bluuebunny/crossref_metadata_2025 huggingface dataset:
Lithium prophylaxis of manic‐depressive disorder: daily lithium dosing schedule versus every second day
Authors: Jensen H. V. , Plenge P. , Mellerup E. T. , Davidsen K. , Toftegaard L. , Aggernaes H. , Bjørum N.
Published: August 2007

The prophylactic efficacy of lithium carbonate given every second day versus daily intake was compared in a double‐blind study including 50 manic‐depressive patients. The patients met the DSM‐III‐R criteria for bipolar disorder or depressive disorder; according to ICD‐8 the patients fulfilled criteria for manic‐depressive disorder. All patients had experienced at least 3 episodes of mania or major depression, and all had been euthymic for at least 4 months. The median doses of lithium carbonate given were 800 mg/day or 1200 mg/every second day corresponding to median 12‐h serum lithium concentrations of 0.6 mmol/1 or 0.7 mmol/1, respectively. Manic or depressive relapse was defined as DSM‐III‐R criteria for mania or major depression, and a score ≥ 10 on the Bech‐Rafaelsen Mania Scale or the Bech‐Rafaelsen Melancholia Scale, respectively. The two treatment schedules were allocated at random. Using the Cox proportional hazard model for statistical analysis, the lithium dosing schedule of every second day did not maintain its prophylactic efficacy against recurrent episodes of manic‐depressive disorder. The risk of relapse increased 3 times when the interval between intake of lithium was extended from 1 to 2 days.
A study of post‐stroke depression in a rehabilitative center
Authors: Ng K. C. , Chan K. L , Straughan P. T.
Published: August 2007

This was a prospective study of 52 stroke patients. The incidence of post‐stroke depression was 55%. A past history of depression was significantly associated with the clinical assessment of depression. There was no association between the clinical assessment of depression and type and site of lesion and intellectual impairment. The clinical assessment of depression was significantly associated with the degree of functional impairment. The clinical assessment of depression also correlated well with Hamilton Depression Rating Scale score. We conclude that post‐stroke depression is unlikely to be caused by neuronal injury due to the cerebrovascular accident. There is also a significant reactive component to it. The Hamilton Depression Rating Scale is suitable for assessing the severity of depression in stroke patients.
Psychological profile of patients suffering from Crohn's disease and ulcerative colitis
Authors: Smith G. J. W. , van der Meer G. , Ursing B. , Prytz H. , Benoni C.
Published: August 2007

Patients with Crohn's disease (CD, n= 61) and ulcerative colitis (UC, n= 24) were studied using an interview and a series of percept‐genetic tests describing anxiety, defensive strategies, and the self‐image. Attention was specifically directed at a subgroup of CD (n= 15) with its inflammation limited to the colon (colon Crohn, CC). There was also a control group (n= 43). CC had more immature parent relations than the other groups. They were more childishly concrete and more alexithymic. While CC differ from other Crohn patients in many respects, the real cleft opens up with regard to UC, in spite of location of their illness. CC patients obviously have a psychological profile of their own.
Predictors of imminent violence in psychiatric inpatients
Authors: Linaker O. M. , Busch‐Iversen H.
Published: August 2007

Behavior and symptoms seen in 48 24‐h periods preceding violent episodes and 93 control observations were studied. Six behaviors were more common before violence: confusion, irritability, boisterousness, physical threats, verbal threats and attacks on objects. A logistic regression equation based on these behaviors in a randomized half of the observations predicted the occurrence of subsequent violence in 92.1% of the other half of the sample without any false positives, giving a sensitivity of 81.3% and a specificity of 100%. It is concluded that mentally ill people display the same behaviour before violent acts as we would expect in people without such disorder. The potential for short‐term prediction of violence seems good.
Moclobemide versus clomipramine in nonmelancholic, nonpsychotic major depression
Authors: Lecrubier Y. , Pedarriosse A.‐M. , Payan C. , Schmid‐Burgk W. , Stabl M. ,   a study group
Published: August 2007

The efficacy and the safety of moclobemide (400‐600 mg/day), a reversible and selective inhibitor of monoamine oxidase‐A (RIMA) and of clomipramine (100–150 mg/day) were compared respectively in 98 and 93 nonmelancholic, nonpsychotic out‐patients with a DSM‐III major depressive episode over 6 weeks and up to 3 months, in a multi‐center double‐blind trial. No statistically significant difference between the treatments was found on the number of responders, at 6 weeks and 3 months, to the Hamilton Depression Rating Scale (HDRS), which was the main criterion for efficacy. The sample size was sufficient to detect a difference of approximatively 20% in response rates. Reduction of the total scores on HDRS and Covi anxiety scale was comparable for both treatments, but the reduction on the Retardation Depressive Scale (RDS) was significantly higher with moclobemide at the 1‐ and 2‐week assessments. According to the RDS as well as the global impression of both patient and physician, a somewhat earlier onset of antidepressant action was evident in the moclobemide group. Tolerance was significantly better in the moclobemide group, mainly due to a lower frequency of weight gain, sedation and anticholinergic effects.
Melatonin in light treatment of patients with seasonal and nonseasonal depression
Authors: Thalén B. E. , Kjellman B. F. , Mørkrid L. , Wetterberg L.
Published: August 2007

