bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of hospitalisation on the outcome of adolescent anorexia nervosa
Authors: Gowers S. G. , An J. Weetm , Shore A. , Hossain F. , Elvins R.
Published: August 2002

Background

Owing to the lack of controlled trials of treatment setting in adolescent anorexia nervosa, the benefits and costs of in-patient treatment are not established.

Aims

To clarify the relationship between a range of presenting features, treatment received and medium- to long-term outcome in adolescent anorexia nervosa.

Method

A range of presenting variables were rated for 75 cases of DSM – III – R anorexia nervosa at presentation to an adolescent service, including the Morgan–Russell Global Assessment Score. Cases were followed up at 2–7 years and outcome rated according to reliable methods. Setting of treatment received was also recorded.

Results

Two out of 75 cases had died by the time of follow-up. Adequate data for 72 enabled an outcome category to be assigned. The 21 who had received in-patient treatment had a significantly worse outcome than the 51 never admitted to hospital. Multivariate analysis suggests admission to be the major predictor of poor outcome.

Conclusions

The benefits and costs of admission to hospital require further investigation, ideally in a randomised-controlled trial. The negative consequences of in-patient treatment are neglected in research.
First-episode major depression in adolescents
Authors: Goodyer I. M. , Herbert J. , Tamplin A. , Altham P. M. E.
Published: August 2002

Background

There is little information on whether patterns of steroids precede and are associated with depressive onset.

Aims

To establish whether there is an association between salivary cortisol and/or dihydroepiandrosterone (DHEA) levels and depression independent of psychosocial risk.

Method

Two subgroups of adolescents in the community at high (n=181) and low (n=65) risk for psychopathology were interviewed for recent psychiatric disorder at entry and again at 12 months. Salivary samples (08.00 and 20.00 h) for hormone estimations and self-reports on current mood and cognitive style were obtained at both assessments.

Results

Neither hormone was associated with risk status, current mood or cognitive style at entry. Of 31 onsets of major depression that occurred over the next 12 months, 30 came from the high-risk group but were not associated with any particular pattern of risk. Increased negative mood and feelings and DHEA (08.00 h) hypersecretion at entry were associated with subsequent major depression.

Conclusions

Both negative mood and feelings and alterations in adrenal steroid function precede the onset of first-episode major depression in adolescents. Variation in levels of hormones may arise from more distal origins than recent life events and current ongoing difficulties.
Cardiff Depression Study
Authors: Farmer Anne , Harris Tanya , Redman Kate , Sadler Stephanie , Mahmood Arshad , McGuffin Peter
Published: August 2002

Background

An excess of both depression and undesirable life events in first-degree relatives of probands with depression as compared with controls has been reported. This association may have reflected a familial factor in common.

Aims

To examine the familiality of life events and depression and whether there may be a common familial factor influencing vulnerability to depression and the experiencing of life events.

Method

In a sib-pairdesign, 108 probands with depression and their siblings were compared with 105 healthy controls and their siblings for psychopathology and life events.

Results

The lifetime relative risk of depressive disorder in the siblings of depressed subjects as compared with siblings of controls was 9.74, although these groups did not differ in the life events measures. Several categories of events showed significant sibling correlations, but this was due to the same event affecting both members of the pair.

Conclusions

Although depressive disorder was strongly familial, the familial effects on life events were largely explained by shared experiences. There was no evidence for a common factor influencing both depression and life events.
Familial influence on variation in age of onset and behavioural phenotype in Alzheimer's disease
Authors: Tunstall Nigel , Owen Michael J. , Williams Julie , Rice Frances , Carty Stephanie , Lillystone Sara , Fraser Lindsay , Kehoe Patrick , Neill David , Rudrasingham Varuni , Sham Pak , Lovestone Simon
Published: August 2002

Background

Alzheimer's disease manifests considerable heterogeneity, the cause of which is unknown.

Aims

To determine the familial (genotypic) influence on phenomenology (phenotype) in Alzheimer's disease.

Method

Affected sibling pairs with Alzheimer's disease were assessed for a range of cognitive and non-cognitive symptoms. Resemblance for phenotypic characteristics was estimated using intraclass correlations for continuous traits and by pairwise concordance for dichotomous traits. The relationship between age of onset and APOE genotype was examined using linear regression analysis.

Results

Significant familial effects on age of onset (intraclass correlation 0.41) and mood state (intraclass correlation 0.26), and a relatively high pairwise concordance for agitation (excess concordance 0.1) were found. The APOE locus was found to account for 4% of the variance in age of onset.

Conclusions

Substantial familial influence on age of onset, depression and agitation suggests that genotype does influence phenotype in Alzheimer's disease. Establishing the molecular basis for this phenotypic variation may prove relevant to other neuropsychiatric disorders.
Prospective controlled study of psychiatric out-patient non-attendance
Authors: Killaspy Helen , Banerjee Sube , King Michael , Lloyd Margaret
Published: August 2002

Background

Psychiatric clinics have high non-attendance rates and failure to attend may be a sign of deteriorating mental health.

