bluuebunny/crossref_metadata_2025 huggingface dataset:
Protocol for assessing services for people with severe mental illness
Authors: Wing John , Rix Susannah , Curtis Roy H. , Lelliott Paul , Beadsmoore Alan
Published: October 2008

Background

The Clinical Standards Advisory Group was asked by UK health ministers to advise on the standards of clinical care being achieved for people with schizophrenia. A subcommittee commissioned a review of standards, followed by research into how far these were reflected in contracts and met by providers.

Method

No comprehensive but practical set of standards was found. A protocol of 143 items of good service practice was constructed, and applied by teams visiting services in 11 UK districts. The team appraisals were summarised in 20 key points, each scored 0 (absent) to 4 (excellent performance). Seven points were used to assess standards of commissioning and 13 for standards of service provision.

Results

When placed into rank order, the mean key point scores for commissioners and providers in the same district tended to be very similar. Total district scores were then used to assign districts to one of three groups. Four performed reasonably well, five were moderate and two were poor.

Conclusions

One of the key elements associated with these differences was the local level of morale. After wide consultation, a revised protocol of 26 key points for direct rating was drawn up and has since been further tested.
Epidemiology of recurrent major and minor depression with a seasonal pattern
Authors: Blazer Dan G. , Kessler Ronald C. , Swartz Marvin S.
Published: October 2008

Background

Previous estimates of the prevalence of seasonal affective disorder (SAD) in community samples have been in the range 2–10%, using methods not derived from DSM algorithms. We report the first community-based study to estimate major and minor depression with a seasonal pattern in a community-based sample using a diagnostic instrument derived from DSM–III–R.

Method

A modified version of the Composite International Diagnostic Interview was administered to 8098 subjects in the 48 coterminous states of the USA (the National Comorbidity Survey) to assess the prevalence of major and minor depression with a seasonal pattern.

Results

The lifetime prevalence of major depression with a seasonal pattern was 0.4%, and the prevalence of major or minor depression with a seasonal pattern was 1.0%. Among respondents with major depression, male gender and older age were associated with a higher prevalence with a seasonal pattern.

Conclusions

Prevalence estimates of major and minor depression with a seasonal pattern are much lower than those found in previous studies of SAD in the community probably due to the approach to diagnosis used in the present study which more accurately represents DSM–III–R criteria for major depression with a seasonal pattern. The distribution of the disorder is similar to that found in previous studies except for the higher prevalence among males.
Mental disorder and violence
Authors: Taylor Pamela J. , Leese Morven , Williams Deborah , Butwell Martin , Daly Rachel , Larkin Emmet
Published: October 2008

Background

From a first clinical description of a complete resident sample of special (high security) hospital patients, we examined the association between mental disorder and violence.

Method

A record survey of all 1740 patients resident at any time between 1 January and 30 June 1993. inclusive, and, for most, the official criminal record.

Results

1015 patients (58%) had functional psychosis, one-quarter of whom also had an independent personality disorder: 461 (26%)had personality disorders uncomplicated by psychosis, and 264 (16%) had learning disabilities. Pre-admission substance misuse, which was probably under-recorded, had been most common among those with psychosis and an independent personality disorder. Less than 10% had never been convicted of a criminal offence, although 25% had been admitted directly from other hospitals. Direct personal violence was more common among men, and fire-setting among women. Schizophrenia was most strongly associated with personal violence. More than 75% of those with a psychosis were recorded as being driven to offend by their delusions. In the absence of delusions, hallucinations had no such effect.

Conclusions

For people with personality disorder better clinical descriptions seem essential. For people with a pure psychosis, as symptoms were usually a factor driving the index offence, treatment appears as important for public safety as for personal health.
Sudden death in psychiatric patients
Authors: Ruschena David , Mullen Paul E. , Burgess Philip , Cordner Stephen , Barry-Walsh Justin , Drummer Olaf , Palmer Simon , Browne Chris , Wallace Cameron
Published: October 2008

Background

The present study investigated histories of prior psychiatric treatment in cases of sudden death reported to the coroner.

Methods

A matching survey linked the register of deaths reported to the coroner with a comprehensive statewide psychiatric case register covering both inpatient and community-based services.

Results

Sudden death was five times higher in people with histories of psychiatric contact. Suicide accounted for part of this excess mortality but deaths from natural causes and accidents were also elevated. Schizophrenic and affective disorders had similar suicide rates. Comorbid substance misuse doubled the risk of sudden death in affective and schizophrenic disorders.

Conclusions

The rates of sudden death are sufficiently elevated to raise questions about current priorities in mental health care. There is a need both for greater attention to suicide risk, most notably among young people with schizophrenia, to the early detection of cardiovascular disorders and to the vigorous management of comorbid substance misuse.
Long-term course of acute brief psychosis in a developing country setting
Authors: Susser Ezra , Varma Vijoy K. , Mattoo S. K. , Finnerty Molly , Mojtabai Ramin , Tripathi B. M. , Misra Arun K. , Wig N. N.
Published: October 2008

Background

This study in North India compared acute brief psychosis – defined by acute onset, brief duration and no early relapse – with other remitting psychoses, over a 12-year course and outcome.