Melatonin as a marker of circadian rhythm and the effect of bright light on melatonin were studied in 63 depressed patients, 42 with a seasonal pattern and 21 with a nonseasonal pattern. The patients were matched for age, time of treatment and severity of depression. Before light treatment, blood was sampled for melatonin and depression was clinically rated with the Comprehensive Psychopathological Rating Scale and Hamilton Depression Rating Scale. Two hours of light treatment, 350 cd/m2, was given daily for 10 days 0600 to 0800 or 1800 to 2000. Of the 42 patients with seasonal depression, 26 were treated with morning light and, 16 with evening light. The melatonin amplitude was significantly decreased by light, and the melatonin phase position was advanced by morning light and delayed by evening light. All patients except for 3 in each group changed in the expected direction. Although the patients with seasonal pattern had a more favorable outcome than patients with nonseasonal pattern, there was no difference in therapeutic outcome related to the baseline melatonin phase position. The hypothesis that the short term clinical effects of light therapy either in the morning or evening are related to pretreatment melatonin levels or alteration of melatonin amplitude or phase position was not supported in the study. There was also no significant difference between the seasonal and nonseasonal patients related to the degree of light suppression of melatonin or the rebound effect of serum melatonin levels following bright light exposure between 2200 and 2300 before regular light treatment.
Conversion disorder revisited
Authors: Sharma P. , Chaturvedi S. K.
Published: August 2007

Fifty four consecutive subjects diagnosed as Hysteria (300.1 according to ICD‐9), were taken up for study, to examine the usefulness and validity of Lazare's criteria and explore its clinical utility in diagnosing conversion disorders. Lazare's validation score was computed for each subject, and the specificity, sensitivity, positive predictive validity and misclassification rates were computed for different cut off scores. A cut off score of 5 on Lazare's validation criteria gave good sensitivity (75%) but only modest specificity (41%). The individual criteria showed variation in presence between 18% and 68%, and some of these such as “disturbed sexuality” and “secondary gain” were felt to require redefining. The study of patterns of previous history of organic illness, physical findings on clinical examination, lateralization of symptoms, handedness and followup status indicated important association between hysteria and organicity.
A prospective three‐year follow‐up study of borderline personality disorder inpatients
Authors: Antikainen R. , Hintikka J. , Lehtonen J. , Koponen H. , Arstila A.
Published: August 2007

Prospective long‐term follow‐up studies on patients with borderline personality disorder (BPD) have been uncommon. Clinical data suggest that their treatment is highly demanding and that short‐term results are sometimes limited. In this study, changes in symptoms and social management were monitored during a hospitalization period of 91 days (mean, range 21–296 days) and during a 3‐year follow‐up period in 62 patients admitted during 1989 to an open ward specializing in the psychotherapeutic treatment of BPD. The patients were thoroughly evaluated, using various rating scales, at the beginning and at the end of the index admission and after the follow‐up period. Forty‐two patients (70%) participated in the follow‐up evaluation. Most patients suffered from overt anxiety and depressive symptoms at the beginning of hospitalization, and these declined significantly during hospital treatment. At the end of the follow‐up period, depressive and anxiety symptoms were at the same level as on discharge, as assessed by the Beck Depression Inventory and Hamilton Depression Rating Scale. Although treatment response was otherwise maintained, the patients often showed suicidal behavior. During the follow‐up period the sample clearly differentiated in two groups: those continually fit for work (33%) and those chronically incapable of working (46%).
A nationwide representative sample of treatment‐seeking alcoholics: a study of psychiatric comorbidity
Authors: Tómasson K. , Vaglum P.
Published: August 2007

In order to elucidate the psychiatric comorbidity of patients in alcohol and other substance use disorder treatment we examined a representative sample of such patients in Iceland (249 men and 102 women). Over 70% of pure alcoholics and over 90% of polysubstance users had comorbid diagnoses, a prevalence higher than in the Epidemiological Catchment Area study in the United States, but similar to clinical studies from North America. The most prevalent disorders were: affective (33%), anxiety (65%), antisocial personality disorder (28%) and psychosexual dysfunction (20%). Pure alcoholics and polysubstance users in studies on psychiatric comorbidity should be separated. Anxiety and affective disorders influence treatment seeking. Findings concerning the impact of psychiatric comorbidity on course should be comparable between North America and Europe.
Is treatment in groups a useful alternative for psychiatry in low‐income countries? An evaluation of a psychiatric outpatient unit in Nicaragua
Authors: Caldera T. , Kullgren G. , Penayo U. , Jacobsson L.
Published: August 2007

Centro de Atención Psicosocial in León, Nicaragua is a psychiatric outpatient unit that has developed a group‐oriented model of working, in which 80% of all visits are in groups: first‐admission groups, insight‐oriented group psychotherapy, psycho‐educative, family groups and relatives groups. The aim of the present study was to analyze patient characteristics and make a preliminary study of improvement, compliance and patient satisfaction in a 1‐year perspective. One hundred consecutive visits were assessed, 44 of them first admissions. They were assessed according to all axes of DSM‐III‐R plus the Structural Clinical Interview for DSM‐III Disorders. A 1‐year follow up was conducted on 39 of 41 selected patients within the major diagnostic groups. One of 4 patients had a psychotic disorder where schizophrenia dominated. Among nonpsychotics major depression, anxiety and adjustment disorders were most frequent. Personality disorders were common (80%) among nonpsychotic patients, paranoid, obsessive‐compulsive, passive‐aggressive and masochistic personality disorders dominating. The illiteracy rate was 10%, but 50% had high school or university background. Severity of mental disorders and functional level did not differ between educational levels. There was a strong male dominance in all diagnostic, socioeconomic and educational level strata and few old patients. Improvement in functional level was clinically and statistically significant in all groups, and more than two thirds were very satisfied with the group treatment offered.
Mental well‐being in people with non‐insulin‐dependent diabetes
Authors: Viinamäki H. , Niskanen L. , Uusitupa M.
Published: August 2007

