of psychopathology across a wide age range.

Aims

To investigate the 10-year course and predictive value of self-reported problems in adolescence in relation to psychopathology in adulthood.

Method

Subjects from the general population, aged 11–19 years, were assessed with the Youth Self-Report (YSR) at initial assessment, and with the Young Adult Self-Report (YASR), the Composite International Diagnostic Interview (CIDI) and three sections of the Diagnostic Interview Schedule (DIS) 10 years later.

Results

Of the subjects with deviant YSR total problem scores, 23% (males) and 22% (females) had deviant YASR total problem scores at follow-up. Subjects with initial deviant YSR total problem, internalising and externalising scores had higher prevalences of DSM–IV diagnoses at follow-up.

Conclusions

Adolescent problems tended to persist into adulthood to a moderate degree. High rates of problems during adolescence are risk factors for psychiatric disorders in adulthood.
The Maudsley long-term follow-up of child and adolescent depression
Authors: Fombonne Eric , Wostear Gail , Cooper Vanessa , Harrington Richard , Rutter Michael
Published: August 2002

Background

Strong links exist between juvenile and adult depression but comorbid conduct disorder in childhood may mitigate this continuity.

Aims

To test the impact of comorbid conduct disorder on psychiatric adult outcomes.

Method

A group of 149 subjects assessed at the Maudsley Hospital in the period 1970–1983 and meeting DSM–IV criteria for major depressive disorder with (n=53) or without (n=96) conduct disorder were interviewed 20 years later. Data were collected on the lifetime history of psychiatric disorders.

Results

Adult depressive recurrence was high for major depression (62.4%) and any depression (75.2%), and survival analyses showed no difference between the two groups. The group with conduct disorders had higher rates of drug misuse and dependence, alcoholism and antisocial personality disorders.

Conclusions

Adolescent depression carries an elevated risk of adult depression irrespective of comorbidity. Comorbid conduct disorder in childhood is associated with raised rates of other psychiatric outcomes.
The Maudsley long-term follow-up of child and adolescent depression
Authors: Fombonne Eric , Wostear Gail , Cooper Vanessa , Harrington Richard , Rutter Michael
Published: August 2002

Background

Strong links exist between juvenile and adult depression, but comorbid conduct disorder may be associated with worse adult social difficulties.

Aims

To test the impact of comorbid conduct disorder on social adjustment and dysfunction, suicidality and criminality of adults who had had depression as youths.

Method

Subjects (n=149) assessed at the Maudsley Hospital in 1970–1983 and meeting DSM–IV criteria for major depressive disorder with (CD–MDD; n=53) or without (MDD; n=96) conduct disorder were interviewed 20 years later. Data were collected on lifetime psychiatric disorders and adult social/personality functioning. Death certificates and criminal records were obtained.

Results

The suicide risk was 2.45%, and 44.3% of the sample had attempted suicide once in their lives. Compared with the MDD group, the CD–MDD group had higher rates of suicidal behaviours and criminal offences, and exhibited more pervasive social dysfunction.

Conclusions

Adolescent depression is associated with raised risks of adult suicidality and with persistent interpersonal difficulties. Youths with CD–MDD show more severe and pervasive social dysfunction.
Examining the comorbidity of ADHD-related behaviours and conduct problems using a twin study design
Authors: Thapar Anita , Harrington Richard , McGuffin Peter
Published: August 2002

Background

Although attention-deficit hyperactivity disorder (ADHD) and conduct disorder (CD) frequently co-occur, the underlying mechanisms for this comorbidity are not well understood.

Aims

To examine whether ADHD and conduct problems share common risk factors and whether ADHD+CD is a more heritable variant of ADHD.

Method

Questionnaires were sent to 2846 families. Parent-rated data were obtained for 2082 twin pairs and analysed using bivariate genetic analysis and a liability threshold model approach.

Results

The overlap of ADHD and conduct problems was explained by common genetic and non-shared environmental factors influencing both categories. Nevertheless, the two categories appeared to be partly distinct in that additional environmental factors influenced conduct problems. It appeared that ADHD+CD was a genetically more severe variant of ADHD.

