bluuebunny/crossref_metadata_2025 huggingface dataset:
Costing mental health services
Authors: Knapp Martin , Beecham Jeni
Published: July 2009

Synopsis

In this paper four principal topics are addressed: (a) the policy and political contexts in which demands arise for cost information; (b) the nature and phasing of those demands; (c) the basic rules of empirical costs research for meeting those demands; and (d) concomitant implications for the design, execution and interpretation of their research. Mental health care policy or practice changes which ignore costs, or which embody cost information without obeying or recognizing the four basic rules, can only be of dubious validity, or can only be used to answer a limited range of questions. But, as the illustrative studies show, it need not be an horrendous, or ideologically compromising or scientifically complex task to add a cost dimension to the evaluation of mental health services. There are enough examples in the literature of bad costs research to demonstrate that it is not as simple as some people think, but there are also enough examples of good research t o encourage further attempts.
Acculturation and psychiatric disorder: a study of Greek Cypriot immigrants
Authors: Mavreas Venos , Bebbington Paul
Published: July 2009

Synopsis

Data are presented from a study of acculturation and psychiatric disorder in 291 Greek Cypriot immigrants from the general population of Camberwell, south London. We hypothesized that ‘pre-acculturation’ would protect against mental disorder, that difficulties in the period immediately after migration would increase the risk of disorder, and that disorder would be least common among those in the middle range of the acculturation spectrum.

Of pre-acculturation factors, only previous knowledge of English was associated with reduced prevalence. Difficulties in the settling-in period were clearly related to current disorder. No relationship was apparent between present acculturation and disorder, but this disguised an interesting but unpredicted gender effect: in males, disorder was most prevalent in the highly acculturated; in females, in the least acculturated.
Random number generation by normal, alcoholic and schizophrenic subjects
Authors: Rosenberg Stewart , Weber Neville , Crocq Marc-Antoine , Duval Fabrice , Macher Jean-Paul
Published: July 2009

Synopsis

Controls (N= 45), schizophrenics (N= 20) and alcoholics (N=23) were asked to choose at random a number between 1 and 10, 100 times. The correlation matrices of five different randomization indices were used to studywithingroup variation; these matrices were similar for the normal and alcoholic groups, but very different for the schizophrenic group. The differencesbetweenthe three groups were studied by canonical analysis and, in terms of the canonical variables, the mean performance of the normal group is clearly discriminated from that of the alcoholic and schizophrenic subjects.
Relatives and depressive relapse: the critical period after discharge from in-patient treatment
Authors: Veiel Hans O. F. , Kühner Christine
Published: July 2009

Synopsis

In a sample of 60 remitted depressed in-patients, the power of three basic parameters of the social support network – Kin Support Network Size; Non-kin Support Network Size; and Satisfaction with Support – to predict depressive symptom levels seven months after discharge was examined. The results suggest that even positive, supportive family relationships can have a distinctly detrimental effect, and that a depressed in-patient's return to his or her family represents a crucial period for the further course of the disorder. The findings are discussed with respect to the social support literature and the ‘Expressed Emotion’ concept. It is held that neither paradigm provides an adequate explanation, and alternative mediating mechanisms are suggested.
The validity and reliability of the fatigue syndrome that follows glandular fever
Authors: White P. D. , Grover S. A. , Kangro H. O. , Thomas J. M. , Amess J. , Clare A. W.
Published: July 2009

SYNOPSIS

The validity and reliability of an empirically defined fatigue syndrome were tested in a prospective cohort study of 245 primary care patients, with glandular fever or an upper respiratory tract infection. Subjects were interviewed three times in the 6 months after onset. Subjects with the empirically defined fatigue syndrome were compared with those who were well and those who had a psychiatric disorder.

The validity of the fatigue syndrome was supported, separate from psychiatric disorders in general and depressive disorders in particular. Only 16% of subjects with the principal component derived fatigue factor also met criteria for a psychiatric disorder (excluding pre-morbid phobias). Compared with subjects with psychiatric disorders, subjects with the operationally defined fatigue syndrome reported more severe physical fatigue, especially after exertion, were just as socially incapacitated, had fewer mental state abnormalities, and showed little overlap on independent questionnaires. A more mild fatigue state also existed. Both the fatigue syndrome and state were more reliable diagnoses over time than depressive disorders. The empirically defined fatigue syndrome probably is a valid and reliable condition in the 6 months following glandular fever.
The General Health Questionnaire: how many items are really necessary in population surveys?
Authors: Jacobsen B. K. , Hasvold T. , Høyer G. , Hansen V.
Published: July 2009