We assessed the prevalence of minor mental disorder and depression in elderly patients with non‐insulin‐dependent (Type 2) diabetes mellitus as compared with control subjects and evaluated the associates of impaired mental well‐being in diabetic patients. The study consists of a community‐based group of patients (n= 82) with a 10 years' known duration of disease and nondiabetic control subjects (n= 115). In addition to clinical and laboratory examinations, self‐rating questionnaires assessing minor mental disorder (General Health Questionnaire, GHQ) and depression (Zung Self‐rating Depression scale) were completed by the patients and control subjects. The mean scores of GHQ and Zung scores tended to be higher in diabetic than in control subjects, but the frequency of case subjects was not different between the diabetic (GHQ: 40%; Zung: 11%) and nondiabetic groups (GHQ: 36%; Zung: 7%). These findings were explained by more severe symptoms in diabetic case subjects as compared to nondiabetic case‐subjects. From the various parameters studied, the presence of symptomatic neuropathy was most strongly associated with depression and minor mental disorder in diabetic subjects. The results suggest that the impact of Type 2 diabetes per se on minor mental disorder or depression in elderly subjects‐is not overwhelming. However, a subgroup of diabetic patients seems to have markedly impaired mental well‐being, and the treatment of its underlying factors may improve overall treatment compliance.
Suicide among New Zealand Maori: is history repeating itself?
Authors: Skegg K. , Cox B. , Broughton J.
Published: August 2007

Suicide rates for New Zealanders identified as Maori were analysed for the period 1957‐91 and compared with those for non‐Maori people. Overall, Maori men had about half the risk of suicide of non‐Maori men, and Maori women one‐third the risk of non‐Maori women. Nevertheless, there was a sharp increase in suicide rates for Maori aged 15–24 years during the period studied, with rates for the 1987–91 time period of 35.2/100,000 for men and 6.0/100,000 for women. These were similar to the high suicide rates of young non‐Maori New Zealanders. Suicide among Maori in pre‐European times appears to have been embedded in traditional culture and may have occurred particularly among bereaved women; today the pattern is one of high rates in young men who are likely to have been from their culture.
War and suicide in northern Sri Lanka
Authors: Somasundaram D. J. , Rajadurai S.
Published: August 2007

A study on the effect of war on the suicide rate in Jaffna town for the 10‐year period from 1980 to 1989 is reported. There was a marked drop in the suicide rate during the war, notably among males and youth. An inverse relationship between suicide and homicide rates was shown in the overall trends, particularly in 1987. It is hypothesized that war may function as an alternate to suicide. The use of agrochemicals for suicidal purposes declined during war, while alary seeds became more popular. The method chosen may reflect availability and cultural popularity.
Neuropsychological correlates of intractable anxiety disorder before and after capsulotomy
Authors: Nyman H. , Mindus P.
Published: August 2007

A comprehensive neuropsychological test battery was administered to 10 consecutive patients undergoing neurosurgical intervention, capsulotomy, as a last resort treatment for chronic, incapacitating, and otherwise intractable illness, either obsessive‐compulsive disorder (OCD; n= 5) or non‐OCD anxiety disorder (n= 5). The aim was to study the neuropsychology of severe anxiety disorders before and after a defined neurosurgical intersection of connections between the frontal lobes and related brain regions. Although extremely disabled by their illness before surgery, the patients performed within the normal range on most tests. After capsulotomy, there was significant improvement on measures of clinical morbidity and of psychosocial functioning, and the general neuropsychological performance remained remarkably intact. In a subgroup of 5 patients, however, perseverative responses were more common postoperatively, possibly indicating dysfunction of systems involving the frontal lobes. Although admittedly sparse, these data can be interpreted as suggesting that in vulnerable individuals, capsulotomy may give rise to increased perseverative behaviour in the laboratory, and possibly in the real world as well. This risk must be weighed against the potential clinical benefit of capsulotomy in this extremely disabled, sometimes suicidal patient population.
The Nordic comparative study on sectorized psychiatry I. Treated point prevalence and characteristics of the psychiatric services
Authors: Hansson L. , Öiesvold T. , Göstas G. , Kastrup M. , Lönnerberg O. , Saarento O. , Sandlund M.
Published: August 2007

