bluuebunny/crossref_metadata_2025 huggingface dataset:
Distracting Painful Injuries Associated with Cervical Spinal Injuries in Blunt Trauma
Authors: Ullrich Ann , Hendey Gregory W. , Geiderman Joel , Shaw Sandi G. , Hoffman Jerome , Mower William R. ,   National Emergency X‐radiography Utilization Study (NEXUS) Group
Published: August 2010

Abstract. Distracting painful injuries (DPIs) may mask symptoms of spinal injury in blunt trauma victims and form an important element in a decision instrument used to identify individuals who require cervical spine radiography. Objective: To identify the types and frequencies of injuries that actually act as DPIs among blunt trauma patients undergoing cervical spinal radiography. Methods: This was a prospective observational study of consecutive blunt trauma victims presenting to an urban Level 1 regional trauma center between April 1, 1998, and September 30, 1998. Prior to cervical spinal radiography, treating physicians evaluated each patient to determine whether a DPI was present or absent and, if present, what type of injury was sustained. Injuries were categorized as fractures, soft‐tissue injuries and lacerations, burns, visceral injuries, crush injuries, or other injuries. Results: Data were collected for 778 patients, between 1 month and 98 years old, of whom 264 (34%) were considered to have DPIs. Physicians were unable to determine the DPI status in 47 (6%) additional cases. Fractures accounted for a majority of DPIs (154, or 58%), 42 (16%) were soft‐tissue injuries or lacerations, and 86 (34%) were due to a variety of other entities, including visceral, crush, burn, or other miscellaneous injuries. Among the 37 (5%) patients with an acute cervical spinal injury, 20 (54%) had a DPI, including three (8%) who had DPI as the only indication for cervical radiography. Conclusions: A significant number of blunt trauma patients are believed by clinicians to have DPIs that can possibly mask the presence of cervical spinal injury. Fractures and trauma to soft tissues are the most common types of DPI.
Emergency Physicians' Perspectives on Smallpox Vaccination
Authors: Kwon Nancy , Raven Maria C. , Chiang William K. , Moran Gregory J. , Jui Jon , Carter Richard A. , Goldfrank Lewis ,   The EMERGEncy ID Net Study Group
Published: August 2010

Objective: To evaluate emergency physician (EP) attitudes toward smallpox vaccination, the treatment of patients with suspected smallpox, and the threat of a bioterrorist attack. Methods: This was a prospective study utilizing a standardized survey instrument that was distributed on November 16, 2002, and collected by February 1, 2003. EPs from a sample of 50 accredited emergency medicine programs were surveyed regarding their perspectives on smallpox vaccination. Results: A total of 989 surveys were collected from 42 emergency medicine programs. Of the respondents, 43.4% would currently volunteer for smallpox vaccination. EPs previously vaccinated against smallpox were 1.46 times more likely to volunteer for vaccination (95% CI = 1.14 to 1.93). EPs who believed they were at risk for complications were less than half as likely to volunteer for vaccination. EPs who perceived a significant risk of a bioterrorist attack were 2.7 times more likely to volunteer for the vaccine compared with those who thought the risk was minimal (95% CI = 2.06 to 3.47). Of the respondents, 34.4% believed the risks of the vaccination outweighed the benefits, 33% did not, and 32.6% were unsure. Conclusions: Currently, fewer than half of EPs surveyed would volunteer for smallpox vaccination. Factors associated with a willingness to be vaccinated include previous smallpox vaccination and the perceived threat of a bioterrorist attack. The variation in EP attitudes toward smallpox vaccination may be due to uncertain risk‐to‐benefit ratio. The opinions and actions of EPs may be influential on current and future government policy and public opinion.
The Pediatric Emergency Care Applied Research Network (PECARN): Rationale, Development, and First Steps*
Authors:   The Pediatric Emergency Care Applied Research Network
Published: August 2010

Since its formal recognition as a medical specialty, the field of pediatric emergency medicine has made substantial advances with respect to its scope and sophistication. These advances have occurred in clinical practice as well as in the research base to improve clinical practice. There remain, however, many areas in emergency medical services for children (EMSC), in the out‐of‐hospital as well as the emergency department (ED) and hospital settings, that suffer from a lack of data to guide practice. In an effort to expand the quality and quantity of research in pediatric emergency care, the Pediatric Emergency Care Applied Research Network (PECARN) was created in October 2001. PECARN is the first federally funded national network for research in EMSC. PECARN is the result of Cooperative Agreement grants funded through the Health Resources and Services Administration (HRSA) with the purpose of developing an infrastructure capable of overcoming inherent barriers to pediatric EMSC research. Among these recognized barriers are low incidence rates of serious pediatric emergency events, the need for large numbers of children from varied backgrounds to achieve broadly representative study samples, lack of an infrastructure to test the efficacy of pediatric emergency care, and the need for a mechanism to translate study results into clinical practice. PECARN will serve as a national platform for collaborative research involving the continuum of care within the EMSC system, including out‐of‐hospital care, patient transport, ED and in‐hospital care, and rehabilitation. This article describes the history of EMSC, the need for a national collaborative research network in EMSC, the organization and development of PECARN, and the work plan for the Network.
Smallpox Vaccination for Emergency Physicians*
Authors:   AAEM/SAEM Smallpox Vaccination Working Group
Published: August 2010