SYNOPSIS

This paper seeks to investigate whether only a few questions selected from the General Health Questionnaire (GHQ) may be used to measure the degree of mental distress in population surveys. Data from 2112 men and women, 18 to 70 years old from two cross-sectional studies conducted in northern Norway and the island of Spitzbergen in the Arctic, were used. Correlation analysis of Likert scores from a 20-item version of GHQ (GHQ-20) with Likert scores based on four and six items selected by multiple regression analysis or by competent physicians was performed. The correlation coefficients between the scores from the subsets of four items and the full GHQ-20 questionnaire were high (greater than 0·80) in all examined subgroups of the populations. Increasing the number of questions from four to six only marginally increased the correlation coefficients. Thus, a simple linear sum of Likert scores based on a few GHQ items can be used to measure the degree of mental distress in population surveys.
The management of non-compliance with referral to out-patient after-care among attempted suicide patients: a controlled intervention study
Authors: Van Heeringen C. , Jannes S. , Buylaert W. , Henderick H. , De Bacquer D. , Van Remoortel J.
Published: July 2009

SYNOPSIS

The failure to comply with referral for out-patient after-care is a well-documented problem among attempted suicide patients. The present study aimed at the investigation of an experimental referral procedure by means of a randomized controlled study. Non-compliant patients in the experimental group were visited in their homes by a community nurse in order to assess reasons for non-compliance and to motivate patients to comply with referral. One year after their suicide attempt patients were visited in their homes in order to assess repetition of suicidal behaviour. Uni-and multi-variate analyses showed a significant beneficial effect of the experimental procedure on compliance with referral. A near-significant effect of the experimental procedure on the rate of repetition of suicidal behaviour was found.
The role of social support in HIV infection
Authors: Nott K. H. , Vedhara K. , Power M. J.
Published: July 2009

SYNOPSIS

A study was carried out in a group of 91 HIV positive gay men to investigate the relationship between social support, measures of affect and health; the changing nature of support over time; and the causal direction of this relationship. Overall levels of support for this group were found to be moderately high and consistent over 6 months and were associated with greater psychological well-being. Individuals in receipt of quantitatively different levels of support were found to differ on measures of depression, stress, coping efficacy and self-esteem, while individuals in receipt of deficient levels of support were found to be more depressed. However, initial support levels were found to be the most powerful predictors of subsequent support levels. The implications of these findings are discussed.
The families of anorexia nervosa and cystic fibrosis patients
Authors: Blair C. , Freeman C. , Cull A.
Published: July 2009

SYNOPSIS

The objective of the study was to determine whether the families of anorexia nervosa (AN) patients were more dysfunctional than those of cystic fibrosis (CF) patients and well controls. Data were collected from self-report questionnaires, from an interview rated for Expressed Emotion (EE) and from direct observation of a family problem solving task which was rated for evidence of Minuchin's ‘psychosomatic family’ dimensions. A total of 87 families participated. Most self-report measures of family functioning did not distinguish between groups. There were no differences in levels of EE criticism. AN and CF households showed more EE emotional over-involvement than did the well households. Over-involvement correlated with illness severity. More households in the AN group were enmeshed, over-protective and poor at problem solving than in the CF and well groups. Minuchin's conceptualization of the anorexia nervosa family was partly supported.
Biochemical and behavioural effects of acute tryptophan depletion in abstinent bulimic subjects: a pilot study
Authors: Oldman A. , Walsh A. , Salkovskis P. , Fairburn C. G. , Cowen P. J.
Published: July 2009

SYNOPSIS

We studied the effect of acute tryptophan (TRP) depletion in a group of eight abstinent bulimic (BN) subjects and in 12 healthy female controls. Despite being free of episodes of bingeeating and vomiting for a prolonged period, the abstinent BN subjects still appeared to practice dietary restraint as judged by their food intake in a test meal. In addition, their plasma TRP concentrations were significantly lower than those of the controls. Administration of a TRP-free amino acid load (52 g) significantly lowered plasma total and free TRP. However, compared to a balanced amino acid load, this procedure did not have significant effects on mood, appetite or food intake in either the abstinent BN subjects or the healthy controls.
The relationship of partial syndrome eating disorders to anorexia nervosa and bulimia nervosa
Authors: Dancyger I. F. , Garfinkel P. E.
Published: July 2009

SYNOPSIS

A variety of sociocultural, familial and individual features associated with the eating disorders were examined in subjects with full syndrome (FS) and partial syndrome (PS) eating disorders and in normal high school students. The EAT-26 was administered to 995 high school students. This was followed by individual interviews with those who scored in the symptomatic range. Fifty-one students with PS eating disorders, 57 students without eating disorders (normal controls) and 30 hospital patients with FS, anorexia nervosa or bulimia nervosa were compared on subscales of the Eating Disorder Inventory, the Diagnostic Survey for Eating Disorders and the Beck Depression Inventory. The three groups displayed statistically significant differences on dimensions of EDI subscales Ineffectiveness and Interoceptive Awareness and also with respect to depression, history of being overweight and past history of emotional problems, as well as having mothers with medical illnesses. On these characteristics, the FS subjects displayed higher levels than the PS subjects, who in turn were higher than the NC subjects. The PS subjects displayed elevations on Body Dissatisfaction (EDI subscale), past medical illnesses, and mother's over-concern with eating and weight. These data support a continuum model of the eating disorders, but a continuum of multiple associated features rather than of dieting.
A twin study of generalized anxiety disorder and major depression
Authors: Roy M-A. , Neale M. C. , Pedersen N. L. , Mathé A. A. , Kendler K. S.
Published: July 2009

SYNOPSIS

Previous analyses with a sample of female twins sampled from the general population in Virginia have suggested that generalized anxiety disorder (GAD) and major depression (MD) share their genetic determinants but have partly different environmental determinants. The goal of this report is to examine whether these findings apply to samples that include male as well as female twins and contain high proportions of subjects who had been hospitalized for MD.