Method

In a cohort of incident psychoses, we identified 20 cases of acute brief psychosis and a comparison group of 43 other remitting psychoses based on two-year follow-up. Seventeen people (85%) in the acute brief psychosis group and 36 (84%) in the comparison group were reassessed at five, seven and 12 years after onset, and were rediagnosed using ICD–10 criteria.

Results

At 12-year follow-up, the proportion with remaining signs of illness was 6% (n=1) for acute brief psychosis versus 50% (n=18) for the comparison group (P=0.002). Using ICD–10 criteria, the majority in both groups were diagnosed as having schizophrenia.

Conclusions

Acute brief psychosis has a distinctive and benign long-term course when compared with other remitting psychoses. This finding supports the ICD– 10 concept of a separable group of acute and transient psychotic disorders. To effectively separate this group, however, the ICD–10 criteria need modification.
Cocaine use, abuse and dependence in a population-based sample of female twins
Authors: Kendler Kenneth S. , Prescott Carol A.
Published: October 2008

Background

Although cocaine use in women has increased substantially over the past half-century, we understand little about the aetiology in women of cocaine use and abuse, and know almost nothing about the role of genetic factors.

Method

We obtained by telephone interview a history of lifetime cocaine use, abuse and dependence from 1934 individual twins from female–female pairs ascertained through a population-based registry, including both members of 485 monozygotic (MZ) and 335 dizygotic (DZ) pairs.

Results

The prevalence of lifetime cocaine use, abuse and dependence were 14.0%, 3.3% and 2.3%. Probandwise concordance rates, in MZ and DZ twins, respectively, were: cocaine use 54% and 42%; cocaine abuse 47% and 8% and cocaine dependence 35% and 0%. In MZ and DZ twins, odds ratios were: cocaine use 14.2 and 6.7 and cocaine abuse 40.8 and 2.7. Biometrical model-fitting suggested that twin resemblance for liability to cocaine use was due to both genetic and familial–environmental factors while twin resemblance for cocaine abuse and symptoms of dependence was due solely to genetic factors. Estimated heritabilities were: cocaine use 0.39, cocaine abuse 0.79 and symptoms of dependence 0.65.

Conclusions

The vulnerability to cocaine use and particularly cocaine abuse and dependence in women is substantially influenced by genetic factors.
From efficacy to effectiveness in community mental health services
Authors: Thornicroft Graham , Wykes Til , Holloway Frank , Johnson Sonia , Szmuckler George
Published: October 2008

Background

The PRiSM Psychosis Study investigated the outcomes of community mental health services for epidemiologically representative cases of psychosis in London.

Method

The results presented in the preceding nine papers are interpreted.

Results

(a) The health and social gains reported in experimental studies of community health services are replicable in ordinary clinical settings, and are more effective than hospital-oriented services which they replace, (b) Dilution does occur - these gains are less pronounced than in experimental (efficacy) studies, (c) Both models of community services produced a range of improved outcomes, (d) Some limited extra advantages (in terms of met needs, improved quality of life, and social networks) were found in the intensive sector, (e) There is no consistent evidence that community-oriented services (which include in-patient beds) fail service users, their families or the wider public. On balance the results weigh slightly in favour of the two-team model (for acute and continuing care) in terms of clinical effectiveness, but the general model is almost as effective and is less expensive.

Conclusions

The evidence supports a community-oriented rather than a hospital-oriented approach and there is little difference between the community mental health team models.
Chronic mania
Authors: Perugi Giulio , Akiskal Hagop S. , Rossi Luciano , Paiano Antonic , Quilici Cinzia , Madaro Donato , Musetti Laura , Cassano Giovanni B.
Published: October 2008

Background

Mania with chronic course has been overlooked in the recent literature. Our aim was clinically to characterise and validate this form of mania.

Method

We evaluated 155 people with DSM–III–R mania and assessed their family history, temperament, symptomatology and course. We used a semi-structured interview for mood disorders, as well as the Comprehensive Psychopathological Rating Scale and the Scale for the Assessment of Positive Symptoms.

Results

Twenty (13%) had a chronic course arising from a background of hyperthymic temperament and recurrent mania, with a deteriorative pattern. Clinically, they were characterised by a significantly high rate of almost constant euphoria, grandiose delusions and related delusions, but had relatively low rates of sleep disturbance, psychomotor agitation and hypersexuality.

Conclusion

Even with current therapies a significant number of people with bipolar disorders have a deteriorative outcome associated with the gradual disappearance of acute mania with an increase in mregalomanic delusions, alienation from loved ones and decreased likelihood of medical and psychiatric care.
Consensus criteria for traumatic grief
Authors: Prigerson Holly G. , Shear M. Katherine , Jacobs Selby C. , Reynolds Charles F. , Maciejewski Paul K. , Davidson Jonathan R. T. , Rosenheck Robert , Pilkonis Paul A. , Wortman Camille B. , Williams Janet B. W. , Widiger Thomas A. , Frank Ellen , Kupfer David J. , Zisook Sidney
Published: October 2008

Background

Studies suggest that symptoms of traumatic grief constitute a distinct syndrome worthy of diagnosis.