Conclusions

Conduct problems and ADHD share a common genetic aetiology; ADHD+CD appears to be a more severe subtype in terms of genetic loading as well as clinical severity.
Child psychiatric symptoms and psychosocial impairment: relationship and prognostic significance
Authors: Pickles Andrew , Rowe Richard , Simonoff Emily , Foley Debra , Rutter Michael , Silberg Judy
Published: August 2002

Background

Relatively little is known about the relationships between psychiatric symptoms, diagnosis and psychosocial impairment.

Aims

To examine these contemporaneous relationships and prognostic significance in a large general population sample.

Method

Symptoms of major depression, conduct and oppositional defiant disorders were assessed by interview in two waves of the Virginia Twin Study of Adolescent behavioural Development (2800 children aged 8–16 years).

Results

Manychildren below the DSM–III–R diagnostic threshold, especially for depression, had symptom-related impairment, whereas many children reaching the symptom threshold for conduct and oppositional defiant disorders were little impaired. Impairment score was linearly related to symptom count, with no evidence of any additional impairment at the diagnostic threshold. For depression, only symptoms predicted later symptoms and diagnosis. For conduct and oppositional defiant disorders, impairment was additionally predictive of later symptoms and diagnosis.

Conclusions

Impairment, in addition to symptoms, is important for both nosology and prognosis.
Development of weight and shape concerns in the aetiology of eating disorders
Authors: Gowers Simon G. , Shore Alison
Published: August 2002

Background

Although weight and shape concerns are considered to be integral to the psychopathology of anorexia and bulimia nervosa, uncertainties remain about developmental aspects of the aetiology of these concerns and their relationship to eating disorders.

Aims

To review the recent literature on weight and shape concern, with particular emphasis on aetiology, to identify a possible developmental pathway from weight concern through abnormal eating behaviour to disorder.

Method

Literature review of Medline and Psychlit databases using the keywords ‘eating disosrder’, ‘weight concern’, ‘shape concern’ and ‘aetiology’. Inclusion criteria were based on the strength of quantitative research findings, originality of ideas and recent publication.

Results

Weight and shape concerns follow a developmental pathway arising before the typical age for the development of eating disorders. The origins are multifactorial, with biological, family and sociocultural features predominating.

Conclusions

Although weight and shape concern seems commonly to underlie the development of eating disorders, an alternative pathway appears to exist through impulsivity and fear of loss of control. Prevention strategies may usefully focus on the attitudes and concerns that lead to dieting behaviour.
Possible role of cortisol and dehydroepiandrosterone in human development and psychopathology
Authors: Goodyer I. M. , Park R. J. , Netherton C. M. , Herbert J.
Published: August 2002

Background

The characteristics of adrenal hormone secretion change markedly during infancy. Disturbances in basal levels may precipitate psychological dysfunction and are associated with psychopathology in young people.

Aims

To relate three aspects of behavioural endocrinology: developmental changes in cortisol and dehydroepiandrosterone (DHEA), the role of these hormones in the psychopathology of young people, and the action of these steroids in the brain.

Method

A selective review from the human developmental, psychiatric and neurosciences literature.

Results

There are developmentally mediated changes in brain sensitivity following excess exposure to cortisol. This may result in impairments of mental and behavioural function. DHEA and gonadal steroids may modulate the actions of cortisol.

Conclusions

Steroid hormones contribute to shaping behavioural function during early development and act as risk factors for psychopathology.
Prevalence of dementia according to DSM–III–R and ICD–10
Authors: Riedel-Heller Steffi G. , Busse Anja , Aurich Conny , Matschinger Herbert , Angermeyer Matthias C.
Published: August 2002

Background

The prevalence of dementia diagnosis according to ICD–10 and DSM–III–R in population surveys remains poorly understood.

Aims

To report and compare prevalence rates according to DSM–III–R and ICD–10.

Method

A population-based sample (n=1692, age 75+ years) was investigated by a Structured Interview for Diagnosis of Dementia of Alzheimer Type, Multiinfarct Dementia and Dementia of other Aetiology according to DSM–III–R and ICD–10 (SIDAM).

Results

Whereas 17.4% (95% CI=15.9–19.5) of individuals aged 75+ years suffer from dementia according to DSM–III–R, only 12.4% (95% CI=10.6–14.2) are diagnosed as having dementia according to ICD–10. The results revealed lower ICD–10 rates in all investigated age groups. The largest differences appear in the oldest of the elderly.