On December 13, 2002, President Bush formally announced the national smallpox vaccination program. The plan involves vaccinating health care workers who would respond to possible smallpox cases, including emergency physicians. Although not all aspects of the program are clearly established, it appears that vaccination of health care workers will occur in the near future. This joint statement has been used by the American Academy of Emergency Medicine and the Society for Academic Emergency Medicine regarding smallpox vaccination for emergency physicians.
Underdosing of Midazolam in Emergency Endotracheal Intubation
Authors: Sagarin Mark J. , Barton Erik D. , Sakles John C. , Vissers Robert J. , Chiang Vincent , Walls Ron M. ,   On behalf of the National Emergency Airway Registry (NEAR) Investigators
Published: August 2010

Objectives: To determine whether midazolam, when used as an induction agent for emergency department (ED) rapid‐sequence intubation (RSI), is used in adequate and recommended induction doses (0.1 to 0.3 mg/kg), and to compare the accuracy of the dosing of midazolam for ED RSI with the accuracy of dosing of other agents. Methods: The authors conducted a systematic query of a prospectively collected database of ED intubations using the National Emergency Airway Registry data, gathered in 11 participating EDs over a 16‐month period. A data form completed at the time of emergency department intubation (EDI) enabled analysis of patients' ages, weights, and indications for EDI, as well as the techniques and drugs used to facilitate EDI. Data were analyzed to determine whether midazolam is used in recommended doses during RSI. Patients intubated with midazolam alone were compared with patients who received other induction agents for RSI. Results: Of 1,288 patients entered in the study, 1,023 (79%) underwent RSI. Of the 888 RSI patients with an age recorded, midazolam was used as the sole induction agent in 140 (16%). The mean (±SD) dosages of midazolam used in RSI were 2.6 (±1.7) mg in children (age ≤ 18) and 3.7 (±2.5) mg in adults (age ≥19); the mean (±SD) dosages by weight were 0.08 (±0.04) mg/kg in children and 0.05 (±0.03) mg/kg in adults. More than half (56%) of the children, and nearly all (92%) of the adults, received dosages lower than the minimum recommended dosage (0.1 mg/kg). Of patients who received barbiturates, only 21% of children and 21% of adults received a dose lower than the minimum recommended. When combined with another induction agent, midazolam was dosed similarly to when it was used alone: mean adult doses were 3.1 (±1.2) mg and 0.04 (±0.02) mg/kg. Conclusions: Underdosing of midazolam during ED RSI is frequent, and appears to be related to incorrect dosage selection, rather than to a deliberate intention to reduce the dose used.
Tobacco is Going, Going … But Where?
Authors: Stull Donald D.
Published: August 2010

Tobacco is America's most vilified agricultural product. It is also the eighth most valuable crop in the United States, and its immense economic value and historic depth made it an agricultural cornerstone and a cultural focus in the Upper South. The federal tobacco program limited production and ensured a fair price to growers, helping many small family farms survive at no net cost to the American taxpayer. Kentucky ranks second in tobacco production and is the most tobacco‐dependent state. This paper examines what has happened to tobacco farmers in western Kentucky since the federal tobacco program was terminated in 2004 and its broader implications.
Sowing the Seeds: Anthropological Contributions to Agrobiodiversity Studies
Authors: Veteto James R. , Skarbø Kristine
Published: August 2010

Agrobiodiversity studies have been a longstanding and current research focus of anthropological inquiry. This article gives an overview of important ongoing anthropological topics of agrobiodiversity research including conservation, cultural memory, farmer decision making, and homegarden studies. It also points to future directions in agrobiodiversity research that have been understudied to date including agrobiodiversity and its relationship to climate change and migration, the potential marriage of agrobiodiversity and food studies, agrobiodiversity in the Global North, and the incorporation of agrobiodiversity into emergent sustainable/alternative agriculture systems. Agricultural anthropology is suggested as a potential holistic subdiscipline for incorporating anthropological studies of agrobiodiversity, which are currently not unified by any theoretical framework.
“Now it is an Easy Life”: Women's Accounts of Cassava, Millets, and Labor in South India
Authors: Finnis Elizabeth
Published: August 2010

Although coarse grains are considered underused and abandoned crops in much of India, they have gained increasing attention as having the potential to improve food security and positively affect small farmers' incomes. These trends offer the opportunity to examine the specific ways that contemporary declines in coarse grains are understood at the local level; in particular, it is necessary to consider how women in specific locales and at specific times view agricultural transitions in terms of their impacts on everyday time demands. I examine the decline of millet varieties, in favor of cassava cultivation, in the Kolli Hills, Tamil Nadu, through the lens of the experiences and workloads of women. A close examination of attitudes toward millets, in terms of field labor and household work, provides insights into the possibilities for local‐level coarse grain projects.
Clopenthixol and flupenthixol depot preparations in outpatient schizophrenics: I. A ONE YEAR DOUBLE‐BLIND STUDY OF CLOPENTHIXOL DECANOATE AND FLUPENTHIXOL PALMITATE
Authors: Dencker S. J. , Lepp M. , Malm U.
Published: August 2010

Clopenthixol decanoate and flupenthixol palmitate, both depot neuroleptics belonging to the thioxanthene group, were studied during double‐blind conditions for 12 months using four week intervals between injections. The 60 patients included in the study were chronic schizophrenics and treated as outpatients after earlier admission to hospital and rehabilitation training periods. They had all been treated with depot neuroleptics in the last three years and they had been free from relapse for at least 15 months. The main aim with this trial was to study the two depot drugs during maintenance treatment conditions in an outpatient setting.

