bluuebunny/crossref_metadata_2025 huggingface dataset:
Gender differences in risk factors for suicide in Denmark
Authors: Qin Ping , Agerbo Esben , Westergård-Nielsen Niels , Eriksson Tor , Mortensen Preben Bo
Published: August 2002

Background

Gender is one of the most frequently replicated predictors for suicide.

Aims

To identify risk factors for suicide among males and females and to investigate whether risk factors for suicide differ by gender.

Method

A time-matched nested case–control design was performed using Danish longitudinal register databases to obtain 811 suicide cases and 79 871 controls. Data were analysed using conditional logistic regression.

Results

A history of hospitalised mental illness was the most marked risk factor for suicide for both genders. Unemployment, retirement, being single and sickness absence were significant risk factors for men, whereas having a child <2 years old was significantly protective for women. The relative risks for suicide differed significantly between genders according to psychiatric admission status and being the parent of a child < 2 years. However, adjustment for these factors did not eliminate the gender difference in suicide risk.

Conclusions

Risk factors for suicide differed by gender and gender differences could not be explained by differential exposure to known risk factors.
Deliberate self-harm and antidepressant drugs
Authors: Donovan Stuart , Clayton Andrew , Beeharry Min , Jones Sheron , Kirk Chris , Waters Keith , Gardner David , Faulding June , Madeley Richard
Published: August 2002

Background

It is not clear if the frequency of deliberate self-harm (DSH) is the same in patients taking different pharmacological classes of antidepressant drugs.

Aims

To compare the frequency of DSH in patients who had been prescribed a tricyclic antidepressant (TCA) or a selective serotonin reuptake inhibitor (SSRI) prior to the DSH event.

Method

This was a prospective study in 2776 consecutive DSH cases attending an accident and emergency department. The incidence of DSH in TCA-treated cases and SSRI-treated cases is expressed as number of DSH events per 10 000 prescriptions of each antidepressant.

Results

Significantly more DSH events occurred following the prescription of an SSRI than that of a TCA (P < 0.001). The occurrence of DSH was highest with fluoxetine and lowest with amitriptyline.

Conclusions

Merely prescribing safer-in-overdose antidepressants is unlikely to reduce the overall morbidity from DSH.
Stress and psychiatric disorder in urban Rawalpindi
Authors: Mumford David B. , Minhas Fareed A. , Akhtar Imtiaz , Akhter Saeed , Mubbashar Malik H.
Published: August 2002

Background

Recent studies in rural areas of Pakistan have yielded high prevalence rates of common mental disorders, especially among women.

Aims

To investigate emotional distress and common mental disorders in a poor urban district using the same survey method.

Method

First-stage screening of a slum district of Rawalpindi used the Bradford Somatic Inventory. Psychiatric interviews were conducted with stratified samples using the ICD–10 research diagnostic criteria.

Results

On a conservative estimate, 25% of women and 10% of men suffered from anxiety and depressive disorders. Levels of emotional distress increased with age in both men and women. Women living in joint households reported more distress than those living in unitary families. Higher levels of education were associated with lower risk of common mental disorders, especially in younger women. Emotional distress was negatively correlated with socio-economic variables among women.

Conclusions

This study found levels of emotional distress and psychiatric morbidity in a poor district of Rawalpindi to be less than half those in a nearby rural village in the Punjab, although rates in women were still double those in men. Possible explanations are that more healthy people migrate to the cities or that urban living is more conducive to good mental health in Pakistan.
Influence of socio-economic deprivation on the prevalence and outcome of depression in primary care
Authors: Ostler K. , Thompson C. , Kinmonth A.-L. K. , Peveler R. C. , Stevens L. , Stevens A.
Published: August 2002

Background

Health inequalities exist for many disorders, but the contribution of deprivation to the prevalence and outcome of depressive symptoms in primary care populations has been infrequently studied.

Aims

To examine the influence of Jarman under-privileged area (UPA) scores on the prevalence and outcome of depressive symptoms in general practice patients.

Method

18 414 patients attending 55 representative practices completed the Hospital Anxiety and Depression Scale and a questionnaire for employment status. Outcome of those screening positive was assessed at 6 weeks and 6 months.

Results

The UPA score accounted for 48.3% of the variance between practices in prevalence of depressive symptoms. Attending a high UPA score practice predicted persistence of depressive symptoms to 6 months.

Conclusions

The socio-economic deprivation of a practice locality is a powerful predictor of the prevalence and persistence of depressive symptoms.
Accuracy of general practitioner's prognosis of the 1-year course of depression and generalised anxiety
Authors: Van Den Brink Rob H. S. , Ormel Johan , Van Der Meer Klaas , Tiemens Bea G. , Van Os Titus W. D. P. , Smit Annet , Jenner Jack A.
Published: August 2002

Background

A prognosis serves important functions for the management of common mental disorders in primary care.

Aims

To establish the accuracy of the general practitioner's (GP) prognosis.

Method

The agreement between GP prognosis and observed course was determined for 138 cases of ICD–10 depression and 65 of generalised anxiety disorder, identified among consecutive attenders of 18 GPs.

