bluuebunny/crossref_metadata_2025 huggingface dataset:
Care of Chronic Neurotic Out-patients by Community Psychiatric Nurses
Authors: Burns Tom , Paykel E. S. , Ezekiel A. , Lemon S.
Published: October 2008

Ninety-nine neurotic patients from a controlled trial of CPN v. psychiatric out-patient aftercare were followed up seven years later. Of the 92 survivors, 76 were successfully interviewed. Few differences were found between the groups. Chronic mild symptoms and moderate social disability persisted, and tended to worsen a little. Treatment patterns persisted for one to two years beyond the original study; the CPN group had more CPN contacts, fewer psychiatric out-patient contacts and less psychiatric care. Thereafter, more out-patients were discharged from psychiatric care and care patterns for the two groups became similar. Out-patients attended more non-psychiatric out-patient clinics than the CPN group, but it is possible that this reflected pre-existing differences. About a third of patients remained in contact with the psychiatric service during follow-up.
Is Sex Necessarily a Risk Factor to Depression?
Authors: Harris Tirril , Surtees Paul , Bancroft John
Published: October 2008

“To isolate and quantify possible determinants of any increased prevalence of depressive disorders in women we studied a select group of men and women, initially similar in terms of a number of putative social determinants of depression, and reviewed the sample five years later when social role diversity was anticipated. We used the Diagnostic Interview Schedule (DIS) to generate DSM–III and RDC diagnoses to estimate lifetime depressive disorders, and established (via corroborative reports) the likely accuracy of those data. Despite lifetime depression being a relatively common experience, no significant sex differences in depressive episodes were demonstrated, suggesting the possible irrelevance of biological factors in determining any sex difference. As there was not major social role divergence over the five year study, we interpret the lack of a sex difference as a consequence, and suggest that findings support the view that social factors are of key relevance in determining any female preponderance in depression described in general population studies.”
Season of Birth in Schizophrenia
Authors: O'Callaghan Eadbhard , Gibson Tessa , Colohan Hubert A. , Walshe David , Buckley Peter , Larkin Conall , Waddington John L.
Published: October 2008

Although it is well recognised that schizophrenic patients are more often born in winter, the significance of this finding remains obscure. Data relating to season of birth and family history were analysed for 561 patients with an ICD–9 diagnosis of schizophrenia. Patients with no family history of any psychiatric disorder group were significantly more likely to be born in winter than patients with a first-degree relative affected by schizophrenia. In comparison with normal population controls, only those without a family history exhibited a significant excess of winter births, suggesting an environmental factor of greater aetiological significance in these patients.
Using the Hospital Anxiety and Depression Scale to Screen for Psychiatric Disorders in People Presenting with Deliberate Self-harm
Authors: Hamer D. , Sanjeev D. , Butterworth E. , Barczak P.
Published: October 2008

In-patients referred to a deliberate self-harm team were asked to complete the HAD questionnaire and diagnoses were made using the SCID. The total prevalence of psychiatric disorder by DSM–III criteria was 54%. The HAD performed well as a screening instrument; a threshold score of eight gave a sensitivity of 88% and a positive predictive value of 80%; its use by non-psychiatrists to detect depressive disorder in patients presenting with deliberate self-harm is to be recommended.
Treatment as an Alternative to Prosecution: Offenders Diverted for Treatment
Authors: Cooke David J.
Published: October 2008

In Scotland, procurators fiscal (state prosecutors) can divert certain offenders from the court process into treatment. This paper describes the first diversion scheme in which offenders who are suspected of having psychological difficulties are referred for psychological and psychiatric treatment before, and generally in lieu of, prosecution. It is argued that the procurator fiscal is successful in selecting suitable cases for treatment: most people referred have significant psychological difficulties but have failed to obtain appropriate assistance through the normal channels of referral.
Psychotherapy 2000 Some Predictions for the Coming Decade
Authors: Holmes Jeremy
Published: October 2008

The purpose of this paper is prediction. It is bound to be proved wrong. Like long range weather forecasters and economists, psychotherapists are in an “impossible profession” (Freud, 1937), dealing with non-linear and therefore inherently unstable systems, unable to make accurate predictions about the future. But psychotherapists are familiar with uncertainty, and indeed perhaps actively cultivate it in order to work more creatively. Also, the development of chaos theory (Gleick, 1988) has now made vagueness a respectable topic for scientific inquiry.
Pathways to Psychiatric Care in South Manchester
Authors: Gater Richard , Goldberg David
Published: October 2008

Of 250 patients newly referred to the mental illness services of South Manchester, almost two-thirds were referred directly by their GPs; a further third were referred by hospital doctors. Non-medical sources of referral accounted for only 2% of new cases. Patients with somatic problems had the longest interval between seeking care and referral to the psychiatric services. Being employed was associated with a longer delay before seeking care; among women, those living with their husbands or children had longer total intervals between the onset of the problem and arrival at the psychiatric services.
The Psychological Consequences of Tardive Dyskinesia the Effect of Drug-Induced Parkinsonism and the Topography of the Dyskinetic Movements
Authors: Brown Keith W. , White Thomas
Published: October 2008