Ten patients dropped out, 7 because of unsatisfactory effect, mainly because only limited dose levels were accepted according to the design. In spite of the earlier long lasting neuroleptic treatment and the good social adaptation in this schizophrenic subgroup there was observed a symptom decrease in all the rating scales even in these symptom poor patients. This improvement in psychopathology with optimal results after half a year seems to be a combined result of the efficient neuroleptics tested and careful monitoring of the drug.
Clopenthixol decanoate and perhenazine enanthate in schizophrenic patients: A DOUBLE‐BLIND NORDIC MULTICENTRE TRIAL
Authors: Ahlfors U. G. , Dencker S. J. , Gravem A. , Remvig J.
Published: August 2010

The clinical properties of clopenthixol decaonate has been investigated versus perphenazine enanthate in a double‐blind clinical multicentre trial including 14 psychiatric hospitals in Finland, Sweden, Norway, and Denmark.
Do concentrations of neurotransmitters in lumbar CSF reflect cerebral dysfunction in depression?
Authors: Gjerris Annette
Published: August 2010

Concentrations of the amines and amine metabolites dopamine (DA), noradrenaline (NA), adrenaline (A), serotonin (5‐HT), homovanillic acid (HVA), 3‐methoxy‐4‐hydroxyphenylglycol (MHPG), 5‐hydroxyindoleacetic acid (5‐HIAA) and of the peptides, vasopressin (AVP), vasoactive intestinal polypeptide (VIP), thyrotropin releasing hormone (TRH) and cholecystokinin (CCK) were measured in lumbar cerebrospinal fluid (CSF) in patients with depression and compared with that of controls. Diagnostic classifications were performed according to ICD‐9 and the Newcastle Rating Scales for Depression. The severity of depression was measured by Bech‐Rafaelsen melancholia scale.

Significantly decreased concentrations of CSF‐A and AVP were found in as well endogenous as in non‐endogenous depression, whereas reduced levels of CSF‐VIP were found only in the non‐endogenous group. CSF‐5‐HT and DA were significantly increased in endogenously depressed patients. In these studies patients with nonendogenous depression were not included. No relationship between severity of depression and concentrations of neurotransmitters was found.

For most of the neurotransmitters no correlation between concentrations measured at the lumbar and at the ventricular level seems to exist. This finding indicates that measurements on CSF collected from the lumbar sack not necessarily are indicative for concentrations measured at more central levels. Although several transmitter systems most likely are disturbed in depression, results from studies on lumbar CSF should be interpreted with precaution, until further information about origin and distribution of neurotransmitters in CSF has been obtained.
Amino acid transport in human red blood cells
Authors: Rosenberg Raben
Published: August 2010

Rafaelsen (1) has proposed a membrane transport model involving transport function deficiencies in affective disorders. The deficiencies of transport concern a group pump as well as a specific pump in the cell membrane. As peripheral blood cells are important for the study of basic features essential to biological transport functions and have been suggested as models for membrane mechanisms in the CNS, a series of studies was undertaken to characterize amino acid transport in the human red blood cell (h‐RBC). Five different transport systems were identified by kinetic analysis and studies of inhibition and sodium dependence of transport: the L‐, T‐, Ly‐, ASC‐ and Gly‐system. The T‐system which appeared specific to L‐tryptophan transport has not been identified in other cells. The L‐system for large neutral amino acids and the T‐system correspond to the group and specific pump, respectively, of the model of Rafaelsen. The importance of the h‐RBC as a tool of biological psychiatry is discussed.
Neural cell adhesion molecule (NCAM) and prealbumin in cerebrospinal fluid from depressed patients
Authors: Jørgensen O. S.
Published: August 2010

The size of the soluble form of the human cerebrospinal fluid (CSF) neural cell adhesion molecule, NCAM‐sol, was by gel permeation chromatography estimated to 160‐250 kDa. Within the CSF the concentration of NCAM‐sol was found about 15‐25% increased in lumbar fluid and 25% increased in ventricular fluid, both compared to cisternal fluid. Whereas prealbumin was found evenly distributed in CSF, albumin was relatively enriched in lumbar fluid. The concentrations of NCAM‐sol and prealbumin were measured in lumbar CSF from psychiatric patients. Prealbumin was increased 7.2% and NCAM‐sol was decreased 15.1% in depressed patients. The changes were partially normalized during recovery from the depression. The findings can be explained by hypothesizing that endogenous depression is associated with an increased choroid plexus activity and CSF production.
Dexamethasone suppression test
Authors: Dam Henrik
Published: August 2010

A connection between a high level of plasma cortisol and psychopathology has long been observed. In depressive pateints increased plasma cortisol and non‐suppression to the dexamethasone suppression test (DST) has often been described. In this study it was found that endogenously depressed patients more often than non‐endogenously depressed patients showed abnormal results to the DST. No difference was found in Δ MAX TSH between suppressors and non‐suppressors to the DST.
MAO inhibitors: Pharmacodynamic aspects and clinical implications
Authors: Larsen J. K.
Published: August 2010