Comparative studies relating characteristics of psychiatric services to rates of treated prevalence are scarce. As part of a Nordic comparative study on sectorized psychiatry, a point‐prevalence study was performed in 5 sectorized psychiatric services with comprehensive service facilities for a defined population under responsibility. The rates of treated prevalence on a census day were related to a number of characteristics of the respective services and to accessibility of care. The results showed a great variation in one‐day point prevalence in the 5 services, with almost fourfold differences. There were also marked differences in the diagnostic distribution of the cohorts. A positive correlation was found between number of beds and point prevalence, measured both as total point prevalence and impatient prevalence. The rates of beds and psychiatrists were most strongly related to the prevalence of patients with organic disorders and functional psychoses. A closed referral system was associated with a lower level of treated prevalence.
Moclobemide and fluoxetine in the prevention of relapses following acute treatment of depression
Authors: Lonnqvist J. , Sihvo S. , Syvälahti E. , Sintonen H. , Kiviruusu O. , Pitkanen H.
Published: August 2007

The efficacy of moclobemide (378 mg ± 76 mg/day) and fluoxetine (36 mg ± 8 mg/day) in preventing relapse was studied during 12 weeks of continuation treatment after a 6‐week initial trial. Fifty‐nine patients with Hamilton Depression Rating Scale (HDRS) scores of 16 or less were enrolled; 29 continued to receive moclobemide and 30 fluoxetine. Efficacy was measured using a 17‐item HDRS, the Montgomery‐Åsberg Depression Rating Scale and the Clinical Global Impression. Improvement in quality of life was measured using a Medical Outcome Study Short‐form General Health Survey and the 15D Measure of Quality of Life. Twenty‐three per cent of the patients in the fluoxetine group dropped out of the study and 10% in the moclobemide group. Two patients (7%) in the moclobemide group and one (3%) in the fluoxetine group suffered a relapse. Health status and quality of life improved in both drug groups during a 12‐week continuation period. The reports of adverse events fell to one third during the continuation phase. The results indicate that benefits may be gained from extending acute treatment.
Comparative assessment of saccadic eye movements, psychomotor and cognitive performance in schizophrenics, their first‐degree relatives and control subjects
Authors: Schreiber H. , Rothmeier J. , Becker W. , Jürgens R. , Born J. , Stolz‐Born G. , Westphal K. P. , Kornhuber H.H.
Published: August 2007

This study is aimed at detecting biological markers for schizophrenia. For this purpose, a total of 70 subjects (21 schizophrenic patients, 27 first‐degree relatives and 22 controls) performed a series of tests assessing various attentional, psychomotor and cognitive functions and saccadic eye movements. The schizophrenics performed significantly poorer than both high‐risk and control subjects in most of the tests demanding attention, concentration and psychomotor speed (d2 concentration test, reaction times and Stroop test of perceptual interference) as well as cognition (Wechsler intelligence scales). On the other hand, these tests did not differentiate between the high‐risk and control subjects. This distinction, however, could be made by two other parameters: hypometria score of saccadic eye movements and ratio of verbal to performance intelligence scores. Both parameters were significantly increased in both the schizophrenic and the high‐risk group, distinguishing both from the control group. The relevance of these findings in indicating a schizophrenic disposition is discussed.
Ear disease and schizophrenia: a case‐control study
Authors: Mason P. R. , Winton F. E.
Published: August 2007

The rates of middle ear disease in 70 patients with schizophrenia from a defined catchment population were compared with the rates in 359 nonpsychiatric controls who were matched for age, sex and general practice. A relative risk (odds ratio) of middle ear disease in schizophrenia of 1.92 was found. This was raised to 2.29 when ear disease occurring after the onset of schizophrenia was excluded. Excluding aetiological factors such as brain damage or family history raised the odds ratio further to 2.50 and 2.71 respectively. The implications of these results are discussed, and it is suggested that middle ear disease may be an aetiological factor in some cases of schizophrenia.
Overdose deaths in young substance abusers: accidents or hidden suicides?
Authors: Kjelsberg E. , Winther M. , Dahl A.A.
Published: August 2007

Of 1969 earlier adolescent psychiatric inpatients, 1792 (91%) were traced after a mean follow‐up period of 15 years. Thirty‐nine patients, 2.3% of the men and 2.0% of the women had died from drug overdoses. An additional 16 drug‐ and alcohol‐related deaths had occurred. The overdose death rate increased significantly during the observation period. At the time of death, 28 (72%) of the 39 overdose cases received a diagnosis of opioid dependence, the rest had polysubstance dependence. Death was most often caused by opioids. Comparing the 39 overdose cases with 39 surviving controls and 35 suicides from the same patient population, we found that the suicide cases had more psychotic symptoms, suicidal ideation, learning difficulties and somatic disorders. The suicide cases received less follow‐up treatment on discharge from hospital, did not enter specific drug treatment programs, and were the only ones to be discharged to the street. We found no significant differences between the overdose cases and their surviving controls. Both groups showed poor impulse control and risk‐taking behavior more often than the suicide group. The study lends support to the hypothesis that the majority of overdose deaths in young drug addicts are accidental poisonings and not misclassified suicides.
The outcome of adolescent suicide attempts
Authors: Granboulan V. , Rabain D. , Basquin M.
Published: August 2007