Aims

To investigate why psychiatric out-patients fail to attend, and the outcome of attenders and non-attenders.

Method

Prospective cohort study of randomly selected attenders and non-attenders at general adult psychiatric out-patient clinics. Subjects were interviewed at recruitment and severity of mental disorder and degree of social adjustment were measured. Six and 12 months later their engagement with the clinic and any psychiatric admissions were ascertained.

Results

Of the 365 patients included in the study, 30 were untraceable and 224 consented to participate. Follow-up patients were more psychiatrically unwell than new patients. For follow-up patients, non-attenders had lower social functioning and more severe mental disorder than those who attended. At 12-month follow-up patients who missed their appointment were more likely to have been admitted than those who attended.

Conclusions

Those who miss psychiatric follow-up out-patient appointments are more unwell and more poorly socially functioning than those who attend. They have a greater chance of drop-out from clinic contact and subsequent admission.
Extent and contributing factors of drug expenditure of injectors in Glasgow
Authors: Hutchinson S. J. , Gore S. M. , Taylor A. , Goldberg D. J. , Frischer M.
Published: August 2002

Background

Recent concern about drug use has focused attention on the illegal income generated by users.

Aims

To investigate factors associated with drugs expenditure and to estimate the cost of illegal acquisitions used to pay for drugs.

Method

We collected self-report data from 954 current injectors, interviewed at multiple street, needle/syringe exchange and drug treatment sites throughout Glasgow.

Results

Injectors' mean weekly drug spending was £324. The mean annual illegal drugs spend was estimated to be £11 000 per injector. We provide a central estimate – £194 million per annum – of the retail value of goods acquired illegally by injectors in Glasgow in order to pay for drugs. Higher drug spends were associated with having been imprisoned more often and with those reporting acquisitive crime, drug dealing and prostitution. Treatment with methadone, among individuals who injected in the previous two months, was associated with a 20% reduction in atypical spend on drugs.

Conclusions

Treatment effectiveness needs to be measured both in terms of health benefit and in terms of reduction in drugs expenditure and recidivism.
Determinants of quality of life at first presentation with schizophrenia
Authors: Browne Stephen , Clarke Mary , Gervin Maurice , Waddington John L. , Larkin Conal , O'Callaghan Eadbhard
Published: August 2002

Background

Quality of life (QOL) has gained importance as a global measure of social and clinical outcome in schizophrenia.

Aims

To identify the clinical correlates of QOL at the time of first presentation with schizophrenia.

Method

Over two years, consecutive first-episode psychosis patients presenting to a catchment area psychiatric service underwent validated clinical assessments of premorbid adjustment, illness duration, symptoms and QOL.

Results

At presentation, subjects already had a diminished QOL. Although independent of gender and age at onset of psychosis, QOL was influenced by premorbid adjustment, duration of untreated psychosis and symptoms.

Conclusions

Reducing the duration of untreated psychosis may have a beneficial effect on the subsequent QOL of patients presenting with schizophrenia. First-episode patients with a protracted duration of untreated psychosis or impaired premorbid adjustment may warrant specific treatment interventions to prevent the development of secondary handicaps.
Phobic nature of social difficulty in facially disfigured people
Authors: Newell Robert , Marks Isaac
Published: August 2002

Background

Over 390 000 people in the UK are disfigured. Facial disfigurement distresses sufferers markedly but has been studied little.

Aims

To compare fearful avoidance of people with a facial disfigurement with that of a group of patients with phobia.

Method

Comparison of Fear Questionnaire agoraphobia, social phobia and anxiety depression sub-scale scores of 112 facially disfigured people (who scored high on Fear Questionnaire problem severity in three survey studies) with those of 66 out-patients with agoraphobia and 68 out-patients with social phobia.

Results

Facially disfigured people and patients with social phobia had similar Fear Questionnaire scores. In contrast, facially disfigured people scored lower on the agoraphobia sub-score but higher on the social phobia sub-score than did patients with agoraphobia.

Conclusions

Facially disfigured people with psychological difficulties resembled people with social phobia on Fear Questionnaire social phobia, agoraphobia and anxiety/depression sub-scores but were less agoraphobic and more socially phobic than were people with agoraphobia. Facially disfigured people thus appeared to be socially phobic and to deserve the cognitive – behavioural therapy that is effective for such phobias.
Effect of acute tryptophan depletion on CO2-induced anxiety in patients with panic disorder and normal volunteers
Authors: Miller H. E. J. , Deakin J. F. W. , Anderson I. M.
Published: August 2002

Background

Uncertainties remain about the role of serotonin in the aetiology and treatment of panic disorder.

Aims

To investigate the effect of reducing brain serotonin function on anxiety at rest, and following 5% CO2 provocation in normal controls and patients with panic disorder.

Method

Twenty drug-free patients with DSM–III–R panic disorder and 19 controls received a tryptophan-free amino acid drink on one occasion and a control drink on the other in a double-blind, balanced protocol. 5% CO2 was given as a panic challenge after 270 minutes.