Results

Modest agreement between GP prognosis and course was found, both for depression (κ=0.21) and generalised anxiety (κ=0.111). Better agreement (κ=0.45 for depression, and κ=0.33 for generalised anxiety) was observed between the course and predictions from a statistical model based on information potentially available to the GP at the time the prognosis was made. This model assesses attainable performance for GPs.

Conclusions

General practitioners do a fair job in predicting the 1-year course of depression and generalised anxiety. Even so, their performance falls significantly short of attainable performance.
Stroke, vascular risk factors and depression
Authors: Stewart R. , Prince M. , Richards M. , Brayne C. , Mann A.
Published: August 2002

Background

Stroke, hypertension and diabetes are common in older Caribbean-born populations in the UK who may be at risk of depression secondary to vascular disease.

Aims

We examined the association between stroke, vascular risk factors and depression in a community-based Caribbean-born population aged 55–75 years.

Method

Vascular risk factors were identified by interview, examination and blood tests. Depression was categorised using the Geriatric Depression Scale. Disablement was assessed as a potential mediating factor.

Results

Physical illness and disablement were strongly associated with depression, independent of disablement. Previous stroke was associated with depression, independent of disablement. No vascular risk factors were associated with depression.

Conclusions

The risk of depression associated with stroke was not explained by disablement. However, the hypothesis that vascular risk factors are important in the genesis of depression was not supported.
Community study of depression in old age in Taiwan
Authors: Chong Mian-Yoon , Chen Chwen-Cheng , Tsang Hin-Yeung , Yeh Tzung-Lieh , Chen Cheng-Sheng , Lee Yi-Hui , Tang Tze-Chun , Lo Hsin-Yi
Published: August 2002

Background

Published studies of prevalence of depression in old age in Taiwan have yielded equivocal results.

Aims

To study the prevalence of depressive disorders among community-dwelling elderly; further, to assess socio-demographic correlates and life events in relation to depression.

Method

A randomised sample of 1500 subjects aged 65 and over was selected from three communities. Research psychiatrists conducted all assessments using the Geriatric Mental State Schedule. The diagnosis of depression was made with the GMS–AGECAT (Automated Geriatric Examination for Computerised Assisted Taxonomy); data on life events were collected with the Taiwanese version of the Life Events and Difficulties Schedule.

Results

One-month prevalence of psychiatric disorders was 37.7%, with 15.3% depressive neurosis and 5.9% major depression. A high risk of depressive disorders was found among widows with a low educational level living in the urban community, and among those with physical illnesses.

Conclusions

Contrary to most previous reports, we found that the prevalence of depressive disorders among the elderly in the community in Taiwan is high and comparable to rates reported in some studies of UK samples.
Evaluating the use of benzodiazepines following recent bereavement
Authors: Warner James , Metcalfe Chris , King Michael
Published: August 2002

Background

There is no evidence to support current advice not to use benzodiazepines after bereavement.

Aims

To determine the role of benzodiazepines in the management of bereavement.

Method

We conducted a randomised, double-blind, placebo-controlled evaluation of the use of diazepam after recent bereavement. Participants were randomised to either 2 mg diazepam or identically packaged placebo up to three times daily. The primary outcome measure was the Bereavement Phenomenology Questionnaire.

Results

Thirty subjects were randomised. No evidence was found of an effect of benzodiazepines on the course of the first 6 months of bereavement (estimated mean difference of combined follow-up assessments=0.3 in favour of placebo; 95% CI –6.2 to +6.7).

Conclusion

We found no evidence of a positive or negative effect of benzodiazepines on the course of bereavement.
Suicide or accident – self-killing in medieval England
Authors: Seabourne Alice , Seabourne Gwen
Published: August 2002

Background

Little is known about suicide in England in the medieval period. Legal records provide the best source of post-mortem data about suicides.

Method

Selected Eyre records from the reigns of Henry III (1216–1272), Edward I (1272–1307), Edward II (1307–1327) and Edward III (1327–1377) were translated and examined for details of self-killing.

Results

One hundred and ninety-eight cases of self-killing were found, eight of which were found to be accidental, non-felonious deaths. Self-killing was more common in men. Hanging was the most common and drowning the second most common method of self-killing in both males and females. Self-killing with sharp objects was predominantly a male method. Other methods of self-killing were rare. There were no reports of deliberate self-poisoning. There is some evidence of underreporting of, and attempts to conceal, self-killing from royal officers.

Conclusions

Eyre records suggest that although some of the facts surrounding self-killing have changed, others have remained constant, particularly the higher proportion of men who kill themselves and the greater use by men than women of sharp instruments to kill themselves. We discuss the description and understanding of psychiatric states by medieval English Eyres, particularly in terms of the perception of the mental states that accompanied suicidal actions.
Psychiatric and personality disorders in deliberate self-harm patients
Authors: Haw Camilla , Hawton Keith , Houston Kelly , Townsend Ellen
Published: August 2002

Background

Previous UK studies have reported much lower rates of psychiatric and personality disorder in those who attempt suicide than in those who die by suicide.