The effect of drug-induced Parkinsonism and of the topography of the dyskinetic movements on the psychological consequences of tardive dyskinesia was assessed in 20 schizophrenic subjects and 20 non-dyskinetic schizophrenic controls matched for age, sex, the presence of anticholinergic medication, and the presence and severity of drug-induced Parkinsonism. Limb–truncal subscale scores but not orofacial scores had a significant correlation with cognitive impairment and with negative symptoms. Drug-induced Parkinsonism was found to be a powerful confounding variable.
Schizophrenia, Bipolar Disorder and Depression a Discriminant Analysis, using ‘Lifetime’ Psychopathology Ratings
Authors: Brockington I. F. , Roper A. , Copas J. , Buckley M. , Andrade C. E. , Wigg P. , Farmer A. , Kaufman C. , Hawley R.
Published: October 2008

Discriminant and canonical variate analyses were performed using 302 patients, on whom ratings of lifetime psychopathology and course of illness had been made. DSM–III diagnoses were used to form the criterion groups. Bipolar disorder emerged as a distinct grouping, but there are reasons for dissatisfaction with its definition. The remaining patients formed a ‘schizodepressive continuum’, but this also had a tendency to bimodality. It is possible that the distinction between schizophrenia and depression was obscured by inadequacies in the data and the inclusion of excessive numbers of patients with schizoaffective depression in this study.
Suicide among Adolescents in Greece
Authors: Beratis Stavroula
Published: October 2008

The mean suicide rate among 10–19–year-olds in Greece from 1980 to 1987 was 0.98/100 000 per year (male 1.07, female 0.89). Girls and boys demonstrated the greatest suicide rate at 16 and 19 years, respectively. The combined suicide rate was significantly higher in the rural areas (1.48) than in Athens (0.48) and the other urban areas (0.98). Boys committed suicide more frequently than girls in Athens and other urban areas, whereas girls did so in the rural areas. The suicide rate declined during the last three years of the study. Differences in the methods used and the reported reasons for suicide were observed among the adolescents in Athens, other urban areas, and the rural areas. Greek adolescents appear to be relatively protected from suicide, particularly those who live in the urban areas.
Suspicion of Somatoform Disorder in Undiagnosed Tabes Dorsalis
Authors: Fichtner Christopher G. , Weddington William W.
Published: October 2008

We present a case of tabes dorsalis, which consisted of intermittent, sharp pains and diffuse neurological abnormalities, and was initially considered to be a somatoform disorder. The unusual behavioural presentations of neurosyphilis may lead to premature psychiatric diagnoses. It is thus important that psychiatric consultants be aware of the myriad manifestations of the disease.
Placebo and Analgesic Nitrous Oxide for Treatment of the Alcohol Withdrawal State
Authors: Gillman Mark A. , Lichtigfeld Frederick J.
Published: October 2008

We present evidence that analgesic (as distinct from anaesthetic) nitrous oxide is superior to placebo in the treatment of the alcohol withdrawal state. ‘Carbogen’ as a placebo is as effective as oxygen or medical air. However, placebo alone offers a means of treating the alcohol withdrawal state with a minimum of pharmacological intervention. Analgesic nitrous oxide for those not responding to placebo is a very rapid, effective, and extremely safe treatment which also reduces the use of highly addictive sedative pharmacological agents. This therapy also provides a rapid method of screening those patients requiring intensive monitoring and treatment in hospital from those who might benefit from out-patient therapy alone.
Treatment Issues in Child Sexual Abuse
Authors: Glaser Danya
Published: October 2008

Child sexual abuse is a commonly encountered and often emotionally damaging experience, maintained by secrecy and followed by denial after disclosure. Treatment in this field involves both the child and the family in a variety of treatment settings and modalities, often proceeding in parallel. Child developmental considerations dictate that treatment often proceeds in phases. It aims to protect the child from further abuse and the consequences of disclosure, and address the trauma and context of the abuse. Careful planning and co-operation is required by the many professionals working in this stressful area in order to avoid confusion, conflicts, and splits which may mirror relationships in the family. The heterogeneity of the problem is reflected in the fact that treatment cannot be offered in a uniform programme. Legal issues may influence the treatment process. Evaluation of treatment modalities, the identification of protective factors and achieving long-term adjustment in the least detrimental manner offer challenges in this newly developing field.
First-Rank Symptoms of Schneider in Late Paraphrenia
Authors: Howard Robert J. , Förstl Hans , Naguib Mohsen , Burns Alistair , Levy Raymond
Published: October 2008

The brains of 41 late paraphrenics, 16 of whom had first-rank symptoms, were examined by CT. Late paraphrenics with first-rank symptoms had significantly less cortical atrophy than those without them.
Milieu and Mutilation – a Case for ‘Special’ Treatment?
Authors: Larkin Emmet P.
Published: October 2008

Special hospitals are principally concerned with the treatment of patients of dangerous, violent or criminal propensities referred from the courts and prisons. However, patients can be transferred from local NHS hospitals. The case of one such patient illustrates the potential benefits of such a transfer, even for patients who are not of immediate danger to others.
Suicide Prevention
Authors: Morgan H. G.
Published: October 2008