Results

Plasma tryptophan fell by more than 80% both patients and controls after the tryptophan-free drink. Tryptophan depletion did not alter resting anxiety. In patients alone, tryptophan depletion caused a greater anxiogenic response and an increased rate of panic attacks (9 v. 2, P<0.05) after 5% CO2 challenge. No normal volunteers panicked.

Conclusions

Serotonin may directly modulate panic anxiety in patients with panic disorder. This may underlie the efficacy of serotonergic antidepressants in treating panic disorder.
Rapid eye movement sleep behaviour disorder, depression and cognitive impairment. Case study
Authors: Clarke Nicholas A. , Williams Adrian J. , Kopelman Michael D.
Published: August 2002

Background

Rapid eye movement (REM) sleep behaviour disorder is a relatively new diagnostic category. It has never before been associated with a treatable depressive condition.

Aims

To repot on a 74-year-old man with a history of depression and REM sleep behaviour disorder, associated with mild cognitive impairment.

Method

Assessment using brain CT, MRI, PET, electroencephalography, neuropsychological testing and nocturnal polysomnography.

Results

Depression was treated with sertraline. Sleep laboratory studies supported a diagnosis of REM sleep behaviour disorder, which was treated with clonazepam. Sleep apnoea, revealed later, was treated with nasal continuous positive airways pressure. Brain MRI showed mild atrophy, but neuropsychological testing indicated no progressive cognitive deterioration.

Conclusions

This case draws attention to REM sleep behaviour disorder and its potential interaction with depression and cognitive impairment, producing symptoms which can be mistaken for early dementia. The diagnosis of REM sleep behaviour disorder is easily missed, and it requires careful history-taking and sleep investigation in all suspected sufferers. Associated neurological, sleep and psychiatric conditions (including depression and cognitive impairment) may confound the diagnosis.
Stalking – a contemporary challenge for forensic and clinical psychiatry
Authors: Kamphuis J. H. , Emmelkamp P. M. G.
Published: August 2002

Background

Stalking is causing pervasive and intense personal suffering and is an area of psychiatry that is currently overlooked.

Aims

To review demographic and clinical characteristics of stalkers as well as the psychological consequences for victims of stalking.

Method

A Medline and PsycLit search was conducted on stalking, forensic psychiatry, personality disorders, de Clérambault syndrome and erotomania, with respect to the relevance of the articles selected for stalking.

Results

Stalkers are best thought of as a heterogeneous group whose behaviour can be motivated by different forms of psychopathology, including psychosis and severe personality disorders.

Conclusions

There is a clear need to arrive at a consensus on a typology of stalkers and associated diagnostic criteria. The effectiveness of psychological and pharmacological treatments have not yet been investigated. Treatment may need to be supplemented with external incentives provided by the legal system.
Three-year outcome of first-episode psychoses in an established community psychiatric service
Authors: Singh Swaran P. , Croudace Tim , Amin Shazad , Kwiecinski Rosemary , Medley Ian , Jones Peter B. , Harrison Glynn
Published: August 2002

Background

Changes in service provision, secular trends in substance misuse and changing social structures might affect outcome in psychosis.

Aims

To assess the three-year outcome of an inception cohort of first-episode psychoses treated in a modern, community-oriented service; to compare outcomes with an earlier cohort treated in hospital-based care; and to examine the predictive validity of ICD–10 diagnostic criteria.

Method

Three-year follow-up (1995–1997) of an inception cohort of first-episode psychoses and comparison with two-year follow-up (1980–1982) of the Determinants of Outcome of Severe Mental Disorders (DOSMED) Nottingham cohort.

Results

On most outcome measures, non-affective psychoses had a worse outcome than affective psychoses. Affective psychoses had better outcome than previously reported. Substance-related psychoses had very poor occupational outcome. Similar proportions of the current and DOSMED cohort were in remission but the former were rated as having greater disability.

Conclusions

In a modern community service, 30–60% of patients with first-episode psychoses experience a good three-year outcome. The ICD–10 criteria have good predictive validity.
Long-stay patients discharged from psychiatric hospitals
Authors: Leff Julian , Trieman Noam
Published: August 2002

Background

There have been no large-scale prospective studies evaluating the transfer of care from psychiatric hospitals to district-based services.

Aims

We aimed to compare the quality of life of patients in two north London hospitals scheduled for closure with that in the community homes to which they were discharged.

Method

The total long-stay population of Friern Hospital and several hundred long-stay patients in Claybury Hospital were assessed with a batch of eight schedules while in hospital. They were followed up after one year in the community and then at five years.

Results

Of the 670 discharged patients, 126 died before the five-year follow-up. Data were obtained on 523 (97%) of the survivors. There was no change in the patients' clinical state or in their problems of social behaviour. However, they gained domestic and community living skills. They also acquired friends and confidants. They were living in much freer conditions and the great majority wanted to remain in their current homes.

