bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical and Magnetic Resonance Imaging Correlates of Hypothalamic–Pituitary–Adrenal Axis Function in Depression and Alzheimer's Disease
Authors: O'Brien John T. , Ames David , Schweitzer Isaac , Colman Peter , Desmond Patricia , Tress Brian
Published: October 2008

Background

An age-related dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis is well recognised in animals, but still remains controversial in humans. There is increasing interest that raised corticosteroid levels, due to activation of the HPA axis, may cause both depressive symptoms and cognitive impairments. Steroid effects on cognition may be via the hippocampus, a major site of corticosteroid action and an important structure involved in learning and memory.

Method

To investigate this further, we examined the relationship between the dexamethasone suppression test, cognitive function, depressive symptoms and hippocampal atrophy on magnetic resonance imaging (MRI) in 32 normal controls, 49 subjects with NINCDS/ADRDA Alzheimer's disease and 51 patients with DSM–III–R Major Depression.

Results

Controlling for differences in dexamethasone concentrations, post-dexamethasone cortisol levels were related to advancing age in controls and depressed subjects. However, among subjects with Alzheimer's disease, post-dexamethasone cortisol levels were independently associated with both minor depressive symptoms and hippocampal atrophy on MRI.

Conclusion

An association between advancing age and increased HPA axis dysregulation is supported for controls and depressed subjects. In Alzheimer's disease, HPA axis changes were associated with depressive symptoms and hippocampal atrophy. Longitudinal studies are now needed to determine the causal direction of these associations.
Increased Occurrence of Schizophrenia and other Psychiatric Illnesses Among Twins
Authors: Kläning Ulla , Mortensen Preben Bo , Kyvik Kirsten Ohm
Published: October 2008

Background

We wished to establish whether the occurrence of schizophrenia among twins is the same as among the general population.

Method

Through record linkage between the New Danish Twin Register and the Danish Psychiatric Case Register, the twins who have ever received a diagnosis of schizophrenia were identified. Through indirect standardisation for age, sex and dates of admission, the rate of first admission with diagnosis schizophrenia among twins is compared to the same rate in the general population.

Results

A 28% increase in the rate of first admissions for schizophrenia in twins compared to the general population was found. This is statistically significant and does not seem to be caused by any known methodological problems. Twins also had an increased first-admission rate of any psychiatric disorders.

Conclusion

This increased risk does not seem to be explained by known methodological problems, but does differ from earlier studies.
A Controlled Study of Education About Drug Treatment in Schizophrenia
Authors: Macpherson Rob , Jerrom Bill , Hughes Anthony
Published: October 2008

Background

Various problems are associated with schizophrenia which may theoretically lead to impaired educability about treatment.

Method

The Understanding of Medication Questionnaire, designed to measure knowledge about treatment in schizophrenia, is described and presented. An educational programme based on a specially designed information booklet was developed. Sixty-four patients with DSM–III–R diagnosis schizophrenia were randomly allocated to groups receiving none (control), one session or three sessions of education.

Results

Pre-intervention low levels of knowledge about illness and treatment increased significantly immediately after a standard education session. Three education sessions led to significantly greater knowledge gain than one session. There was no significant change in the control group. Only the PANSS negative syndrome score independently and consistently explained a significant proportion of the education effect. The influence on educability of attitudes to education, impaired insight, cognitive impairment and other variables were considered. Three sessions of education led to significantly increased insight, but no change in compliance.

Conclusions

Techniques appropriate for educating schizophrenic patients were discussed, and the value of involving patients in education emphasised. A series of patient education sessions is needed to consolidate learning, rather than a single informing process. The strong association between impaired learning and more severe negative schizophrenic syndrome emphasises the need for responsible prescribing of antipsychotic treatment in schizophrenia.
Mental Disorder in an Elderly Home Care Population: Associations with Health and Social Service Use
Authors: Banerjee Sube , Macdonald Alastair J. D.
Published: October 2008

Background

Home care services maintain people in their own households by providing practical help such as with housework, shopping and personal care. In this study associations between mental disorder and health and social service use, demographics and activity limitation are investigated.

Method

A cross-sectional study with random cluster sampling of people over 65 receiving home care in Lewisham. Mental disorder was rated using the GMS/AGECAT system.

Results

We interviewed 169/177 eligible individuals, a response rate of 96%. Forty-six percent of this population were rated as cases of mental disorder (15% organic and 26% depressive). Most (84%) of those with depression did not appear to be receiving appropriate treatment. Home care provision to those with depression (unlike dementia) was only partially explicable in terms of activity limitation.

Conclusions

There is a high level of depressive disorder in this population with little in the way of appropriate primary or secondary care management. Those in sheltered housing seem particularly at risk; depression may lead to increased service use independent of disability.
Alcohol-Metabolising Genes and Alcoholism Among Taiwanese Han Men: Independent Effect of ADH2, ADH3 and ALDH2
Authors: Chen Wei J. , Loh E. W. , Hsu Yun-Pung P. , Chen Chiao-Chicy , Yu Jeng-Ming , Cheng Andrew T. A.
Published: October 2008

Background

Previous population association studies have indicated that certain alleles of alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) may reduce the risk of alcoholism in Asian populations. The association of ALDH2 and ADH2 with the development of alcoholism was found to be independent of each other and has been replicated in different Asian populations, while the effect of ADH3 is less studied.