Conclusions

The ICD–10 sets a higher threshold for dementia diagnosis. Larger differences in the eldest age groups might reflect difficulties in applying case definitions, especially in those beyond 90 years old.
Incidence of Dementia According to DSM–III–R and ICD–10
Authors: Riedel-Heller Steffi G. , Busse Anja , Aurich Conny , Matschinger Herbert , Angermeyer Matthias C.
Published: August 2002

Background

The impact of different case definitions on incidence rates remains unclear.

Aims

To compare incidence rates of dementia according to DSM–III–Rand ICD–10.

Method

A two-wave community study was conducted (n=1692, age 75+ years follow-up period 1.6 years). Cognitive function was assessed by the Structured Interview for Diagnosis of Dementia of Alzheimer Type, Multiinfarct Dementia and Dementia of other Aetiology according to ICD–10 and DSM–III–R (SIDAM).

Results

The annual incidence rate for dementia by applying different case definitions was found to be quite similar (DSM–III–R: 47.4 (95% Cl=36.1–61.2) per 1000 person-years; ICD–10: 45.8 (95% Cl= 35.0–59.0) per 1000 person-years). Age-specific incidence rates increase steeply with age.

Conclusions

The impact of different case definitions on incidence rates of dementia appears limited if case definitions and case-finding procedures at baseline and follow-up are applied consistently.
Costs of dementia in England and Wales in the 21st century
Authors: McNamee Paul , Bond John , Buck Debbie
Published: August 2002

Background

An important factor determining future health care expenditure is the relationship between ageing, health status and development of age-related disorders such as dementia.

Aims

To estimate the formal care costs associated with dementia in England and Wales between 1994 and 2031.

Method

Epidemiological cost model, applied to individuals aged 65 years or over with dementia, using estimates of life expectancy with dementia and dementia-free life expectancy.

Results

Total costs per year were £0.95 billion (men) and £5.35 billion (women) using 1994 population estimates. For 2031, costs were £2.34 billion and £11.20 billion, respectively. Reduced dementia prevalence rates and improvements in mental and physical functioning resulted in lower estimates: £1.01 billon (men) and £5.77 billion (women), and £1.65 billion (men) and £7.87 billion (women), respectively.

Conclusions

Future increases in the population aged 65 years or over lead to rising formal care costs. However, the magnitude of cost changes depends on assumptions over dementia prevalence and levels of mental and physical functioning.
Systematic meta-review of depot antipsychotic drugs for people with schizophrenia
Authors: Adams Clive E. , Fenton Mark K. P. , Quraishi Seema , David Anthony S.
Published: August 2002

Background

Long-acting depot antipsychotic medication is a widely used treatment for schizophrenia.

Aims

To synthesise relevant systematic Cochrane reviews.

Method

The Cochrane Database was searched and summary data were extracted from randomised controlled clinical trials of depots.

Results

Standard dose depot v. placebo resulted in significantly less relapse but more movement disorders. Those on depots (v. oral drugs) showed more global change on one outcome measure; relapse and adverse effects showed no difference. Comparisons showed no convincing advantages for one depot over another.

Conclusions

Depot antipsychotics are safe and effective. They may confer a small benefit over oral drugs on global outcome. Those for whom depots are most indicated may not be represented. Large studies are required to discern differences in relapse rates and long-term adverse effects, and data on satisfaction, quality of life and economics.
Systematic review of patient and nurse attitudes to depot antipsychotic medication
Authors: Walburn Jessica , Gray Richard , Gournay Kevin , Quraishi Seema , David Anthony S.
Published: August 2002

Background

Depot antipsychotic medication is used widely in the treatment and prophylaxis of severe mental illness.

Aims

To review the literature on patient and nurse satisfaction with, and attitudes towards, depots.

Method

A systematic search of Medline, Embase, PsycINFO, CINAHL and The Cochrane Library was undertaken, along with citation searches. Studies were selected if satisfaction/attitude data were described in the title or abstract and original data were included. Study quality was rated.

Results

The search produced 1374 articles; 22 articles met the inclusion criteria, 18 of which were cross-sectional surveys. Of the 12 studies with relevant data, 10 conveyed a positive opinion of depot medication. Five out of six studies comparing depot with oral medication showed patient preference for depot.