Conclusions

Community care has enhanced the quality of life of this group of patients, involved in a well-planned and adequately resourced reprovision programme.
Outcome of hospital-treated depression at 4.5 years
Authors: Tuma T. A.
Published: August 2002

Background

Direct comparisons of the prognosis for treated depression in adult and elderly cohorts are few, but suggest higher morbidity and mortality in the elderly.

Aims

To examine outcome in two such groups after 4.5 years and compare results with those reported elsewhere.

Method

Fifty-six adults (aged under 65) and 54 elderly people (over 65) with primary depression were assessed 4.5 years after receiving hospital treatment, and factors influencing the outcome were explored.

Results

Recovery rates were higher in the adults than in the elderly (42.8% v. 24%), largely due to higher rates of death (33%) and dementia (14.8%) in the latter group, who also suffered more serious health problems (62.9% v. 28.5%). Survival analysis showed no difference in the recovery time between cohorts, with over 90% recovered after 25 weeks. After deducting the natural deaths, melancholic illness proved a poor outcome predictor in the adults.

Conclusions

The outlook for elderly depressed patients is poorer than for younger patients because of concurrent physical disease, a higher death rate and the development of dementia.
Lifetime panic–depression comorbidity in the National Comorbidity Survey
Authors: Roy-Byrne Peter P. , Stang Paul , Wittchen Hans-Ulrich , Ustun Bedirhan , Walters Ellen E. , Kessler Ronald C.
Published: August 2002

Background

Most prior studies of panic-depression comorbidity have been limited methodologically by use of small clinical samples and incomplete analyses.

Aims

General population data were used to study the association of lifetime and recent (12 months) panic–depression comorbidity with symptom severity, impairment, course and help-seeking in the National Comorbidity Survey (NCS).

Method

The NCS is a nationally representative survey of the prevalences and correlates of major DSM–III–R disorders in the US household population.

Results

Strong lifetime and current comorbidity were found between panic and depression. Comorbidity was associated with greater symptom severity, persistence, role impairment, suicidality and help-seeking, with many findings persisting after controlling for additional comorbid diagnoses. Findings did not differ according to which disorder was chronologically primary.

Conclusions

Both lifetime and current panic–depression comorbidity are markers for more severe, persistent and disabling illness. Neither additional comorbid diagnoses nor the primary–secondary distinction were important moderators of these associations.
Synaptophysin gene expression in schizophrenia
Authors: Eastwood Sharon L. , Cairns Nigel J. , Harrison Paul J.
Published: August 2002

Background

Decreased expression of proteins such as synaptophysin in the hippocampus and prefrontal cortex in schizophrenia is suggestive of synaptic pathology. However, the overall profile of changes is unclear.

Aims

To investigate synaptophysin gene expression in the cerebral cortex in schizophrenia.

Method

The dorsolateral prefrontal (Brodmann area [BA] 9/46), anterior cingulate (BA 24), superior temporal (BA 22) and occipital (BA 17) cortex were studied in two series of brains, totalling 19 cases and 19 controls. Synaptophysin was measured by immunoautoradiography and immunoblotting. Synaptophysin messenger RNA (m RNA) was measured using in situ hybridisation.

Results

Synaptophysin was unchanged in schizophrenia, except for a reduction in BA 17 of one brain series. Synaptophysin mRNA was decreased in BA 17, and in BA 22 in the women with schizophrenia. No alterations were seen in BA 9/46.

Conclusions

Synaptophysin expression is decreased in some cortical areas in schizophrenia. The alterations affect the mRNA more than the protein, and have an unexpected regional distribution. The characteristics of the implied synaptic pathology remain to be determined.
Neighbourhood variation in incidence of schizophrenia
Authors: Van Os Jim , Driessen Ger , Gunther Nicole , Delespaul Philippe
Published: August 2002

Background

Neighbourhood characteristics may influence the risk of psychosis, independently of their individual-level equivalents.

Aims

To examine these issues in a multi-level model of schizophrenia incidence.

Method

Cases of schizophrenia, incident between 1986 and 1997, were identified from the Maastricht Mental Health Case Register. A multi-level analysis was conducted to examine the independent effects of individual-level and neighbourhood-level variables in 35 neighbourhoods.

Results

Independent of individual-level single and divorced marital status, an effect of the proportion of single persons and proportion of divorced persons in a neighbourhood was apparent (per 1% increase respectively: RR=1.02; 95% CI 1.00–1.03; and RR=1.12, 95% CI 1.04–1.2.1). Single marital status interacted with the neighbourhood proportion of single persons, the effect being stronger in neighbourhoods with fewer single-person households.

Conclusions

The neighbourhood environment modifies the individual risk for schizophrenia. Premorbid vulnerability resulting in single marital status may be more likely to progress to overt disease in an environment with a higher perceived level of social isolation.
Unpublished rating scales: A major source of bias in randomised controlled trials of treatments for schizophrenia
Authors: Marshall Max , Lockwood Austin , Bradley Caroline , Adams Clive , Joy Claire , Fenton Mark
Published: August 2002

Background

A recent review suggested an association between using unpublished scales in clinical trials and finding significant results.

Aims

To determine whether such an association existed in schizophrenia trials.