Method

We genotyped the alcohol metabolism genes among Han men with alcohol dependence (n=46) and their ethnically matched normal controls (n=63) in Taiwan. Multiple logistic regression was then applied to assess the contribution of ADH3 to alcoholism by controlling the effect of ALDH2 and ADH2.

Results

The results of multivariate analyses demonstrated that the odds ratios for an increment of one allele of ADH2∗1, ADH3∗2 and ALDH2∗1 in the development of alcoholism were 4.18, 3.82, and 6.89, respectively.

Conclusions

These findings clearly indicate that all three alcohol-metabolising genes contribute to susceptibility to alcoholism.
Obsessive–Compulsive Disorder
Authors: Lensi P. , Cassano G. B. , Correddu G. , Ravagli S. , Kunovac J. L. , Akiskal H. S.
Published: October 2008

Background

Demographic data, family history, psychopathological features, comorbidity and course of obsessive–compulsive disorder (OCD) are investigated and data generated to support the possible existence of two subgroups with gender-related differences of a broader nature.

Method

Two hundred and sixty-three OCD patients, consecutive admissions to the Institute of Psychiatry, University of Pisa over a period of 5 years, not excluding those with comorbid Axis I and Axis II conditions, were studied. Patients were evaluated with a specifically designed semi-structured OCD interview.

Results

We found a significantly greater history of perinatal trauma in men who also had an earlier onset, greater likelihood of never having been married and a higher frequency of such symptoms as sexual, exactness and symmetry obsessions and odd rituals; by contrast, women suffered a later onset of the disorder, were more likely to be married, had higher rates of associated panic attacks after the onset of OCD and a higher frequency of aggressive obsessions at the onset of their illness, and were less frequently associated with bipolar disorders.

Conclusions

Pathophysiological mechanisms in OCD seem to differ by gender. Perinatal trauma might predispose to earlier onset in men, whereas in women there is a close association between OCD and panic disorder.
Development of a Clinical Rating Scale to Assess Mother-Infant Interaction in a Psychiatric Mother and Baby Unit
Authors: Kumar R. , Hipwell A. E.
Published: October 2008

Background

Psychiatrists are sometimes asked to express an opinion about the competence and motivation of a mentally ill mother to be a consistent, adequate and safe parent of her recently born infant, There are no reliable methods for assessing mother–infant interaction and relationship in a psychiatric context.

Method

The Bethlem Mother–infant Interaction Scale (BMIS) was developed by the staff of a specialised psychiatric mother and baby unit. Of the seven subscales, four measured different aspects of the mother's contribution to the dialogue with her baby, one measured her capacity to organise and maintain routine care, one attempted to rate the perception by staff of risk to the child, and the remaining subscale rated the baby's contribution to their interaction. In normal clinical practice the ratings were made consensually by nurses and they encompassed observations that had been made by them during the previous week.

Results

Despite the simple and global nature of the ratings of the BMIS, moderate to high coefficients of inter-rater reliability were obtained for weekly ratings by nurses as well as for intra-rater reliability of ratings of videotaped interactions between mothers and their infants. Ratings of mothers and babies in day-to-day activity in the unit that were based on one hour's observation only were much less reliable. The internal consistency of the BMIS was high and comparisons with other methods used in non-clinical settings showed good criterion-related validity.

Conclusions

Using the BMIS facilitated attempts to reliably assess disturbances of mother–infant interaction and the scale was acceptable and clinically useful. The nurses' ratings of their perceptions of ‘risk’ to the infant, which are in some ways the most important, were the least reliable. Repeated weekly ratings gave a valuable impression of change or lack of it over time. The predictive validity of the scale has yet to be determined.
The Cost of Comprehensive Care of People with Schizophrenia Living in the Community
Authors: Salize Hans Joachim , Rössler Wulf
Published: October 2008

Background

In community mental health care, knowledge about costs of care is very limited. Only few studies have related costs to outcome measures.

Method

This German study assesses the cost of psychiatric care of 66 schizophrenic patients during one year of living in the community. Predictors of high cost were identified.

Results

The average cost of comprehensive community care of one patient of the cohort was US$ 353 per week. This was only 43% of the cost of constant long-term care in a psychiatric hospital. Significant predictors of total cost of community care were the number of rehabilitative problems at the beginning and at the end of the study period, the type of accommodation before index hospitalisation and the gender of patients.

Conclusions

Results must be understood in terms of the characteristics of the special patient group and the catchment area we studied and are of high relevance in planning future care.
Concurrent Validity of the Opcrit Diagnostic System
Authors: Craddock Nick , Asherson Philip , Owen Michael J. , Williams Julie , McGuffin Peter , Farmer Anne E.
Published: October 2008

Background

OPCRIT (a suite of computer programs that allow data entry and generate diagnoses according to 12 operational diagnostic systems) is used in a wide range of psychiatric research including both European Science Foundation and NIMH research initiatives in the molecular genetics of mental disorders. We examined its concurrent validity in 100 subjects collected for linkage studies of Bipolar Disorder and Schizophrenia.

