bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment and Treatment Approaches for Survivors of Torture
Authors: McIvor Ronan J. , Turner Stuart W.
Published: October 2008

Background

Torture, with its personal, cultural, political and psychosocial effects, is presented as a complex trauma. The efficacy of different treatment modalities for those survivors who need assistance is examined critically.

Method

International literature searches using MEDLINE and Psych-Info, books and relevant book chapters were examined.

Results

One hundred and twenty-five articles were selected for analysis; 30 of the most relevant are discussed.

Conclusions

Discrete approaches to treatment have been developed, but many have yet to be evaluated critically. Common therapeutic elements are outlined. It is recommended that an integrated, flexible, client-centred approach utilising several techniques is most likely to achieve best results. Wider socio-political aspects should be taken into account, and treatment must be consistent with cultural expectations. Future directions for research are outlined and the role of primary prevention is stressed.
Normal Asymmetry of the Planum Temporale in Patients with Schizophrenia
Authors: Kulynych Jennifer J. , Vladar Katalin , Fantie Bryan D. , Jones Douglas W. , Weinberger Daniel R.
Published: October 2008

Background

Abnormal cerebral anatomical lateralisation has been reported in schizophrenia and may implicate anomalous neurodevelopment in the aetiology of this disease. A popular recent hypothesis has predicted that such disturbances in normal lateralisation should be especially apparent in the morphology of the temporal lobes.

Method

A temporal cortical region lying in the plane of the Sylvian fissure – known as the planum temporale – exhibits pronounced leftward asymmetry in normal right-handed males. We compared lateralisation of the planum temporale in schizophrenic and control males using MRI surface-rendering morphometry of the supratemporal cortex.

Results

Contrary to the lateralisation hypothesis, normal patterns of leftward planum asymmetry were detected in both the schizophrenic and control groups. Schizophrenics and controls also exhibited a predicted symmetry in the bilateral areas of Heschl's gyrus, a supratemporal cortical structure immediately anterior to the planum.

Conclusion

These data do not support the notion that neurodevelopmental mechanisms of cerebral asymmetry are abnormal in schizophrenia.
Neuroleptic Associated Tardive Dyskinesias in Young People with Psychoses
Authors: Pourcher Emmanuelle , Baruch Philippe , Bouchard Roch Hugo , Filteau Marie-Josée , Bergeron Danielle
Published: October 2008

Background

Apart from ageing, the factors associated with vulnerability to the emergence of tardive dyskinesia are poorly defined.

Method

Risk factors associated with the presence of a chronic choreic or dystonic disorder were assessed in a cross-sectional comparison of anamnestic and clinical data in a homogeneous group of 64 young psychotic patients (under 40 years of age) on chronic low to moderate doses of neuroleptics.

Results

Dyskinetic subjects presented more indirect indicators of occult brain damage, such as a perinatal event or traumatic brain injuries in infancy and early childhood; neurological examination showed more anomalies in dyskinetic patients than in non-dyskinetics, with a higher prevalence of facial release reflexes.

Conclusion

These data may support the hypothesis that occult acquired brain damage is important in the genesis of this ‘drug-induced’ disorder.
The Genetic Epidemiology of Self-Esteem
Authors: Roy Marc-André , Neale Michael C. , Kendler Kenneth S.
Published: October 2008

Background

Previous studies on self-esteem have focused exclusively on its psychosocial determinants. The goal of the present study is to clarify genetic v. environmental determinants of self-esteem.

Method

Participants were Caucasian women sampled from the Virginia Twin Register: 363 pairs of MZ and 238 pairs of DZ twins were available from the first wave of the study, and 430 pairs of MZ and 308 pairs of DZ twins from the second. Self-esteem was assessed with the Rosenberg's Self-Esteem Scale.

Results

Using univariate twin analyses of self-esteem and a repeated measurement twin model, we found that self-esteem is a moderately heritable trait (heritability = 52% in the repeated measurement model); environmental influences are also very important, and are probably mostly not shared by members of a twin pair.

Conclusions

Aetiological models of self-esteem which examine only psychosocial factors are incomplete; genetic factors need to be integrated.
Psychological Interventions in Infection with the Human Immunodeficiency Virus
Authors: Catalan Jose
Published: October 2008

Background

Infection with the human immunodeficiency virus (HIV) is associated with substantial psychiatric morbidity. This paper summarises the main forms of psychological intervention currently used, and reviews research evidence for their efficacy.

Method

Publications on the mental health aspects of HIV infection and psychological interventions were identified through the main HIV journals and general psychiatric and psychological periodicals, with the assistance ofAIDS Abstracts.

Results

Publications concerned psychological interventions at the time of HIV testing, interventions for infected people at different stages of disease, and risk-reduction interventions. While many publications were identified describing uncontrolled investigations, only a few studies had involved systematic evaluative research.

Conclusions

There is a need for systematic evaluation of psychological interventions for HIV infection, in terms of both efficacy and cost.
Tardive Dyskinesia in Schizophrenia: Relationship to Minor Physical Anomalies, Frontal Lobe Dysfunction and Cerebral Structure on Magnetic Resonance Imaging
Authors: Waddington John L. , O'Callaghan Eadbhard , Buckley Peter , Madigan Cathy , Redmond Oonagh , Stack John P. , Kinsella Anthony , Larkin Conall , Ennis Joseph T.
Published: October 2008

Background

It was hypothesised that schizophrenic patients with tardive dyskinesia show an excess of neurodevelopmental disturbance, particularly minor physical anomalies, in association with cognitive dysfunction and abnormalities of cerebral structure.