A sample of 265 adolescents hospitalized between 1971 and 1980 in a psychiatric unit following a suicide attempt was studied to evaluate outcome. After an average of 11.5 years, 48% of the original sample, or 127 subjects, could be traced. Thirty‐nine per cent of these subjects showed signs of improvement, 22% appeared to be unchanged and 33% were worse. Substantial dropout rates were found in postdischarge care, only 32% of the patients having been followed up for a sufficient amount of time. Fifteen subjects had died, only one of whom from a natural cause. Of the remaining 14, 5 had committed suicide and 9 had died from unnatural or violent causes other than suicide, the cause of death appearing in all cases to be closely linked to the subject's adolescent disorders. The implications of these findings for suicide prevention are discussed.
Risperidone versus zuclopenthixol in the treatment of acute schizophrenic episodes: a double‐blind parallel‐group trial
Authors: Huttunen M. O. , Piepponen T. , Rantanen H. , Larmo I. , Nyholm R. , Raitasuo V.
Published: August 2007

A double‐blind, randomized, multi‐center, parallel‐group study was conducted in Finland to compare the efficacy and safety of risperidone with zuclopenthixol in patients with acute exacerbations of schizophrenia or schizophreniform disorder. Ninety‐eight patients were randomly assigned to treatment with risperidone (n= 48) or zuclopenthixol (n= 50), in variable doses, for 6 weeks. The mean daily doses of risperidone and zuclopenthixol at the end of the trial were 8 mg and 38 mg respectively. Efficacy was assessed throughout by the Positive and Negative Syndrome Scale for schizophrenia and Clinical Global Impression. Safety assessments included the Extrapyramidal Symptom Rating Scale, UKU Side‐Effect Rating Scale, vital signs, body weight and laboratory screening. The results indicate that risperidone is at least as effective as zuclopenthixol for the treatment of acute schizophrenic episodes, with a trend towards greater improvement in the overall severity of symptoms. The onset of action was significantly shorter with risperidone than with zuclopenthixol. Although the general tolerability of the two drugs was comparable, fewer patients experienced extrapyramidal symptoms with risperidone, so that significantly fewer risperidone‐treated patients required antiparkinsonian medication.
Neuropsychological changes during steady‐state drug use, withdrawal and abstinence in primary benzodiazepine‐dependent patients
Authors: Tönne U. , Hiltunen A. J. , Vikander B. , Engelbrektsson K. , Bergman H. , Bergman I. , Leifman H. , Borg S.
Published: August 2007

Impairment on neuropsychological tests during steady‐state drug use and withdrawal, and after discontinuation of benzodiazepines, was studied in primary benzodiazepine‐dependent patients. One group of patients was tested before and the other group after the initiation of a gradual tapering‐off of the drug, and both groups were tested approximately 1 year later. At the initial assessment, both groups of patients showed impairment on most of the tests of general intelligence and on several of the tests in the Halstead‐Reitan battery, as well as on a test of nonverbal memory, in comparison with healthy controls. At follow‐up the patient groups had reached the level of the control group. This study confirmed earlier observations of neuropsychological deficits in long‐term benzodiazepine‐using patients and demonstrated that these changes are at least partly reversible by discontinuing drug intake.
Survival analysis of suicide risk after attempted suicide
Authors: Nordström P. , Samuelsson M. , Åsberg M.
Published: August 2007

Survival analysis of suicide risk by sex and age after attempted suicide was studied in a cohort of 1573 suicide attempters referred to the psychiatric emergency room at the Karolinska Hospital from 1981 to 1988. The time course of suicide risk and the overall prognosis after attempted suicide and, in particular, the possible usefulness of sex and age as risk factors for the prediction of suicide risk after attempted suicide was analyzed. Nearly two thirds of the sample were women and most of the suicide attempters were young (in their twenties and thirties), and the median age was 35 years. The overall mortality after a 5‐year mean observation period after attempted suicide was 11%, and the suicide mortality was 6 %. The suicide risk after attempted suicide among men (8.3%) was nearly twice the female suicide risk (4.3%). Age as a possible suicide risk factor was analyzed for each sex separately by median split subgrouping. It was concluded that both older and younger male suicide attempters are at high risk of suicide (7% and 10% respectively), and older women are at higher risk than younger (6%, vs 2%). The suicide risk is particularly high during the first year after the suicide attempt. The high suicide risk group of young adult male suicide attempters is one of the main feasible targets of psychiatric intervention research programs on suicidal behavior. Suicide among young men is a major cause of years of life lost.
Schizophreniform disorder, delusional disorder and psychotic disorder not otherwise specified: clinical features, outcome and familial psychopathology
Authors: Kendler K.S. , Walsh D.
Published: August 2007