Method

We compared diagnoses generated by OPCRIT from data rated by two trained clinicians with diagnoses made according to consensus, best-estimate, lifetime procedures by the same two raters according to DSM–III–R and RDC classifications.

Results

Good to excellent agreement was achieved between OPCRIT diagnoses and those made by consensus best-estimate procedures.

Conclusions

OPCRIT provides a convenient, reliable, rapid and valid approach to polydiagnostic assessment that can be used as an adjunct to conventional (but time consuming) best-estimate consensus diagnostic procedures.
The Entry of Mentally Disordered People to the Criminal Justice System
Authors: Robertson Graham , Pearson Richard , Gibb Robert
Published: October 2008

Background

The police are the gatekeepers to the criminal justice system (CJS). It is agreed that where possible mentally ill people should be diverted to psychiatric care. The purpose of this investigation was to determine what factors were associated with the entry of obviously mentally ill people into the CJS.

Method

The population of all detainees arrested in seven London police stations was observed to determine the presence of obvious mental illness. All detainees regarded as ill or known to have significant psychiatric histories were followed through the CJS to court disposal. Defendants diagnosed as psychotic by court liaison psychiatrists were identified and the circumstances of their arrest and detention examined.

Results

Of all police detainees observed, 1.4% were found to be acutely ill. Diversion of obviously ill detainees was common practice. The factor most strongly associated with entry to the CJS was the presence of violence at time of arrest. Other factors were the persistence of (petty) offending and the operation of court warrants issued as a result of the person's failure to appear at court when required to do so.

Conclusions

Both police and courts are well aware of the inappropriateness of custody for acutely ill people and efforts are made to divert such people out of the CJS. Persistent petty offenders are often being recycled from the street to police station to court and back to the street without the benefit of care. A dedicated facility is recommended in central London to meet this need.
Individual Behavioural–Cognitive Therapy v. Marital Therapy for Depression in Maritally Distressed Couples
Authors: Emanuels-Zuurveen Lineke , Emmelkamp Paul M. G.
Published: October 2008

Background

Depressed patients are often characterised by marital distress, but few studies investigate the effects of marital therapy on depressed mood and relationship dysfunction.

Method

Twenty-seven depressed patients experiencing marital distress were randomly assigned to either individual behavioural–cognitive therapy or marital therapy. The individual treatment condition focused on depressed mood, behavioural activity and dysfunctional cognitions, whereas in the marital condition the partner was involved in the treatment and the focus was on the communication process in the marital relationship. MANOVAs revealed that treatment led to statistically significant improvements in depressed mood, behavioural activity and dysfunctional cognitions, an increase in relationship satisfaction and improvement of communication in patients and spouses. A significant interaction effect was found, showing that marital therapy had more impact on relationship variables than the individual treatment.

Conclusion

Both individual cognitive–behaviour therapy and marital therapy lead to less depressive complaints, and both treatment conditions have a positive effect on the relationship, although the effect on the relationship is significantly stronger in couples who were treated by marital therapy compared with patients who were treated individually.
Ten-Year Prognosis of Conversion Disorder
Authors: Mace C. J. , Trimble M. R.
Published: October 2008

Background

Previous work suggests neurological disease commonly supervenes in cases of conversion disorder but has not identified clear predisposing factors. Patients' subsequent use of services has been neglected.

Method

Clinical outcomes for 73 patients investigated for pseudoneurological symptoms at a neurological hospital 10 years earlier were compared with findings on presentation. Fifty-six patients complied with a structured interview concerning use of services.

Results

Thirty patients had no relief from their original symptom at follow-up. They had been older, with more chronic symptoms, and different auxiliary psychiatric diagnoses. In 11 patients a clear neurological diagnosis was subsequently made for the original symptom. Provisional neurological diagnoses at presentation had been disproportionately common among these 11. Small numbers of patients with poor outcomes made most use of hospital and community services. High attenders met screening criteria for somatisation disorder at follow-up.

Conclusions

The prognosis for chronic symptoms remains poor, but subsequent rediagnosis of neurological disease is less frequent than commonly supposed. Somatisation disorder may develop if hospital contact does not lead to diagnosis of another disease.
Manchester and Oxford Universities Scale for the Psychopathological Assessment of Dementia (MOUSEPAD)
Authors: Allen N. H. P. , Gordon Sheila , Hope Tony , Burns Alistair
Published: October 2008

Background

There is increasing awareness of the importance of psychopathological and behavioural changes in dementia and a need for an instrument to measure these features which achieves an appropriate compromise between brevity and breadth. We describe a newly developed 59-item instrument: the MOUSEPAD.

Method

Reliability, sensitivity and validity were examined with 30 carers, each of whom was interviewed four times over six weeks.

Results

For different symptom groups, kappa ranged from 0.43 to 0.93 for test–retest reliability, from 0.56 to 1.0 for inter-rater reliability, and from 0.43 to 0.67 for the validation study.