Aims

A consensus conference aimed to develop and test a criteria set for traumatic grief.

Method

The expert panel proposed consensus criteria for traumatic grief. Receiver operator characteristic (ROC) analyses tested the performance of the proposed criteria on 306 widowed respondents at seven months post-loss.

Results

ROC analyses indicated that three of four separation distress symptoms (e.g. yearning, searching, loneliness) had to be endorsed as at least ‘sometimes true’ and four of the final eight traumatic distress symptoms (e.g. numbness, disbelief, distrust, anger, sense of futility about the future) had to be endorsed as at least ‘mostly true’ to yield a sensitivity of 0.93 and a specificity of 0.93 for a diagnosis of traumatic grief.

Conclusions

Preliminary analyses suggest the consensus criteria for traumatic grief have satisfactory operating characteristics, and point to directions for further refinement of the criteria set.
Cantabria First-Episode Schizophrenia Study: three-year follow-up
Authors: Vázquez-Barquero José L. , Cuesta Maria J. , Castanedo Sara Herrera , Lastra Ismael , Herrán Andrés , Dunn Graham
Published: October 2008

Background

We present the findings from the three-year follow-up of all first episodes of schizophrenia occurring during a two-year period in Cantabria (in Spain).

Aims

(a) To describe the clinical characteristics of the illness from the early stages of the disease, and (b) to study the long-term psychosocial adjustment and psychopathological evolution of these patients, identifying predictors for the course of the illness.

Method

Of the original cohort of 86 patients, 76 (88.3%) were fully evaluated at three-year follow-up. Psychiatric assessment was performed (PSE–9 and SANS/SAPS). Social adjustment was evaluated using the Disability Assessment Schedule (DAS). Information regarding the clinical evolution and use of health resources was also gathered.

Results

The majority of patients with a first-contact diagnosis of schizophrenia failed to meet the criteria for a CATEGO diagnosis at follow-up. The SANS/SAPS assessments revealed a doubling in the proportion of patients with ‘negative schizophrenia’. The pattern of clinical course was also evaluated, with 24 (31.5%) of the patients having a good outcome. Being male and having low social class tended to be associated with poor clinical outcome.

Conclusions

The outcome of schizophrenia is less pessimistic than was originally thought.
Befriending as an intervention for chronic depression among women in an inner city
Authors: Harris Tirril , Brown George W , Robinson Ruth
Published: October 2008

Background

Volunteer befriending promoted remission of chronic depression when clinical and other treatment variables were controlled.

Aims

To examine the role of other psychosocial factors relevant for outcome.

Method

Factors measured at baseline interview were examined in multivariate analyses along with psychosocial factors occurring during follow-up, such as ‘fresh-start’ experiences and new severe events and difficulties.

Results

Fresh-start experiences and a standard attachment style were found to enhance chances of remission, with new severe stressors and markedly poor coping strategies liable to prevent it, with volunteer befriending continuing to play a role.

Conclusions

The positive result reported in the preceding paper is unlikely to be an artefact. However, fresh-start experiences, absence of new severe stressors and standard attachment style were more important predictors of remission. This knowledge might profitably be incorporated into the evaluation of existing treatments.
Serious sex offending against women by men with schizophrenia
Authors: Smith Alan D. , Taylor Pamela J.
Published: October 2008

Background

Little is known about men who commit sex offences in the context of psychosis.

Aims

To examine the relationship of illness and psychotic symptoms to sex offending in men with schizophrenia.

Method

A search of Home Office records was completed for all 84 male restricted hospital order in-patients with schizophrenia, resident in any hospital in England and Wales during May 1997, with an index conviction for a contact sex offence against a woman.

Results

At the time of their index offences 80 men were psychotic and half of them had delusions or hallucinations related to the offences. Specific delusional or hallucinatory drive was pertinent in only 18 men but the majority of men committed their first sex offence after onset of schizophrenia. Exclusive sex offending was uncommon.

Conclusions

When a man with schizophrenia commits a serious sex offence the illness is, more commonly than not, relevant to that offence even though a direct symptom relationship may be relatively unusual.
Diagnostic significance of Schneider's first-rank symptoms in schizophrenia
Authors: Peralta Victor , Cuesta Manuel J.
Published: October 2008

Background

Despite the lack of consistent empirical support, modern diagnostic criteria of schizophrenia give particular emphasis to Schneider's first-rank symptoms (FRSs).

Aims

To examine the diagnostic significance of FRSs for schizophrenia by trying to overcome the limitations of previous studies.

Methods

This study examined the diagnostic accuracy of FRSs for schizophrenia in 660 in-patients with the full spectrum of functional psychotic disorders. Schizophrenia was diagnosed according to three criteria: DSM–III–R broad, DSM–III–R narrow and Feighner, the latter being considered as the gold standard because it does not give particular emphasis to FRSs.

Results

FRSs were highly prevalent in both schizophrenia and non-schizophrenic psychoses. The likelihood ratios (and 95% Cl) of one or more FRSs for Feighner, DSM–III–R narrow and DSM–III–R broad schizophrenia were 1.06 (0.94–1.20), 1.23 (1.09–1.39) and 1.73 (1.44–2.08), respectively. These data indicate that FRSs do not significantly increase the likelihood of having schizophrenia.