Aims

To determine the nature and prevalence of psychiatric and personality disorders in deliberate self-harm (DSH) patients.

Method

A representative sample of 150 DSH patients who presented to a general hospital were assessed using a structured clinical interview and a standardised instrument. Follow-up interviews were completed for 118 patients approximately 12–16 months later.

Results

ICD–10 psychiatric disorders were diagnosed in 138 patients (92.0%), with comorbidity of psychiatric disorders in 46.7%. The most common diagnosis was affective disorder (72.0%). Personality disorder was identified in 45.9% of patients interviewed at follow-up. Comorbidity of psychiatric and personality disorder was present in 44.1%.

Conclusions

Psychiatric and personality disorders, and their comorbidity, are common in DSH patients. This has important implications for assessment and management.
Medium secure forensic psychiatry services
Authors: Coid Jeremy , Kahtan Nadji , Gault Simon , Cook Adrian , Jarman Brian
Published: August 2002

Background

Regional medium secure developments have proceeded unevenly, with wide variations in resources to deliver services.

Aims

To compare patients admitted to seven (pre-reorganisation) regional services and styles of service delivery.

Method

A record survey of a complete sample of 2608 patients admitted on 3403 occasions between 1 January 1988 and 31 December 1994.

Results

Services differed according to location of patients before admission, their legal basis for detention, criminal and antisocial behaviour, diagnosis, security needs and length of stay. Regions with more resources and lower demand provided a wider range of services. Thames services were relatively under-provided during the study period, with North East Thames substantially reliant on admissions to private hospitals.

Conclusions

Uncoordinated development led to under-provision despite high demand. Certain regions prioritised offender patients and did not support local psychiatric services. New standards are required for service specification and resource allocation to redress inequality. Traditional performance measures were of limited usefulness in comparing services.
Survey of patients from an inner-London health authority in medium secure psychiatric care
Authors: Lelliott Paul , Audini Bernard , Duffett Richard
Published: August 2002

Background

Underprovision by the National Health Service (NHS) has led to an increase in medium secure psychiatric beds managed by the independent sector. Black people are overrepresented in medium secure care.

Aims

To describe those people from an inner-London health authority occupying all forms of medium secure provision. To compare those in NHS provision with those in the independent sector, and Black patients with White patients.

Method

A census of those in medium secure care in August 1997.

Results

The 90 patients in independent-sector units were similar to the 93 patients in NHS units except that they were more likely to have been referred from general psychiatric services (48% v. 19%) and less likely to have been referred from the criminal justice system or a high-security hospital (37% v. 63%). There were few differences between Black and White patients.

Conclusions

The NHS meets only part of the need for medium secure care of the population of this London health authority. This comparison of the characteristics of Black and White patients does not help to explain why Black people are overrepresented in medium secure settings.
Legal pitfalls of psychiatric research
Authors: Dawson John , King Michael , Papageorgiou Alexia , Davidson Oliver
Published: August 2002

Background

The increasing complexity of psychiatric research, including recent attempts to evaluate mental health legislation, suggests legal advice may be valuable in a wide range of research contexts.

Aims

We aim to illustrate both the legal pitfalls of research in psychiatry and the potential for solutions if the methods are carefully chosen.

Method

Two examples of research are subject to legal analysis, one involving advance directives, the other the random discharge of compulsory out-patients.

Results

This analysis illustrates that participation in research may expose clinicians to additional forms of liability, but the legal risks can be minimised through changes in the methods or additional safeguards.

Conclusions

Collaboration between academic law and psychiatry can enrich research agendas and avoid serious legal pitfalls. We argue that sound legal advice should be sought at the planning stage of research in psychiatry, but the fear of liability should not lead to overly defensive research practices. The aim should be to strike the right balance between avoiding unacceptable exposure to liability and stifling innovative research.
Genetic risk of Alzheimer's disease: advising relatives
Authors: Liddell M. B. , Lovestone S. , Owen M. J.
Published: August 2002

Background

Clinicians are increasingly asked by relatives of patients with Alzheimer's disease to advise on their genetic risk of developing Alzheimer's disease in later life. Many clinicians find this a difficult question to answer.

Aims

To provide information for old age psychiatrists wishing to advise relatives of their risk of developing Alzheimer's disease.

Method

A selective review of the key literature on the genetic epidemiology of Alzheimer's disease.

Results

Currently a DNA diagnosis is attainable in some 70% of families with autosomal dominant Alzheimer's disease. In first-degree relatives of most cases, risk is increased some three- or four-fold relative to controls, but only one-third of this is realised in the average life span. Apolipoprotein E genotyping cannot be used as a predictive test and confers only minimal diagnostic benefit.

Conclusions

Pedigrees with familial Alzheimer's disease should be referred to a Regional Centre for Medical Genetics. Accurate risk prediction is not possible in the vast majority of pedigrees with Alzheimer's disease, although it is possible for the psychiatrist to give a rough estimate of the risk, which can reasonably the couched in reassuring terms.
Mortality and long-term course in schizophrenia with a poor 2-year course
Authors: Mojtabai Ramin , Susser Ezra , Varma Vijoy K. , Malhotra Savita , Mattoo Surendra K. , Misra Arun K. , Wig Narendra N.
Published: August 2002

Background

The short-term course of schizophrenia is reported to be better in some developing country settings. The long-term course in such settings, however, has rarely been studied.