Conclusions

The scale may be useful as an outcome measure in drug trials, for correlating psychopathological and behavioural changes with post-mortem findings, and in epidemiological surveys.
An Index of Need for Psychiatric Services based on In-patient Utilisation
Authors: Smith Peter , Sheldon Trevor A. , Martin Stephen
Published: October 2008

Background

The paper describes the development of an index of the relative need for psychiatric services for the purposes of distributing NHS funds in England.

Method

The study is based on an empirical analysis of all psychiatric in-patient completed episodes in England in 1991/92. Any index of need should be independent of the effect of variations in health care supply on the use of psychiatric services. In order to disentangle the influences of supply from social and clinical determinants of utilisation, two stage least squares regression and multilevel modelling techniques were used.

Results

The outcome was an index comprising six health and socio-economic variables. This is now being used by the NHS Executive to distribute about £2.2 billion of annual NHS expenditure for psychiatric services between English health authorities.

Conclusion

It is shown that the index is much more sensitive to needs and therefore more redistributive than the previous index of need used in the NHS.
Who Responds to Electroconvulsive Therapy?
Authors: Sobin Christina , Prudic Joan , Devanand D. P. , Nobler Mitchell S. , Sackeim Harold A.
Published: October 2008

Background

It has been reported that real ECT is more effective than simulated treatment among depressed patients with delusions and/or retardation, and that ECT is not effective among depressed patients who lack these features.

Method

In two randomised, double-blind studies, 143 patients with major depression were subtyped regarding psychosis, retardation and agitation. In both studies, low dosage, right unilateral ECT was ineffective compared with other forms of ECT. This report examined whether the depressive subtypes differed in clinical response to the ineffective and effective forms of ECT.

Results

The therapeutic advantage of effective forms of ECT was similar across the depression subtypes. Patients who lacked both psychosis and retardation showed this pattern.

Conclusions

The findings cast doubt on the utility of these depression subtypes in predicting ECT response. ECT is a viable treatment option for patients with major depression regardless of the presence or absence of psychosis, retardation and/or agitation.
Mental Health, ‘Burnout’ and Job Satisfaction among Hospital and Community-Based Mental Health Staff
Authors: Prosser David , Johnson Sonia , Kuipers Elizabeth , Szmukler George , Bebbington Paul , Thornicroft Graham
Published: October 2008

Background

Concerns have been expressed that staff burnout may make community mental health care difficult to sustain. This study compares stress and job satisfaction between community and hospital-based staff.

Method

The GHQ-12, the Maslach Burnout Inventory and a job satisfaction measure were used to study 160 Inner London staff.

Results

Community staff scored significantly higher on the GHQ-12 and the ‘emotional exhaustion’ component of the Maslach Burnout Inventory than hospital-based in-patient, day care or out-patient staff. Satisfaction did not vary significantly between settings.

Conclusions

These results may be explained in several ways. Community work may be inherently more stressful than hospital work, or may currently be stressful because of inadequate resources, training or supervision. The results may also reflect widespread recent changes in community services or the specific effects of working in a deprived area.
Victims and Perpetrators of Child Sexual Abuse
Authors: Hilton M. R. , Mezey G. C.
Published: October 2008

Background

This article aims to inform clinicians of current thinking in the area of victims and perpetrators of child sexual abuse. It covers prevalence data as well as identification, effects and interventions with victims, and also characteristics, assessment and treatment of perpetrators.

Method

The review is based on manual searches and the authors' own clinical experience.

Results

All clinicians should be aware of signs and symptoms that raise the possibility that someone has been or is being sexually abused and also of the possibilities of abuse of boys and of women as abusers. Methods of intervening are discussed, both in relation to victims and perpetrators. The importance of thoroughness when assessing perpetrators is emphasised because of their tendency to deny and/or minimise their offending. The demands of this work are underlined in a section on the necessary qualifications and characteristics of therapists working in this area.

Conclusions

Despite the lack of agreement in definitions and outcome measures used in research there are some positive findings in relation to clinical efficacy. In particular, the need for long-term treatment with those offenders who are more seriously deviant has been supported by recent research. There is a need for continuing attempts to standardise definitions and measures to aid realistic comparison of research results.
Paroxetine versus Clomipramine in the Treatment of Obsessive–Compulsive Disorder
Authors: Zohar Joseph , Judge Rajinder ,   Ocd Paroxetine Study Investigators
Published: October 2008

Background

The aim was to assess the effect of a flexible dose of paroxetine, compared with clomipramine and placebo, in obsessive-compulsive disorder (OCD).

Method

In a multinational randomised study, 406 subjects with OCD of at least six months duration received double-blind mediation for up to 12 weeks. Doses were adjusted according to therapeutic effect and side-effects. Primary efficacy measures were the Yale–Brown Obsessive–Compulsive Scale and the National Institute of Mental Health Obsessive–Compulsive Scale. Secondary efficacy measures were the Montgomery–åsberg Depression Rating Scale, Symptom Check-List (90), Clinical Global Impression, and Patients' Global Evaluation.

Results

Paroxetine was significantly more effective than placebo, and of comparable efficacy to clomipramine. Paroxetine had significantly superior tolerability to clomipramine on three measures: CGI efficacy index, anticholinergic adverse events, and adverse events leading to withdrawal.