Conclusions

FRSs are not useful in differentiating schizophrenia from other psychotic disorders. Diagnostic systems for schizophrenia that are heavily based on these symptoms may arise from a tautological definition of the disorder.
Motor seizure monitoring during electroconvulsive therapy
Authors: Mayur Prashanth M. , Gangadhar B. N. , Janakiramaiah N. , Subbakrishna D. K.
Published: October 2008

Background

The occurrence of a seizure during electroconvulsive therapy (ECT) should be confirmed. Most clinicians use motor seizure monitoring alone and recent guidelines have not considered electroencephalogram (EEG) monitoring mandatory.

Aims

To examine the potential pitfalls of motor seizure monitoring.

Method

Consenting consecutive patients (n=232) were prospectively studied at the first ECT session using both motor and EEG seizure monitoring. It was ensured (by titration) that all the patients had an adequate EEG seizure. Adequate and prolonged seizures were defined according to the latest recommendations of the Royal College of Psychiatrists.

Results

Motor seizure was inadequate in 15 (7%) of patients. EEG seizure was prolonged in 38 (16%) of patients. Fifteen patients (39%) did not have a prolonged motor seizure. Motor seizure correlated well (r=0.8, P < 0.001) with EEG seizure when the latter was adequate, but not when prolonged (r=0.12, P > 0.5).

Conclusions

Motor seizure monitoring without EEG is undependable. The study provides a rational basis for the Royal College of Psychiatrists' definition of prolonged EEG seizure.
‘Subthreshold’ mental disorders
Authors: Pincus Harold Alan , Davis Wendy Wakefield , McQueen Laurie E.
Published: October 2008

Background

Subthreshold conditions (i. e. not meeting full diagnostic criteria for mental disorders in DSM–IV or ICD–10) are prevalent and associated with significant costs and disability. Observed more in primary care and community populations than in speciality settings, varying conceptualisations have been applied to define these conditions.

Aims

To examine definitional issues for subthreshold forms of depression (e. g. minor depression) and to suggest future directions for research and nosology in psychiatry and primary care.

Method

A Medline search was conducted. The relevant articles were reviewed with regard to specific categories of information.

Results

Studies applied a myriad of names and definitions for subthreshold depression with varying duration, symptom thresholds and exclusions. Prevalence rates also vary depending upon the definitions, settings and populations researched.

Conclusions

Future research needs to apply methodological and intellectual rigour and systematically consider a broader clinical and nosological context. In addition, collaboration between psychiatry and primary care on research and clinical issues is needed.
Routine clinical outcome measures for patients with severe mental illness: CANSAS and HoNOS
Authors: Slade Mike , Beck Andrew , Bindman Jonathan , Thornicroft Graham , Wright Steve
Published: October 2008

Background

Two recently developed measures intended for clinical use are HoNOS (Health of the Nation Outcome Scales), measuring social functioning, and CANSAS (Camberwell Assessment of Need Short Appraisal Schedule), for measuring need.

Aims

We investigated the association between CANSAS and HoNOS.

Results

For some domains there were substantial associations, with high HoNOS rating correlated with CANSAS rating of the presence of a need. For other areas the agreement was less than might be expected. Seven factors were identified within the 22 CANSAS domains, and the presence of needs in the Drug/alcohol and Activities of daily living factors was associated with high scores in the related HoNOS domains.

Conclusions

CANSAS and HoNOS assessments differ. HoNOS can track changes in social functioning over time, but may be less useful for treatment planning, and should not be used to infer the level of morbidity in a case-load. CANSAS indicates when treatment should be commenced or continued. It can also be used as a case-load measure, but may be insufficiently sensitive to be used as an outcome measure at the individual level.
Reduction of the parahippocampal gyrus and the hippocampus in patients with chronic schizophrenia
Authors: Razi Kamran , Greene Kimberly P. , Sakuma Michael , Ge Shuming , Kushner Maureen , Delisi Lynn E.
Published: October 2008

Background

There have been many studies reporting reduced volume of the hippocampus or other limbic structures in patients with schizophrenia, but the literature is inconsistent.

Aims

To compare patients with either first-episode or chronic schizophrenia with controls using high-resolution volumetric magnetic resonance imaging (MRI) scans.

Method

Thirteen patients with first-episode schizophrenia, 27 with chronic schizophrenia and 31 controls had 1.5 mm coronal slices taken through the whole brain using a spoiled-grass MRI acquisition protocol.

Results

The parahippocampal gyrus was reduced significantly on the left side in patients with chronic schizophrenia compared with controls for both male and female patients, whereas the hippocampus was reduced significantly on both sides only in female patients. There were no significant reductions in any structure between patients with first-episode schizophrenia and controls.

Conclusions

Volumetric reduction seen in patients with chronic schizophrenia may be due to an active degenerative process occurring after the onset of illness.
Outcome of psychosis in people of African–Caribbean family origin
Authors: Harrison Glynn , Amin Shazad , Singh Swaran P. , Croudace Tim , Jones Peter
Published: October 2008

Background

An increased incidence of psychotic disorders has repeatedly been reported among African–Caribbeans in the UK.