Method

Forty-seven out-patients with a DSM–III diagnosis of schizophrenia were examined for tardive dyskinesia using the Abnormal Involuntary Movement Scale; they were examined also for minor physical anomalies and neuropsychological test performance. Cortical atrophy, signal hyperintensities and lateral ventricular volume were determined on magnetic resonance imaging.

Results

Patients with and without tardive dyskinesia could not be distinguished by age, gender distribution or a number of clinical measures; however, patients with tardive dyskinesia sorted fewer categories on the Wisconsin Card Sorting Test (P = 0.04). Cerebral structure in patients with and without tardive dyskinesia could not be distinguished on magnetic resonance imaging but those with dyskinesia, all of whom showed involvement of the orofacial region, showed more evident minor physical anomalies of the head relative to those of the periphery (P = 0.02).

Conclusions

Tardive orofacial dyskinesia in schizophrenia appears to be associated particularly with poorer frontal lobe function, while predominance of craniofacial dysmorphogenesis may constitute a vulnerability factor that is related to the early origins of the disease process.
Prevalence and Correlates of Depression in a Population of Nonagenarians
Authors: Forsell Y. , Jorm A. F. , Strauss E. Von , Winblad B.
Published: October 2008

Background

Clinicians see many more nonagenarian patients now and there is a need for epidemiological data relating to this group. The aim of the present study was to investigate the prevalence of depressive symptoms and syndromes in this age group.

Method

The DSM–IV and the ICD–10 criteria for depression were used and correlated with physical health, disability in daily life, gender, use of drugs, social circumstances and cognitive dysfunction. Data were derived from 329 persons aged 90 and over, registered in a parish of Stockholm, who had been extensively examined by physicians and nurses.

Results/Conclusions

The prevalence of Major Depressive Episode as defined in DSM–IV was 7.9%; and of mild, moderate and severe Depressive Episode (combined); as defined in ICD–10 9.1%. No gender difference was found. Disability in daily life and the use of psychotropic drugs were found to correlate with depressive symptoms and syndromes.
Cognitive Functioning and Magnetic Resonance Imaging in Chronic Fatigue
Authors: Cope Helen , Pernet Amanda , Kendall Brian , David Anthony
Published: October 2008

Background

This study examines whether cognitive dysfunction in chronic fatigue may be accounted for by depression and anxiety or is due to brain pathology evident on magnetic resonance imaging (MRI).

Method

Twenty-six subjects with chronic fatigue, with and without coexisting depression, and 18 age-matched normal controls were recruited from primary care following a presumed viral illness six months previously. Comparison was made with 13 psychiatric controls with depressive illness on standardised cognitive tests. MRI determined the presence of cerebral white-matter lesions.

Results

No substantial differences in performance were shown between subjects with chronic fatigue, most of whom met the criteria for chronic fatigue syndrome, and controls. Subjective cognitive dysfunction increased with psychopathology. White-matter lesions were found in a minority from all groups. Improvement in fatigue and depression coincided with improved performance on cognitive measures.

Conclusions

Subjective complaints of cognitive impairment are a prominent feature of chronic fatigue, but objective cognitive and MRI abnormalities are not. Such complaints probably reflect psychopathology rather than a post-viral process.
The Neuropsychiatric Sequelae of Mercury Poisoning
Authors: O'Carroll R. E. , Masterton G. , Dougall N. , Ebmeier K. P. , Goodwin G. M.
Published: October 2008

Background

The detailed effects of mercury poisoning on cognitive function, brain anatomy and regional brain function are largely unknown. We report the case of a 38-year-old man who was exposed to toxic levels of inorganic mercury.

Method

Four years after exposure, the patient was assessed using magnetic resonance imaging (MRI), single-photon emission computerised tomography (SPECT) and detailed neuropsychological evaluation.

Results

The patient developed a myriad of physical and psychiatric complaints, including stomatitis, muscle spasm, tremor, skin rash and the psychiatric syndrome known as ‘erythism’ (Mad Hatter's disease). Neuropsychological evaluation revealed marked and significant deficits of attention concentration, particularly when under time pressure. The MRI scan was unremarkable; however, SPECT revealed hypermetabolism of the posterior cingulate cortex.

Conclusions

Mercury poisoning appeared to result in a dysregulation of posterior cingulate cortex, which was associated with attention/concentration deficits and marked anxiety/agitation.
Effect of Valine on 5-HT-mediated Prolactin Release in Healthy Volunteers, and on Mood in Remitted Depressed Patients
Authors: Williamson D. J. , McTavish S. F. B. , Park S. B. G. , Cowen P. J.
Published: October 2008

Background

Animal experimental studies suggest that the amino acid valine may decrease brain serotonin (5-HT) function by inhibiting the transport of the 5-HT precursor, L-tryptophan, across the blood barrier. The aim of the present study was to assess whether valine could decrease brain 5-HT function in healthy subjects and provoke symptomatic relapse in recently remitted depressed patients taking antidepressant drug treatment.