Aims

To examine the long-term course and mortality of schizophrenia in patients with a poor 2-year course.

Method

The report is based on two incidence cohorts of first-contact patients in urban and rural Chandigarh, India, originally recruited for the World Health Organization Determinants of Outcome of Severe Mental Disorders study. Patients were assessed using standardised instruments at 2- and 15-year follow-ups.

Results

Ninety-two per cent of the patients with a poor 2-year course had a poor long-term course and 47% died – a nine times higher mortality rate than among patients with other 2-year course types.

Conclusions

In this developing country setting, a poor 2-year course was strongly predictive of poor prognosis and high mortality, raising questions about the adequacy of care for such patients.
Ambulance personnel and critical incidents
Authors: Alexander David A. , Klein Susan
Published: August 2002

Background

The association between mental health and occupational factors among ambulance personnel has not been thoroughly investigated in the UK.

Aims

To identify the prevalence of psychopathology among ambulance personnel and its relationship to personality and exposure to critical incidents.

Method

Data were gathered from ambulance personnel by means of an anonymous questionnaire and standardised measures.

Results

Approximately a third of the sample reported high levels of general psychopathology, burnout and posttraumatic symptoms. Burnout was associated with less job satisfaction, longer time in service, less recovery time between incidents, and more frequent exposure to incidents. Burnout and GHQ–28 caseness were more likely in those who had experienced a particularly disturbing incident in the previous 6 months. Concerns about confidentiality and career prospects deter staff from seeking personal help.

Conclusions

The mental health and emotional well-being of ambulance personnel appear to be compromised by accident and emergency work.
Pharmacology and effects of cannabis: A brief review
Authors: Ashton C. Heather
Published: August 2002

Background

Increasing prevalence of recreational cannabis use among the young population has stimulated debate on the possible effects of acute and long-term use.

Aims

To highlight recent knowledge of mechanisms of action, effects on psychomotor and cognitive performance, and health risks associated with cannabis consumption.

Method

A brief review of recent literature on the prevalence of recreational cannabis use, the potency of modern cannabis preparations and the pharmacological actions of cannabis.

Results

Cannabinoids derived from herbal cannabis interact with endogenous cannabinoid systems in the body. Actions on specific brain receptors cause dose-related impairments of psychomotor performance with implications for car and train driving, aeroplane piloting and academic performance. Other constituents of cannabis smoke carry respiratory and cardiovascular health risks similar to those of tobacco smoke.

Conclusions

Cannabis is not, as widely perceived, a harmless drug but poses risks to the individual and to society.
Therapeutic aspects of cannabis and cannabinoids
Authors: Robson Philip
Published: August 2002

Background

Review commissioned in 1996 by the Department of Health (DOH).

Aims

Assess therapeutic profile of cannabis and cannabinoids.

Method

Medline search, references supplied by DOH and others, and personal communications.

Results and Conclusions

Cannabis and some cannabinoids are effective antiemetics and analgesics and reduce intraocular pressure. There is evidence of symptom relief and improved well-being in selected neurological conditions, AIDS and certain cancers. Cannabinoids may reduce anxiety and improve sleep. Anticonvulsant activity requires clarification. Other properties identified by basic research await evaluation. Standard treatments for many relevant disorders are unsatisfactory. Cannabis is safe in overdose but often produces unwanted effects, typically sedation, intoxication, clumsiness, dizziness, dry mouth, lowered blood pressure or increased heart rate. The discovery of specific receptors and natural ligands may lead to drug developments. Research is needed to optimise dose and route of administration, quantify therapeutic and adverse effects, and examine interactions.
Psychiatric effects of cannabis
Authors: Johns Andrew
Published: August 2002

Background

Cannabis is commonly regarded as an innocuous drug and the prevalence of lifetime and regular use has increased in most developed countries. However, accumulative evidence highlights the risks of dependence and other adverse effects, particularly among people with pre-existing psychiatric disorders.

Aims

To re-evaluate the adverse effects of cannabis in the general population and among vulnerable individuals, including those with serious psychiatric disorders.

Method

A wide-ranging review of the topics related to these issues.

Results and conclusions

An appreciable proportion of cannabis users report short-lived adverse effects, including psychotic states following heavy consumption, and regular users are at risk of dependence. People with major mental illnesses such as schizophrenia are especially vulnerable in that cannabis generally provokes relapse and aggravates existing symptoms. Health workers need to recognise, and respond to, the adverse effects of cannabis on mental health.
Evaluating alternative cannabis regimes
Authors: MacCoun Robert , Reuter Peter
Published: August 2002

Background

Cannabis policy continues to be controversial in North America, Europe and Australia.

Aims

To inform this debate, we examine alternative legal regimes for controlling cannabis availability and use.