Aims

To test whether the increased incidence of psychotic disorders in first-and second-generation African–Caribbeans in the UK could be caused by a relative excess of affective-related psychoses with good prognosis.

Method

Thirty-three patients of African–Caribbean family origin identified in a population-based study of first-episode psychoses were compared with the remaining cases. Three-year outcomes and patterns of course were compared.

Results

There was a trend for better outcomes in African–Caribbean patients for symptoms and social disability, but patterns of course were similar (odds ratio=0.9 (–0.50 to –2.00)). Pattern of course improved after adjustment for confounding by gender, social class, age, diagnosis and duration of untreated illness (odds ratio=0.59 (–0.21 to –1.66)). Diagnostic profiles were similar, with no evidence of greater diagnostic instability in the African–Caribbean group.

Conclusion

Pattern of course of psychosis did not differ significantly by ethnic family background. An excess of good-prognosis affective psychoses is an unlikely explanation for increased rates of psychosis in African–Caribbeans.
British psychiatry and homosexuality
Authors: King Michael , Bartlett Annie
Published: October 2008

Background

Opposition to homosexuality in Europe reached a crescendo in the 19th century. What had earlier been regarded as a vice evolved as a perversion or psychological illness. Official reviews of homosexuality as both an illness and (for men) a crime led to discrimination, inhumane treatments and shame, guilt and fear for gay men and lesbians. Only recently has homosexuality been removed from all international diagnostic glossaries.

Aims

To review how British psychiatry has regarded homosexuality over the past century.

Method

Review of key publications on homosexuality in British psychiatry.

Results

The literature on homosexuality reflects evolving theories on sexuality over the past century. The assumptions in psychoanalysis and the behavioural sciences that sexuality could be altered led to unscientific theory and practice.

Conclusions

Mental health professionals in Britain should be aware of the mistakes of the past. Only in that way can we prevent future excesses and heal the gulf between gay and lesbian patients and their psychiatrists.
Paroxetine in social phobia/social anxiety disorder
Authors: Baldwin David , Bobes Julio , Stein Dan J. , Scharwächter Ingebor , Faure Michel
Published: October 2008

Background

Preliminary studies have suggested that paroxetine may be effective in social phobia/social anxiety disorder.

Aims

To assess the efficacy and tolerability of paroxetine in the acute (12-week) treatment of social phobia.

Method

Two-hundred and ninety patients with social phobia were assigned randomly to paroxetine (20–50 mg/day flexible dose) or placebo for 12 weeks of double-blind treatment. Primary efficacy outcomes were the Liebowitz Social Anxiety Scale (LSAS) total score (patient-rated) and the Clinical Global Impression (GGI) scale global improvement item. The secondary efficacy variables included CGI scale severity of illness score and the patient-rated Social Avoidance and Distress Scale.

Results

Paroxetine produced a significantly greater reduction in LSAS total score (mean change from baseline: –29.4 v. –15.6; P 0.001) and a greater proportion of responders (score $2 on CGI global improvement) (65.7% v. 32.4%; P < 0.001) compared with placebo at the end of the 12-week study period. Both primary efficacy variables were statistically significant compared with placebo from week 4 onwards. Paroxetine was generally well tolerated.

Conclusions

Paroxetine is an effective, well-tolerated treatment for patients with social phobia.
Prevalence and characteristics of patients with severe mental illness and borderline intellectual functioning
Authors: Hassiotis Angela , Ukoumunne Obioha , Tyrer Peter , Piachaud Jack , Gilvarry Catherine , Harvey Kate , Fraser Janelle
Published: October 2008

Background

Low cognitive ability and developmental delays have been implicated in the causation of mental illness.

Aims

To examine the prevalence, socio-demographic characteristics, psychopathology and social functioning profiles of people with low intelligence and recurrent psychotic illness.

Method

A multi-centre randomised controlled trial of case management provided the opportunity to explore associations between mental illness and borderline intellectual functioning (assessed using the National Adult Reading Test)

Results

Overall prevalence of borderline intelligence was 18%. Significant positive associations were shown with: being Black Caribbean; having a father who worked in a manual occupation; lower educational achievement; having had special education; longer course of illness. Those with borderline intelligence had greater disability and were more likely to suffer extrapyramidal side-effects and show evidence of negative symptoms. Educational achievement, history of special education and social class were the best socio-demographic predictors of intellectual level.

Conclusions

Many patients who attend generic psychiatric services have considerable intellectual deficits. This may lead to difficulties in other domains of adaptive functioning, and merits further investigation as well as clinical vigilance.
Characteristics, context and consequences of memory recovery among adults in therapy
Authors: Andrews Bernice , Brewin Chris R. , Ochera Jennifer , Morton John , Bekerian Debra A. , Davies Graham M. , Mollon Phil
Published: October 2008

Background

There are concerns that memories recovered during therapy are likely to be the result of inappropriate therapeutic techniques.

Aims

To investigate systematically these concerns.

Method

One-hundred and eight therapists provided information on all clients with recovered memories seen in the past three years, and were interviewed in detail on up to three such clients.