Method

Three hundred trials were randomly selected from the Cochrane Schizophrenia Group's Register. All comparisons between treatment groups and control groups using rating scales were identified. The publication status of each scale was determined and claims of a significant treatment effect were recorded.

Results

Trials were more likely to report that a treatment was superior to control when an unpublished scale was used to make the comparison (relative risk 1.37 (95% C11.12–1.68)). This effect increased when a ‘gold-standard’ definition of treatment superiority was applied (RR 1.94 (95% C11.35–2.79)). In non-pharmacological trials, one-third of ‘gold-standard’ claims of treatment superiority would not have been made if published scales had been used.

Conclusions

Unpublished scales are a source of bias in schizophrenia trials.
Trends in special (high-security) hospitals
Authors: Jamieson Elizabeth , Butwell Martin , Taylor Pamela , Leese Morven
Published: August 2002

Background

Special hospitals in England provide psychiatric care and treatment in high security. Their future is often questioned.

Aims

To test for variation in demand for high-security psychiatric services over one 10-year period.

Method

This study was from the special hospitals' case registers and hospital records. The main measures were numbers and annual rates for referrals and beds offered; the Mental Health Act 1983 (MHA) classification of mental disorder; adjusted population rates by health region; admission episodes; legal category of detention; admission source and type of offence.

Results

Referrals to special hospitals showed no decrease during the 10 years; an apparent increase may reflect under-recording before 1992. Admissions fell by about 16% over the 10 years, but with regional variation. Women, civil cases, admissions under the MHA classifications of psychopathic disorder or mental impairment and directly from a court on a hospital order were most affected. There was an increase in admissions of pre-trial and sentenced male prisoners, and of transferred hospital order patients from other hospitals.

Conclusions

There is continuing demand from all parts of the country for high-security hospital beds. The smaller numbers admitted appear to include more demanding cases.
Trends in special (high-security) hospitals
Authors: Butwell Martin , Jamieson Elizabeth , Leese Morven , Taylor Pamela
Published: August 2002

Background

It has been argued that many patients in special hospital beds do not need to be there. In the 1990s there were initiatives to discharge women and people with learning difficulties.

Aims

To test for trends in special hospital discharges and to examine annual resident cohorts.

Method

This study was from case registers and hospital records. The main measures were numbers and annual rates for referrals and beds offered; the Mental Health Act 1983 (MHA) classification of mental disorder; adjusted population rates by region; admission episodes; legal category of detention; admission source and type of offence.

Results

The median annual number of residents was 1859 (range 1697–1910), with an 8% fall for the period. This particularly affected people in mental impairment categories. Numbers were sustained in the male mental illness groups. Discharges, mainly to other institutions, increased. There was no overall change over the 10 years in length of stay for treatment, but successive admission cohorts from 1986 did show some reduction, even with solely remand order cases excluded.

Conclusions

Service planners need a longitudinal perspective on service use. Trends over 10 years to both fewer admissions and more discharges have reduced the special hospital population, but despite new treatments for schizophrenia, men under mental illness classification, as well as transfer from other secure settings, have gone against this trend.
Suicide in psychiatric hospital in-patients
Authors: Powell John , Geddes John , Deeks Jonathan , Goldacre Michael , Hawton Keith
Published: August 2002

Background

Psychiatric hospital inpatients are known to be at high risk of suicide, yet there is little reliable knowledge of risk factors or their predictive power.

Aims

To identify risk factors for suicide in psychiatric hospital in-patients and to evaluate their predictive power in detecting people at risk of suicide.

Method

Using a case–control design, 112 people who committed suicide while in-patients in psychiatric hospitals were compared with 112 randomly selected controls. Univariate analysis and multivariate analyses were used to estimate odds ratios and adjusted likelihood ratios.

Results

The rate of suicide in psychiatric in-patients was 13.7 (95% CI 11.7–16.1) per 10 000 admissions. There were five predictive factors with likelihood ratios >2, following adjustment: planned suicide attempt, 4.1; actual suicide attempt, 4.9; recent bereavement, 4.0; presence of delusions, 2.3; chronic mental illness, 2.2; and family history of suicide, 4.6. On this basis, only two of the patients who committed suicide had a predicted risk of suicide above 5%.

Conclusions

Although several factors were identified that were strongly associated with suicide, their clinical utility is limited by low sensitivity and specificity, combined with the rarity of suicide, even in this high-risk group.
Childhood predictors of adult medically unexplained hospitalisations
Authors: Hotopf Matthew , Wilson-Jones Charlotte , Mayou Richard , Wadsworth Michael , Wessely Simon
Published: August 2002

Background

It has been suggested that adults with medically unexplained physical symptoms experienced greater ill-health then others (either in themselves or their families) during childhood.

Aims

To test these hypotheses.

Method

We used data from the Medical Research Council (MRC) National Survey of Health and Development, a population-based cohort study established in 1946 (n=5362). Subjects were followed from birth in 1946 until 1989 (age 43 years). As outcome, we used operationally defined medically unexplained hospital admissions at age 15–43 years. Exposure variables included childhood illness, and illness in parents during the childhood of the subjects.