Method

We review evidence on the effects of cannabis depenalisation in the USA, Australia and The Netherlands. We update and extend our previous (MacCoun & Reuter, 1997) empirical comparison of cannabis prevalence statistics in the USA, The Netherlands and other European nations.

Results

The available evidence indicates that depenalisation of the possession of small quantities of cannabis does not increase cannabis prevalence. The Dutch experience suggests that commercial promotion and sales may significantly increase cannabis prevalence.

Conclusions

Alternatives to an aggressively enforced cannabis prohibition are feasible and merit serious consideration. A model of depenalised possession and personal cultivation has many of the advantages of outright legalisation with few of its risks.
Amitriptylinev.the rest: still the leading antidepressant after 40 years of randomised controlled trials
Authors: Barbui Corrado , Hotopf Matthew
Published: August 2002

Background

Tricyclic antidepressants have similar efficacy and slightly lower tolerability than selective serotonin reuptake inhibitors (SSRIs). However, there are no systematic reviews assessing amitriptyline, the reference tricyclic drug,v.other tricyclics and SSRIs directly.

Aims

To review the tolerability and efficacy of amitriptyline in the management of depression.

Method

A systematic review of randomised controlled trials (RCTs) comparing amitriptyline with other tricyclics/heterocyclics or with an SSRI.

Results

We reviewed 186 RCTs. The overall estimate of the efficacy of amitriptyline revealed a standardised mean difference of 0.147 (95% CI 0.05–0.243), significantly favouring amitriptyline. The overall OR for dropping out was 0.99 (95% CI 0.91–1.08) and that for side-effects was 0.62 (95% CI 0.54–0.70), favouring the control drugs. With drop-outs included as treatment failures, the estimate of the effectiveness of amitriptylinev.tricyclics/heterocyclics and SSRIs showed a 2.5% difference in the proportion of responders in favour of amitriptyline (number needed to treat 40, CI 21–694; OR 1.12 (95%CI 1.01–1.24)).

Conclusions

Amitriptyline is less well tolerated than tricyclics/heterocyclics and SSRIs, but slightly more patients treated on it recover than on alternative antidepressants.
Prevalence, comorbidity, disability and service utilisation
Authors: Andrews Gavin , Henderson Scott , Hall Wayne
Published: August 2002

Background

Health planning should be based on data about prevalence, disability and services used.

Aims

To determine the prevalence of ICD–10 disorders and associated comorbidity, disability and service utilisation.

Method

We surveyed a national probability sample of Australian households using the Composite International Diagnostic Interview and other measures.

Results

The sample size was 10 641 adults, response rate 78%. Close to 23% reported at least one disorder in the past 12 months and 14% a current disorder. Comorbidity was associated with disability and service use. Only 35% of people with a mental disorder in the 12 months prior to the survey had consulted for a mental problem during that year, and most had seen a general practitioner. Only half of those who were disabled or had multiple comorbidity had consulted and of those who had not, more than half said they did not need treatment.

Conclusions

The high rate of not consulting among those with disability and comorbidity is an important public health problem. As Australia has a universal health insurance scheme, the barriers to effective care must be patient knowledge and physician competence.
Natural course of schizophrenia: 2-year follow-up study in a rural Chinese community
Authors: Ran Maosheng , Xiang Mengze , Huang Mingsheng , Shan Youhe
Published: August 2002

Background

A number of studies have questioned whether the natural course of schizophrenia is more favourable in ‘developing’ than ‘developed’ societies and whether culture is a factor in producing a favourable course.

Aims

This prospective study tests the hypothesis that the natural outcome of schizophrenia would be favourable in a Chinese rural area.

Method

We investigated all patients with schizophrenia, including patients who had not received any treatment, among 149 231 rural community population in Xinjin County, Sichuan in 1994. Those patients who had never received treatment were followed up for two years.

Results

Three-quarters of patients with schizophrenia who had not been treated remained symptomatic. As the duration of illness increased, the illness became more serious. The clinical outcome of the drug-treatment group was significantly better than for patients who had not received any treatment.

Conclusions

The natural clinical outcome of schizophrenia in the Chinese rural community was poor, and occupational functioning of patients with schizophrenia was comparatively better. Schizophrenia itself has a specific natural course – antipsychotic drug treatment and psychosocial treatment will produce an improvement in prognosis.
Comparison of the Outcome and Treatment of Psychosis in People of Caribbean Origin Living in the Uk and British Whites
Authors: McKenzie K. , Samele C. , Van Horn E. , Tattan T. , Van Os J. , Murray Robin
Published: August 2002

Background

The comparative outcome of psychosis in British Whites and UK African-Caribbeans is unclear. Some report that African-Caribbeans have worse outcome, whereas others claim better symptomatic outcome and a more benign course.

Aims

To compare the course, outcome and treatment of psychosis in African-Caribbeans and British Whites in a large multi-centre sample.

Method

A secondary analysis of 708 patients with research diagnostic criteria-defined psychosis from a 2-year, randomised controlled trial of case management. Outcome measures (hospitalisation, illness course, self-harm, social disability and treatment received) were adjusted for socio-economic and clinical differences between groups at baseline using regression analysis.