Many recent studies have stressed the importance of maintaining the MAO inhibitors in the therapeutic arsenal for depressive patients. In most cases MAO inhibitors are generally safe and as well tolerated as the cyclic antidepressants. It has been suggested that MAO inhibitors are more likely to benefit depressed patients with atypical vegetative symptoms like gain in weight, sleep or libido. However, they may be therapeutic for a wide spectrum of psychiatric disorders ranging from depression with generalized anxiety or phobia, hysteroid dysphoria and endogenous affective illness refractory to conventional therapies. Because of the hazards: drug‐drug and drug‐food interactions the irreversible and unspecific MAO inhibitors are only to be recommended on the condition that a good patient compliance can be obtained.
The impact of long‐term lithium treatment on renal function and structure
Authors: Hetmar O.
Published: August 2010

The effects of long‐term lithium treatment on kidney function have been intensively studied. Both retrospective and prospective functional studies have shown that prolonged lithium treatment has a profound influence on renal tubular fucntion, and may result in reduced renal concentrating capacity and increased urine volumes. More improtant, long‐term lithium administration at non‐toxic serum levels has little demonstrable or no effect at all on glomerular function. Prospective studies found no evidence of a progressive impairment of renal clearance. Renal biopsy studies have shown significant histopathological changes in patients with acute lithium intoxication, but only a slight degree of morphological injury in patients with no episodes of lithium posisoning. Other factors than lithium may contribute (e.g. analgesic abuse) or predispose (e.g. pyelonephritis) to similar changes. The lithium dosage schedule may represent an important factor.
Anticholinergic side‐effects of antidepressants: Studies of the inhibition of salivation
Authors: Clemmesen Lars
Published: August 2010

Studies of the peripheral anticholinergic effects of antidepressants initiated by Ole J. Rafaelsen are reviewed. They were all cross‐over trials, either in patients who received continuous medication or in which continuous medication was temporarily discontinued, or in volunteers given single doses. Anticholinergic effects were evaluated from the inhibition of salivation rate measured by a tampon method. In essence, the studies revealed that 1) the method was sufficiently reliable and sensitive, 2) inhilbition of salvation by tricyclic antidepressants persisted during long‐term treatment, and 3) the newer antidepressants Nomifensine, Zimeldine, Mianserin, Citalopram, and Femoxetine were less potent as to anticholinergic effects than tricyclic antidepressants.

The results of the studies reviewed have generally been in good agreement with similar studies of other centers and with clinilcal between‐group studies. Other authors have found a sufficient specificity of salilvation rate measurements for antilcholinergic effects, but other methods, for instance based on heart rate measurements, may prove to be more specific
Delirium tremens and related clilnical states:| Psychopathology, cerebral pathophysiology and psychochemistry: A two‐component hypothesis concerning etiology and pathogenesis
Authors: Hemmingsen R. , Kramp P.
Published: August 2010

Clinically patients with Delirium Tremens (DT) and acute alcohol hallucinosis (impending DT) appear excited with vivid false perception. Cerebral blood flow and eeg correspondingly point to hyperexcitability in the CNS during these conditions. Clinical trials with barbital treatment in alcohol withdrawal shows that the amount of drug and the drug plasma concentration is the same no matter whether the physical signs of withdrawal are accompanied by halluciations and clouding of consciousness. The psychotic signs in DT and acute alcoholic hallucinosis develops after many years of alcoholism as dose seizures. Wehypothesizethat physical withdrawal ils determined by the degree of physica dependence developed during the most recent drilnking period whereas the psychotic silgns and sizures are due to a cumulated CNS hyperactivity developed over many years of repeated alcohol intoxication and withdrawal.

Changes of electrolyte concentrations in plasma or CSF do not play an important role in the pathogenesis of DT and realted clilnical states except that changes in calcium and inorganic phosphate metabolism indirectly point to changes in membrane excitability.

A new model for a study of rapidly repeated intoxication and withdrawal episodes in rats has shown that repetition of episodes augments the convulsive component of withdrawal whereas the non‐convulsive signs are dependent on the most recent episode only.

The augmentation of the convulsive component correlates with regional difference in brain glucose consumption. Furthermaore, synaptic proteins and acidic phospholipids may be involved in the development of CNS hyperexcitability during alcohol withdrawal.

In conclusion both clinical and experimental studies indicate that severe alcohol withdrawal reactions may consist of two components: 1) Physical withdrawal signs determined by recent phsical dependence. 2) A long term cumulated CNS hyperexcitability relating to seizures and psychotic signs during withdrawal. This state is elicited by alcohol withdrawal but it represents a cumulated and permanent or long lasting CNS dysfunction in alcholilcs. This precise biochemical/pathophysiological mechanisms for the development of the two‐comoponent dysfuction stiil remain to be clarified in detail.
Incidence and Causality of Anorexia Nervosa seen in a historical perspective
Authors: Tolstrup Kai
Published: August 2010

Tolstrup K. Incidence and causality of Anorexia Nervosa seen in a historical perspective.

Acta Psychiatr Scand Suppl. 361, Vol. 82. 1990: 1–6.