The subjects were ascertained through two different sources: (i) index probands were ascertained through the Swedish Psychiatric Twin Registry for a diagnosis of unipolar or bipolar affective illness; (ii) control twin probands were ascertained through the Swedish Twin Registry. Subjects were sent questionnaires for the assessment of lifetime history of GAD and MD. Positing multinormal distribution of the liability for GAD and MD, we fitted bivariate models to examine the sources of comorbidity.

The full model included additive genetic effects, shared environment and individual-specific environment, as well as scalar and non-scalar sex limitations and different thresholds across genders. The best-fitting model included: (i) a genetic correlation of unity; (ii) no common environment; (iii) an individual-specific environmental correlation of 0·28; (iv) different thresholds across genders, but neither scalar nor non-scalar sex-limitations. A model that included additive and dominant genetic effects and individual-specific environment, with correlation of unity for both additive and dominant genetic effects, provided an equivalent fit.

These analyses confirm that GAD and MD share the same genetic factors but that their environmental determinants are mostly distinct. Moreover, the present report supports the feasibility of combining clinically ascertained and general-population samples into a single bivariate analysis.
Validation of three dimensions of schizophrenic symptoms in a large unselected sample of patients
Authors: Johnstone Eve C. , Frith Christopher D.
Published: July 2009

Synopsis

A principal components analysis was conducted upon current symptoms and signs rated in a sample of 329 essentially unselected patients with schizophrenia. Three dimensions emerged clearly and closely resembled those previously described in smaller, more selected samples. The clearly defined psychotic dimensions were related in turn to: (i) other mental state variables; (ii) physical treatments administered; (iii) movement disorder; (iv) demographic and historical features; and (v) cognitive function. The correlates of the three dimensions were very different. The clarity of separation achieved in this investigation provides strong support for the view that the three psychotic dimensions of ‘poverty’, ‘hallucinations and delusions’ and ‘disorganization’ are valid and may well have different underlying pathophysiologies.
A multicentre inter-rater reliability study using the OPCRIT computerized diagnostic system
Authors: Williams J. , Farmer A. E. , Ackenheil M. , Kaufmann C. A. , McGuffin P. ,   The OPCRIT Reliability Research Group
Published: July 2009

Synopsis

We examined the reliability of the OPCRIT system from ratings produced by 30 USA and European clinicians involved in molecular genetic research. The OPCRIT system facilitates a polydiagnostic approach to research on severe psychiatric disorders. OPCRIT comprises a 90-item checklist of signs and symptoms and a suite of computer programs, which together generate diagnoses according to the operational criteria of 12 major classificatory systems (e.g. DSM-III, DSM-III-R, RDC, ICD-10). Thirty summaries of actual cases ranging in signs and symptoms, taken from independent sources, were rated by participants from research centres across Europe and the USA using the OPCRIT system. Each rating was then compared to a standard rating using a kappa statistic. Good levels of reliability were observed within all classifications (e.g. DSM-III-R, kappa = 0·73, RDC, kappa = 0·71; ICD-10, kappa = 0·70) and a similar pattern of ratings was found in both the European and USA samples. We conclude that the OPCRIT system, is both flexible and practicable retaining the ‘top-down’ advantage of operational definitions as well as the ‘bottom-up’ potential offered by well defined signs, symptoms and other component items. Within the limitations of an international, multicentre design this study shows that the OPCRIT system affords good reliability with raters from a variety of geographical and theoretical backgrounds.
Chronic fatigue in the community: ‘A question of attribution’
Authors: Chalder T. , Power M. J. , Wessely S.
Published: July 2009

Synopsis

Thirty-eight subjects identified in a large community survey were found to attribute their fatigue to ‘myalgic encephalomyelitis’ (ME). They were matched randomly to two other groups of subjects who attributed their fatigue to either psychological or social factors. All three groups were followed up 18 months later and were asked to complete a series of questionnaires that examined fatigue, psychological distress, number of symptoms, attributional style and levels of disability. At onset the ‘ME’ group were found to be more fatigued, had been tired for longer but were less psychologically distressed than the other two groups. At follow-up the ‘ME’ group were more handicapped in relation to home, work, social and private leisure activities, even when controlling for both duration of fatigue and fatigue at time 1, but were less psychologically distressed. The relationships between psychological distress, specific illness attributions, attributional style and their effect on the experience of illness and its prognosis are discussed. Attributing fatigue to social reasons appears to be most protective.
Genetic influences on life events in childhood
Authors: Thapar Anita , McGuffin Peter
Published: July 2009