Results

African–Caribbeans were less likely to have a continuous illness and to receive treatment with antidepressants or psychotherapy.

Conclusions

The outcome of psychosis is complex but differs between UK African–Caribbeans and British Whites. This may reflect risk factors that increase the rate of psychosis in UK African–Caribbeans. Treatment differences require further investigation.
Intellectual functioning and outcome of patients with severe psychotic illness randomised to intensive case management
Authors: Hassiotis A. , Ukoumunne O. C. , Byford S. , Tyrer P. , Harvey K. , Piachaud J. , Gilvarry K. , Fraser J.
Published: August 2002

Background

Little research has been carried out on the benefits of intensive case management (ICM) for people with borderline IQ and severe mental illness.

Aims

To compare outcome and costs of care of patients with severe psychotic illness with borderline IQ to patients of normal IQ and to assess whether ICM is more beneficial for the former than for the latter.

Method

The study utilises data from the UK700 multi-centre randomised controlled trial of case management. The main outcome measure was the number of days spent in hospital for psychiatric reasons. Secondary outcomes were costs of care and clinical outcome.

Results

ICM was significantly more beneficial for borderline-IQ patients than those of normal IQ in terms of reductions in days spent in hospital, hospital admissions, total costs and needs and increased satisfaction.

Conclusions

ICM appears to be a cost-effective strategy for a subgroup of patients with severe psychosis with cognitive deficits.
Cerebral white matter lesions in bipolar affective disorder: relationship to outcome
Authors: Moore P. Brian , Shepherd Debra J. , Eccleston Donald , Macmillan Iain C. , Goswami Uptal , McAllister Victor L. , Ferrier I. Nicol
Published: August 2002

Background

Twenty per cent of patients with bipolar affective disorder suffer an illness that responds inadequately to treatment and has a poor outcome. Many patients, but not all, with bipolar disorder show white matter abnormalities on T2-weighted magnetic resonance imaging (MRI).

Aims

To explore the hypothesis that white matter abnormalities on MRI are seen more frequently in subjects whose illness has a poor outcome compared with those with a good outcome or controls.

Method

Two groups of age- and gender-matched patients with bipolar disorder (14 with a good outcome and 15 with a poor outcome) and 15 controls, aged 20–65 years, were studied. Axial T2-weighted MRI scans were examined for the presence and severity of white matter abnormalities.

Results

Significantly more poor outcome group members had deep subcortical punctate, but not periventricular, white matter hyperintensities than the good outcome group (P=0.035) or controls (P=0.003) and these abnormalities were of greater severity (P=0.030 and P < 0.014, respectively).

Conclusions

Subcortical white matter lesions are associated with poor outcome bipolar disorder.
Highlights of this issue
Authors: Cannon Mary
Published: August 2002

STIGMA, SOCIETY AND EVOLUTION

Susan Sontag has observed that every society seems to need one illness that attaches stigma and blame to its ‘victims’ – mental illness, particularly schizophrenia, appears to have taken this mantle over from AIDS. A review paper by Haghighat (pp. 207–215) proposes that stigmatisation is a fundamental human tendency – a vestige of our animal evolutionary heritage – and, consequently, anti-stigma campaigns must work on many different levels in order to be successful. The power of the mass media has greatly increased the impact of stigma. If every time we hear the word ‘schizophrenic’ on television there is news of another murder, a form of classical conditioning occurs. Cognitive, affective and cultural strategies are therefore needed to ‘desensitise’ the public's fear and anxiety. Crisp (pp. 197–199), in an accompanying editorial, favours legislative and political interventions and feels that people with mental illnesses, like those with physical disabilities, should be empowered to ‘fight their corner’ and test out the relevance of human rights and disability discrimination legislation for their own ends.
Implementing evidence-based psychiatry: Whose responsibility?
Authors: Lawrie Stephen M. , Scott Allan I. F. , Sharpe Michael C.
Published: August 2002

Evidence-based medicine is fine in principle, but needs to demonstrate tangible benefits to clinicians and their patients in practice. The main obstacles to its implementation are: (a) identifying information needs; (b) delivering reliable and clinically useful information to the ward/clinic; and (c) ensuring the information is regularly updated. How can this be achieved in psychiatry?
Cognitive deficits in depression: Possible implications for functional neuropathology
Authors: Austin Marie-Paule , Mitchell Philip , Goodwin Guy M.
Published: August 2002

Background

While depression is known to involve a disturbance of mood, movement and cognition, its associated cognitive deficits are frequently viewed as simple epiphenomena of the disorder.

Aims

To review the status of cognitive deficits in depression and their putative neurobiological underpinnings.

Method

Selective computerised review of the literature examining cognitive deficits in depression and their brain correlates.

Results

Recent studies report both mnemonic deficits and the presence of executive impairment – possibly selective for set-shifting tasks – in depression. Many studies suggest that these occur independent of age, depression severity and subtype, task ‘difficulty’, motivation and response bias: some persist upon clinical ‘recovery’.