The history of the affliction known as anorexia nervosa can be divided into two periods. Before the year 1600, this condition is described first and foremost in connection with religious life, ‘holy anorexia’. From about 1600 onward and up to our own times, it has become more of medical and pathological concept, depending on and reflecting the changing directions of medical fashion so‐matically, psychiatrically, and socio‐culturally. There seems to be increased interest at certain times, but it has not been possible to document the alleged increase in incidence in recent decades.
Anorexia/Bulimia Nervosa: Dental problems
Authors: Hellstrlkn Ingrid
Published: August 2010

This short survey is essentially based on the complete and illustrated articles listed under References.
Personality, life stress and the course of eating disorders
Authors: Sohlberg Staffan
Published: August 2010

Sohlberg S. Personality, life stress and the course of eating disorders. Acta Psychiatr Scand Suppl. 361. Vol. 82. 1990: 29–33.

We tested whether personality disturbance and stressful life events can help explain why some patients with Anorexia nervosa or Balimia nervosa remain al for several years. In a follow‐up of 37 patients, both factors were found to be significantly associated with a poorer outcome after a year, and preliminary data suggest this mend continues after two years. Further follow‐up is necessary, but the data so far suggests that treatment goals and methods must be tailored to widely dissimilar needs. They also imply that therapeutic efforts to help patients cope with stressful events may be rewarded by measurably reduced morbidity.
Drugs in the treatment of Bulimia Nervosa
Authors: Trygstad Olav
Published: August 2010

Trygstad O. Drugs in the treatment of Bulimia Nervosa. Acta Psychiatr Scand Suppl. 361, Vol. 82. 1990: 34–37.

The neuro‐transmitter serotonin seems to be important in the treatment of disturbed eating behaviour. In Anorexia Nervosa (AN) a serotonin antagonist has been proposed, whereas in Bulimia Nervosa (BN) serotonin agonists have been used with success, e.g. fen‐fluramine. A new generation of antidepressants has been introduced, that selectively have a serotonergic effect. The previous tricyclic and particularly the tetracyclic antidepressants had a noradrenergic effect as well. Fluoxetine belongs to the new generation. A total of 30 females with BN were treated with fluoxetine in an open study. Clinical effect was observed after 2 to 6 weeks. One patient discontinued after 3 weeks, the other were treated for 3 to 10 months. A moderate effect with 75% reduction of bingeing and purging was observed in 15 patients, 14 stopped bingeing and purging. There was no serious side effects. However, drug treatment alone had no significant effect. The fluoxetine treatment is not instead of, but in addition to the traditional behavioral treatment with strict limits regarding food and meals.
Eating disorders in Norway
Authors: Mkhalsen Helge
Published: August 2010

Michalsen H. Eating disorders in Norway. What do the public health services offer today ‐ what should be offered in the future? Acta Psychiatr Scand Suppl. 361, Vol. 82. 1990: 59–61.
Making psychiatric epidemiology useful: the contribution of epidemiology to government policy
Authors: Jenkins Rachel
Published: August 2010

Objective:This paper aims to discuss the contribution of epidemiology to aspects of public policy that have either a direct influence on mental health and mental disorders, or an indirect effect by influencing environmental factors which influence mental health. Both kinds of public policy will need to be considered by governments wishing to protect, promote and improve the mental health of their populations. The paper draws on information from both relatively wealthy and low‐income countries.  Method:The paper defines epidemiology and mental health policy, sets out the range of government policies which may have an impact on mental health, and explores the ways in which epidemiology may contribute to mental health policy in relation to service inputs, processes and outcomes as well as to wider government policies. The paper also examines the advantages and disadvantages of different sources of data.  Results:There are a number of reasons to carry out large‐scale surveys of psychiatric morbidity. First, effective policy should address the needs of the population, which can best be assessed by the epidemiology and the social and economic causes and consequences of psychiatric morbidity. Secondly, representative information in a defined geographic area can document the use of existing services and can estimate the extent of unmet needs and the services required meeting those needs. Thirdly, valid information on prevalence and associated risk factors of presumed causal importance allow aetiological hypotheses to be generated and tested and models developed for prevention. Finally, by repeating community surveys, it is possible to monitor the health of the population and trends. Epidemiological findings emphasize the importance of mental health policy addressing the key role of primary care, the social context and social consequences of disorder, the importance of addressing services for children, the need to reduce premature mortality from suicide and from physical illness. Epidemiological findings show that mental health and mental disorders are related to the environment both in its structural physical sense and in the sense of the social processes connected to and influenced by particular settings. Thus epidemiology can contribute to general policies on employment and unemployment, housing and homelessness, education and women's issues.  Conclusion:Mental health policy is increasingly recognized as an essential area for countries wishing to enhance their economic, social and human capital. Epidemiological data are a basic prerequisite to informing such policies. Expert professional and epidemiological advice to ministries is essential if policy is to be rooted in the evidence for population needs, risk factors, effective treatments and services, and measurement of outcomes. It is therefore important to develop the capacity for policy work in the psychiatric profession by including public health, epidemiology and policy placements for young psychiatrists.
Self‐reported life satisfaction and recovery from depression in a 1‐year prospective study
Authors: Koivumaa‐Honkanen H. , Honkanen R. , Antikainen R. , Hintikka J. , Laukkanen E. , Honkalampi K. , Viinamäki H.
Published: August 2010

Objective: To study the relationship of a self‐rated four‐item life satisfaction scale (LS) to the self‐rated 21‐item Beck Depression Inventory (BDI) and the 17‐item Hamilton Rating Scale for Depression (HAMD) and to study LS changes during recovery from depression.