Conclusions

High-quality data examining patient and nurse attitudes regarding depot antipsychotics are sparse. What data there are show a positive attitude to depots from patients. Future randomised controlled trials should include satisfaction as an outcome.
Depressive disorders in Europe: prevalence figures from the ODIN study
Authors: Ayuso-Mateos Jose Luis , Vázquez-Barquero Jose Luis , Dowrick Christopher , Lehtinen Ville , Dalgard Odd Steffen , Casey Patricia , Wilkinson Clare , Lasa Lourdes , Page Helen , Dunn Graham , Wilkinson Greg ,   the Odin Group
Published: August 2002

Background

This is the first report on the epidemiology of depressive disorders from the European Outcome of Depression International Network (ODIN) study.

Aims

To assess the prevalence of depressive disorders in randomly selected samples of the general population in five European countries.

Method

The study was designed as a cross-sectional two-phase community study using the Beck Depression Inventory during Phase 1, and the Schedule for Clinical Assessment in Neuropsychiatry during Phase 2.

Results

An analysis of the combined sample (n=8.764) gave an overall prevalence of depressive disorders of 8.56% (95% Cl 7.05–10.37). The figures were 10.05% (95% Cl 7.80–12.85) for women and 6.61% (95% Cl 4.92–8.83) for men. The centres fall into three categories: high prevalence (urban Ireland and urban UK), low prevalence (urban Spain) and medium prevalence (the remaining sites).

Conclusions

Depressive disorder is a highly prevalent condition in Europe. The major finding is the wide difference in the prevalence of depressive disorders found across the study sites.
Dimensional perspective on the recognition of depressive symptoms in primary care
Authors: Thompson Chris , Ostler Kevin , Peveler Robert C. , Baker Nigel , Kinmonth Ann-Louise
Published: August 2002

Background

Most studies of the recognition of depression in primary care have used a categorical definition of depression. This may overstate the extent of the problem.

Aims

Our objective was to investigate the relationship between severity and recognition of depression, and its modification by patient and practitioner characteristics.

Method

An association study in multiple consecutive adult cohorts of 18 414 primary care consultations drawn from a representative sample of 156 general practitioners in Hampshire, UK.

Results

There was a curvilinear relationship between the severity of depression and practitioners' ratings of depression. One case of probable depression was missed in every 28.6 consultations. Anxiety and unemployment altered the chances of recognition, but age, gender and deprivation scores did not.

Conclusions

A dimensional approach to severity of depression shows that general practitioners may be better able to recognise depression than previous categorical studies have suggested. Efforts to improve the care of depression should therefore focus on doctors who have been shown to have difficulty making the diagnosis and on improving the treatment of identified patients.
Prevalence of obsessive–compulsive disorder in the British nationwide survey of child mental health
Authors: Heyman Isobel , Fombonne Eric , Simmons Helen , Ford Tamsin , Meltzer Howard , Goodman Robert
Published: August 2002

Background

Obsessive–compulsive disorder (OCD) is a disorder that appears to be underdiagnosed and undertreated, despite the evidence for effective treatments. There are variable estimates of OCD prevalence in the under-16s and published rates give little indication of age trends.

Aims

To establish the prevalence and associates of OCD in young people aged 5–15 years.

Method

A nationwide (UK) epidemiological study of rates of psychiatric disorder in 5— to 15-year-olds (1999 British Child Mental Health Survey): 10 438 children were assessed.

Results

Twenty-five children with OCD were identified (weighted overall prevalence 0.25%; 95% Cl 0.14–0.35), with prevalence rising exponentially with increasing age. Compared with normal controls, children with OCD were more likely to be from lower socio-economic class and of lower intelligence. Only three of these children had been seen by specialist children's services.

Conclusions

Although OCD is rare in young children, the rate increases towards the adult rates at puberty. Children with OCD have additional psychosocial disadvantage. The majority of the childhood cases identified in this survey appear to have been undetected and untreated.
Grey matter abnormalities in obsessive–compulsive disorder
Authors: Kim Jae-Jin , Lee Myung Chul , Kim Jaeseok , Kim In Young , Kim Sun I. , Han Moon Hee , Chang Kee-Hyun , Kwon Jun Soo
Published: August 2002

Background

Although a number of functional imaging studies are in agreement in suggesting orbitofrontal and subcortical hyperfunction in the pathophysiology of obsessive–compulsive disorder (OCD), the structural findings have been contradictory.