Method

We studied the effect of valine (30 g) on the prolactin (PRL) response to the 5-HT releasing agent, d-fenfluramine, in healthy male subjects and on the mood of 12 remitted depressed patients taking either selective serotonin re-uptake inhibitors (n = 10) or lithium and amitriptyline (n = 2).

Results

Valine significantly lowered the PRL response to d-fenfluramine in healthy subjects. In the remitted depressives, valine caused a mild but detectable lowering of mood on a number of measures but only one patient experienced a significant relapse in mood.

Conclusions

Valine administration may decrease brain 5-HT neurotransmission in humans. This effect could explain the mild increase in depressive symptoms in patients taking 5-HT-potentiating drugs.
Incidence of Clinically Diagnosed Subtypes of Dementia in an Elderly Population
Authors: Brayne C. , Gill C. , Huppert F. A. , Barkley C. , Gehlhaar E. , Girling D. M. , O'Connor D. W. , Paykel E. S.
Published: October 2008

Background

In developed countries, most dementia appears to be due to Alzheimer's disease and vascular dementia. We report rates for incidence of subtypes of dementia based on clinical diagnosis.

Method

This study was a 2.4-year (s.d. 2.6 months) follow-up of a cohort aged 75 years and over, seen initially in a prevalence study of dementia. A screening interview in 1173 survivors was followed in a subsample of 461 respondents by a diagnostic interview 1.8 months after screening (s.d. 1.5 months). This comprised a standardised interview with respondent and informant, with venepuncture where possible. Clinical diagnoses of subtypes were made by specified criteria.

Results

The incidence of Alzheimer's disease of mild and greater severity was 2.7/1000 person-years at risk (1.6–4.4); in men 1.5 (0.8–2.7) and in women 3.3 (1.8–5.9). The incidence of vascular dementia was 1.2/100 person-years at risk (0.7–1.9); in men 1.1 (0.4–2.8) and in women 1.2 (0.7–2.0). Alzheimer's disease, but not vascular dementia, showed a marked increase with age, particularly in women. Rates for minimal dementia of different subtypes showed similar age and sex effects, but were much higher for Alzheimer's disease than vascular dementia.

Conclusions

The striking rise in incidence rates of dementia in the very old appear to be due to Alzheimer's disease, while rates for vascular dementia remain relatively constant. These trends are particularly marked for minimal dementia, but emphasise the importance of Alzheimer's disease in the community as a cause of cognitive decline of all degrees.
A 15–20 Year Follow-Up of Adult Psychiatric Patients
Authors: Quinton David , Gulliver Lesley , Rutter Michael
Published: October 2008

Background

An exploratory study was undertaken of the importance of personality disorder in predicting the long-term outcome for both episodic disorders and social functioning.

Method

In 1966–67, a representative series of patients with children, free of episodic illness for at least one year, was sampled from the Camberwell Psychiatric Register and systematically assessed over a four-year period, using measures of known reliability and validity. Psychiatric disorder was measured using a PSE-compatible instrument. The follow-up after 15–20 years used the PSE and a systematic assessment of social functioning.

Results

Overall outcomes were similar across diagnoses, but an initial categorical diagnosis of personality disorder predicted much poorer outcomes on psychiatric and social measures for patients with unipolar depressive disorders than for those with other diagnoses.

Conclusions

The findings indicate the importance for prognosis of including a systematic assessment of personality disorder in the clinical assessment of patients with depressive disorder.
The Maine and Vermont Three-Decade Studies of Serious Mental Illness
Authors: DeSisto Michael , Harding Courtenay M. , McCormick Rodney V. , Ashikaga Takamaru , Brooks George W.
Published: October 2008

Background

This paper supplements the cross-sectional outcome comparisons of the companion paper by providing a brief account of the longitudinal courses of the Maine and Vermont samples across several outcome domains.

Method

A Life Chart method was used to document changes in individual lives over the domains of residence, work, income source, and use of community resources over a 20-year period. Reliability studies between states were conducted.

Results

Throughout much of the period, more Vermont subjects lived independently, were working, and were less likely to use community resources compared to Maine subjects.

Conclusions

Differences in both policies and programmes contributed to course differences between the groups. System characteristics that may lead to better outcomes are discussed.
Regional Brain Activity in Chronic Schizophrenic Patients during the Performance of a Verbal Fluency Task
Authors: Frith C. D. , Friston K. J. , Herold S. , Silbersweig D. , Fletcher P. , Cahill C. , Dolan R. J. , Frackowiak R. S. J. , Liddle P. F.
Published: October 2008

Background

This study examined the pattern of cerebral blood flow observed in chronic schizophrenic patients while they performed a paced verbal fluency task. Such tasks engage a distributed brain system associated with willed action. Since willed action is impaired in many chronic schizophrenic patients we hypothesised that task performance would be associated with an abnormal pattern of blood flow.

Method

Positron emission tomography (PET) was applied to 18 chronic schizophrenic patients stratified into three groups on the basis of verbal fluency performance and current symptoms. Regional cerebral blood flow (rCBF) was measured while the patients performed (a) verbal fluency, (b) word categorisation, and (c) word repetition. Results were compared with six normal controls matched for age, sex and premorbid IQ. Analysis was restricted to six brain regions previously identified in studies of normal volunteers.