Method: A 1‐year prospective study on 188 depressive patients receiving standard psychiatric outpatient treatment; 137 of the patients had major depression.

Results: LS correlated strongly with BDI and HAMD. It explained 46.6% of the variation in BDI at baseline and 66.2% at 12 months. LS improved substantially during recovery. The main recovery occurred during the first 6 months, the change in the LS score explaining 46.5% of the change in the BDI score (P<0.001).

Conclusion: Life satisfaction is strongly affected in depression, but it improves concurrently with recovery from depression. LS scale may prove useful in screening for those whose subjective wellbeing deserves attention and in assessing alleviation from depression.
Comparison of key worker and patient assessment of needs in schizophrenic patients living in the community:a Nordic multicentre study
Authors: Hansson Lars , R Vinding Hanne , Mackeprang Torben , Sourander André , Werdelin Ginie , Bengtsson‐Tops Anita , Bjarnason Olafur , Dybbro Jesper , Nilsson Liselotte , Sandlund Mikael , Sørgaard Knut , Middelboe Thomas
Published: August 2010

Objective:  The present study is part of a Nordic multicentre study investigating the life and care situation of community samples of schizophrenic patients. The specific aim of the present part of the study was to examine the agreement between patients and their key worker concerning the presence of met and unmet needs in a number of life domains, and help or support given in these domains.

Method:  The comparisons were based on 300 matched pairs of assessments of need using the Camberwell Assessment of Need interview.

Results:  The results showed that key workers identified slightly more needs, 6.17 vs. 5.76, a significant difference. There was a moderate or better agreement on the presence of a need in 17 of 22 life domains investigated, but in only 11 life domains concerning the presence of an unmet need. Disagreement concerning whether the patient was given the right kind of help or support was even more substantial.

Conclusion:  It is concluded that key workers and patients disagree particularly concerning unmet needs and that this is potentially related to a number of factors associated with the key worker and patient. It is also concluded that further research is needed to increase the knowledge concerning the sources of this disagreement if need assessment is to become a valid basis for service planning and individual treatment planning.
Review of validation studies of the Edinburgh Postnatal Depression Scale
Authors: Eberhard‐Gran Malin , Eskild Anne , Tambs Kristian , Opjordsmoen Stein , Ove Samuelsen Sven
Published: August 2010

Objective:  To review validation studies of the Edinburgh Postnatal Depression Scale (EPDS).

Method:  A systematic search was performed in Medline and the Science Citation Index Expanded (ISI) from the period 1987–2000. For sensitivity and specificity of the EPDS presented in each study, 95% confidence intervals were estimated. Positive and negative predictive values were estimated assuming prevalences of postpartum depression ranging from 5% to 20%.

Results:  Eighteen validation studies were identified. The study design varied between studies. The sensitivity and specificity estimates also varied: 65–100% and 49–100%, respectively. The confidence intervals were estimated to be wide. Our estimates suggest a lower positive predictive value in a normal population than in the validation study samples.

Conclusion:  Most studies show a high sensitivity of the EPDS. Because of the differences in study design and large confidence intervals, uncertainty remains regarding the comparability between the sensitivity and specificity estimates of the different EPDS versions.
Sertraline treatment of panic disorder: results of a long‐term study
Authors: Rapaport Mark Hyman , Wolkow Robert , Rubin Arkady , Hackett Elizabeth , Pollack Mark , Ota Kay Y.
Published: August 2010

Objective: To investigate the long‐term efficacy, prevention of relapse and safety of sertraline in the treatment of panic disorder.

Method: This study consisted of 52 weeks of open‐label sertraline treatment (n=398) followed by a 28 weeks of a double‐blind, placebo‐controlled discontinuation trial (n=183).

Results: Ninety‐three patients were randomized to sertraline and 90 were randomized to placebo. Discontinuation due to insufficient clinical response occurred in 23.6% of placebo‐treated patients and 12.0% of sertraline‐treated patients (log‐rank test, P=0.040). Thirty‐three per cent of placebo‐treated patients had an exacerbation of panic symptomatology, versus 13% of sertraline‐treated patients (log‐rank test, P=0.005). Abrupt cessation of sertraline resulted in dizziness (4.3% sertraline vs. 16.9% placebo; P=0.007) and insomnia (4.3% sertraline vs. 15.7% placebo; P=0.013) occurring at significantly higher rates.

Conclusion: Long‐term sertraline treatment was effective in preventing relapse of panic disorder, well tolerated and associated with minimal discontinuation symptoms.
Intractable depression or psychosis
Authors: Rubin Nancy J. , Arceneaux Janet M.
Published: August 2010

Objective:  Some patients with treatment resistant depression may have a difficult to recognize and therefore untreated thought disorder. Even a subtle disorder may significantly impact patients' lives. This case illustrates a mechanism for identifying and treating this subgroup of patients.

Method:  The treatment of a 67‐year‐old female with intractable depression is described.

Results:  The Rorschach Exner Comprehensive System identified the presence of a thought disorder with four out of five conditions positive on the Schizophrenia Index and five out of seven conditions positive on the Depression Index. Low‐dose risperidone was added to the patient's medications with excellent results. Post‐testing indicated that the Schizophrenia and Depression Indices were no longer positive.