In 1989 a crisis occurred in a West Country seaside town. Its psychiatric services had been regarded as a vanguard of community care, having been fully established some three years previously when the in-patient facilities which had been based in a mental hospital some 15 miles away were closed. The framework of the new-style service consisted of five mental health centres scattered throughout the residential area and a 60-bed in-patient unit, based in the grounds of the local district general hospital.
Drug Treatment of Panic Disorder: Comparative Efficacy of Alprazolam, Imipramine, and Placebo
Authors: Klerman Gerald L.
Published: October 2008

The Cross-National Collaborative Panic Study, Phase Two, compared alprazolam with imipramine and with placebo in a sample of 1168 randomly assigned subjects. The study, conducted at 12 centres, assessed clinical change over eight weeks of double-blind drug treatment. Improvement occurred with alprazolam by week 1 and 2, and with imipramine by week 4. By the end of week 8, however, the effects of the two active drugs were similar to each other, and both were superior to placebo for most outcome measures.
Anorexia Nervosa of Late Onset
Authors: Boast N. , Coker E. , Wakeling A.
Published: October 2008

Forty-two female anorexia nervosa patients, with onset of first illness at 25 or more years of age, are described and compared with 143 patients with onset of first illness between the ages of 15 and 20 years. The data support the view that the older group forms part of the total population of anorexia nervosa patients, but that age exerts a pathoplastic influence on psychopathology and psychosocial stressors. Older patients lost more weight, but did not have significantly higher rates of concurrent mood disorder.
Reconquest of the Subjective
Authors: van Praag Herman M.
Published: October 2008

Psychiatric research over the past three decades has now acquired the esteem it clearly deserves. Since empirical research presupposes definition of the object one studies and availability of instruments to measure it, operationalisation of diagnosis and development of psychometric instruments have become major concerns for psychiatry. This progress was promoted to a large degree by biological psychiatry. The search for biological underpinnings of abnormal human behaviour and the study of the efficacy and mechanism of action of biological treatments are both contingent on the use of standardised diagnoses and objective measurement. Biological psychiatry moved in recent years from a minority position into the mainstream, and its methods became the standard approach, especially in research.
Who Benefits from Electroconvulsive Therapy?
Authors: Buchan Heather , Johnstone Eve , McPherson K. , Palmer R. L. , Crow T. J. , Brandon S.
Published: October 2008

This paper describes the results obtained by combining data from the Northwick Park and Leicester randomised controlled trials of ECT. Patients who suffered from depression in which retardation and delusions were features and who received real ECT had a significantly improved outcome at the end of four weeks of treatment (as measured by improvement in the HRSD) in comparison with those who received simulated ECT. However, this treatment effect was not detectable at six-month follow-up. Patients who were neither retarded nor deluded did not benefit significantly from real as opposed to simulated ECT.
A Study of Suicide in Schizophrenic In-patients
Authors: Modestin Jiří , Zarro Ivo , Waldvogel Doris
Published: October 2008

A retrospective analysis of the clinical records of 53 schizophrenic in-patients who committed suicide, and the same number of matched control subjects, was carried out using a larger set of demographic, psychosocial and clinical variables. Univariate analysis of the data indicated an early disturbed psychosocial adjustment, more severe mental illness, unsatisfactory social situation, and more frequent suicidal behaviour in the suicide group. Suicide in schizophrenic in-patients thus appears to be closely connected with a particularly incapacitating form of the illness and its deleterious psychosocial consequences.
Schizophrenia Following Pre-natal Exposure to Influenza Epidemics Between 1939 and 1960
Authors: Sham Pak C. , O'Callaghan Eadbhard , Takei Noriyoshi , Murray Graham K. , Hare Edward H. , Murray Robin M.
Published: October 2008

We examined the relationship between the dates of births of schizophrenic patients admitted to hospitals for the first time in England and Wales between 1970 and 1979, and the occurrence of influenza epidemics between 1939 and 1960. Our results indicate that exposure to influenza epidemics between the third and seventh month of gestation is associated with schizophrenia in adult life. The hypothesis that maternal viral infection is an important cause of schizophrenia can explain many aspects of the enigmatic epidemiology of the condition.
Attempted Suicide by Poisoning in the Sofia Region
Authors: Milev V. , Mikhov D.
Published: October 2008

Data on 9235 persons who had attempted suicide and been admitted to hospital over an eight-year period showed that a female:male ratio of 4:1 in young subjects gradually decreased with age; from the age of 79, the number of men slightly exceeded the number of women. More than half the attempts were made by people aged under 24, and the same proportion was unmarried. Attempts occurred mainly after 2 p.m., with the maximum frequency between 8 p.m. and midnight; over the week, the smallest number was on Saturdays. There was a slight seasonal variation, with the highest number in March and the lowest in August.