Results

In five brain areas, including the left dorsolateral prefrontal cortex, the patients showed the same pattern of activation as control subjects. However, in the left superior temporal cortex, all patient groups failed to show the normal decrease in blood flow when verbal fluency was compared with word repetition.

Conclusion

These observations suggest that (a) chronic schizophrenic patients can show a normal magnitude of frontal activation when matched for performance with controls, and (b) they fail to show the expected reductions of activity in the superior temporal cortex. This latter result may reflect abnormal functional connectivity between frontal and temporal cortex.
Paroxetine in the Treatment of Panic Disorder a Randomised, Double-Blind, Placebo-Controlled Study
Authors: Oehrberg S. , Christiansen P. E. , Behnke K. , Borup A. L. , Severin B. , Soegaard J. , Calberg H. , Judge R. , Ohrstrom J. K. , Manniche P. M.
Published: October 2008

Background

This study compared the efficacy and tolerability of paroxetine with placebo in the treatment of panic disorder.

Method

After three weeks of placebo, patients received 12 weeks of treatment with paroxetine (20, 40, or 60 mg) or placebo, and finally two weeks of placebo. Dosages were adjusted according to efficacy and tolerability. Standardised cognitive therapy was given to all patients. The primary measure of outcome was reduction in the number of panic attacks.

Results

Analysis of the results showed statistically significant differences in favour of paroxetine between the two treatment groups in two out of the three primary measures of outcome, i.e. 50% reduction in total number of panic attacks and number of panic attacks reduced to one or zero over the study period. For the third measure of outcome, the mean change in the total number of attacks from baseline, there was a positive trend in favour of paroxetine. The results of the primary measures of outcome were strongly supported by the results of the secondary efficacy measures of outcome. In addition, paroxetine, at all doses, was very well tolerated.

Conclusion

Paroxetine plus cognitive therapy was significantly more effective than placebo plus cognitive therapy in the treatment of panic disorder.
Anorexia Nervosa in ‘Non-White’ Populations
Authors: Soomro G. M. , Crisp A.H. , Lynch D. , Tran Duong , Joughin N.
Published: October 2008

Background

Comparisons were made between two groups of anorectic patients, ‘non-white’ and ‘white‘, on a variety of clinical and social characteristics.

Method

The study is based on a 34-year long database (1960–93) associated with a national tertiary referral centre. Thirty-six non-white patients meeting DSM–III–R criteria for anorexia nervosa (AN) and five with ‘partial syndrome’ are compared with a white group comprising 944 patients with full syndrome.

Results

The main finding is clinical similarity between the two groups, extending to social class and pathological patterns of family relationship. The non-whites are shorter in stature (P = 0.004) and report earlier menarche (P = 0.004); they are younger at presentation (P < 0.001), somewhat less emaciated, and practice veganism slightly more commonly; they less often acknowledge sensitivity to ‘fatness’ (P < 0.003). This sensitivity was exposed later whenever treatment involved substantial weight gain. The proportion of non-white cases accepted for assessment has not changed in respect of year of onset (around 6%) for the last 20 years, or year of presentation (around 6–7%) over the last 15 years. There was a tendency for non-white patients to be referred earlier in their illness.

Conclusions

The clinical and background profiles of non-white and white anorectics are generally similar. The numbers arising and presenting have not changed recently. Non-white patients apparently have as ready access as white patients to assessment and treatment by us.
Investigation by Linkage Analysis of the XY Pseudoautosomal Region in the Genetic Susceptibility to Schizophrenia
Authors: Kalsi Gursharan , Curtis David , Brynjolfsson Jon , Butler Robert , Sharma Tonmoy , Murphy Patrice , Read Tim , Petursson Hannes , Gurling Hugh M. D.
Published: October 2008

Background

A susceptibility locus for schizophrenia in the pseudoautosomal region has been proposed on the basis of a possible excess of sex chromosome aneuploidies among patients with schizophrenia and an increased sex concordance in affected sib pairs. Several studies investigating this hypothesis have produced conflicting evidence.

Method

In a series of Icelandic and British families, we used lod score and sib pair linkage analyses with markers for the MIC2 and DXYS14 loci on the pseudoautosomal XY region.

Results

Lod and sib pair linkage analysis with these markers produced strongly negative scores. Heterogeneity testing also produced negative results.

Conclusion

We conclude that the present study provides no support for the involvement of either the pseudoautosomal region or the nearby region of the sex chromosomes in the aetiology of schizophrenia.
Behaviour Symptoms among Severely and Profoundly Mentally Retarded Patients
Authors: Reid Andrew H. , Ballinger Brian R.
Published: October 2008

Background

Little is known about the natural history and evolution of behaviour symptoms and patterns in severely and profoundly mentally retarded adults. This paper reports a cohort study of 100 such adults.

Method

Abnormal behaviour symptoms and patterns have been followed, using a carer rating scale and the Modified Manifest Abnormality Scale of Goldberg's Clinical Interview Schedule (1970) by the same two consultant psychiatrists in 1975, 1981 and 1992.

Results

Emotional withdrawal, stereotypies and eye avoidance are particularly persistent. Carer ratings of noisiness and social withdrawal, and psychiatrist ratings of suspiciousness, overactivity and hostile irritability, are also persistent but to a lesser degree. Overall ratings of psychiatric disorder are persistent and act against successful community placement.