Aims

To investigate grey matter abnormalities in patients with OCD by employing a novel voxel-based analysis of magnetic resonance images.

Method

Statistical parametric mapping was utilised to compare segmented grey matter images from 25 patients with OCD with those from 25 matched controls.

Results

Increased regional grey matter density was found in multiple cortical areas, including the left orbitofrontal cortex, and in subcortical areas, including the thalamus. On the other hand, regions of reduction were confined to posterior parts of the brain, such as the left cuneus and the left cerebellum.

Conclusions

Increased grey matter density of frontal–subcortical circuits, consonant with the hypermetabolic findings from functional imaging studies, seems to exist in patients with OCD, and cerebellar dysfunction may be involved in the pathophysiology of OCD.
Comparison of the incidence of schizophrenia in rural Dumfries and Galloway and urban Camberwell
Authors: Allardyce J. , Boydell J. , Van Os J. , Morrison G. , Castle D. , Murray R. M. , McCreadie R. G.
Published: August 2002

Background

Being born or living in urban areas is associated with high rates of schizophrenia. However, few studies have compared the incidence in urban/rural areas using the same methodology.

Aims

To compare service-based incidence rates for schizophrenia in rural Dumfries and Galloway in south-west Scotland with urban Camberwell in south-east London.

Method

Using Research Diagnostic Criteria diagnoses from the OPCRIT computer algorithm, we compared the incidence of schizophrenia over 12 years (1979–1984 and 1992–1997) using indirect standardisation techniques and Poisson regression modelling.

Results

The incidence was 61% higher in urban Camberwell than in rural Dumfries and Galloway (standardised incidence ratio (SIR)= 1.61; 95% Cl=1.42–1.81). There was no difference in incidence when we compared the White population in Camberwell with Dumfries and Galloway (SIR=1.12; 95% CI=0.86–1.43).

Conclusions

The incidence of schizophrenia in urban Camberwell was higher than that in rural Dumfries and Galloway; the high incidence of non-Whites in Camberwell largely explains the urban/rural difference.
Duration of untreated psychosis and cognitive functioning in first-episode patients
Authors: Norman Ross M. G. , Townsend Laurel , Malla Ashok K.
Published: August 2002

Background

The ‘toxicity’ model of duration of untreated psychosis (DUP) suggests that longer DUP will be associated with poorer performance on cognitive tests in first-episode patients.

Aims

To test this hypothesis on a sample of 113 patients in a community-based early intervention programme for psychosis.

Method

Information was collected concerning a number of possible predictors of cognitive functioning including DUP. These were examined for their relation to performance on an extensive battery of cognitive tests administered shortly after the patients' admission to the programme.

Results

Although several variables such as gender, premorbid adjustment, education and handedness predicted cognitive functioning, no relation was found between DUP and performance on any component of the test battery.

Conclusions

Findings do not provide support for a toxic effect of DUP on cognitive functioning. Other mechanisms through which DUP might affect outcome such as psychological engulfment, social support and adherence to medication are discussed.
Association between schizophrenia and social inequality at birth: case–control study
Authors: Harrison Glynn , Gunnell David , Glazebrook Cris , Page Kim , Kwiecinski Rosemary
Published: August 2002

Background

The association between social inequality at birth and subsequent risk of schizophrenia is uncertain.

Aims

To investigate the relationship between adult-onset schizophrenia and two indicators of social inequality at birth: social class and area of residence.

Method

A matched case–control design was used with data from birth certificates of first-episode cases and age— and gender-matched controls.

Results

Risk increased with increasing levels of deprivation at birth. Subjects whose fathers were social class IV–V or who were born in deprived areas were at increased risk of schizophrenia (odds ratio=2.1; 95% Cl=0.8–5.5). Risk was greater in those with both of these indicators (odds ratio=8.1; 95% CI=2.7–23.9). There was some evidence that associations were stronger in older subjects. Exclusion of African–Caribbeans or cases with positive family history somewhat attenuated the association.

Conclusions

Indicators of social inequality at birth are associated with increased risk of adult-onset schizophrenia, suggesting that environmental factors are important determinants of schizophrenic disorders.