British Journal of Psychiatry (1992), 160, 560–562
Audit of Electroconvulsive Treatment in two National Health Service Regions
Authors: Pippard John
Published: October 2008

The practice of ECT has been surveyed by visits to all 35 NHS hospitals and five private clinics where it is used in the North East Thames and East Anglian Regions, and observation of ECT administration in 29 NHS and two private clinics. Since 1981 there has been much improvement in the physical conditions in which ECT is given and in anaesthetic practice. Nursing is good or excellent in a majority. About half the clinics have the most effective Ectron constant-current series 5 apparatus; the rest have older models with which ‘missed’ fits and undertreatment are frequent. Stimulus-dosing is usually by habit rather than rational strategy, and routine instrument settings differ fourfold between clinics. Most hospitals have nominated consultants in charge of ECT, but few of these are closely involved and little has changed in the unsatisfactory training and supervision of those who give the treatment. The use of ECT has fallen by 55% in North East Thames Region since 1979, but has risen by 20% in the East Anglian Region. There are up to 12–fold differences in usage between districts.
An Assessment of the Educational Needs of Chronic Psychiatric Patients and their Relatives
Authors: Mueser Kim T. , Bellack Alan S. , Wade Julie H. , Sayers Steven L. , Rosenthal Carole K.
Published: October 2008

Both psychiatric patients and their relatives benefit from learning about mental illness and how to cope with it, but the specific interests of these consumers remain unclear. To determine specific educational needs and to compare the needs of different consumers, a questionnaire survey was conducted with a sample of patients with schizophrenia and affective disorder and their relatives. Both patients and relatives reported strong interest in learning more about psychiatric illness and strategies for coping with common problems, but patients with schizophrenia were less interested than patients with affective disorder and both sets of relatives. Discriminant analyses revealed that needs differed as a function of patient diagnosis, patient/relative status, and relatives' membership of a self-help and advocacy organisation. Consumers of mental health services are capable of specifying their own educational needs, and educational programmes should be tailored to meet these.
Long-Term Mortality in Anorexia Nervosa
Authors: Crisp Arthur H. , Callender John S. , Halek Christine , Hsu L. K. George
Published: October 2008

Two cohorts of anorexia nervosa patients were followed up for a mean of 20 years. All except 4% of each cohort was traced. The crude mortalities were: St George's, 4%; Aberdeen, 13%. The SMRs were: St George's, 136; Aberdeen, 471. If the untraced were assumed to be dead, crude mortalities were 7.6% and 15.9% respectively, and SMRs were 276 and 592 respectively. Causes of death were complications of the illness and suicide. Medical treatment may reduce early mortality, while comprehensive medical and psychotherapeutic treatment may reduce late mortality.
The Treatment of a Chronic Organic Mental Disorder with Dextromethorphan in a Man with Severe Mental Retardation
Authors: Welch Leisa , Sovner Robert
Published: October 2008

Response to dextromethorphan (15 mg b.i.d.), an antitussive agent not usually considered to have psychotropic properties, was seen in a 25–year-old man with severe developmental disabilities, congenital rubella, and an organic mental disorder. Dextromethorphan affects CNS serotonergic systems, and this was the probable therapeutic mechanism. This and other published cases suggest the existence of a distinct organic mental syndrome in developmentally disabled persons which responds to drugs that increase indoleaminergic activity.
Estimation of Premorbid Intelligence in Schizophrenia
Authors: Crawford J. R. , Besson J. A. O. , Bremner M. , Ebmeier K. P. , Cochrane R. H. B. , Kirkwood K.
Published: October 2008

To determine whether the National Adult Reading Test (NART) would provide a valid estimate of premorbid intelligence in schizophrenia, two schizophrenic samples were recruited, one consisting of 35 patients resident in long-stay wards, the other of 29 patients normally resident in the community. Schizophrenic patients were individually matched for age, sex, and education with a healthy, normal subject. Both schizophrenic samples scored significantly lower on the Wechsler Adult Intelligence Scale (WAIS) than their respective control groups. NART-estimated IQ did not differ significantly between the community-resident schizophrenics and their controls, suggesting that the NART provides a valid means of estimating premorbid intelligence in such a population. NART-estimated IQ was significantly lower in the long-stay sample than in their controls. Although low NART scores in this latter sample could be a valid reflection of low premorbid IQ, the alternative explanation that NART performance was impaired by onset of the disease cannot be ruled out.
Physical Illness in Chronic Psychiatric Patients from a Community Psychiatric Unit Revisited
Authors: Honig A. , Pop P. , De Kemp E. , Philipsen H. , Romme M. A. J.
Published: October 2008

A group of 156 psychiatric patients from an urban community psychiatric unit for chronic psychiatric patients was routinely medically screened and reported on. Re-evaluation of the medical diseases found in those patients was carried out three years later. Those who were still being treated – 73 patients (47%) – were interviewed, as were their psychiatrist and, where necessary, their general practitioner (GP). The implementation of medical recommendations given following the physical screening by the specialist in internal medicine was also assessed. Re-evaluation of the diagnoses confirmed that 36% of this population had one or more physical diseases, rather than the 53% found earlier. The results show that the majority of physical complaints and diseases as well as functional illnesses were as persistent as the psychiatric diagnoses in this patient group. The patients' GP seems to be the person best suited as the primary physician responsible for the patient's physical health.
Absence from School and Mental Health
Authors: Berg Ian
Published: October 2008