Conclusions

Abnormal behaviour patterns in severely and profoundly mentally retarded adults show only a modest degree of abatement over time. Care staff need a good understanding of clinical psychiatric and behaviour management techniques.
First Admission Incidence Study of Mania, 1975–1981
Authors: Daly Ian , Webb Marcus , Kaliszer Michael
Published: October 2008

Background

A previous cross-national epidemiological study of first admission rates in London and in Aarhus, Denmark, found that the incidence of mania was virtually identical for both centres. This study sought to examine the corresponding rate for a defined catchment area in Dublin, Ireland, and to establish whether the impression of a higher rate could be validated.

Method

The study combined a six-year retrospective review and one-year prospective collection of first-admission cases of mania from a defined catchment area. Diagnosis was according to ICD criteria and the Syndrome Check List of the Present State Examination (PSE). Cross-national comparisons were made using standardised incidence rate ratios (SIRs).

Results

The crude incidence rate for Dublin in the age range 18–60 years was established at 4.5 per 100 000 per year. A comparison of SIRs for the three centres showed the Dublin rate to be higher than expected (P < 0.02). Age-specific analysis indicated that this increase came mainly from the age range 18–29 (χ2 = 9.08, P = 0.01).

Conclusions

The study confirmed the impression that the local incidence of mania in Dublin is higher than that reported from two other North European centres. A variation in rates from contrasting socioeconomic districts within the catchment area points to some caution in the interpretation of the results and suggests further study from wider catchment areas.
Gender-Specific Changes Since 1900 in the Season-of-Birth Effect in Schizophrenia
Authors: Eagles John M. , Hunter David , Geddes John R.
Published: October 2008

Background

It was hypothesised that the size of the season-of-birth effect may have decreased in tandem with the apparent decline in the incidence of schizophrenia.

Method

Through the Aberdeen Psychiatric Case Register, subjects were identified who had been diagnosed as schizophrenic and had been born between 1900 and 1969. The ratio of winter/spring to summer/autumn births was compared across the seven decades for both sexes together, for men, and for women.

Results

For the 1935 men, but not for the 1620 women, there was a highly significant increase (P = 0.0009) in season-of-birth effect.

Conclusion

Non-seasonal factors have contributed to a declining incidence of schizophrenia in both sexes. ‘Seasonal’ factors to which female foetuses are more susceptible than male foetuses (such as infection or malnutrition) have also decreased in frequency, severity, or both, but this has not happened with factors affecting males, leading to an increase of their season-of-birth effect.
Psychotic and Depressive Symptoms in Parkinson's Disease a Study of the Growth Hormone Response to Apomorphine
Authors: Mellers John D. C. , Quinn Niall P. , Ron Maria A.
Published: October 2008

Background

The growth hormone (GH) response to apomorphine, thought to reflect central dopaminergic receptor sensitivity, has been reported as enhanced in acute schizophrenia. We investigated this response in relation to the psychotic episodes associated with Parkinson's disease (PD).

Method

The GH response to apomorphine was measured in three groups of patients with Parkinson's disease: those currently psychotic (n = 9), those with a past history of psychosis (n = 7) and those who had never been psychotic (n = 8).

Results

Apomorphine-induced GH response was not related to psychosis but was unexpectedly associated with measures of depression.

Conclusions

Visual hallucinations were a prominent feature in the psychotic patients and the atypical nature of these psychoses might explain why we found no evidence of dopaminergic sensitivity. Serotonergic dysfunction would be in keeping with this. Dopaminergic mechanisms may contribute to the minor depressive symptomatology seen in PD.
Apolipoprotein E Genotype and its Effect on Duration and Severity of Early and Late Onset Alzheimer's Disease
Authors: Norrman Jennie , Brookes Anthony J. , Yates Celia , Clair David St
Published: October 2008

Background

The apolipoprotein E (ApoE) ∊4 allele is associated with an increased risk of senile and probably presenile Alzheimer's disease. It is not yet clear whether the ∊4 allele also influences the duration/rate of progress of illness and the severity of the dementia.

Method

We have retrospectively examined a series of ApoE genotyped presenile and senile autopsy cases of Alzheimer's disease (AD) for length of illness and severity of pathology.

Results

We find no evidence that ApoE genotype affects the rate of progress of AD, but the degree of pathology at death may be increased.

Conclusion

It appears that the rate of progress of AD as a whole is independent of the ApoE genotype.
Determinants of the Extremes of Outcome in Schizophrenia
Authors: Johnstone E. C. , Frith C. D. , Lang F. H. , Owens D. G. C.
Published: October 2008

Background

Although poor prognosis has been considered a defining characteristic of schizophrenia, long-term studies show marked heterogeneity of outcome.

Method

Assessments of positive and negative symptoms, premorbid and current IQ, and months of in-patient care made in an outcome study of 342 schizophrenic patients were categorised by severity. Determinants of these categorisations were sought from the historical variables available, using analysis of variance. Vignettes of patients with the best and worst symptomatic outcomes were then compared.