Results

Of a total of 690 clients, therapists reported that 65% recalled child sexual abuse and 35% recalled other traumas, 32% started recovering memories before entering therapy According to therapists' accounts, among the 236 detailed client cases very few appeared improbable and corroboration was reported in 41%. Techniques to aid recall were used in 42%, but only in 22% were they used before memory recovery started.

Conclusions

Some of the data are consistent with memories being of iatrogenic origin, but other data clearly point to the need for additional explanations.
Case register study of suicide risk in mental disorders
Authors: Baxter David , Appleby Louis
Published: October 2008

Background

There have been few large-scale studies of long-term suicide risk in mental disorders in the UK.

Aims

To estimate the long-term risk of suicide in psychiatric patients.

Method

A sample of 7921 individuals was identified from the Salford Psychiatric Case Register. Mortality by suicide or undetermined external cause during a follow-up period of up to 18 years was determined using the NHS Central Register; suicide risks were estimated as rate ratios.

Results

Suicide risk was increased more than ten-fold in both genders: the rate ratio for males was 11.4; for females it was 13.7. The risk was highest in young patients, but high risk continued into late life. The diagnoses with the highest risk were schizophrenia, affective disorders, personality disorder and (in males) substance dependence. Risk was also associated with recent initial contact and number of admissions but not comorbidity.

Conclusions

The suicide risks estimated in this study are generally higher than those previously reported, notably in schizophrenia and personality disorder, and in previous in-patients. Patients with these high-risk diagnoses, an onset of illness within the previous 1–3 years, or more than one previous admission should be regarded as priority groups for suicide prevention by mental health services.
Sensorimotor and cognitive development of infants of mothers with schizophrenia
Authors: Yoshida K. , Marks M. N. , Craggs M. , Smith B. , Kumar R.
Published: October 2008

Background

The parenting environment provided by mothers with schizophrenia is likely to contribute to the cognitive impairment observed in their offspring.

Aims

To assess the relative contribution of maternal schizophrenia, obstetric factors and mothers' lifestyle to the cognitive development of infants in their first year.

Method

The Bayley Scales of Infant Development were administered to 19 infants of mothers with schizophrenia, 34 with non-psychotic depression in the mother, 29 with affective psychosis in the mother and 24 normal controls when the babies were two and seven months of age.

Results

At two months, infants of mothers with schizophrenia and of those with affective psychosis had lower mental development index (MDI) scores than controls. At seven months, infants of mothers with schizophrenia had lower MDI scores than all other groups. When infant birth weight and mothers' social class were taken into account there was no effect of maternal schizophrenia on infants' MDI scores.

Conclusions

Infants of mothers with schizophrenia are likely to have impaired cognitive development. This may be due in part to environmental factors such as the mother's lifestyle.
Undifferentiated dementia, Alzheimer's disease and vascular dementia: Age- and gender-related incidence in Liverpool
Authors: Copeland J. R. M. , McCracken Cherie , Dewey M. E. , Wilson K. C. M. , Doran Mark , Gilmore Chris , Scott Anne , Larkin Bernie
Published: October 2008

Background

Does incidence of dementia follow the age pattern of prevalence? Is gender a risk factor? Do patterns of incidence differ between dementias?

Aims

To assess age-specific incidence rates of undifferentiated dementias, Alzheimer's disease and vascular dementia.

Method

5222 individuals aged $65 years, were interviewed using the Geriatric Mental State/History and Aetiology Schedule. The AGECAT package was used to identify cases at three interviewing waves at two-year intervals. Diagnoses were made using ICD −10 Research Criteria and validated against neurological and psychological examination, with imaging and neuropathology on unselected subsamples.

Results

Incidence rates of the dementias increase with age. Age patterns are similar between Alzheimer's disease and vascular dementia. Gender appears influential in Alzheimer's disease. In England and Wales, 39 437 new cases of Alzheimer's disease (4.9/1000 person-years at risk); 20 513 of vascular dementia (2.6/1000 person-years) and 155 169 of undifferentiated dementia (19/1000 person-years) can be expected each year.

Conclusions

Incidence rates for Alzheimer's disease and vascular dementia appear to behave differently with an increased risk of Alzheimer's disease for women compared to vascular dementia.
Assessment of the Accuracy of the Gail Model in Women With Atypical Hyperplasia
Authors: Pankratz V. Shane , Hartmann Lynn C. , Degnim Amy C. , Vierkant Robert A. , Ghosh Karthik , Vachon Celine M. , Frost Marlene H. , Maloney Shaun D. , Reynolds Carol , Boughey Judy C.
Published: October 2008

Purpose

An accurate estimate of a woman's breast cancer risk is essential for optimal patient counseling and management. Women with biopsy-confirmed atypical hyperplasia of the breast (atypia) are at high risk for breast cancer. The Gail model is widely used in these women, but has not been validated in them.

Patients and Methods

Women with atypia were identified from the Mayo Benign Breast Disease (BBD) cohort (1967 to 1991). Their risk factors for breast cancer were obtained, and the Gail model was used to predict 5-year–and follow-up–specific risks for each woman. The predicted and observed numbers of breast cancers were compared, and the concordance between individual risk levels and outcomes was computed.