Synopsis

Until recently, life events were considered as chance occurrences. However, there is now increasing evidence that reported life events, at least in adult life are not random. Life events not only tend to cluster in families but also appear to be influenced by genetic factors. The aim of this study was to investigate whether genetic factors also influence reported life events in childhood using a systematically ascertained sample of 376 twin pairs aged 8 to 17. Overall, reported life events in this younger population were found to be heritable. However, the degree of genetic and environmental influence appeared to vary across the sexes, at least for parent-rated life events and according to whether life events were rated by the parents or the children themselves. Genetic influences appeared to be more important for self reports, suggesting that individual differences in cognition play a role in reporting life events.
Dementia and ‘borderline dementia’ in Britain: 8-year incidence and post-screening outcomes
Authors: Clarke D. , Morgan K. , Lilley J. , Arie T. , Jones R. , Waite J. , Prettyman R.
Published: July 2009

Synopsis

Survivors from a nationally representative sample of elderly people originally screened in 1985 were reassessed in 1989 and again in 1993. On each occasion respondents were rated as cognitively impaired, borderline impaired or unimpaired (using a brief information/orientation scale), with the validity of these ratings assessed in subsequent clinical interviews. Where follow-up screening was not possible, information was derived from death certificates and hospital case-notes. Over 8 years (1985–93) the overall incidence rate per person–year at risk was 1·58%, giving age-specific rates of 0·72, 1·32, 1·63, 3·46, 2·55 and 1·41% for the age groups 65–69, 70–74, 75–79, 80–84, 85–89 and ≥ 90 respectively. Of 43 individuals classified at screening as borderline impaired in 1985 and 1989, 19 were diagnosed as demented at clinical interviews conducted within 16 weeks of screening. Four-year follow-ups among the remaining 24 showed that 15 had died, while 6 showed a worsened cognitive status. Controlling for both age and sex, aggregated 4-year mortality was significantly higher among those defined at screening in 1985 and 1989 as either impaired or borderline, when compared with the unimpaired.
Normality, deviance and minor psychiatric morbidity in the community – a re-interpretation
Authors: Whittington Joyce E.
Published: July 2009

Synopsis

Anderson et al. (1993) presented two models of psychiatric morbidity that they claimed represented ‘individual’-based and ‘community’-based explanations. They used data from the Health and Lifestyle Survey to test the models and concluded that the data support a ‘community’-based explanation. Their deductions from the models appear to be flawed, nevertheless, their conclusion may be valid.
The time for suicide
Authors: Gallerani M. , Avato F. M. , Dal Monte D. , Caracciolo S. , Fersini C. , Manfredini R.
Published: July 2009

Synopsis

To evaluate whether a time pattern exists in the occurrence of suicide, 223 cases observed in Ferrara, Italy, over a 10-year period were considered. The determination of the hour of suicide was precise in 99 cases, presumptive (within a range of 1 hour) in 53, while for another 44 cases it was possible to define a probable time of suicide, grouping into four 6-hour periods (night, morning, afternoon, and evening). The remaining 27 cases were excluded as it was impossible to determine the time reliably. The data were analysed both by means of χ2test for goodness-of-fit and by single cosinor. A specific pattern, characterized by a significant peak in the late morning – early afternoon hours was found for the entire sample and sex subgroups.
Familial calcification of the basal ganglia: a case report and review of the literature
Authors: Flint J. , Goldstein L. H.
Published: July 2009

Synopsis

Although calcification of the basal ganglia is a relatively common and asymptomatic finding on cranial computed tomography, familial idiopathic calcification of the basal ganglia (ICBG) is a rare disorder with neurological and behavioural manifestations. Attention has recently been drawn to the frequency with which cases are diagnosed as schizophrenic (Cummingset al.1983; Lowenthal, 1986; Davison, 1987). We report a family in which a mother and son have ICBG, but while the son has a paranoid schizophrenia and intellectual deterioration, the mother shows no psychiatric illness. A review of the relevant literature suggests that psychosis is not as common as usually supposed, and may only be coincidentally associated with familial ICBG. Moreover, we find little convincing evidence that familial ICBG is an independent entity; instead, and in agreement with earlier authorities (Bruynet al.1964), we argue that published accounts and our own cases provide evidence that the condition is related to pseudo-hypoparathyroidism (PHP) and, therefore, may be due to a defect in a guanine nucleotide binding protein.
The anatomy of melancholia – focal abnormalities of cerebral blood flow in major depression
Authors: Bench Christopher J. , Friston Karl J. , Brown Richard G. , Scott Lynette C. , Frackowiak Richard S. J. , Dolan Raymond J.
Published: July 2009