Severe school attendance problems, which once commanded a great deal of attention in child and adolescent psychiatry, have fallen from favour and are increasingly viewed as varieties of social impairment which may accompany disorders such as anxiety disturbances in the case of school refusal and conduct disturbances in the case of truancy. It is argued that this relegation of school attendance difficulties may have gone too far. As presenting complaints, albeit sometimes masked by apparent physical illness, they still have much to recommend them as indicators of a wide variety of present and future problems: educational, social, family, legal, medical, and, last but not least, psychiatric. Prevalence, features, causative factors, outcome, and management are discussed. Particular attention is paid to DSM and ICD classification. Gaps in present knowledge are indicated.
Are There More Than Two Syndromes in Schizophrenia?
Authors: Peralta Victor , De Leon Jose , Cuesta Manuel J.
Published: October 2008

A sample of 115 DSM–III–R schizophrenics was studied by means of the SANS and SAPS. A factor analysis from the nine subscales and two symptoms (inappropriate affect and poverty of content) and a review of the previous factor analyses suggest that schizophrenic symptoms cannot be appropriately classified into positive and negative syndromes. The low internal consistency of the SAPS suggests that the positive symptoms are not a homogeneous syndrome. Our results fit better with Liddle's model of three syndromes (negative, delusion-hallucination and disorganisation syndromes). It is argued that we are far from a valid classification of schizophrenic symptoms and the positive-negative dichotomy appears to be an oversimplification.
Schizophrenia after Prenatal Exposure to 1957 A2 Influenza Epidemic
Authors: Cooper Stephen J.
Published: October 2008

“The birth dates of schizophrenic inpatients in eight health regions in England and Wales were reviewed for any effect of the 1957 A2 influenza epidemic. 5 months after the peak infection prevalence, the number of births of individuals who later developed schizophrenia was 88% higher than the average number of such births in the corresponding periods of the 2 previous and the next 2 years. This finding is in accordance with a study from Helsinki and with clinical and neuropathological evidence of aberrant fetal brain development in the pathogenesis of schizophrenia.”
Periodic Psychosis Associated with the Menstrual Cycle and Increased Blink Rate
Authors: Lovestone Simon
Published: October 2008

The association of a recurrent psychosis in the premenstrual period with an increased blink rate is reported. This case adds to evidence supporting a hormonal hypothesis of certain psychotic disorders.
Drug Treatment of Panic Disorder
Authors: Klerman Gerald L.
Published: October 2008

The February 1992 issue of the British Journal of Psychiatry contained the summary report from the Second Phase of the Cross-National Collaborative Panic Study (CNCPS) on a clinical treatment trial of panic disorder. This manuscript was submitted in 1988 and took four years of response to critiques and revisions to generate a manuscript that was acceptable to the Editor of the British Journal of Psychiatry. In the same issue, Marks et al (1992) provided a ‘Comment’ which was critical of the study, calling it an “elephantine labour” which “resulted in the delivery of a mouse” and was highly critical of the statistical analyses and interpretation. Moreover, their ‘Comment’ was a springboard for discussing general issues in the treatment of panic disorder and the relative value of pharmacological versus psychological treatments. In our opinion, the Marks et al ‘Comment’ is inaccurate and misleading. At many points, they make reference to topics being missing that are actually addressed to our manuscript and they presented a statistical summary in Table 1 (p. 203) of our data which was inaccurate. In this Comment, we address each item criticised.
The Scottish First Episode Schizophrenia Study
Authors: McCreadie Robin G. , Wiles David H. , Livingston Martin G. , Watt James A. G. , Greene J. G. , Kershaw Peter W. , Todd Norman A. , Scott Angus M. , Crocket George T. , Mahmood Zahid , Loudon John , Dyer James A. T. , Philip Alistair E. , Batchelor David ,   The Scottish Schizophrenia Research Group
Published: October 2008

Forty-four schizophrenic patients were followed up for five years after their first admission to hospital for a first episode of illness. Thirteen (30%) of 43 patients had not relapsed; 28 of the 30 patients who did relapse did so within the first 42 months. The relapses occurred despite antipsychotic drug therapy. Also, 24% of patients had at least one course of ECT. Only 19% of the patients at five years were in open employment; unemployment was strongly associated with relapse. Eighteen per cent had neither relapses nor schizophrenic symptoms at follow-up. Poor outcome at five years was associated with greater psychological distress among relatives at first admission. At five years 43% of relatives continued to show case level psychological stress.
Mental Play in Gilles de la Tourette's Syndrome and Obsessive-Compulsive Disorder
Authors: Cath D. C. , van de Wetering B. J. M. , van Woerkom T. C. A. M. , Hoogduin C. A. L. , Roos R. A. C. , Rooijmans H. G. M.
Published: October 2008

A new phenomenon, found only in Gilles de la Tourette (GTS) patients, and which we have called ‘mental play’, is described. It was compared with the phenomenon of counting, which occurred in both GTS and obsessive-compulsive patients. In the GTS patients both mental play and counting were best characterised as playful impulsions. In contrast to the GTS patients, the counting of the obsessive-compulsive patients was in line with their obsessive-compulsive behaviour. These findings suggest that repetitive symptoms in GTS patients, even when they share superficial similarities with obsessive-compulsive symptoms, should not be diagnosed automatically as obsessive-compulsive.
Positive and Negative Symptoms
Authors: Baron Miron , Gruen Rhoda S. , Romo-Gruen Joan M.
Published: October 2008