Results

The risk set (n=4603) comprised individuals still in the Survey at age 15. Ninety-five unexplained hospital admissions were identified. Subjects whose mothers reported below-average health in the father were at increased risk of subsequent unexplained admissions. Below average reported health in the mother was not associated with this increased risk. Defined physical diseases in childhood were not associated, but persistent abdominal pain at age 7–15 years was.

Conclusions

Unexplained hospital admissions are associated with certain childhood experiences of illness, but defined physical illness in childhood is not a risk factor.
Obsessive-compulsive disorder and delusions revisited
Authors: O'Dwyer Anne-Marie , Marks Isaac
Published: August 2002

Background

The concept of fixed, unshakeable (delusional) beliefs within the context of obsessive–compulsive disorder (OCD) is one that has received varying amounts of attention in the literature, and has not yet received universal acknowledgement. There are good grounds for including these cases within the diagnostic concepts of OCD, with significant implications for clinical management.

Aims

To present cases with unusual OCD, in order to re-evaluate the issue of delusions and OCD.

Method

The cases of five subjects with delusions in the course of obsessive–compulsive disorder are presented to illustrate ‘delusional’ OCD. The management and outcome of these cases are discussed.

Results

Fixity and bizarreness of beliefs in OCD occur on a continuum from ‘none’ to ‘delusional intensity’ and may fluctuate within subjects.

Conclusions

The idea that these cases may represent a form of OCD has implications for management, as, if this is correct, they should be able to respond to appropriate behavioural and/or pharmacological strategies used in OCD.
Psychiatric symptoms among clients seeking treatment for drug dependence
Authors: Marsden John , Gossop Michael , Stewart Duncan , Rolfe Alexandra , Farrell Michael
Published: August 2002

Background

Many people with substance use disorders are vulnerable to other psychiatric disorders and present to addiction treatment services with comorbid psychiatric symptoms.

Aims

To describe the prevalence of recent psychiatric treatment and current psychiatric symptoms and explore links between substance misuse, personal/social functioning and symptom severity.

Method

Subjects were 1075 adults recruited to the National Treatment Outcome Research Study (NTORS), of whom 90% were opiate-dependent. Psychiatric symptoms at intake were recorded using sub-scales from the Brief Symptom Inventory.

Results

Recent psychiatric treatment was reported by one in five subjects. Psychiatric symptom levels were high and females had elevated scores on all scales. Symptoms were elevated among opiate users who were also frequent users of benzodiazepines, alcohol and, in particular, stimulants. Gender, physical health, drug dependence and personal relationship problems were more powerful predictors of psychiatric symptoms than substance use.

Conclusions

Addictions service providers should be vigilant to psychiatric problems among their clients at intake to treatment. Psychiatric symptoms are more closely linked to polydrug use than to opiate use in this population.
Studying grief in adults with learning disabilities
Authors: Lyons C. A.
Published: August 2002

I read with interest the article by Bonell-Pascual et al (1999) and would agree that recognition of, and service provision for, the bereaved adult learning disability population is markedly deficient. However, their conclusion that learning disability is a significant predictor of future mental health problems following bereavement is not substantiated and should be interpreted with caution in view of the flawed research methodology.
Developing a clinically useful actuarial tool for assessing violence risk
Authors: Monahan John , Steadman Henry J. , Robbins Pamela C. , Silver Eric , Appelbaum Paul S. , Grisso Thomas , Mulvey Edward P. , Roth Loren H.
Published: August 2002

Background

A new actuarial method for violence risk assessment – the Iterative Classification Tree (ICT) – has become available. It has a high degree of accuracy but can be time and resource intensive to administer.

Aims

To increase the clinical utility of the ICT method by restricting the risk factors used to generate the actuarial tool to those commonly available in hospital records or capable of being routinely assessed in clinical practice.

Method

A total of 939 male and female civil psychiatric patients between 18 and 40 years old were assessed on 106 risk factors in the hospital and monitored for violence to others during the first 20 weeks after discharge.

Results

The ICT classified 72.6% of the sample as either low risk (less than half of the sample's base rate of violence) or high risk (more than twice the sample's base rate of violence).

Conclusions

A clinically useful actuarial method exists to assist in violence risk assessment.
Evidence-based rehabilitation in forensic psychiatry
Authors: Lindqvist Per , Skipworth Jeremy
Published: August 2002

Background

The extent to which forensic psychiatric rehabilitation alters an individual's level of risk is unclear.

Aims

To highlight some essential features of a forensic psychiatric rehabilitation system, and to discuss risk assessment in this context to create a conceptual framework for risk research and practice.

Method

The applicability of risk assessment instruments to forensic psychiatric rehabilitation was examined. Core processes and elements considered essential in this type of rehabilitative work were reviewed.

Results

Current risk research has limited application to rehabilitation. Future research aimed at analysing forensic psychiatric rehabilitation will be hampered by the complexity of the treatment systems and the number of methodological issues relevant to this type of research.