Synopsis

Using positron emission tomography (PET) and 15Oxygen, regional cerebral blood flow (rCBF) was measured in 33 patients with primary depression, 10 of whom had an associated severe cognitive impairment, and 23 age-matched controls. PET scans from these groups were analysed on a pixel-by-pixel basis and significant differences between the groups were identified on Statistical Parametric Maps (SPMs). In the depressed group as a whole rCBF was decreased in the left anterior cingulate and the left dorsolateral prefrontal cortex (P < 0·05 Bonferroni-corrected for multiple comparisons). Comparing patients with and without depression-related cognitive impairment, in the impaired group there were significant decreases in rCBF in the left medial frontal gyrus and increased rCBF in the cerebellar vermis (P < 0·05 Bonferroni-corrected). Therefore an anatomical dissociation has been described between the rCBF profiles associated with depressed mood and depression-related cognitive impairment. The pre-frontal and limbic areas identified in this study constitute a distributed anatomical network that may be functionally abnormal in major depressive disorder.
Bulimia nervosa and major depression: a study of common genetic and environmental factors
Authors: Walters Ellen E. , Neale Michael C. , Eaves Lindon J. , Heath Andrew C. , Kessler Ronald C. , Kendler Kenneth S.
Published: July 2009

Synopsis

A genetic analysis of the co-occurrence of bulimia and major depression (MD) was performed on 1033 female twin pairs obtained from a population based register. Personal interviews were conducted and clinical diagnoses made according to DSM-III-R criteria.

Additive genes, but not family environment, are found to play an important aetiological role in both bulimia and MD. The genetic liabilities of the two disorders are correlated 0·456. While unique environmental factors account for around half of the variation in liability to both bulimia and MD, these risk factors appear to be unrelated, i.e., each disorder has its own set of unique environmental risk factors. Thus, the genetic liability of bulimia and MD is neither highly specific nor entirely nonspecific. There is some genetic correlation between the two disorders as well as some genetic and environmental risk factors unique to each disorder. Limitations and directions for future research are discussed.
The epidemiology of psychiatrist-ascertained depression and DSM-III depressive disorders Results from the Eastern Baltimore Mental Health Survey Clinical
Authors: Romanoski A. J. , Folstein M. F. , Nestadt G. , Chahal R. , Merchant A. , Brown C. H. , Gruenberg E. M. , McHugh P. R.
Published: July 2009

Synopsis

Psychiatrists used a semi-structured Standardized Psychiatric Examination method to examine 810 adults drawn from a probability sample of eastern Baltimore residents in 1981. Of the population, 5·9% was found to be significantly depressed. DSM-III major depression (MD) had a prevalence of 1·1% and ‘non-major depression’ (nMD), our collective term for the other depressive disorder categories in DSM-III, had a prevalence of 3·4%. The two types of depression differed by sex ratio, age-specific prevalence, symptom severity, symptom profiles, and family history of suicide. Analyses using a multiple logistic regression model discerned that both types of depression were influenced by adverse life events, and that nMD was influenced strongly by gender, marital status, and lack of employment outside the home. Neither type of depression was influenced by income, education, or race. This study validates the concept of major depression as a clinical entity. Future studies of the aetiology, mechanism, and treatment of depression should distinguish between these two types of depression.
Parental representations of melancholic and non-melancholic depressives: examining for specificity to depressive type and for evidence of additive effects
Authors: Parker Gordon , Hadzi-Pavlovic Dusan
Published: July 2009

Synopsis

Several studies have suggested that ‘anomalous parenting’, as measured by the Parental Bonding Instrument (PBI), may be a differential risk factor to subsequent depression in adulthood – being irrelevant to melancholia but over-represented in non-melancholic depressive disorders. Such a ‘specificity’ effect is confirmed in our current sample of 65 melancholic and 84 non-melancholic depressed patients. Secondly, we examine the risk to depression effected by exposure to one parent with an anomalous parental style, and the extent to which that risk is modified by characteristics of the other parent. We find clear evidence of additive effects with the risk to non-melancholic depression being raised by exposure to ‘anomalous parenting’ from two parents. Of the varying parental styles measured by the PBI, low parental care from both parents provided the highest risk to non-melancholic depression (being 4–7 time higher in one sample and 13–27 times higher in the other).
Labelling and illness in primary care: comparing factors influencing general practitioners' and psychiatrists' decisions regarding patient referral to mental illness services
Authors: Farmer Anne E. , Griffiths Huw
Published: July 2009

Synopsis

GPs and psychiatrists from South Wales were asked to make decisions based on the information included in each of 16 vignettes describing depressed and anxious subjects. This information contained randomly assigned sex, psychiatric label, good and bad psychosocial context and age as well as eight different severity ratings of depression and anxiety symptoms. Our results showed that both GPs and psychiatrists were influenced in their decision making by the severity of the illness, but that GPs alone were also strongly influenced by the presence of male sex and by the presence of a psychiatric label. Good or bad psychosocial context had no influence on the GPs' referral decision, and previous experience in psychiatry or other vocational training had no detectable effect, but this may be because of the sample size.
Social class and minor psychiatric disorder in British Civil Servants: a validated screening survey using the General Health Questionnaire
Authors: Stansfeld S. A. , Marmot M. G.
Published: July 2009