Conclusion

Paroxetine is as effective as clomipramine in the treatment of OCD. The comparable efficacy and better tolerability of paroxetine suggest that it would be an appropriate treatment for OCD.
Suicide in the 18 Years After Deliberate Self-harm
Authors: De Moore Gregory M. , Robertson Andrew R.
Published: October 2008

Background

Clinical and demographic information on patients seen as a result of deliberate self-harm (DSH) was collected in an attempt to identify factors in the index episode of DSH predictive of subsequent suicide.

Method

Specific data were prospectively collected on all DSH patients who lived in Blacktown Municipality, Sydney, Australia, and seen from October 1975 to September 1976. Follow-up at 18 years was by evaluation of coroners' records and identification of ‘probable suicide’.

Results

Two hundred and twenty-three patients harmed themselves on one or more occasions. Follow-up at 18 years showed that 15 of the 223 (6.7%) had completed suicide. The proportion at five and eight years was 4.0% and at 10 years was 4.5%. Identified predictors of suicide were: narcotic overdose; more than one episode of DSH in the year of the study; planned episode; and mental illness. Teenage narcotic-abusing males were at greatest risk, and in females a planned episode was the most powerful predictor.

Conclusions

Suicides continued to occur over 18 years. One of the striking differences between this and other studies is the finding of teenage male DSH, associated with narcotic abuse, as a strong predictor of subsequent suicide. These findings are particularly relevant to the issue of young male suicide, which increased from the 1970s onwards in Australia and elsewhere.
The Course of Schizophrenia Over 13 Years
Authors: Mason Peter , Harrison Glynn , Glazebrook Cristine , Medley Ian , Croudace Tim
Published: October 2008

Background

This paper describes the 13 year course of illness in an epidemiologically defined and representative cohort of patients selected when they were experiencing their first episode of schizophrenia.

Method

In a 13-year follow-up study of 67 patients with ICD–9 schizophrenia, identified in Nottingham in 1978–80, the course of illness (symptoms, disability and hospitalisation) was assessed using standardised instruments, applied at onset 1, 2, and 13 years. Time to first relapse and first readmission were calculated and plotted as survival curves and patients were assigned to the course types described by Ciompi.

Results

The survival curves show that first relapses and first readmissions occur during the first five years. The amount of time spent in psychotic episodes and in hospital is greatest in the first year of follow-up, but stable thereafter. Social adjustment improves from entry to the study to the first follow-up year, but there is a small deterioration in social adjustment between 2 and 13 years.

Conclusions

The findings reported suggest that after the initial episode the course of schizophrenia is relatively stable. The data support neither concepts of progressive deterioration nor progressive amelioration. There was no evidence of a ‘late recovery’.
Cognitive Therapy and Recovery from Acute Psychosis: a Controlled Trial
Authors: Drury Val , Birchwood Max , Cochrane Ray , MacMillan Fiona
Published: October 2008

Background

A trial of CT in acute psychosis conducted by the authors has shown a significant impact on the rate and degree of recovery of positive symptoms, the focus of the intervention. This paper seeks to determine whether these effects generalise to other features of acute psychosis including dysphoria, insight and ‘low level’ psychotic thinking which were not directly targeted.

Method

Measures of dysphoria, insight and psychotic thinking were taken over a six-month period following presentation for acute psychosis. Using survival analysis, time to recovery from psychosis using three definitions of increasing stringency was compared between the CT and control group.

Results

CT was associated with a 25–50% reduction in recovery time depending on the definition used.

Conclusion

The impact of the CT intervention extended beyond positive symptoms to include insight, dysphoria and ‘low level’ psychotic thinking. Nevertheless this kind of ‘clinical’ recovery required a median of 20 weeks to complete. Implications for clinical models of acute care are discussed.
Double-Blind, Placebo-Controlled, Crossover Trial of Glycine Adjuvant Therapy for Treatment-Resistant Schizophrenia
Authors: Heresco-Levy Uriel , Javitt Daniel C. , Ermilov Marina , Mordel Clara , Horowitz Avraham , Kelly Dalia
Published: October 2008

Background

It has been proposed that schizophrenia is associated with underactivity of brain glutamatergic neurotransmission, especially at the level of the N-methyl-D-aspartate (NMDA) subtype of glutamate receptor. Glycine potentiates NMDA receptor-mediated neurotransmission, indicating that it may serve as an effective therapeutic agent in the treatment of schizophrenia.

Method

Eleven treatment-resistant patients with chronic schizophrenia completed a double-blind placebo-controlled, six-week, randomly assigned, crossover treatment trial of 0.8 g/kg body weight/day of glycine, added to their prior antipsychotic treatment.

Results

Glycine was well tolerated, resulted in significantly increased serum glycine levels and induced a mean 36 (7%) reduction in negative symptoms (P < 0.0001). Significant improvments were also induced in depressive and cognitive symptoms. The greatest reduction in negative symptoms was registered in the patients who had the lowest baseline serum glycine levels.