Conclusion:  A subgroup of patients with intractable depression may have an underlying thought disorder that can be identified with the Rorschach and successfully treated with low‐dose antipsychotic medication.
Associations between childhood living circumstances and schizophrenia: a population‐based cohort study
Authors: Wahlbeck K. , Osmond C. , Forsén T. , Barker D. J. P. , Eriksson J. G.
Published: August 2010

Objective:  It has been suggested that household crowding may constitute an enviromental risk factor for schizophrenia. The present population‐based cohort study explores the associations of childhood family size and living conditions to schizophrenia.

Method:  The cohort comprised people born at Helsinki University Central Hospital from 1924 to 1933, who went to school in the city and were still living in Finland in 1971. Prospectively gathered data from birth and school health records of these 7086 individuals were collected and linked to the Finnish Hospital Discharge Register.

Results:  Ninety‐eight cases of schizophrenia were identified in the cohort. Number of siblings at school start was significantly associated with schizophrenia when adjusted for sex and age of mother. Number of siblings was negatively correlated with body mass index at age 7. Childhood household crowding, defined as number of people per room, and total number of rooms in household were not significantly associated with schizophrenia.

Conclusion:  Our study indicates that the total number siblings in household during childhood is of greater importance than childhood number of inhabitants per room. Subjects who originated from families with many children had been leaner, which may imply that childhood nutritional factors partly is the mediating factor between number of siblings and schizophrenia. Other possible underlying mechanisms of the associations found include infectious and psychological factors.
Oestrogen withdrawal associated psychoses
Authors: Mahé V. , Dumaine A.
Published: August 2010

Objective: Oestrogen withdrawal has been hypothesized as playing a causal role in puerperal psychoses. However, oestrogen withdrawal exists in conditions others than puerperium. We searched the published case reports where a decrease in oestrogen levels not occurring during puerperium was associated with a psychotic disorder, in order to evaluate the relevance of this hypothesis. These cases were defined as oestrogen withdrawal associated psychoses.

Method: A systematic research of the literature was conducted for the period 1960–2000.

Results: We identified 26 observations reporting an association between a psychotic disorder and a phase of oestrogen withdrawal. Psychotic episodes were short and reversible with recurrences reported when oestrogen withdrawal recurred. Puerperal psychosis was frequently reported in the history of patients.

Conclusion: The oestrogen withdrawal hypothesis can be extended to certain psychotic episodes not occurring during in puerperium. This provides an additional argument for the clinical relevance of oestrogen withdrawal in puerperal and related psychoses.
Characteristics of violent behaviour in acute psychiatric in‐patients: a 5‐year Italian study
Authors: Grassi Luigi , Peron Luana , Marangoni Claudio , Zanchi Pierluigi , Vanni Adello
Published: August 2010

Objective:  In order to examine prospectively the characteristics of violence among psychiatric patients, a 5‐year study was carried out in an acute psychiatric unit.

Method:  All assaultive behaviour occurred in the ward during the study period were assessed routinely using the Staff Observation Aggression scale (SOAS).

Results:  Of 1534 patients admitted to the unit during the study period, 116 were responsible for 329 aggressive episodes (prevalence of violence=7.5%, 2.8 incidents/patient). Most violent patients had an ICD‐9 diagnosis of schizophrenia and/or delusional syndromes (55.1%), a history of violence (80.7%) and previous psychiatric admissions (92%). Approximately half of the incidents had no specific cause, occurred during daytime and the first week of admission and, in most cases, was directed towards individuals (77.8%).

Conclusion:  Although confirming the low rate of violence among Italian psychiatric in‐patients, the study indicates the need for more attention to the problem of aggression in general hospital psychiatric units.
Thyroid function test abnormalities in newly admitted psychiatric patients residing in an iodine‐deficient area: patterns and clinical significance
Authors: Lederbogen Florian , Hermann Derik , Hewer Walter , Henn Fritz A.
Published: August 2010

Objective:
 The prevalence of abnormal in‐vitro thyroid function tests in psychiatric in‐patients may be as high as 24%. Thus far, however, there is only limited data addressing the underlying causes of these abnormal test results, i.e. how often they can be attributed to genuine thyroid disease.

Method:  We conducted an observational study of all in‐patients admitted to our institution during 1 calendar year running analyses of total thyroxin (T4), free thyroxin index (FTI) and thyroid‐stimulating hormone (TSH). Patients with abnormal test results were classified according to an algorithm which had been established previously.

Results:
 In 243 of 880 patients with in‐vitro thyroid function analysis, at least one concentration of either T4, FTI or TSH was found to be outside the reference range. Work‐up according to the algorithm was completed in 848 patients; alterations were classified as representing thyroid dysfunction in 100 (41% of patients with abnormal test results), non‐specific findings in 92 (38%), influence of ingested drugs in 18 (7%) and of severe physical disease in 1 (0.4%). As measures of T4 and/or FTI provided no essential information in 854 patients (97% of tested), we found that in most cases the determination of TSH alone was sufficient for demonstrating normal thyroid function.