Synopsis

Major psychiatric disorder is more common in people of lower rather than higher socioeconomic status. This is less clear for the commoner, so-called minor psychiatric disorders, but these are more affected by tendency to report symptoms. To examine this the distribution of minor psychiatric disorder by employment grade measured by the 30-item General Health Questionnaire is reported from the first cross-sectional phase of the Whitehall II Study of 10314 London-based civil servants, men and women between 35 and 55 years. Validation of the GHQ in a random subsample stratified by grade and sex (N= 201) suggested that people in lower employment grades tend to under-report minor psychiatric disorder on the GHQ relative to those in higher employment grades. The prevalence of minor psychiatric disorder corrected by the coefficients from the validity study was greater in the lower employment grades than the higher employment grades particularly for men. This was echoed in grade differences in well-being measured by the Affect Balance Scale, and in symptoms and recurrent health problems. Overall, for women there were few clear-cut differences in minor psychiatric disorder by employment grade. The lack of social class gradient in women suggests that further exploration should examine women's role at work and their personal lives for the aetiology of minor psychiatric disorder.
Pterin metabolism in depression: an extension of the amine hypothesis and possible marker of response to ECT
Authors: Anderson David N. , Abou-Saleh Mohammed T. , Collins James , Hughes Kevin , Cattell Richard J. , Hamon Christopher G. B. , Blair John A. , Dewey Michael E.
Published: July 2009

Synopsis

Urinary excretion of neopterins and biopterins was measured in 23 patients with severe depression before and after receiving electroconvulsive therapy (ECT) and 26 healthy control subjects. Patients with psychotic depression and those responding to ECT had neopterin:biopterin (N:B) ratio significantly higher than controls before commencing ECT and positive therapeutic response was associated with reduction of N:B ratio towards control values. As a raised N:B ratio implies failure to convert neopterin to biopterin it is possible that reduced availability of tetrahydrobiopterin, the essential cofactor for the formation of noradrenaline, serotonin and dopamine, may exert rate limiting control over the synthesis of monoamines implicated in the pathogenesis of depressive disorders. The N:B ratio may be a marker for certain depressive subtypes and response to ECT.
Folate deficiency, biopterin and monoamine metabolism in depression
Authors: Bottiglieri T. , Hyland K. , Laundy M. , Godfrey P. , Carney M. W. P. , Toone B. K. , Reynolds E. H.
Published: July 2009

Synopsis

Seven (21%) of 34 patients with a severe DSM-III diagnosis of major depression had red-cell folate levels below 150 ng/ml. This subgroup with folate deficiency had significantly lower CSF 5-hydroxyindoleacetic acid (5HIAA) compared to neurological controls. For all depressed patients red-cell folate was significantly correlated with CSF 5HIAA and homovanillic acid (HVA). CSF tetrahydrobiopterin (BH4) was significantly correlated with CSF 5HIAA and HVA and red-cell folate. Our observations provide further evidence of the links between folate, biopterin and monoamine metabolism in depression.
Clinical and neuropathological correlates of depression in Alzheimer's disease
Authors: Förstl Hans , Burns Alistair , Luthert Philip , Cairns Nigel , Lantos Peter , Levy Raymond
Published: July 2009

Synopsis

Depressive symptoms have been reported in patients with mild to moderate Alzheimer's disease (AD). Recent evidence suggests that a noradrenergic deficit originating from neuronal degeneration in brainstem nuclei may represent an organic correlate of these disturbances. We examined the neuropathological changes in the locus coeruleus (LC), substantia nigra (SN), basal nucleus of Meynert and cortex of 52 patients (12 male, 40 female, mean age 83·2 ± 6·4 years) with pathologically verified AD. Fourteen patients (1 male, 13 female) showed signs of depression. The majority of these patients suffered from severe physical disability or sensory impairment and developed persistent delusions, but had less cognitive impairment. Neuronal counts in the LC were significantly lower than in the 38 patients without depression (36·9 ± 14 ·0; 51·4 ± 28·0 neuromelaninpigmented cells per section per nucleus;F= 3·4, df = 1, 50,P= 0·04). Neuron counts were higher in the basal nucleus of Meynert in depressed AD patients and there were no differences of the neuron numbers in the SN. Depression (main effect;F= 4·5,P= 0·04) contributed significantly to the variance of neuronal counts in the LC, even when covarying for gender, age of onset, cognitive impairment and cortical Alzheimer pathology. The observed disproportionate loss of noradrenergic and cholinergic neurons in the LC and basal nucleus of Meynert may represent an important organic substrate of depression in AD.
Operational criteria for senile dementia of Lewy body type (SDLT)
Authors: McKeith I. G. , Perry R. H. , Fairbairn A. F. , Jabeen S. , Perry E. K.
Published: July 2009

Synopsis

Recent reports have suggested that brain stem and cortical Lewy body formation may identify a neurodegenerative disorder in elderly demented individuals which accounts for up to 20% of cases of senile dementia coming to autopsy. Retrospective analysis of case notes of 21 autopsy patients with neuropathologically proven senile dementia of Lewy body type (SDLT) and 37 cases with neuropathologically proven Alzheimer's disease (AD) identified a characteristic clinical syndrome in SDLT. Fluctuating cognitive impairment; psychotic features including visual and auditory hallucinations, and paranoid delusions; depressive symptoms; falling and unexplained losses of consciousness were all seen significantly more often than in AD.