The authors assessed the relevance of clinical symptoms to genetic research in schizophrenia in the nuclear families of 65 chronic schizophrenic probands. The morbidity risk for schizophrenia and schizotypal personality (a ‘spectrum’ disorder) was markedly reduced in first-degree relatives of probands with predominant negative symptoms, as compared with relatives of probands with other symptom patterns. The data support the notion that negative-symptom schizophrenia has an attenuated genetic component.
The TAPS Project. 6: New Long-Stay Psychiatric Patients and Social Deprivation
Authors: Thornicroft Graham , Margolius Olga , Jones David
Published: October 2008

The clinical and social characteristics of new long-stay (NLS) patients at Friern and Claybury hospitals are described, together with their accumulation rates within health districts in northeast London, and the associations between accumulation rates and social deprivation. There is a fourfold variation between local districts in annual accumulation rates of NLS patients (between 2.5 and 11 per 100 000 population); 0.55 of this variation is accounted for by the Jarman scores of social deprivation, and 0.81 by local rates of unemployment. Other recent British studies support this finding that measures of social deprivation can statistically explain a large proportion of the variation in treated rates of psychiatric morbidity, and may be useful in predicting needs for psychiatric services.
The Psychosocial Impact of HIV Infection in Gay Men
Authors: Catalan Jose , Klimes Ivana , Day Ann , Garrod Adrienne , Bond Alison , Gallwey John
Published: October 2008

This study aimed to establish the prevalence of psychosocial problems in gay men with HIV infection, and to identify factors associated with psychological morbidity. The study was a cross-sectional controlled investigation, which included 24 HIV seropositive and 25 seronegative gay men. Outcome measures included current psychological status and psychiatric history; coping and health beliefs; and social and sexual functioning. Seropositive subjects had worse scores on the PSE total score, and greater sexual difficulties. There were also differences in health beliefs and coping. Psychological morbidity was associated with hopelessness, previous psychiatric illness, symptomatic HIV disease, and low self-esteem.
The Influence of Ethnicity and Family Structure on Relapse in First-Episode Schizophrenia
Authors: Birchwood Max , Cochrane Ray , Macmillan Fiona , Copestake Sonja , Kucharska Jo , Cariss Margaret
Published: October 2008

There is overwhelming evidence that the outcome for people with schizophrenia in Western industrialised countries is inferior to that of those living in the Third World. Extended family structures, greater opportunities for social reintegration, and more positive constructions of mental illness have been offered as possible explanations for this effect. The Asian community in the UK retains many of these features as well as strong links with native cultures of origin. The issue arises as to whether similar differences in outcome may be observed in the UK. An exploratory study was undertaken, examining the early progress of schizophrenia in a first-episode sample (n=137), and based on systematic examination of case-note data. A lower rate of relapse/readmission in the first 12 months after discharge was found in the Asian (16%) as compared with white (30%) and Afro-Caribbean (49%) patients. Available evidence suggested that speed of access to care, living with a family, and employment may account for this effect. Medication compliance may have contributed to differences in relapse between white and Afro-Caribbeans but was not a factor influencing the low rate among Asians. The limitations and strengths of case-note studies are discussed at length, and it is concluded that a prospective study is warranted and would be highly instructive.
Change in Locus of Control Following Admission in Adolescent In-patients
Authors: Roberts Jane , Zachorchemny Christine , Cohen Jessica
Published: October 2008

A multidimensional measure of children's perception of control was administered to 56 adolescents before and after admission. Different sources of control (‘internal’, ‘powerful others' and ‘unknown’) were analysed by domain (sphere of behaviour) and outcome (‘success' or ‘failure’). There were changes across domain and outcome for all three sources of control with significant changes away from ‘powerful others' and ‘unknown’ control. The trend towards internality was also evident in significant changes in the adolescents' perceptions in the ‘general’ domain and for a ‘success' outcome. Changes towards ‘internal’ source of control were associated with higher cognitive ability, whereas changes away from ‘powerful others' were most marked in girls, and changes away from ‘unknown’ were greatest in the older adolescents. These preliminary observations may help us understand beneficial effects of in-patient care and plan strategies for sustained change in these patients.
Deliberate Self-poisoning and Self-injury in Adolescents
Authors: Hawton Keith , Fagg Joan
Published: October 2008

In Oxford during the late 1970s and early 1980s a decline in rates of deliberate self-poisoning and self-injury in older female teenagers was followed by a steady increase between 1986 and 1989. Rates for male adolescents and young female adolescents remained relatively stable throughout 1976–89. Applying the Oxford rates to England and Wales suggests a total of 18 000–19 000 hospital-referred cases per year. While self-poisoning with minor tranquillisers and sedatives has declined, there has been a marked increase in paracetamol self-poisoning, such that by 1988–89 it was involved in 48.3% of overdoses. Relationship difficulties were the most frequent problems faced by these adolescents, especially the females, with unemployment and alcohol and drug problems also being common, especially in males, but psychiatric disorders relatively rare. Substantial proportions of the adolescents, especially the males, were not living with either relatives or friends, and had a history of violence or a criminal record. The annual rate of repetition of attempts, which was 8.9% overall, was higher in adolescents not admitted to the general hospital, and in females not referred to the hospital psychiatric service. Adolescent attempted suicide clearly continues to be a major health problem for which both effective preventive and therapeutic strategies are badly needed.
Neuroleptic Malignant Syndrome and Diabetic Keto-acidosis
Authors: de Boer C. , Gaete H. P.
Published: October 2008