Conclusions

These results extend previous findings and suggest an additional approach to the pharmacotherapy of negative symptoms and cognitive deficits in schizophrenia.
Emotional Overinvolvement in Parents of Patients with Schizophrenia or Related Psychosis: Demographic and Clinical Predictors
Authors: Bentsen Håvard , Boye Birgitte , Munkvold Ole Georg , Notland Tor Helge , Lersbryggen Annette B. , Oskarsson Kirsti H. , Ulstein Ingun , Uren Gunvor , Bjørge Heidi , Berg-Larsen Rolf , Lingjærde Odd , Malt Ulrik F.
Published: October 2008

Background

Parental emotional overinvolvement (EOI) may entail a worse outcome in schizophrenia. In the present study we examined demographic and clinical predictors of EOI.

Method

The predictors were examined in a Norwegian sample of 41 recently admitted patients (schizophrenia or schizophreniform disorder) and 66 parents. Parents' expressed emotion was assessed by the Camberwell Family Interview.

Results

Regression analyses showed that higher EOI was significantly related, on the part of the parent to being a mother, single, spending more time with the patient; and, on the part of the patient, to no substance misuse, more anxiety–depression, and less uncritical and aggressive behaviour. EOI was not linked to previous hospital admissions.

Conclusion

Our analyses indicate that characteristics of the parent and of the parent–patient dyad seem to be the most important determinants of EOI. EOI is probably not linked to psychotic relapse, but rather to affective disturbances in the patient.
Antidepressant-Treated Patients in Ambulatory Care
Authors: Bingefors Kerstin , Isacson Dag , Von Knorring Lars , Smedby Björn , Wicknertz Kristina
Published: October 2008

Background

Non-institutionalised patients treated with antidepressants have been shown to have indicators of a generalised vulnerability, such as high rates of health service use and excessive prescription drug use. Therefore, mortality in this patient group is of interest.

Method

All first-incidence antidepressant users in a defined population during a five-year period were identified. Their total mortality during a nine-year follow-up was analysed. Cox proportional hazards regression was used to analyse total mortality, and mortality in cardiovascular disease, controlling for baseline chronic medical disease.

Results

Antidepressant treatment at the index date was a statistically significant predictor for increased long-term mortality in the over-65s, even when controlling for pre-existing chronic medical disease. Baseline ischaemic heart disease and concurrent antidepressant treatment significantly predicted mortality from cardiovascular causes.

Conclusion

Prescribed antidepressant treatment identifies patients who are at risk of increased mortality. For the physician in ambulatory care, knowledge of a patient's antidepressant treatment history may be a valuable tool in managing patient care.
Women's Self-Esteem: A Community Study of Women who Report and do not Report Childhood Sexual Abuse
Authors: Romans Sarah E. , Martin Judy , Mullen Paul
Published: October 2008

Background

The determinants of self-esteem have been little studied in non-clinic samples. It has been suggested recently that child sexual abuse (CSA) may be a major determinant of low self-esteem in adulthood.

Method

The psychosocial circumstances associated with low self-esteem in two random samples of women, one reporting CSA, the other not were compared, with particular emphasis on characteristics of family of origin. A two-phase (postal-then-interview) random community study assessed self-esteem and related variables.

Results

Psychosocial variables predicting low self-esteem were the same in the two groups. They included being a follower or a loner, having an overcontrolling mother, being poorly qualified, giving a history of depressive disorder and displaying current psychiatric disorder. In addition, the subject's CSA status led to low self-esteem but only when it was of the most intrusive type. The CSA women had a substantially lower mean total self-esteem score. However, not all aspects of self-esteem were diminished equally; 12/30 items differed between the two groups, and two of the five generated self-esteem factors, which we named Pessimism and Fatalism, which differed between the control group and the whole CSA group. There were no differences for Likeability and Determination.

Conclusions

Predictors of low self-esteem for women include childhood temperament, a poor relationship with the mother, low qualification attainment, psychiatric morbidity, both previous and current, and, only when it is the most intrusive, CSA.
PTSD Symptoms and Comorbid Mental Disorders in Israeli War Veterans
Authors: Skodol Andrew E. , Schwartz Sharon , Dohrenwend Bruce P. , Levav Itzhak , Shrout Patrick E. , Reiff Marian
Published: October 2008

Background

The purpose of this study was to investigate patterns of mental disorders comorbid with PTSD symptoms in young Israeli men exposed to combat.

Method

Six hundred and seventeen subjects were selected via a general population sample and evaluated in a two-phase case-identification procedure, culminating in a modified SADS–L interview, administered by psychiatrists.

Results

Major depressive disorder (OR=3.2), substance use disorders (OR=1.9) and personality disorders (OR=3.0) occurred more frequently in men reporting symptoms of PTSD than in men who had been under fire who did not report symptoms. With the possible exception of personality disorders, comorbid disorders did not constitute risk factors for PTSD. Comorbid PTSD and RDC disorders were associated with increased help-seeking.