Over half of the SDLT patients in this series who were given neuroleptics in standard dose showed acute and often irreversible adverse reactions indicative of a neuroleptic sensitivity syndrome. The survival time of drug treated patients was reduced by 50%.

Operational criteria to aid in the clinical distinction between SDLT and AD patients are proposed and hypotheses regarding possible aetiology and treatment discussed.
Sub-syndromes of tardive dyskinesia and some clinical correlates
Authors: Brown K. W. , White T.
Published: July 2009

Synopsis

Syndromes of dyskinetic movements in subjects (N = 70) with chronic schizophrenia were investigated, using principal components analysis of AIMS ratings. Consonant with previous research, three discrete groupings were found, namely dyskinetic movements of lips-jaw-tongue, limb-truncal and facial movements. These were then related to demographic, psychological and movement disorder variables. The limb-truncal, but neither the lips-jaw-tongue nor facial movements components, were associated with negative symptoms and cognitive impairment.
The outcome of childhood conduct disorder: implications for defining adult personality disorder and conduct disorder
Authors: Zoccolillo Mark , Pickles Andrew , Quinton David , Rutter Michael
Published: July 2009

Synopsis

The effect of conduct disorder on adult social functioning in the areas of work, sexual/love relationships, social relationships and criminality was studied in a sample of young adults who spent much of their childhoods in group-cottage children's homes and an inner-city comparison group. Most subjects with conduct disorder had pervasive (but not necessarily severe) social difficulties compared to peers without conduct disorder. Less than half of this group met DSM-III adult criteria for antisocial personality disorder and just over half were given a diagnosis of personality disorder on interviewer clinical ratings. A latent class model that used both the retrospective and contemporaneous indicators of conduct disorder confirmed the very high continuity with adult social difficulties. Current diagnoses did not adequately describe this group and conduct disorder appeared to be an almost necessary condition for multiple social disability in adults in these samples.
Dimensions of neurosis
Authors: Lewis Glyn
Published: July 2009

Synopsis

Factor analyses of the General Health Questionnaire have attempted to interpret the factors as measuring anxiety, depression and social functioning. Data from two large community surveys were used to conduct an unrotated principal components analysis of the 30-item General Health Questionnaire. A general factor, indicating overall severity of psychiatric disorder, accounted for around 30% of the variance. The next most important factor, accounting for about 8% of the variance, was bipolar with the positive (‘less than usual’) items of the General Health Questionnaire having positive coefficients and the negative (‘more than usual’) items having negative coefficients. It is suggested that the concepts of positive and negative mental health derive empirical support from the results and may prove to be a useful classification of dimensions of mental health in the community.
A longitudinal psychopathological schedule
Authors: Brockington Ian , Roper Anne , Edmunds Elaine , Kaufman Carol , Meltzer Herbert Y.
Published: July 2009

Synopsis

A schedule is described for rating the symptoms of mental illness over a period of time which includes several episodes. The reliability was measured in a study involving six raters. The sources of information required were studied, in 20 patients, by comparing an interview with the patient, a similar interview with an informant and an analysis of the case records. A synopsis of interview and record data are necessary to obtain adequate information about longitudinal psychopathology and ‘lifetime’ diagnosis.
Neopterin measurement provides evidence of altered cell-mediated immunity in patients with depression, but not with schizophrenia
Authors: Dunbar P. R. , Hill J. , Neale T. J. , Mellsop G. W.
Published: July 2009

Synopsis

Neopterin is a validated marker of the activation of cell-mediated immunity in a variety of disease states. We measured neopterin and creatinine concentrations in the plasma and urine of 22 schizophrenic and 26 depressed patients admitted acutely to hospital, and compared results with those in a large group of normal controls. Neopterin/creatinine ratios were normal in the schizophrenic patients, but significantly elevated in the plasma of depressed patients. In each diagnostic group, the use of psychotropic drugs before admission had no effect on the neopterin ratios observed. Our findings indicate altered cell-mediated immunity in depression.
An early Dutch study of déjà vu experiences
Authors: Sno Herman N. , Draaisma Douwe
Published: July 2009

Synopsis

In 1904 and 1906, Heymans reported the results of two prospective questionnaire surveys on déjà vu experiences and depersonalization in a sample of mainly students. Déjà vu experiences appeared to be more frequent than episodes of depersonalization. Emotional sensitivity, unstable mood fluctuations, apathetic episodes and irregular working rhythm emerged as predisposing personality traits. With the exception of the working rhythm, these traits were more prominent among the respondents with episodes of depersonalization than among those with déjà vu experiences. Heymans inferred that these findings supported his hypothesis that déjà vu experiences and depersonalization both resulted from the diminishing or disappearance of a sense of familiarity due to a momentary reduction of psychological energy. A re-analysis of Heymans' data partly confirmed his findings and conclusions as to the predisposing factors. The authors conclude that his studies and his hypothesis have been hitherto undervalued and would deserve more attention.
A computerized magnetic resonance imaging study of corpus callosum morphology in schizophrenia
Authors: Woodruff P. W. R. , Pearlson G. D. , Geer M. J. , Barta P. E. , Chilcoat H. D.
Published: July 2009