A patient suffering from schizophrenia developed diabetic keto-acidosis and NMS after treatment with neuroleptics. The combination of two uncommon complications of treatment with neuroleptics proved fatal.
The Effect of Clozapine on Cognition and Psychiatric Symptoms in Patients with Schizophrenia
Authors: Goldberg Terry E. , Greenberg Richard D. , Griffin Suzanne J. , Gold James M. , Kleinman Joel E. , Pickar David , Schulz S. Charles , Weinberger Daniel R.
Published: October 2008

Psychiatric symptoms and cognition were assessed in 13 patients with schizophrenia, one patient with schizoaffective disorder, and one patient with psychosis not otherwise specified while they received a conventional neuroleptic and again after an average of 15 months on clozapine. Despite improvements in psychiatric symptoms, attention, memory, and higher-level problem-solving were essentially unchanged. This suggests that certain cognitive deficits are relatively independent of psychotic symptoms in schizophrenia, and are probably central and enduring features of the disorder. Cognitive disability appeared to have been rate-limiting in the sample's rehabilitation, as patients' social and vocational adjustment remained marginal during the study. We also observed that treatment with clozapine was associated with a decline in some memory functions; the potent anticholinergic properties of the drug may have been responsible for this.
The Influence of Age and Sex on the Onset and Early Course of Schizophrenia
Authors: Häfner Heinz , Maurer Kurt , Löffler Walter , Riecher-Rössler Anita
Published: October 2008

A new standardised interview for the retrospective assessment of onset and early course of schizophrenia (IRAOS) was used to study the influence of age and sex on time of onset and psychopathology before first admission in 267 schizophrenic patients admitted for the first time. Mean age at onset, according to various operationalised definitions, differed by three to four years between the sexes. The age distribution at the earliest sign of mental disorder showed an early and steep increase until the age of 25 in males, and a delayed and smaller increase in females, with a second peak in women aged 45–79. Schizophrenia began with negative symptoms in 70% of cases, appearing two to six years before admission, and all positive symptoms appearing up to two years before. Both positive and negative symptoms accumulated exponentially. The early course of the disease was similar across age groups, except there was a longer period of negative symptoms before first admission in late-onset schizophrenia in women. The few significant age differences in symptoms were presumably due to general age-dependent reaction patterns like anxiety and depression or the cognitive development of personality, as indicated by an increase in fully elaborated positive symptoms, especially systematised paranoid delusions, with age.
How Long Should the Elderly Take Antidepressants?
Authors:   Old Age Depression Interest Group, Jacoby Robin , Lunn A. Daniel , Ardern M. , Bergmann K. , Conway J. , Cooling N. , Davies G. , Fisk J. , Gehlhaar E. , Harrison-Read P. , Hawley R. , Jacoby R. , Jones R. , Levy R. , MacDonald A. , Naguib M. , Oppenheimer C. , Philpot M. , Philpott R. , Pitt B. , Price M. , Robinson J. , Silverman M. , Simons R. , Slattery Z. , Staley C. , Taws E. , Tym E. , White M. ,   PICOS-Veneto Group
Published: October 2008

Of 219 elderly patients with a major depressive disorder (meeting RDC), 69 recovered sufficiently and consented to enter a two-year double-blind placebo-controlled trial of dothiepin. Survival analysis revealed that dothiepin reduced the relative risk of relapse by two and a half times. Past but not current serious physical illness was also associated with a favourable outcome, whereas a prolonged index depressive illness trebled the relative risk of relapse. In the light of previous research on prognosis it is suggested that elderly persons who recover from a major depressive illness should continue with antidepressant medication for at least two years, if not indefinitely.
Psychiatric Referrals within the General Hospital: Comparison with Referrals to General Practitioners
Authors: Creed Francis , Guthrie Elspeth , Black Dawn , Tranmer Mark
Published: October 2008

The increase in referrals to a new consultant psychiatrist within a teaching hospital was documented. During 1987/88 there were 279 consecutive referrals from physicians and surgeons (159 out-patients and 120 ward-consultation requests) which were compared with 184 consecutive GP referrals over the same period. Hospital referrals tended to be older, and less socially disadvantaged, but with psychiatric disorder of similar severity to GP referrals. They were more likely to have a concurrent physical diagnosis, and demonstrate somatisation. The latter was not confined to patients without physical disorder; half of the patients classified as ‘psychological reaction to physical disorder’ showed somatisation. ICD–10 appeared to perform better than ICD–9 or DSM–III for somatoform disorders, but a comprehensive classification system is still needed for liaison psychiatry. Personal discussion with the referring doctor was most common among the ward-consultation requests; in this situation the referring doctor usually continued primary management of the patient.
The Million Dollar Man
Authors: Powell Robin , Boast Neil
Published: October 2008