Conclusions

Novel research approaches are suggested to analyse further the risk factors and processes important in forensic psychiatric rehabilitation.
Involuntary out-patient commitment and reduction of violent behaviour in persons with severe mental illness
Authors: Swanson Jeffrey W. , Swartz Marvin S. , Wagner H. Ryan , Burns Barbara J. , Borum Randy , Hiday Virginia A.
Published: August 2002

Background

Violent behaviour among persons with severe mental illness (SMI) causes public concern and is associated with illness relapse, hospital recidivism and poor outcomes in community-based treatment.

Aims

To test whether involuntary out-patient commitment (OPC) may help to reduce the incidence of violence among persons with SMI.

Method

One-year randomised trial of the effectiveness of OPC in 262 subjects with psychotic or major mood disorders and a history of hospital recidivism. Involuntarily hospitalised subjects awaiting OPC were randomly assigned to release or court-ordered treatment after discharge. Those with a recent history of serious assault remained under OPC until expiry of the court order (up to 90 days); then OPC orders were renewed at clinical/court discretion. Control subjects had no OPC. Four-monthly follow-up interviews with subject, case manager and collateral informant took place and service records were collected.

Results

A significantly lower incidence of violent behaviour occurred in subjects with ⩾6 months' OPC. Lowest risk of violence was associated with extended OPC combined with regular out-patient services, adherence to prescribed medications and no substance misuse.

Conclusions

OPC may significantly reduce risk of violent behaviour in persons with SMI, in part by improving adherence to medications while diminishing substance misuse.
Future directions for treatment in forensic psychiatry
Authors: Gunn John
Published: August 2002

Background

As the availability of mental hospital beds has fallen, so the number of people in prison has risen.

Aims

To review current policy trends in British forensic psychiatry and put them in an international context.

Method

Literature on the prevalence rates of psychiatric disorder in prisons and jails has been examined for the USA, England & Wales and New Zealand.

Results

All studies show a high prevalence of mental disorder in prisons and jails. Authors in the USA suggest that prisons are replacing mental hospitals. In England & Wales rates of psychosis are reported as 4–10% for remanded prisoners and 2–7% for sentenced prisoners. Substance misuse among prisoners is a major problem. Prison is the preferred place of disposal for large numbers of mentally disordered people. Does this matter? Why should this be the case? Is this the cheapest option? Politicians are considering new powers to direct more people into institutions (presumably prisons) on the grounds of public protection.

Conclusions

We need more information about attitudes and their formation. We need more interprofessional dialogue about the best arrangements for people with mental disorders, and inter-disciplinary education.
Violence in the workplace: new perspectives in forensic mental health services in the USA
Authors: Fletcher Tony A. , Brakel Samuel Jan , Cavanaugh James L.
Published: August 2002

Background

This paper reviews current research on workplace violence in the USA and offers suggestions concerning the roles that mental health professionals with forensic expertise can play in this expanding field.

Aims

To clarify the role of the mental health professional in evaluating issues related to workplace violence.

Method

Manual and computer literature searches were performed.

Results

The incidence of reported workplace violence is on the rise and can be devastating beyond the immediate injury. Forensically oriented mental health professionals can assist companies by providing pre-employment screenings, fitness-for-duty evaluations and threat assessment by using the results of current research on potentially violent individuals.

Conclusions

With the growing interest in workplace violence come many opportunities for mental health professionals to assist companies in assessment, intervention and prevention.
Substance misuse, psychiatric disorder and violent and disturbed behaviour
Authors: Soyka Michael
Published: August 2002

Background

Epidemiological studies suggest schizophrenia and substance misuse to be associated with a higher rate of violence and crime.

Aims

The literature was evaluated to assess whether people with schizophrenia who use substances have an increased risk for violence and disturbed behaviour.

Method

A detailed Medline analysis was performed and relevant studies were reviewed.

Results

A large number of studies have linked substance misuse in schizophrenia with male gender, high incidence of homelessness, more pronounced psychotic symptoms, non-adherence with medication, poor prognosis, violence and aggression. The latter has been proved by clinical, epidemiological and longitudinal prospective studies of unselected birth cohorts. The increased risk for aggression and violent acts cannot be interpreted only as a result of poor social integration. Male gender, more severe psychopathology, a primary antisocial personality, repeated intoxications and non-adherence with treatment are important confounding variables.

Conclusion

Substance misuse has been shown consistently to be a significant risk factor for violence and disturbed behaviour. Future research should try to evaluate possible pharmacological and psychosocial treatment approaches.
Psychiatric morbidity of a rural Indian community
Authors: Nandi D. N. , Banerjee Gauranga , Mukherjee S. P. , Ghosh Asit , Nandi P. S. , Nandi S.
Published: August 2002

Background

Cross-sectional studies give no indication of the changes that may occur in the mental health status of a community in course of times. Studies should be designed to assess these changes.

Aims

To assess the changes, if any, in the prevalence of mental disorders in a rural community after an interval of 20 years in the context of its changing socioeconomic conditions.