Results

Of the 9,376 women in the BBD cohort, 331 women had atypia (3.5%). At a mean follow-up of 13.7 years, 58 of 331 (17.5%) patients had developed invasive breast cancer, 1.66 times more than the 34.9 predicted by the Gail model (95% CI, 1.29 to 2.15; P < .001). For individual women, the concordance between predicted and observed outcomes was low, with a concordance statistic of 0.50 (95% CI, 0.44 to 0.55).

Conclusion

The Gail model significantly underestimates the risk of breast cancer in women with atypia. Its ability to discriminate women with atypia into those who did and did not develop breast cancer is limited. Health care professionals should be cautious when using the Gail model to counsel individual patients with atypia.
Roles of Radiotherapy and Chemotherapy in the Development of Contralateral Breast Cancer
Authors: Hooning Maartje J. , Aleman Berthe M.P. , Hauptmann Michael , Baaijens Margreet H.A. , Klijn Jan G.M. , Noyon Ruth , Stovall Marilyn , van Leeuwen Flora E.
Published: October 2008

Purpose

Few studies have examined whether modern radiotherapy and chemotherapy affect the risk of contralateral breast cancer (CBC), and results are inconclusive.

Patients and Methods

We assessed long-term risk of CBC in a predominantly young breast cancer (BC) population (n = 7,221), focusing on the effects of radiation dose, chemotherapy, and family history of BC. Risk of CBC was evaluated using Cox proportional hazards regression models.

Results

Radiotherapy-associated risk of CBC increased with decreasing age at first treatment (age < 35 years, hazard ratio [HR] = 1.78; 95% CI, 0.85 to 3.72; age > 45 years, HR = 1.09; 95% CI, 0.82 to 1.45). Postmastectomy radiotherapy using direct electron fields led to a significantly lower radiation exposure to the contralateral breast than postlumpectomy radiotherapy using tangential fields. Women treated before age 45 years with postlumpectomy radiotherapy experienced 1.5-fold increased risk of CBC compared with those who had postmastectomy radiotherapy. The joint effects of postlumpectomy radiotherapy and strong family history for BC on risk of CBC were greater than expected when individual risks were summed (HR = 3.52; 95% CI, 2.07 to 6.02; Pdeparture from additivity = .043). Treatment with adjuvant chemotherapy (cyclophosphamide, methotrexate, and fluorouracil) was associated with a nonsignificantly decreased risk of CBC in the first 5 years of follow-up but did not reduce CBC risk in subsequent years.

Conclusion

Young patients with BC irradiated with breast tangentials experience increased risk of CBC, especially in those with a positive family history of BC. This finding should be taken into account when advising breast radiation with tangential fields to young patients with BC. Adjuvant chemotherapy seemed to reduce the risk of CBC during the first 5 years after treatment only.
Bevacizumab Beyond First Progression Is Associated With Prolonged Overall Survival in Metastatic Colorectal Cancer: Results From a Large Observational Cohort Study (BRiTE)
Authors: Grothey Axel , Sugrue Mary M. , Purdie David M. , Dong Wei , Sargent Daniel , Hedrick Eric , Kozloff Mark
Published: October 2008

Purpose

Bevacizumab provides a survival benefit in first- and second-line metastatic colorectal cancer (mCRC). In a large, observational, bevacizumab treatment study (Bevacizumab Regimens: Investigation of Treatment Effects and Safety [BRiTE]) in patients who had mCRC, a longer-than-expected overall survival (OS) of 25.1 months was reported. The association between various pre- and post-treatment factors (including the use of bevacizumab beyond first progression [BBP]) and survival was examined.

Patients and Methods

The 1,445 of 1,953 previously untreated patients with mCRC who were enrolled in BRiTE and who experienced disease progression (PD) were classified into three groups: no post-PD treatment (n = 253), post-PD treatment without bevacizumab (no BBP; n = 531), and BBP (n = 642). Relevant baseline and on-study variables, including BBP, were analyzed with a Cox model with respect to their independent effect on survival beyond first PD.

Results

Median OS was 25.1 months (95% CI, 23.4 to 27.5 months), and median progression-free survival was 10.0 months in the overall BRiTE population. Baseline and postbaseline factors were well balanced between the BBP and no-BBP groups. Median OS rates were 12.6, 19.9, and 31.8 months in the no post-PD treatment, no-BBP, and BBP groups, respectively. In multivariate analyses, compared with no BBP, BBP was strongly and independently associated with improved survival (HR, 0.48; P < .001). Hypertension that required medication was the only bevacizumab-related safety event that occurred more frequently in the BBP group (24.6% v 19.2%).