Munchausen's syndrome in a man of subnormal intelligence is described. The case is unique for the extent of detailed, corroborated history. This man has been a voracious consumer of NHS and other services, and an estimate has been made of his cost to the health and prison services. The case raises various ethical, forensic, and resource issues.
The Nithsdale Schizophrenia Surveys. XI: Relatives' Expressed Emotion
Authors: McCreadie R. G. , Robertson L. J. , Hall D. J. , Berry I.
Published: October 2008

The level of expressed emotion (EE) in 32 relationships between relatives and schizophrenic patients was assessed on three separate occasions over five years. EE was high on all three occasions in 25% of relatives, low on all three in 38%, and fluctuating in 38%; that is, in the majority of relatives (63%) the level of EE was stable over time. Three relatives who had previously shown high EE had evidence of dementia at the time of the third assessment, and showed low EE. Fourteen patients relapsed at least once over five years; patients who relapsed were evenly spread throughout those living in a home in which EE was consistently high, consistently low, or fluctuating. However, patients living in low-EE homes who did relapse did so significantly less often than those who relapsed and were living in homes in which EE was high or fluctuating. At the time of relapse, EE was not consistently high, and some patients in consistently high-EE homes did not relapse at all over five years.
Attitudes of British Psychiatrists to the Diagnosis of Somatisation Disorder
Authors: Stern Julian , Murphy Michael , Bass Christopher
Published: October 2008

A postal questionnaire was sent to 195 senior British psychiatrists who were asked about their attitudes towards the DSM-III-R diagnosis of somatisation disorder (SD) and the ICD-10 diagnosis of multiple somatisation disorder. Of the 148 respondents, 98 (66%) had experience of liaison psychiatry, and these psychiatrists used the diagnosis significantly more often than those without liaison sessions. More than half the respondents perceived SD as both a personality disorder and a mental state disorder, although 27% thought that patients with SD had an undiagnosed physical disease. The marked discrepancy between British and North American psychiatrists in diagnostic practices was perceived to be a consequence of both the difference in health care systems and the interest shown in the disorder by North American psychiatrists, rather than a reflection of genuine differences in prevalence.
The Adult Adjustment of Offspring of Parents with Drinking Problems
Authors: Velleman Richard , Orford Jim
Published: October 2008

One hundred and sixty-four 16–35-year-old offspring of parents with drinking problems, recruited from a variety of clinical and community sources, were compared with 80 respondents of similar ages from similar sources who did not have parents with drinking problems. Each was interviewed using a semistructured interview. Adult adjustment was similar in the two groups, but the offspring of parents with drinking problems did report considerably more disharmony in their families of origin, and many more childhood difficulties. Factor analysis of the adult adjustment data for the samples combined showed four factors which accounted for 41% of the variance; these factors differed little in their effect in the two groups. The groups' reports of the drinking problems of their siblings, however, suggests that this sample might be unrepresentative of the true risk to the children of parents with drinking problems for the development of alcohol-related (although not other) difficulties in adulthood: 16% of this group reported a sibling with a drink problem and a further 9% were unsure, but only one member of the comparison group reported a sibling with a drink problem, and one was unsure. Path analysis showed that both parental problem drinking and family disharmony are related in complex ways to adjustment difficulties in adulthood. ‘Demoralisation’, the largest of the four factors, was particularly related to disharmony in the family of origin: in the absence of disharmony, offspring versus comparison status was negatively correlated to demoralisation in adulthood, suggesting that having a parent with a drinking problem might sometimes be a strengthening experience.
A Proposal to Classify Happiness as a Psychiatric Disorder
Authors: Harris John , Birley J. L. T. , Fulford K. W. M.
Published: October 2008

“It is proposed that happiness be classified as a psychiatric disorder and be included in future editions of the major diagnostic manuals under the new name: major affective disorder, pleasant type. In a review of the relevant literature it is shown that happiness is statistically abnormal, consists of a discrete cluster of symptoms, is associated with a range of cognitive abnormalities, and probably reflects the abnormal functioning of the central nervous system. One possible objection to this proposal remains - that happiness is not negatively valued. However, this objection is dismissed as scientificaly irrelevant.”
Caffeine: use and Effects in Long-Stay Psychiatric Patients
Authors: Mayo K. M. , Falkowski W. , Jones C. A. H.
Published: October 2008

In a double-blind crossover study of 26 long-stay schizophrenic patients, no correlation was found between caffeine consumption and levels of anxiety and depression. No significant changes in patients' behaviour or levels of anxiety and depression occurred when the wards changed to decaffeinated products. Serum caffeine levels confirmed compliance. No evidence was found to support a removal of caffeinated products from this group of patients.
Cross-dressing in Men with Learning Disabilities
Authors: Bowler Clare , Collacott Richard A.
Published: October 2008

Four men with learning disabilities were considered to show transvestic fetishism, and a fifth to show transvestism. However, developmental retardation and personality problems may modify the concepts behind such categorisation.