Conclusions

The results suggest similar rates and types of PTSD comorbidity in Israeli war veterans as in veterans in the US assessed in general population studies, and are consistent with shared risk factors for PTSD and comorbid disorders.
Amisulpride versus placebo in the medium-term treatment of the negative symptoms of schizophrenia
Authors: Loo H. , Poirier-Littre M.-F. , Theron M. , Rein W. , Fleurot O.
Published: October 2008

Background

Amisulpride is a substituted benzamide with high selectivity for dopamine D2 and D3 receptors. The purpose of the study was to evaluate the effect of 100 mg amisulpride in patients with predominantly negative symptoms of schizophrenia.

Method

This was a multi-centre, randomised, parallel-group, double-blind study. Patients received either amisulpride (100 mg/day) or placebo over a six-month treatment period.

Results

A total of 141 patients were included, 69 received amisulpride, 72 placebo. Fifty-eight patients (41%) had received neuroleptic treatment prior to inclusion. The percentage of amisulpride patients completing the study (55%) was significantly higher than that with placebo (32%), and drop-out rates due to lack of efficacy were 27% with amisulpride and 47% with placebo. All efficacy assessments were statistically in favour of amisulpride compared with placebo. The overall incidence of extrapyramidal symptoms was comparable in both groups; only five patients started anti-Parkinsonian treatment during the study (one in the placebo and four in the amisulpride group).

Conclusion

Amisulpride is effective in the medium-term treatment schizophrenic patients with predominantly negative symptoms.
A randomised controlled trial and cost analysis of problem-solving treatment for emotional disorders given by community nurses in primary care
Authors: Mynors-Wallis Laurence , Davies Ioana , Gray Alastair , Barbour Faith , Gath Dennis
Published: October 2008

Background

We set out to investigate whether community nurses could be trained in problem-solving therapy and, once trained, how effective they would be in treating emotional disorders in primary care.

Method

Seventy patients with an emotional disorder in primary care were randomly allocated to receive either problem-solving therapy from a trained community nurse or treatment as usual from their general practitioner. Interview and self-rated assessments of clinical and economic outcome were made pre-treatment, at eight weeks and at 26 weeks after treatment.

Results

There was no difference in clinical outcome between patients who received problem-solving treatment and patients who received the general practitioner's usual treatment. However, patients who received problem-solving treatment had fewer disability days and fewer days off work. The health care cost of problem-solving was greater than that of the general practitioner's usual treatment but this was more than offset by savings in the cost of days off work.

Conclusions

Problem-solving treatment can be given by trained community nurses. The clinical effectiveness and cost-benefit of the treatment will depend on the selection of appropriate patients.
Discontinuation rates of SSRIs and tricyclic antidepressants: a meta-analysis and investigation of heterogeneity
Authors: Hotopf Matthew , Hardy Rebecca , Lewis Glyn
Published: October 2008

Background

Previous meta-analyses suggest that individuals treated with serotonin-specific reuptake inhibitors (SSRIs) in randomised controlled trials (RCTs) are less likely to discontinue treatment than those on tricyclic antidepressants. This metaanalysis investigates whether this is due to the frequent use in RCTs of older reference tricyclics (imipramine and amitriptyline), which may have worse side-effects than more recent compounds.

Methods

A meta-analysis of RCTs comparing tricyclic and heterocyclic antidepressants with SSRIs in the treatment of depression.

Results

The overall odds ratio of discontinuation on tricyclic/heterocyclic antidepressants compared with SSRIs was 0.86 (95% CI 0.78–0.94). The odds ratio for reference tricyclics was 0.82 95% CI 0.72–0.23), newer tricyclics 0.89 (95% CI 0.74–1.06), and heterocyclics 1.02 (95% CI 0.78–1.35). The pooled advantage of SSRIs over tricyclics was maintained whether the population studied consisted of younger adults or only the elderly. No differences in discontinuation rates were detected between the SSRIs.

Conclusions

The lower rate of discontinuation in patients on SSRIs may be due to the use of old tricyclics (which have worse side-effects) as reference compounds. The SSRIs do not show a statistically significant difference in discontinuation rates when compared with newer tricyclics or heterocyclics.
Aggressive, socially disruptive and antisocial behaviour associated with fronto-temporal dementia
Authors: Miller B. L. , Darby A. , Benson D. F. , Cummings J. L. , Miller M. H.
Published: October 2008

Background

Research suggests an association between frontal and temporal injury and antisocial conduct. We studied the frequency of antisocial behaviours in fronto-temporal dementia (FTD) where pathology is anterior frontal-temporal, compared with Alzheimer's disease (AD) where pathology is primarily posterior temporal-parietal.

Method

The presence of antisocial conduct was compared in 22 FTD versus 22 AD subjects. All FTD patients had anterior frontal or temporal hypoperfusion with single photon emission computed tomography, whereas those with AD had posterior temporal-parietal hypoperfusion.

Results

Ten FTD and one AD subject showed antisocial behaviours, which included assault, indecent exposure, shoplifting and hit-and-run driving. Three FTD subjects were arrested. This difference was highly significant (P = 0.004).