Results

Negative symptoms were associated with early onset, male sex and poor academic record. Positive symptoms were associated with occupational decline. Cognitive decline was associated with occupational variables, and in-patient care with academic and occupational variables. The vignettes showed that good outcome was associated with family psychiatric history and poor outcome with unavailability of family history.

Conclusions

The findings support the view that the most malignant form of schizophrenia is neurodevelopmental, but poor outcome was clearly associated with family fragmentation.
Effect of Emotional Salience on Thought Disorder in Patients with Schizophrenia
Authors: Haddock Gillian , Wolfenden Melanie , Lowens Ian , Tarrier Nicholas , Bentall Richard P.
Published: October 2008

Background

This study examined the effect of emotional salience on the severity of thought disorder in schizophrenic patients.

Method

Ten thought disordered and ten non-thought disordered schizophrenic patients were interviewed under two conditions: a personal interview involving material which was emotionally salient and an impersonal interview involving material which was not emotionally salient.

Results

Both groups exhibited some thought disorder during both interviews. The thought disordered patients exhibited significantly more thought disorder during the emotionally salient interview.

Conclusions

Thought disorder in schizophrenic patients is affected by the emotional salience of the material being discussed. Clinical implications are discussed.
Regional Cerebral Blood Flow in Obsessive-Compulsive Disordered Patients at Rest
Authors: Lucey James V. , Costa Durval C. , Blanes Tomas , Busatto Geraldo F. , Pilowsky Lyn S. , Takei N. , Marks Isaac M. , Ell Peter J. , Kerwin Robert W.
Published: October 2008

Background

We tested whether cortical and subcortical regional cerebral blood flow (rCBF) differs between patients with obsessive-compulsive disorder (OCD) and healthy controls. We then explored the relationship between rCBF and OCD mental state.

Method

Thirty out-patients from the Maudsley Hospital with OCD as defined in DSM–III–R were scanned at rest using brain-dedicated, high-resolution, single photon emission tomography. RCBF was measured as uptake of 99mTc-HMPAO in 15 regions of interest and compared with rCBF data in 30 healthy people matched for age, sex and handedness. Symptom ratings were obtained using standard measures on the scanning day. Principal components factor analysis identified two distinct clinical dimensions: obsessive–compulsive (OC) and anxious–avoidant (AA). These were correlated with patients' rCBF measurements, using Spearman's rank correlation coefficient, and multiple regression coefficients calculated.

Results

We found significant reductions in rCBF measurements of OCD patients compared with resting, healthy controls (F = 1.92, P = 0.04) in seven brain regions: the right and left superior frontal cortex, right inferior frontal cortex, left temporal cortex, left parietal cortex, right caudate nucleus and right thalamus. Regional differences were not secondary to generalised reduction in patients' brain perfusion. Reduced blood flow to the right inferior frontal cortex correlated significantly with illness severity (r = 0.37, P = 0.02). There was no relationship with age, age-of-onset, sex, handedness, depression or medication status. OC clinical dimension, concerning obsessions, compulsions and low mood, was significantly negatively correlated with left inferior frontal, medial frontal and right parietal rCBF. AA dimension, concerning anxiety and avoidance, was significantly positively associated with left and right superior frontal, right inferior frontal, medial frontal cortical, and right and left caudate and thalamic rCBF.

Conclusions

rCBF differs significantly between resting OCD patients and healthy controls, and separate clinical dimensions are associated with functionally distinct rCBF patterns.
A Controlled Study of Cognitive Behaviour Therapy with Buspirone or Placebo in Panic Disorder with Agoraphobia
Authors: Cottraux Jean , Note Ivan-Druon , Cungi Charly , Légeron Patrick , Heim François , Chneiweiss Laurent , Bernard Geneviève , Bouvard Martine
Published: October 2008

Background

This multicentre study compared a 16-week buspirone treatment with placebo in patients presenting with panic disorder with agoraphobia and also receiving cognitive behaviour therapy (CBT).

Method

Double-blind testing was maintained until week 68, but not tested; 91 patients were included; 14 placebo-responders excluded; 77 patients randomised; 48 reached week 16 and 41 reached week 68.

Results

At week 16, within-group analysis showed significant improvements in agoraphobia, panic attacks, and depression in both groups. Generalised anxiety improved only in CBT + buspirone. Between-group comparisons showed buspirone to have an effect on generalised anxiety and agoraphobia. Changes in degree of agoraphobia and depression were correlated in subjects on CBT + buspirone only. A significantly higher proportion of women, and of subjects showing high avoidance dropped out. Positive expectations regarding medication predicted success in both groups. At week 68, improvement was retained without significant buspirone effect.

Conclusion

Buspirone enhanced the effects of cognitive behaviour therapy on generalised anxiety and agoraphobia in the short term.
Family Functioning in Adolescent Anorexia Nervosa
Authors: North Clive , Gowers Simon , Byram Victoria
Published: October 2008

Background

Difficulties in family functioning have been noted since early descriptions of anorexia nervosa and may be of importance aetiologically. Previous studies have a number of methodological problems.

Method

Thirty-five anorexic adolescents were age/sex matched with psychiatric and community controls. A diagnostic interview and a questionnaire, the Family Assessment Device (FAD) were administered to control subjects and their mothers. Anorexic families only received the McMaster Structured Interview of Family Functioning.