The relationship between DSM‐III‐R schizophreniform disorder, delusional disorder (DD) and psychotic disorder not otherwise specified (PD‐NOS) and schizophrenia and affective illness (AI) remains uncertain. We explore this question in the Roscommon Family Study by examining symptoms, outcome and patterns of psychopathology in relatives. Probands were selected from a population‐based case registry in the west of Ireland with an ICD‐9 diagnosis of schizophrenia or AI. Personal interviews were conducted with 88% of traceable, living probands, a mean of 16 years after onset, and 86% of traceable, living first‐degree relatives. Best‐estimate diagnoses were made at follow‐up. Schizophreniform disorder, DD and PD‐NOS constituted 6.4%, 2.8% and 7.5%, respectively, of all probands with a registry diagnosis of schizophrenia. Probands with schizophreniform disorder had prominent positive psychotic symptoms, negligible negative symptoms and a good outcome, comparable to that seen in AI probands. Their relatives had an excess risk of schizophrenia spectrum illness but not AI. Probands with DD had prominent delusions but no other psychotic symptoms, few negative symptoms, fair to good outcome and an increased risk in relatives for alcoholism. Probands with PD‐NOS had both moderate positive and negative psychotic symptoms, a poor to fair outcome and a substantially elevated risk in relatives of schizophrenia and schizophrenia spectrum disorders but not AI. These results suggest that i) DSM‐III‐R criteria for schizophreniform disorder define a good outcome disorder with prominent positive psychotic symptoms that probably has a familial relationship to schizophrenia, but not AI; ii) DD is a rare, monosymptomatic psychosis that may have a modest etiologic relationship with alcoholism, but probably not with schizophrenia or AI and iii) PD‐NOS is probably heterogeneous but, of these 3 disorders, most closely resembles schizophrenia with respect to symptoms, outcome and familial psychopathology. These results should be seen as tentative given the small number of probands and relatives evaluated.
An acute psychiatric rating scale for the clinical assessment of functionally disturbed inpatients
Authors: Squier R. W.
Published: August 2007

A 28‐item behavioral rating scale, the Acute Psychiatric Rating Scale (APRS), was developed using factor‐analytic methods for the assessment of functionally disturbed psychiatric inpatients. Fifty‐eight staff rated 74 patients on the scale. Seven factorial dimensions were extracted comprising neuroticism, aggression, emotional withdrawal, cognitive impairment, schizophrenia, hypomania and self‐injuriousness. The scale was evaluated in 4 different psychiatric inpatient units: two acute admission wards, an intensive care unit and a regional secure unit. Behavioral ratings on the scale were related to several patient demographic and treatment variables, including age, sex, marital status, legal status, length of admission and electroconvulsive therapy. The scale was found to possess a clear factorial structure, good interrater reliability and promising clinical validity for further research use in psychiatric inpatient settings.
Antidepressants and drug‐metabolizing enzymes — expert group report
Authors: Meyer U. A. , Amrein R. , Balant L. P. , Bertilsson L. , Eichelbaum M. , Guente T. W. , Henauer S. , Jackson P. , Laux G. , Mikkelsen H. , Peck C. , Pollock B. G. , Priest R. , Sjöqvist F. , Delini‐Stula A.
Published: August 2007

Antidepressant drugs are extensively metabolized. Consequently, the biotransformation pattern of antidepressants has an important influence on their clinical properties, i.e., pharmacokinetics, toxicity, drug‐drug interactions, side‐effect profile and last but not least therapeutic efficacy. It was against this background that a multidisciplinary group of experts discussed the clinical relevance of the rapidly increasing body of knowledge of antidepressant‐metabolizing enzymes. The variability of the response of a given individual to an antidepressant is determined genetically and by the environment. Genetic polymorphism of drug‐metabolizing enzymes and inhibition by other substrates may affect the enzymatic biotransformation of antidepressants. In vitro assay techniques allow an estimation of the potential variability in clinical response to antidepressants and a reasonable prediction of the drug‐drug interaction patterns. The results of in vitro tests should therefore be considered early in the development of an antidepressant as a background for designing clinical studies (treatment schedules and dosing).

Physicians should have an understanding of the relevance of genetic polymorphism for clinical practice. Education is needed in order to fill the existing gaps in knowledge about antidepressant‐enzyme interactions and their application in daily treatment practice. The information on potential drug interactions determined by genetic polymorphism and based on studies with enzymes should be increasingly contained in drug compendia.
Routine evaluation of mental health: reliable information or worthless‘guesstimates’?
Authors: Loevdahl H. , Friis S.
Published: August 2007

Routine evaluation of mental health care systems necessitates a quick assessment of progress and outcome. This study was designed to determine the value of the GAF‐scale in such applications. We allowed 104 raters from six therapeutic centres to rate five clinical case‐vignettes. Interrater reliability was almost equal for raters within different professional categories. The highest and the lowest scores for each of the case‐vignettes differed by between 39 and 45 points. The raters’ biases ranged from −23 to +30 points, and random deviations were between 1 and 20 points. Systematic differences between centres were up to 6 points. Our main finding is that the reliability of GAF scores in routine settings proved unsatisfactory with untrained raters.
Catatonia. II. Treatment with lorazepam and electroconvulsive therapy
Authors: Bush G. , Fink M. , Petrides G. , Dowling F. , Francis A.
Published: August 2007

Case material and retrospective studies support the use of both lorazepam and ECT in treating catatonia, but few prospective investigations exist and none employ quantitative monitoring of response. In this study we test their efficacy in an open, prospective protocol, and define a‘lorazepam test’ with predictive value for treatment. Twenty‐eight patients with catatonia were treated systematically with parenteral and/or oral lorazepam for up to 5 days, and with ECT if lorazepam failed. Outcome was monitored quantitatively during the treatment phase with the Bush‐Francis Catatonia Rating Scale (BFCRS). In 16 of 21 patients (76%) who received a complete trial of lorazepam (11 with initial intravenous challenge), catatonic signs resolved. A positive response to an initial parenteral challenge predicted final lorazepam response, as did length of catatonic symptoms prior to treatment. Neither demographic variables nor severity of catatonia predicted response to lorazepam. Four patients failing lorazepam responded promptly to ECT. It is concluded that lorazepam and ECT are effective treatments for catatonia. The rating scale has predictive value and displays sensitivity to change in clinical status.
Criminality and psychopathy as related to thyroid activity in former juvenile delinquents
Authors: Alm P. O. , Af Klinteberg B. , Humble K. , Leppert J. , Sörensen S. , Tegelman R. , Thorell L.‐H. , Lidberg L
Published: August 2007