Conclusions

Degeneration of frontal and temporal lobes predisposes to antisocial behaviour. This study supports a relationship between frontal-temporal dysfunction and certain types of antisocial activities.
Enhanced growth hormone responses to pyridostigmine challenge in patients with panic disorder
Authors: Cooney J. M. , Lucey J. V. , Dinan T. G.
Published: October 2008

Background

Panic disorder is associated with neuroendocrinological abnormalities, some of which overlap with those seen in major depression. To date, there has been little assessment of the role of cholinergic mechanisms in this disorder.

Method

Sixteen patients with DSM–III–R panic disorder and an age and gender-matched comparison group were administered 120 mg of the acetylcholinesterase inhibitor pyridostigmine. Growth hormone (GH) responses over a three-hour period were monitored.

Results

Mean ΔGH, the difference between basal and the maximum pyridostigmine levels, was significantly greater in patients with panic disorder than in the comparison group.

Conclusions

This may reflect increased cholinergic responsivity in panic disorder.
Perceived parental styles in a Japanese sample of depressive disorders
Authors: Sato Tetsuy , Sakado Kaoru , Uehara Toru , Nishioka Kazuo , Kasahara Yomishi
Published: October 2008

Background

Dysfunctional parental styles, as measured by the Parental Bonding Instrument (PBI), have been associated with adult depression in Western cultures. This study sought to determine whether such parental styles are also associated with adult depression in a non-Western society.

Method

PBI scores and parental styles assessed by PBI quadrants were explored in 51 Japanese depressive patients and controls in a matched, case-control design.

Results

Low care and high protection scores were associated not with melancholic but with non-melancholic depression. Subjects exposed to dysfunctional parental styles demonstrated a high risk for non-melancholic depression.

Conclusions

These data suggest that the association between dysfunctional parental styles on PBI and non-melancholic depression may be independent of cultural differences.
Total mortality in people admitted to a psychiatric hospital
Authors: Hansen Vidje , Arnesen Egil , Jacobsen Bjarne K.
Published: October 2008

Background

The aim was to document the mortality of psychiatric patients within a service system characterised by a low beds-to-population ratio.

Method

All patients admitted to one psychiatric hospital were followed from date of first admission after 31 July 1980 until 31 December 1992 with regard to death, by linkage to the Norwegian Central Register of Persons. Age-adjusted total mortality rates and standardised mortality ratios (SMRs) compared with the general population were computed.

Results

Mortality rates were highest in men, and increased with age in both sexes. SMRs were highest in the younger age-groups, and the overall SMR was significantly higher for men than for women. Mortality was highest during the first year after admission for both sexes and was higher than in the general population in all diagnostic groups.

Conclusions

The mortality of psychiatric patients is still unsatisfactorily high, and men constitute a special high-risk group.
Suicide as an outcome for mental disorders
Authors: Harris E. Clare , Barraclough Brian
Published: October 2008

Background

Mental disorders have a strong association with suicide. This meta-analysis, or statistical overview, of the literature gives an estimate of the suicide risk of the common mental disorders.

Method

We searched the medical literature to find reports on the mortality of mental disorders. English language reports were located on MEDLINE (1966–1993) with the search terms mental disorders', ‘brain injury’, ‘eating disorders’, ‘epilepsy’, ‘suicide attempt’, ‘psychosurgery’, with ‘mortality’ and ‘follow-up studies’, and from the reference lists of these reports. We abstracted 249 reports with two years or more follow-up and less than 10% loss of subjects, and compared observed numbers of suicides with those expected. A standardised mortality ratio (SMR) was calculated for each disorder.

Results

Of 44 disorders considered, 36 have a significantly raised SMR for suicide, five have a raised SMR which fails to reach significance, one SMR is not raised and for two entries the SMR could not be calculated.

Conclusions

If these results can be generalised then virtually all mental disorders have an increased risk of suicide excepting mental retardation and dementia. The suicide risk is highest for functional and lowest for organic disorders with substance misuse disorders lying between. However, within these broad groupings the suicide risk varies widely.
Psychopathological syndromes and familial morbid risk of psychosis
Authors: Van Os Jim , Marcelis Machteld , Sham Pak , Jones Peter , Gilvarry Karyna , Murray Robin
Published: October 2008

Background

Familial liability in the functional psychoses had traditionally been examined by comparing mutually exclusive diagnostic categories. This study examines overlapping psychopathological dimensions in relation to familial morbid risk of psychosis.

Method

We tested for associations between seven factor-analysis derived psychopathological dimensions and familial morbid risk of psychosis, in a sample of 150 patients with recent-onset functional psychosis and 548 of their first-degree relatives.

Results

A syndrome characterised by affective blunting and insidious and early onset of illness, non-specifically predicted psychosis in the first-degree relatives, whereas a manic syndrome specifically predicted affective psychosis in the relatives. No other main effects were observed, but there were interactions with proband diagnosis: a syndrome characterised by bizarre behaviour, inappropriate affect, catatonia and poor rapport predicted psychosis in relatives of schizophrenic probands, and a syndrome of depressive: symptoms predicted psychosis in relatives of schizoaffective probands. Positive symptoms were not associated with illness in the relatives.

Conclusions

Genetic effects in the functional psychoses may comprise non-specific components that canalise a general, early-onset, affective blunting phenotype and several other, more specific, influences on phenotypic variation.