Method

A door-to-door survey of the prevalence of psychiatric morbidity in two villages was conducted by a team of psychiatrists. The survey was repeated after 20 years by the same team and by the same method. Changes in the mental health status of the community were compared.

Results

Total morbidity per 1000 fell from 116.8 to 105.2. Morbidity in men fell from 86.9 to 73.5 per 1000 and in women from 146.8 to 138.3 per 1000. Rates of anxiety, hysteria and phobia had fallen dramatically and those of depression and mania had risen significantly.

Conclusion

The level of psychiatric morbidity showed no statistically significant change. The morbidity pattern (relative proportion of type of morbidity), however, showed some interesting changes. Similar studies should be done on a larger sample.
Catatonia in autistic spectrum disorders
Authors: Wing Lorna , Shah Amitta
Published: August 2002

Background

The clinical pictures of autistic spectrum disorders include features described in catatonia.

Aims

To examine the severe exacerbation of the catatonic features of autistic disorders in adolescence or early adult life, which occurs in some individuals.

Method

A semi-structured interview schedule was used to collect information from parents or other care-givers concerning 506 referrals to a specialist clinic for autistic spectrum disorders. Individuals with severe exacerbation of catatonic features were compared with a same-age group of referrals without this type of deterioration in skills and behaviour.

Results

Seventeen per cent of referrals aged 15 or over had severe exacerbation of catatonic features. They were significantly more likely than the comparison group to have had, before the onset of the change in behaviour, impaired language and passivity in social interaction.

Conclusions

Catatonia is a later complication of autistic spectrum disorders, which adds considerably to the burden of caring. More research is needed to identify causes, neuropathology, and early signs of vulnerability.
Interruption of selective serotonin reuptake inhibitor treatment
Authors: Michelson David , Fava Maurizio , Amsterdam Jay , Apter Jeffrey , Londborg Peter , Tamura Roy , Tepner Rosalinda G.
Published: August 2002

Background

Abrupt interruption of therapy with selective serotonin reuptake inhibitors (SSRIs) has been associated with somatic and psychological symptoms.

Aims

Systematically to assess symptoms and effects on daily functioning related to interruption of SSRI therapy.

Method

Patients treated with fluoxetine, setraline or paroxetine underwent identical five-day periods of treatment interruption and continued active treatment under double-blind, order-randomised conditions, with regular assessment of new symptoms.

Results

Placebo substitution for paroxetine was associated with increases in the number and severity of adverse events following the second missed dose, and increases in functional impairment at five days. Placebo substitution for sertraline resulted in less pronounced changes, while interruption of fluoxetine was not associated with any significant increase in symptomatology.

Conclusions

Abrupt interruption of SSRI treatment can result in a syndrome characterised by specific physical and psychological symptoms. Incidence, timing and severity of symptoms vary among SSRIs in a fashion that appears to be related to plasma elimination characteristics.
Labour and delivery complications at birth and later mania
Authors: Browne Roy , Byrne Majella , Morris Mary , O'Callaghan Eadbhard , Mulryan Niamh , Scully Ann , Kinsella Anthony , McNeil Thomas F. , Walsh Dermot
Published: August 2002

Background

Several reports postulate that manic depression and schizophrenia share environmental risk factors. Although obstetric adversity has been suggested as a risk factor for schizophrenia, few studies have examined its relationship to bipolar affective disorder.

Aims

To assess the rate of obstetric complications incurred by patients with mania compared with controls.

Method

From the Dublin Psychiatric Case Register we identified individuals with a discharge diagnosis of mania and traced their birth records. Each case was matched with a control of the same gender, born in the same hospital, in the same year, matched for maternal age, parity and social class. Two obstetric complication scales were used to make blind evaluations of labour and delivery data.

Results

Patients with mania did not experience a greater frequency or severity of labour and delivery complications than their matched controls. Rates of obstetric adversity were unrelated to the presence or absence of family history of psychiatric disorder. Obstetric adversity was unrelated to the age at first diagnosis.

Conclusions

These findings suggest that obstetric adversity is not a risk factor for later mania.
Self-efficacy as a mediator between stressful life events and depressive symptoms
Authors: Maciejewski Paul K. , Prigerson Holly G. , Mazure Carolyn M.
Published: August 2002

Background

Self-efficacy, a characteristic that is protective against depressive symptoms, may be undermined by stressful life events.

Aims

To estimate the effects of stressful life events on self-efficacy, and to examine self-efficacy as a mediator of the effect of stressful life events on symptoms of depression.

Method

Using a sample of 2858 respondents from the longitudinal Americans' Changing Lives study, path analyses were used to evaluate interrelationships between self-efficacy, life events and symptoms of depression controlling for a variety of potentially confounding variables. Separate models were estimated for those with and without prior depression.

Results

For those with prior depression, dependent life events had a significant, negative impact on self-efficacy. For those without prior depression, life events had no effect on self-efficacy.

Conclusions

For those with prior depression, self-efficacy mediates approximately 40% of the effect of dependent stressful life events on symptoms of depression.