Levels of triiodothyronine (T3) and thyroid‐stimulating hormone (TSH), psychopathy‐related personality traits and criminality from the age of 15 years onward were examined in 70 former juvenile delinquents and 35 control subjects aged 38–46 years. T3 levels were significantly associated with criminality but not with psychopathy‐related personality traits. TSH levels were not related to any of these variables. Juvenile delinquents who displayed persistent criminal behaviour were found to have higher mean T3 levels than juvenile delinquents who did not display criminality in adulthood and non‐criminal controls. Former juvenile delinquents with T, levels above the mean level found in the controls were registered for criminality 3.8 times more often than juvenile delinquents with T3 levels below the mean level found in the control group. The results are discussed in terms of elevated T3 levels representing a compensatory or stress phenomenon for low social adaptive ability of individuals who display persistent criminal behaviour.
The ‘Dhat syndrome’ : a culturally determined symptom of depression?
Authors: Mumford D. B.
Published: August 2007

The status of the ‘Dhat syndrome’ is called into question by the results of an epidemiological study of men attending general medical clinics in Lahore. The Dhat complaint was reported by 30% of men attending medical clinics, and to an equal extent by patients with ‘functional’ and ‘organic’ diagnoses. It was strongly associated with depressed mood, fatigue symptoms, and a DSM‐III‐R diagnosis of depression. It is argued that the Dhat complaint should be primarily regarded not as the focus of a culture‐bound syndrome, but as a culturally determined symptom associated with depression.
Schizophrenia with childhood and adolescent onset — a nationwide register‐based study
Authors: Thomsen P. H.
Published: August 2007

The aim of this study was to determine the frequency, demographic characteristics and course of children and adolescents admitted with a diagnosis of schizophrenia before the age of 18 years. The paper describes 312 patients from Denmark who were given a diagnosis of schizophrenia during the period between 1970 and 1993. Schizophrenia with a childhood onset was extremely rare. Only four children under the age of 13 years and 28 children under the age of 15 years had received such a diagnosis. The study showed that a number of adolescents who were diagnosed with schizophrenia at their first admission were not given the same diagnosis at later admissions in adulthood. The most common diagnoses in this group of apparently misdiagnosed cases were personality disorders, primarily borderline and antisocial personality disorder.
Schizotypal disorder: at the crossroads of genetics and nosology
Authors: Battaglia M. , Torgersen S.
Published: August 2007

The aim of this paper is to review the available evidence in support of the correctness of including the DSM‐III/III‐R schizotypal personality disorder (SPD) in the schizophrenia spectrum, to discuss the components that may account for the familial segregation of SPD, and to consider the implications for research and clinical use of this diagnostic category. The majority of the available data from genetic epidemiology studies, starting from probands with schizophrenia or with SPD, suggest that SPD is one of several phenotypes of liability for the schizophrenia spectrum. Recent twin studies suggest that the affect‐constricted and eccentric aspects of SPD are the features that truly belong to the spectrum of schizophrenia, sharing important genetic influences. However, other components are more useful for the identification of SPD in clinical settings, and these may be the specific focus of treatment. The present categorization appears to be a reasonable trade‐off for the purposes of both the investigator and the clinician, even though different components within SPD may have different origins and can be selectively emphasized according to the different aims involved.
Personality traits and psychiatric and somatic morbidity among kleptomaniacs
Authors: Sarasalo E. , Bergman B. , Toth J.
Published: August 2007

Although the behaviour of kleptomania has been identified for decades, very little is known about the reasons, prevalence, course and treatment of this disorder. Current knowledge about kleptomania is generally derived from case reports or from material collected from highly selected groups. There are no published systematic studies of personality traits among kleptomaniacs, and knowledge of somatic and psychiatric co‐morbidity is limited. The purpose of the present study was to describe personality characteristics, psychiatric disorders and somatic illness among kleptomaniacs. A total of 37 patients (two‐thirds of whom were female) who fulfilled the DSM‐IV criteria for kleptomania were recruited by advertising in a daily newspaper. Monotony avoidance was a prominent personality trait, as was a low degree of socialization. Depression and anxiety were also very common, as was a history of attempted suicide. Somatic illness was commonly reported, and a high proportion of the kleptomaniacs were regularly receiving pharmacological treatment for either psychiatric or somatic illness. The representativeness of this group of kleptomaniacs is as yet unknown. However, the present study is based on the largest sample of patients fulfilling DSM‐III‐R/DSM‐IV criteria for kleptomania to date who were not primarily recruited through the medical or legislative systems.
Atypical depressive symptoms and clusters in unipolar and bipolar depression
Authors: Robertson H. A. , Lam R. W. , Stewart J. N. , Yatham L. N. , Tarn E. M. , Zis A. P.
Published: August 2007