Conclusions

M nemonic and executive deficits do not appear to be epiphenomena of depressive disorder. A focus on the interactions between motivation, affect and cognitive function may allow greater understanding of the interplay between key aspects of the dorsal and ventral aspects of the prefrontal cortex in depression.
A unitary theory of stigmatisation: Pursuit of self-interest and routes to destigmatisation
Authors: Haghighat Rahman
Published: August 2002

Background

Stigmatisation is of increasing importance in relation to racism, ageism and sexism but also as an impediment to treating patients.

Aims

To develop a theoretical foundation to help comprehend the core meaning of stigmatisation and to guide practical anti-stigmatisation measures.

Method

Personal reflection; re-interpretation of stigmatisation and reformulation of the relevant concepts.

Results

Emergence of a unitary theory of stigmatisation.

Conclusions

Based on the structure of stigmatisation one could explore six levels of intervention in anti-stigmatisation campaigns: the cognitive level – educational intervention; the affective level – psychological intervention; the discrimination level – legislative intervention; the denial level – linguistic intervention; the economic origin – political intervention; the evolutionary origin – intellectual and cultural intervention. As destigmatisation has to challenge fundamental human tendencies, anti-stigmatisation campaigns have to be continuous, non-stop, open-ended projects aiming at keeping alive thought processes that moderate and humanise the pursuit of self-interest and the urge to survive in a competitive world.
Psychological therapies for adults with anorexia nervosa
Authors: Dare Chris , Eisler Ivan , Russell Gerald , Treasure Janet , Dodge Liz
Published: August 2002

Background

Currently, without systematic evidence, psychotherapy for anorexia nervosa in adults draws on psychodynamic, cognitive and systemic theories.

Aims

To assess effectiveness of specific psychotherapies in out-patient management of adult patients with anorexia nervosa.

Method

Eighty-four patients were randomised to four treatments: three specific psychotherapies – (a) a year of focal psychoanalytic psychotherapy; (b) 7 months of cognitive-analytic therapy (CAT); (c) family therapy for 1 year – and (d) low contact, ‘routine’ treatment for 1 year (control).

Results

At 1 year, there was symptomatic improvement in the whole group of patients. This improvement was modest, several patients being significantly undernourished at follow-up. Psychoanalytic psychotherapy and family therapy were significantly superior to the control treatment; CAT tended to show benefits.

Conclusions

Psychoanalytic and family therapy are of specific value in the out-patient treatment of adult patients with anorexia.
Income inequality and the prevalence of common mental disorders in Britain
Authors: Weich Scott , Lewis Glyn , Jenkins Stephen P.
Published: August 2002

Background

It has been hypothesised that the association between greater income inequality and increased mortality is mediated by poor psychosocial health.

Aims

To test the hypothesis that individuals in regions of Britain with the highest income inequality have a higher prevalence of the common mental disorders, after adjusting for individual income.

Method

Cross-sectional survey of 8191 adults aged 16–75 in private households in England, Wales and Scotland. The prevalence of common mental disorders was assessed using the General Health Questionnaire.

Results

The association between income inequality and prevalence of the common mental disorders varied with individual income level. Among persons with the highest incomes, common mental disorders were more frequent in regions with greater income inequality (as indicated by high Gini coefficient) (adjusted OR 1.31, 95% CI 1.05–1.65; P=0.02). The opposite was true for those with the lowest incomes.

Conclusions

Income inequality was associated with worse mental health among the most affluent individuals.
Common mental disorders in Santiago, Chile
Authors: Araya Ricardo , Rojas Graciela , Fritsch Rosemarie , Acuña Julia , Lewis Glyn
Published: August 2002

Background

There have been relatively few surveys in Latin America that have attempted to estimate the prevalence of psychiatric morbidity in private households.

Aims

To determine the prevalence of common mental disorders and socio-demographic correlates among adults from Santiago, Chile.

Method

Cross-sectional survey of private households with a probabilistic sampling design was used. Common mental disorders were measured using the Clinical Interview Schedule–Revised (CIS–R).

Results

Three thousand eight hundred and seventy adults were interviewed. Twenty-five per cent were CIS–R cases and 13% met criteria for an ICD–10 diagnosis. Low education, female gender, unemployment, separation, low social status and lone parenthood were associated with a higher prevalence.

Conclusions

Prevalence rates were higher than those found in urban areas of Great Britain, both for ICD–10 diagnoses and ‘non-specific neurotic disorders’. Similar socio-demographic factors were associated with an increased prevalence of common mental disorders in Chile as in the UK. There is a need to unify methodologies to be able to compare results internationally.
Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors
Authors: Thase Michael E. , Entsuah A. Richard , Rudolph Richard L.
Published: August 2002

Background

It had been suggested that the antidepressant venlafaxine, which inhibits reuptake of both serotonin and (at higher doses) noradrenaline, may result in better outcomes than treatment with selective serotonin reuptake inhibitors (SSRIs).

Aims

To compare remission rates during treatment with SSRIs or venlafaxine.