Results

Multivariate analyses of FAD scores showed pathological ratings for psychiatric control but not anorexic families, compared with community controls. By contrast objective ratings revealed marked dysfunction in anorexic families (greater in the purging subgroup).

Conclusion

Family functioning in anorexic families is normal by self-report but not by an objective measure. Anorexic families in the purging subgroup appear most dysfunctional.
The Significance of a History of Childhood Sexual Abuse in Bulimia Nervosa
Authors: Sullivan Patrick F. , Bulik Cynthia M. , Carter Frances A. , Joyce Peter R.
Published: October 2008

Background

Childhood sexual abuse (CSA) is found to have occurred to a substantial minority of women with bulimia nervosa. Its clinical significance is unclear.

Method

We studied 87 bulimic women in a clinical trial. Structured interviews determined the presence of CSA, DSM–III–R disorders, global functioning, and depressive and bulimic symptoms.

Results

Forty-four per cent reported a history of CSA. Bulimic women with CSA reported earlier onset of bulimia, greater depressive symptoms, worse global functioning and more suicide attempts, and were more likely to meet criteria for bipolar II disorder, alcohol and drug dependence, conduct disorder and avoidant personality disorder.

Conclusions

Although those with CSA had greater comorbidity, it was not an important modifier of bulimic symptoms.
Epidemiology of Presenile Alzheimer's Disease in Scotland (1974–88)
Authors: Whalley Lawrence J. , Thomas Brenda M. , McQuade Cecilia A. , McGonigal Gerard , Swingler Robert , Black Roger
Published: October 2008

Background

Factors that determine geographical differences in incidence rates of ‘probable’ presenile Alzheimer's disease (AD PSD) may help to clarify the possible role of the environment in its aetiology.

Method

We have ascertained the treated incidence of AD PSD in Scotland by scrutiny of hospital casenotes and searched for cases outside hospital settings. Small area geographical analysis compared the observed distribution of cases (each allocated to one of Scotland's 898 postcode sectors) with the estimated random distribution of cases.

Results

There was non-random geographical distribution of AD PSD but not of the comparison conditions (vascular dementia (VaD), motor neurone disease, prostatic or ovarian cancers). Substantial differences between Scottish regions were probably not attributable to methodological artefact, as other techniques of case finding showed the same regional differences.

Conclusions

The observed differences in incidence of AD PSD between Scotland's regions are real and some localities have a higher incidence, mostly in central Scotland.
Social Factors in Suicide
Authors: Heikkinen Martti E. , Isometsä Erkki T. , Marttunen Mauri J. , Aro Hillevi M. , Lönnqvist Jouko K.
Published: October 2008

Background

The study objective was to investigate the age-related variation of social factors in suicide.

Method

Age-related variations in marital status, living arrangements, employment and social interaction were investigated in an entire 12-month suicide population in Finland (n= 1067); these findings were compared with appropriate census data.

Results

Several social factors varied across age groups among suicides, with some age-related sex differences. Compared with the general population, the suicides were more commonly never married (especially men aged 30–39 years), divorced, and widowed (especially women aged 60–69 years); living alone was more frequent among the suicides, as was living with parents among male suicides aged 25–39 years. A history of psychiatric admission was especially common among young male suicides who had never married or were living with parents. Living alone was particularly frequent among middle-aged male suicides who had misused alcohol.

Conclusions

While most of the age-related variation in social factors found in suicide seems to parallel the natural variation of these factors in the general population, some social findings in suicide might be related to the victims' psychopathology and excessive alcohol use.
Expressed Emotion and the Course of Schizophrenia in Japan
Authors: Tanaka Shuichi , Mino Yoshio , Inoue Shimpei
Published: October 2008

Background

We examined whether expressed emotion (EE) influenced the course of schizophrenia in Japan.

Method

We conducted a cohort study. Of 73 subjects with schizophrenia meeting the diagnostic criteria of ICD–9 or DSM–III–R, 52 participated in the study. The Camberwell Family Interview was conducted to evaluate EE. The subjects had been followed up for nine months and psychiatrists who were blind to the EE status evaluated their symptoms with the Brief Psychiatric Rating Scale.

Results

The relapse rate in the high-EE group was 58% and that in the low-EE group 21 % (P < 0.01). Nine-month relapse risk ratio was 2.72 (95% CI 1.24 to 5.97).

Conclusion

In Japan, as elsewhere, EE is a good predictor of schizophrenic relapse.
Life Events and Miscarriage
Authors: O'Hare Tom , Creed Francis
Published: October 2008

Background

The aetiology of miscarriage is poorly understood. The aim of this study is to determine whether women admitted to hospital with miscarriage have experienced more psychosocial stress in early pregnancy than women whose pregnancies progress to labour.

Method

Interviews of 48 case-control pairs, matched for known predictors of miscarriage risk, using the Life Events and Difficulties Schedule.

Results

The miscarriage group were more likely to have experienced a “severe life event” in the three months preceding miscarriage (35% v. 15%; P < 005); more likely to have been experiencing a “major social difficulty” (31% v. 4%; P < 0.002); and more likely to have experienced “life events of severe short-term threat” in the fortnight immediately beforehand (31% v. 4%; P < 0.002). Fifty-four per cent of the miscarriage group had experienced at least one of the above indicators of psychosocial stress before miscarrying, compared with 15% of controls (P = 0.0001). Other factors significantly associated with miscarriage included childhood maternal separation; non-UK European origin; poorer reported relationships with partners, and fewer social contacts.