In order to examine differences in the atypical symptoms of depression between unipolar and bipolar patients, we studied 109 depressed patients (79 unipolar and 30 bipolar subjects) diagnosed with DSM‐IV criteria. Patients were assessed using the Atypical Depression Diagnostic Scale (ADDS), a semi‐structured interview that rates mood reactivity and other atypical depressive symptoms. Although atypical depression was common in this sample (28% of cases with definite atypical depression), no differences were found between the unipolar and bipolar patients in either the atypical symptom profile or the prevalence of an atypical depression diagnosis. The interrelationships between the atypical symptoms were also examined using a hierarchical cluster analysis. A five‐cluster solution maximized differences between groups, with results suggesting that atypical depression may be a heterogeneous diagnosis.
A 5‐year follow‐up study of suicide attempts
Authors: Fridell E. Johnsson , Öjehagen A. , Träskman‐Bendz I.
Published: August 2007

Johnsson Fridell E, Öjehagen A, Träskman‐Bendz L. A 5‐year follow‐up study of suicide attempts. Acta Psychiatr Scand 1996: 93: 151–157. Q Munksgaard 1996.

Seventy‐five patients were admitted to the ward of the Lund Suicide Research Center following a suicide attempt. After 5 years, the patients were followed up by a personal semistructured interview covering sociodemographic, psychosocial and psychiatric areas. Ten patients (13%) had committed suicide during the follow‐up period, the majority within 2 years. They tended to be older at the index attempt admission, and most of them had a mood disorder in comparison with the others. Two patients had died from somatic diseases. Forty‐two patients were interviewed, of whom 17 (40%) had reattempted during the follow‐up period, most of them within 3 years. Predictors for reattempt were young age, personality disorder, parents having received treatment for psychiatric disorder, and a poor social network. At the index attempt, none of the reattempters had diagnoses of adjustment disorders or anxiety disorders. At follow‐up, reattempters had more psychiatric symptoms (SCL‐90), and their overall functioning (GAF) was poor compared to those who did not reattempt. All of the reattempters had had long‐lasting treatment (> 3 years) as compared to 56% of the others. It is of great clinical importance to focus on treatment strategies for the vulnerable subgroup of self‐destructive reattempters.
What do anxiety scales measure?
Authors: Keedwell P. , Snaith R. P.
Published: August 2007

Keedwell P, Snaith RP. What do anxiety scales measure? Acta Psychiatr Scand 1996: 93: 177–180. c̊ Munksgaard 1996.

At present researchers appear to rely on instruments for the assessment of anxiety without due consideration of what it is that the instrument may be presumed to measure. A survey was undertaken of the presently most frequently used rating scales which purport to assess anxiety. The allocation of items of the scales to the major aspects of anxiety was examined. It was found that the scales tapped different areas of psychopathology. Furtherance of research requires closer attention to the nature of the scales and the assumption that they all measure much the same construct must be discarded.
The sleep of non‐depressed patients with panic disorder: a comparison with normal controls
Authors: Arriaga F. , Paiva T. , Matos‐Pires A. , Cavaglia F. , Lara E. , Bastos L.
Published: August 2007

Arriaga F, Paiva T, Matos‐Pires A, Cavaglia F, Lara E, Bastos L. The sleep of non‐depressed patients with panic disorder: a comparison with normal controls. Acta Psychiatr Scand 1996: 93: 191–194. © Munksgaard 1996.

All‐night sleep EEG recordings were performed in non‐depressed patients with panic disorder, agoraphobia, and a group of age‐ and sex‐matched normal controls. Patients were selected according to DSM‐IV and all subjects were studied under drug‐free conditions. In addition to sleep continuity disturbances, patients with panic disorder have a reduced percentage of slow wave sleep, mainly due to diminished amounts of stage 4. REM sleep characteristics are identical in the two groups. When depressive co‐morbidity and non‐specific causes of insomnia are excluded, the sleep EEG of panic patients seems to be characterized by modest changes in sleep continuity and sleep architecture. These findings favour the existence of a neurophysiological frontier between anxiety disorders and depressive illness.
Subjective experience of treatment, side‐effects, mental state and quality of life in chronic schizophrenic out‐patients treated with depot neuroleptics
Authors: Larsen E. B. , Gerlach J.
Published: August 2007

Larsen EB, Gerlach J. Subjective experience of treatment, side‐effects, mental state and quality of life in chronic schizophrenic out‐patients treated with depot neuroleptics.

Acta Psychiatr Scand 1996: 93: 381–388. © Munksgaard 1996.

Attitude towards treatment, side‐effects, mental state and quality of life was assessed in 53 chronic schizophrenic out‐patients on maintenance treatment with depot neuroleptics. It was found that 60% of the patients viewed depot medication positively, while only 8% viewed it negatively. Only 70% of patients complained about side‐effects, even though 94% had scored as having them. Hypokinesia and hyperkinesis were the side‐effects least noticed by the patients, but most noticed by the treating physician, while the opposite was the case with psychic side‐effects. Only 49% of patients thought they had a psychotic illness, and there was no correlation between the patients' own evaluation of the severity of their illness and their score on the Positive and Negative Symptom Scale (PANSS) or the treating physician's evaluation. Quality of life did not correlate with either side‐effect score or PANSS score. The schizophrenic patients' assessment of their condition was therefore in general different both from that of the treating physician and from that determined using rating scales.