Conclusion:  In 27.6% of newly admitted patients living in an iodine‐deficient area, at least one abnormal result in either T4, FTI or TSH values was found. Genuine thyroid disease was found in slightly less than half the patients with an abnormal value.
Increased risk of developing Parkinson's disease for patients with major affective disorder: a register study
Authors: Nilsson F. M. , Kessing L. V. , Bolwig T. G.
Published: August 2010

Objective:  To investigate whether patients with a diagnosis of affective disorder are at an increased risk of developing Parkinson's disease compared with medically ill control groups.

Method:  By linkage of public hospital registers from 1977 to 1993, three study cohorts were identified: patients with affective disorder episodes (mania or depression) and patients with osteoarthritis or diabetes. Time to the first diagnosis of Parkinson's disease was estimated with the use of survival analysis.

Results:  A total of 164 385 patients entered the study base. The risk of being given a diagnosis of Parkinson's disease was significantly increased for patients with affective disorder, odds ratio 2.2 (CI 95% 1.7–2.8) compared with osteoarthritis, and depressive disorders, odds ratio 2.2 (CI 95% 1.7–2.9) compared with osteoarthritis.

Conclusion:  This study supports the hypothesis of a common aetiology for major affective disorder and Parkinson's disease.
A lithium clinic for bipolar patients: 2‐year outcome of the first 148 patients
Authors: Licht R. W. , Vestergaard P. , Rasmussen N.‐A. , Jepsen K. , Brodersen A. , Hansen P. E. B.
Published: August 2010

Objective: This paper describes the outcome for the first 148 patients referred to a lithium clinic.

Method: Two‐year follow‐up data from treatment charts are reported for all patients entering a lithium clinic in the study period.

Results: Lithium was given as the only mood stabilizer in 132 (89.2%) of the cases. Thirty‐two (21.6%) patients were readmitted with a new affective disorder episode. Twenty‐nine (19.6%) patients discontinued treatment prematurely. Variables predicting the recurrence of new affective disorder episodes as well as premature discontinuation of treatment were identified.

Conclusion: The majority of bipolar patients received lithium for prophylaxis against recurrent affective disorder episodes. The outcome was moderate but comparable to the 30–40% improvement usually reported in follow‐up studies of bipolar patients given long‐term prophylactic treatment with lithium. Better long‐term treatment results for bipolar patients depend on both the development of more effective mood stabilizing drugs or drug combinations and the improvement of patients' adherence to treatment.
Familial occurrence of tardive dyskinesia
Authors: Müller D. J. , Schulze T. G. , Knapp M. , Held T. , Krauss H. , Weber T. , Ahle G. , Maroldt A. , Alfter D. , Maier W. , Nöthen M. M. , Rietschel M.
Published: August 2010

Objective:  Familial occurrence of tardive dyskinesia (TD) and schizophrenia has been hypothesized to confer risk to the development of TD. We investigated these hypotheses in a large patient sample applying standardized methods for phenotype characterization.

Method:  Two hundred and twenty‐two patients with a diagnosis of schizophrenia or schizoaffective disorder were assessed for TD and for family history of schizophrenia or schizoaffective disorder. Thirty‐nine patients had 40 affected first‐degree family members, one patient having two first‐degree relatives. Of these, 17 pairs and one triplet were personally examined.

Results:  1) There was a tendency for TD in the affected relatives to be associated with the TD status of the index‐patient; this finding was unrelated to age and doses of neuroleptic medication. 2) No association between a family history of schizophrenia or schizoaffective disorder and TD was found.

Conclusion:  A family history of TD might represent a risk factor for TD, whereas a family history of schizophrenia does not.
Agranulocytosis and granulocytopenia associated with quetiapine
Authors: Ruhé Henricus G. , Becker Hiske E. , Jessurun Pytha , Marees Chris H. , Heeringa Marten , Vermeulen Hans D. B.
Published: August 2010

Objective:  Quetiapine is a recently introduced atypical antipsychotic. Although adverse effects are mainly mild, more serious infrequent adverse effects including leucopenia are mentioned.

Method:  We describe three case‐reports concerning haematological adverse effects of quetiapine.

Results:  Quetiapine was associated with leucopenia in two patients and clinically apparent agranulocytosis in one patient.

Conclusion:  Although a definite association has not been proven, clinicians should be aware of the possibility of agranulocytosis while using quetiapine. Further post‐marketing surveys are required.
Gender differences in adolescents and young adults with suicidal behaviour
Authors: Wunderlich U. , Bronisch T. , Wittchen H.‐U. , Carter R.
Published: August 2010

Objective: Gender differences in prevalence rates of suicide attempts and suicidal thoughts as well as in risk factors for suicide attempts such as traumatic events and mental disorders were investigated in a random sample of 3021 adolescents aged 14–24 years.

Method: The M‐CIDI (Composite International Diagnostic Interview) was used to survey suicidal behaviour, DSM‐IV lifetime diagnoses and traumatic events.

Results: The female suicide attempters showed suicidal thoughts and suicide attempts significantly more often, and suicide attempts at a much younger age than the males. Furthermore, the females experienced sexual abuse much more often, and suffered significantly more often from anxiety disorders. The male suicide attempters showed higher rates of alcohol disorders and financial problems.

Conclusion: A higher rate of anxiety in female suicide attempters results probably as a consequence of sexual abuse, which in turn makes them more vulnerable than males for attempting suicide between the age of 14–17.