Conclusion

These results from a large, prospective, observational study suggest that continued vascular endothelial growth factor inhibition with bevacizumab beyond initial PD could play an important role improving the overall success of therapy for patients who have mCRC.
Designing mobile dietary management support technologies for people with diabetes
Authors: Årsand Eirik , Tufano James T , Ralston James D , Hjortdahl Per
Published: October 2008

We performed two cycles of laboratory-based usability testing of three food registration prototypes for people with diabetes. The design concepts were a commercial web application, various smartphones and a mobile phone photo blogging approach. Six adults with Type 1 diabetes and three adults with Type 2 diabetes participated in the usability tests. The results provided five distinct implications for devices for the future dietary management support of people with diabetes. Study participants valued many of the features offered by the three systems that were tested, although the usability tests also revealed several opportunities to enhance their design. Our findings suggest that further development is justified of mobile dietary and nutritional support for individuals living with diabetes. Applications that support healthy eating habits should be integrated with applications for managing blood glucose data and physical activity data, and potentially medication data as well.
Validation of an automatic tool for the assessment of image quality in digital tele-echocardiography
Authors: Giansanti Daniele , Giordano Andrea , Morelli Sandra
Published: October 2008

We investigated a novel tool for assessing image degradation in tele-echocardiography. Different video recordings from an echocardiographic examination were transmitted using commercial videoconferencing equipment via a local area network. Different compression schemes were selected, ranging from MPEG 1 to MPEG 4, with transmission at different bit rates ranging from 1.0 to 4.5 Mbit/s. Three methods were used to compare the transmitted and received video sequences: the peak signal to noise ratio, the Double Stimulus Impairment Scale (DSIS) and the National Telecommunication and Information Administration Virtual Quality Metric (VQM). The results showed that the most useful grading procedure was the subjective DSIS. There was a high correlation between the DSIS results and the VQM. The VQM could be thus an effective tool for evaluating tele-echocardiography transmission systems, avoiding the costs and times associated with conducting subjective tests in repeatable conditions.
A home-care system for the telemonitoring and telerehabilitation of the hand incorporating interactive biofeedback
Authors: Morelli Sandra , Maccioni Giovanni , Lanzetta Marco , Macellari Velio , Giansanti Daniele
Published: October 2008

We have designed and constructed force measurement equipment to assess hand–finger function in pressing tasks. The equipment was used for monitoring the follow-up of five hand-transplanted subjects. Interactive software was integrated into the instrument to monitor the functionality of the hand and fingers during exercises in realtime. The interactive software included biofeedback to provide realtime quantitative responses for the patient and the therapist. Acceptance of the system was investigated with patients and therapists: the system was found to be user-friendly and effective; it was practical both for patients and therapists. The system could be used in a telerehabilitation centre or in a patient's home.
Teleconsultation – collaborative work and opportunities for learning across organizational boundaries
Authors: Nilsen Line Lundvoll , Moen Anne
Published: October 2008

Over a period of five months we observed teleconsultations between general practitioners (GPs) in community care and specialists in hospitals in two Norwegian health regions (A and B). In total, 47 teleconsultations between GPs and specialists were recorded. In region A, teleconsultations were organized when needed to discuss specific medical problems. In region B, teleconsultations took place during the specialists' daily morning meeting. The teleconsultations lasted for 5–40 min. There were three categories of talk. In the first two there was information exchange for patient updates and practical organization of the service. The third category, consultation, was the communicative process in which the GP and the specialist engaged in collaborative work, primarily discussing medical problems related to decision-making in patient care. Regular use of teleconsultation opens access to different repertoires of knowledge and experience, and brings knowledge to the point of patient care and medical decision-making.
A prototype home robot with an ambient facial interface to improve drug compliance
Authors: Takacs Barnabas , Hanak David
Published: October 2008

We have developed a prototype home robot to improve drug compliance. The robot is a small mobile device, capable of autonomous behaviour, as well as remotely controlled operation via a wireless datalink. The robot is capable of face detection and also has a display screen to provide facial feedback to help motivate patients and thus increase their level of compliance. An RFID reader can identify tags attached to different objects, such as bottles, for fluid intake monitoring. A tablet dispenser allows drug compliance monitoring. Despite some limitations, experience with the prototype suggests that simple and low-cost robots may soon become feasible for care of people living alone or in isolation.
Secondary student motivation orientations and standards‐based achievement outcomes
Authors: Meyer Luanna H. , McClure John , Walkey Frank , Weir Kirsty F. , McKenzie Lynanne
Published: October 2008

BackgroundIndividual student characteristics such as competence motivation, achievement values, and goal orientations have been related in meaningful ways to task attainment. The standards‐based National Certificate of Educational Achievement (NCEA) was developed in New Zealand with the intention of strengthening connections between student learning behaviours and achievement outcomes.

AimThis study investigates interrelationships between self‐reported motivation orientations and achievement outcomes on the NCEA, a standards‐based, criterion‐referenced assessment system for senior secondary students.

SampleParticipants were 3,569 Year 11–Year 13 students at 20 nationally representative secondary schools in New Zealand.

MethodSurvey data were factor analysed followed by regression analyses to examine relationships across demographic factors, self‐report survey results, and NCEA achievement outcomes.

ResultsSeveral theoretically meaningful self‐reported motivation orientations were strongly related to actual achievement includingdoing my best(high achievement) anddoing just enough(low achievement). These dimensions varied by gender, ethnicity, and school zone decile.

ConclusionsThese findings illustrate how particular design features of a standards‐based assessment system relate to student attitudes and achievement. They also highlight the need for longitudinal research to investigate patterns over time as well as the possible impact of interventions to alter motivation and/or academic task performance.