Method

Data from eight comparable randomised, double-blind studies of major depressive disorder were pooled to compare remission rates (Hamilton Rating Scale for Depression score ≤ 7) during treatment with venlafaxine (n=851), SSRIs (fluoxetine, paroxetine, fluvoxamine;n=748) or placebo (four studies;n=446).

Results

Remission rates were: venlafaxine, 45% (382/851); SSRIs, 35% (260/748); placebo, 25% (110/446) (P< 0.001; odds ratio for remission is 1.50 (1.3–1.9), favouring venlafaxinev.SSRIs). The difference between venlafaxine and the SSRIs was significant at week 2, whereas the difference between SSRIs and placebo reached significance at week 4. Results were not dependent on any one study or the definition of remission.

Conclusions

Remission rates were significantly higher with venlafaxine than with an SSRI.
Psychiatric battle casualties: An intra- and interwar comparison
Authors: Jones Edgar , Wessely Simon
Published: August 2002

Background

Psychiatric casualties are recognised as an important and inevitable feature of modern warfare. At the beginning of the 20th century they were scarcely acknowledged and still less treated. Today, as a result of lessons learned in the First and Second World Wars, numbers can be predicted on the basis of battle intensity and effective clinical interventions applied.

Aims

To discover more about the factors that cause psychiatric casualties and their relationship to total battle casualties.

Method

A survey of historical War Office reports and the papers of Royal Army Medical Corps psychiatrists has provided both statistics and treatment strategies.

Results

Reported psychiatric casualties were low in the Boer War, influenced, in part, by the misdiagnosis of psychosomatic disorders. Their incidence rose appreciably in the First World War with the identification of shell-shock and neurasthenia. The Second World War saw the collection of accurate data, and combat stress was treated efficiently, although few soldiers returned to fighting units.

Conclusions

A constant relationship exists between the incidence of the total killed and wounded and the number of psychiatric casualties, mediated by the nature of the fighting and quality of the troops involved.
Relatives of patients with severe psychotic disorders: Factors that influence contact frequency
Authors: Harvey Kate , Burns Tom , Sedgwick Philip , Higgitt Anna , Creed Francis , Fahy Tom
Published: August 2002

Background

The isolation experienced by many patients with severe psychotic disorders is generally assumed to be due to their social withdrawal. An alternative possibility is that relatives avoid frequent contact with patients because they find the situation distressing.

Aims

To examine the predictors of frequent patient-relative contact, in particular the role of relatives' experience.

Method

UK700 trial data were used to determine baseline predictors of frequent contact and establish whether relatives' experience at baseline predicted continued frequent contact 2 years later.

Results

Neither characteristics associated in the literature with relatives' ‘burden’ nor relatives' experience predicted patient-relative contact frequency. Instead, the predictors were mainly demographic.

Conclusions

Many relatives experience considerable distress, but the evidence does not suggest that they avoid frequent contact with the patient as a consequence.
Suicidal behaviour in psychosis: Prevalence and predictors from a randomised controlled trial of case management
Authors: Walsh Elizabeth , Harvey Kate , White Ian , Higgitt Anna , Fraser Janelle , Murray Robin
Published: August 2002

Background

It is unclear whether intensive case management influences the prevalence of suicidal behaviour in patients with psychosis.

Aims

To compare the effect of intensive case management and standard care on prevalence of suicidal behaviour in patients with chronic psychosis.

Method

Patients with established psychosis (n=708) were randomised either to intensive case management or to standard care. The prevalence of suicidal behaviour was estimated at 2-year follow-up and compared between treatment groups. Suicide attempters and non-attempters were compared on multiple socio-demographic and clinical variables to identify predictors of suicidal behaviour.

Results

There was no significant difference in prevalence of suicidal behaviour between treatment groups. Recent attempts at suicide and multiple recent hospital admissions best predicted future attempts.

Conclusions

Intensive case management does not appear to influence the prevalence of suicidal behaviour in chronic psychosis. Predictors identified in this study confirm some previous findings.
Changes in the quality of life of patients receiving antidepressant medication in primary care: Validation of the WHOQOL–100
Authors: Skevington Suzanne M. , Wright Anne
Published: August 2002

Background

The study arises from the need for good quality of life (QOL) assessment and a new comprehensive generic QOL profile for cross-cultural use.

Aims

To examine changes in the QOL of patients receiving antidepressants from a general practitioner, and to assess the validity and sensitivity of a new QOL measure, the World Health Organization Quality of Life Assessment (100-item version) (WHOQOL–100).

Method

Patients with moderate depression (n=106) completed the WHOQOL–100 and Beck Depression Inventory at the start of treatment and again after 6 weeks.

Results

Depression decreased significantly over 2 months and 74% reported feeling better. WHOQOL–100 scores increased in 24 of the 25 facets, demonstrating that QOL improves significantly in the 8 weeks following the start of antidepressant treatment. It also shows the instrument's validity and sensitivity to changes in clinical condition.

Conclusions

The UK WHOQOL–100 is confirmed as excellent to good. Antidepressants significantly and comprehensively improve QOL.