Conclusion

Psychosocial stress may be a factor in the aetiology of miscarriage. Alternatively, there may be a common determinant (e.g. personality, lifestyle or environmental) predisposing to both stress and miscarriage.
Classification of Veterans with Post-Traumatic Stress Disorder Using Visual Brain Evoked P3s to Traumatic Stimuli
Authors: Attias Joseph , Bleich Avi , Gilat Shlomo
Published: October 2008

Background

Post-traumatic stress disorder (PTSD) typically involves a re-experiencing of traumatic events. In a previous P3 study it was found that PTSD patients react both selectively and involuntarily to combat-related pictures, exhibiting augmented P3 event-related potentials and thus providing a brain activity measure. The clinical application of these findings in differentiating PTSD patients from controls was tested.

Method

Twenty Israeli combat veterans suffering from PTSD and 20 age-matched veterans without PTSD were evaluated. P3 potentials were recorded at Pz and Cz in response to visual motor-task target stimuli (pictures of domestic animals), non-target probe stimuli (combat-related pictures), and non-target irrelevant stimuli (pictures of furnishings and flowers).

Results

Using the Fisher Linear Discrimination Method the P3 measures correctly classified 90% of the PTSD patients and 85% of the controls.

Conclusions

Visual P3s recorded in response to combat-related pictorial stimuli may introduce an efficient tool for studying higher brain activity in PTSD, complementing other behavioural and psychophysiological measurements.
A Comparison of the Characteristics of Chronic Fatigue Syndrome in Primary and Tertiary Care
Authors: Euba R. , Chalder T. , Deale A. , Wessely S.
Published: October 2008

Background

To evaluate the characteristics of Chronic Fatigue Syndrome (CFS) in primary and tertiary care.

Method

A comparison of subjects fulfilling criteria for CFS seen in primary care and in a hospital unit specialising in CFS. Subjects were 33 adults fulfilling criteria for CFS, identified as part of a prospective cohort study in primary care, compared to 79 adults fulfilling the same criteria referred for treatment to a specialist CFS clinic.

Results

Hospital cases were more likely to belong to upper socio-economic groups, and to have physical illness attributions. They had higher levels of fatigue and more somatic symptoms, and were more impaired functionally, but had less overt psychological morbidity. Women were over-represented in both primary care and hospital groups. Nearly half of those referred to a specialist clinic did not fulfil operational criteria for CFS.

Conclusion

The high rates of psychiatric morbidity and female excess that characterise CFS in specialist settings are not due to selection bias. On the other hand higher social class and physical illness attributions may be the result of selection bias and not intrinsic to CFS.
Mental Health of Preschool Children and their Mothers in a Mixed Urban/Rural Population
Authors: Thompson Margaret J. J. , Stevenson Jim , Sonuga-Barke Edmund , Nott Peter , Bhatti Zam , Price Andy , Hudswell Matthew
Published: October 2008

Background

The prevalence rate of behaviour problems and maternal mental disturbance was estimated using a sample of 1047 families with a 3-year-old child from a mixed urban/rural area.

Method

Parents completed the Child Behaviour Checklist, EAS Temperament Questionnaire, Weiss–Werry–Peters Activity Scale and the GHQ–30.

Results

The rate of behaviour problems (13.2%) was similar to that obtained in studies of urban children. The rate of maternal disturbance (27.6%) was lower than in other population samples. Few differences were found in the prevalence rates in the urban and rural areas.

Conclusions

Preschool children and their parents living in non-urban areas had the same rates of problems as those in conurbations. The service needs of such families are similar regardless of locality.
Paracetamol Self-Poisoning Characteristics, Prevention and Harm Reduction
Authors: Hawton Keith , Ware Christopher , Mistry Hamant , Hewitt Jonathan , Kingsbury Stephen , Roberts Dave , Weitzel Heather
Published: October 2008

Background

Paracetamol is now the most common drug used for self-poisoning in the UK and is associated with potentially fatal liver damage. Patients admitted to hospital because of paracetamol overdoses were studied in order to determine their characteristics and factors which might have deterred them from taking paracetamol or reduced the dangers of the overdose.

Method

Eighty patients were studied in hospital using a structured interview schedule, measures of depression and suicidal intent, information collected through the Oxford Monitoring System for Attempted Suicide, and the results of liver function tests.

Results

Acute liver dysfunction (25 patients) was associated with consumption of more than 25 tablets (odds ratio 4.46, 95% CI 1.31 to 17.41, P = 0.014). The proportionate use of tablets from blister packs (60%) and loose preparations (46%; 5 patients using both types) reflected their general availability. More of those who took tablets from a loose preparation consumed 25 or more tablets (69%) than those who used a blister-pack preparation (40%; odds ratio = 3.0, 95% CI 1.12 to 9.95, P = 0.028). Only 20 patients thought that any type of warning label would have deterred them from taking a paracetamol overdose.

Conclusions

Establishing a maximum number of tablets (e.g. 25) that can be available in individual preparations is likely to reduce the dangers of paracetamol self-poisoning. The potential effects of other measures are uncertain.