Synopsis

The hypothesis tested was that, in schizophrenia, corpus callosum size would be reduced, particularly in the region responsible for communication between both temporal lobes. This is supported by knowledge of: (a) anatomical homotopicity and functional specialization of fibres within the corpus callosum; (b) evidence linking structural and functional deficits of the corpus callosum and left temporal lobe with schizophrenia; and (c) that temporal lobe neuronal fibres pass through the middle region of the corpus callosum. Brain area and corpus callosum areas, widths and length were measured on mid-sagittal MRI scans using a computer outlining method. Scans from 30 schizophrenics and 44 normal subjects were compared. Mid-sagittal brain area, corpus callosum area, length and anterior widths were reduced in the schizophrenic group compared with controls. A significant area difference between schizophrenics and controls was seen in the mid-corpus callosum which communicates between the temporal lobes, including the superior temporal gyri. In schizophrenics, corpus callosum area reduction was not accounted for by brain area shrinkage alone. Differences between the two groups were accounted for by comparisons between males only. These findings support the hypothesis and the possibility that localized abnormalities of bilaterally connected brain regions might have secondary effects on their homotopically distributed fibres within the corpus callosum.
Memory for visuospatial patterns in Alzheimer's disease
Authors: Grossi Dario , Becker James T. , Smith Christine , Trojano Luigi
Published: July 2009

Synopsis

Immediate memory for visuospatial information was assessed in patients affected by Alzheimer-type dementia but with unimpaired visuo-perceptual functions. Patients were given two tasks: one was a traditional visuospatial memory task (Corsi's block tapping test), the second explored specifically immediate memory for visuospatial patterns. The experiment was conducted in two parallel groups of patients in Italy and the United States, each with its own appropriate sample of normal control subjects. Results showed a specific deficit of visual working memory in demented patients, even in a task in which control subjects achieved error-free performance. These data are interpreted in the light of the Working Memory Model, and suggest that in dementia the functions of the Visuospatial Scratchpad, unlike the functions of the verbal subsystems, may be impaired.
Learning and memory in monozygotic twins discordant for schizophrenia
Authors: Goldberg Terry E. , Torrey E. Fuller , Gold James M. , Ragland J. Daniel , Bigelow Llewellyn B. , Weinberger Daniel R.
Published: July 2009

Synopsis

Learning and memory were assessed in 24 monozygotic (MZ) pairs of individuals discordant for schizophrenia or delusional disorder and seven normal pairs of MZ twins. On declarative memory tasks, the affected group displayed a pattern that might best be characterized as dysmnesic in that they performed significantly worse than the discordant unaffected group on story recall, paired associated learning, and visual recall of designs, but they learned over time, had relatively preserved recognition memory, and did not show profoundly accelerated rates of forgetting. Effortful, volitional retrieval from the lexicon, measured by verbal fluency, was also compromised in the affected group. On the other hand, procedural learning of the motor skill in a pursuit rotor task was relatively intact in the affected group. Comparisons of the normal group and unaffected group indicated that the latter group had very mild impairments in some aspects of episodic memory, namely, immediate and delayed recall of stories and delayed recall of designs. It is highly unlikely that the impairments observed in the affected group can be attributed to differences in genome, family environment, socioeconomic circumstance, or educational opportunity, as all of these were controlled by the twin paradigm. Rather, the impairments appear to be related to the intercession of disease. The neuropsychological profile is consistent with frontal lobe and medial temporal lobe dysfunction, as noted in this sample as well as other samples of schizophrenic singletons. Significant correlations between many measures of memory and global level of social and vocational functioning within the discordant group were also found. Thus difficulties in rapidly acquiring new information and propitiously retrieving old information may burden patients with schizophrenia in many of the transactions of everyday life.
A prospective study of delirium in elderly patients admitted to a psychiatric hospital
Authors: Koponen Hannu J. , Riekkinen Paavo J.
Published: July 2009

Synopsis

Seventy consecutive elderly patients meeting the DSM-III criteria for non-alcohol delirium were examined during the acute stage and followed to four years later. The mean age of the patients at the beginning of the index admission was 74, 8±6, 4 years. The most common aetiologies for delirium were stroke, infections and metabolic disorders. Coexistent structural brain disease predisposing to delirium was found in 57 cases (81%). During the index admission, the cognitive dysfunction associated with delirium ameliorated significantly (mean±S.D. Mini Mental State Examination score 9·7±6·6 at admission and 13·9±7·2 at discharge,P< 0·001), but during the follow-up period of four years progression of the basic central nervous system disease was observed together with declining cognition and deteriorating functions of daily living. Four patients died during the index admission and 42 patients during the follow-up period. In deceased patients there was a statistically significant connection between the levels of cognitive functioning and functions of daily living at the end of the index admission and the life span after delirium.