bluuebunny/crossref_metadata_2025 huggingface dataset:
Profile of Female Firesetters
Authors: Stewart Lynn A.
Published: October 2008

We studied 28 female arsonists and 28 female controls admitted to Holloway Prison over four months to examine the psychological and situational antecedents to firesetting so that the behaviour could be targeted for treatment. Over 92% of the arson group had received a psychiatric diagnosis. Both groups had similarly high rates of early deprivation and abuse. None of the female arsonists had set a fire for financial gain. There was no evidence of sexual arousal being associated with firesetting; only two women described their firesetting in terms that suggest a level of compulsion - one of these was alcoholic, the other was diagnosed as severely personality disordered. Several behavioural and psychological antecedents to offending were identified which could be targeted for treatment: low self-esteem, depression, limited communication skills, and deficits in anger management. The relapse prevention model is suggested as a possible intervention for recidivistic arsonists.
Recognising Psychiatric Symptoms
Authors: Berrios G. E. , Chen E. Y. H.
Published: October 2008

Current overemphasis on nosological diagnosis has led to a neglect of the process of symptom recognition. There is evidence, however, that the perception of the symptom alone does not guarantee symptom ascertainment since a decision-making component is also involved. To achieve the latter, additional information must be provided by the contextual cues implicit in the ongoing diagnostic hypothesis. Current diagnostic systems, however, still assume a two-stage model according to which symptom and disease recognition are independent cognitive events. This paper suggests that this model is inadequate and that descriptive psychopathology is nottransparent. It then describes a neural network simulation to make various aspects of the problem explicit. This takes into account the multidimensional and probabilistic aspects of symptom recognition and is, from this point of view, superior to traditional algorithmic models. It also has the capacity to represent the different cognitive styles involved in symptom recognition.
Neuropathological Correlates of Behavioural Disturbance in Confirmed Alzheimer's Disease
Authors: Förstl Hans , Burns Alistair , Levy Raymond , Cairns Nigel , Luthert Philip , Lantos Peter
Published: October 2008

Clinico-pathological correlations were examined in 54 patients with neuropathologically verified Alzheimer's disease (AD) who were part of a prospective study. Behavioural disturbance was documented using an expanded version of the Stockton Geriatric Rating Scale (SGRS). The subscores for physical disability (P), apathy (A) and communication failure (C) (summation score PAC) were closely correlated and were high in most patients during the late stages of illness. High PAC scores correlated with an earlier onset and longer duration of illness, lower brain weight, more severe tangle pathology in the parahippocampal gyrus and the frontal and parietal neocortex, and lower neuron counts in the hippocampus and basal nucleus of Meynert. Features of the Klüver-Bucy syndrome (range behaviour and hypermetamorphosis) were significantly associated with lower counts of large neurons in the parahippocampal gyrus and parietal neocortex, but not with more severe plaque or tangle formation or with neuronal loss in the subcortical nuclei. No correction was made for multiple comparisons. These findings may signify decreased cortical inhibition in patients with relatively well preserved subcortical structures who show features suggestive of the Klüver-Bucy syndrome. High PAC scores on the SGRS could reflect more advanced and widespread cerebral pathology in the end stages of AD.
Life Events and Relapse in Established Bipolar Affective Disorder
Authors: Mcpherson Heather , Herbison Peter , Romans Sarah
Published: October 2008

A New Zealand cohort of 58 patients with bipolar affective disorder was studied prospectively with three-monthly interviews in order to determine the relationship between life events and their relapses. Careful attention was paid to dating life events and the earliest signs of relapse and to assessing the independence of life events from the illness. No statistically significant association was found between life events and the likelihood of relapses, either mania or depression, for the 71% of patients who experienced at least one relapse during the two-year study. This finding is at variance with a companion study, with identical methodology, which found a small increase of life events before relapse. These data add further weight to the previous reports that life events are significant precipitants of bipolar illness only for earlier episodes in the course of this chronic disorder.
Attachment Theory: A Biological Basis for Psychotherapy?
Authors: Holmes Jeremy
Published: October 2008

John Bowlby bemoaned the separation between the biological and psychological approaches in psychiatry, and hoped that attachment theory, which brings together psychoanalysis and the science of ethology, would help bridge the rift between them. Recent findings in developmental psychology have delineated features of parent–infant interaction, especially responsiveness, attunement, and modulation of affect, which lead to either secure or insecure attachment. Similar principles can be applied to the relationship between psychotherapist and patient - the provision of a secure base, the emergence of a shared narrative (‘autobiographical competence’), the processing of affect, coping with loss - these are common to most effective psychotherapies and provide the basis for a new interpersonal paradigm within psychotherapy. Attachment theory suggests they rest on a sound ethological and hence biological foundation.
“A Special Defence”: A Psychiatric Approach to Formalising Euthanasia
Authors: Helme Tim
Published: October 2008

Domestic and world opinion is gradually changing towards the idea of tolerating or even legalising active euthanasia. The implications of this are examined using Foulke's concept of the ‘levels' in group discussions. Psychiatrists have a unique experience in using the statutory mental health legislation, in addition to the ordinary law, to regulate medical care. A new ‘special defence’ is suggested, to be enacted by Parliament, intended to justify, but also designed to control, deliberate acts of medical euthanasia.
Psychiatric Morbidity in Older People with Moderate and Severe Learning Disability
Authors: Moss Steve , Patel Pradip , Prosser Helen , Goldberg David , Simpson Neill , Rowe Steve , Lucchino Ron
Published: October 2008

This paper describes the development of the PAS-ADD, a semistructured clinical interview for use specifically with patients with learning disabilities, based on items drawn from the PSE. The PAS-ADD includes a number of novel features including: parallel interviewing of patient and informant; a three-tier structure to provide a flexible interview appropriate to the patient's intellectual level; use of a memorable ‘anchor event’ in the patient's life to improve time focus; and simplified wording, improved organisation and lay out. Inter-rater reliability was investigated using an experimental design in which two raters viewed and re-rated videotaped PAS-ADD interviews which had been conducted by an experienced clinician. Reliability results compared favourably with those obtained in a major study of PSE reliability with a sample drawn from non-learning disabled individuals. Mean kappa for all items was 0.72. Other indexes of reliability were also good. In the current phase of development, the PAS-ADD is to be expanded to include further diagnostic categories, including schizophrenia and autism. The new version will be updated for use with ICD–10 criteria.
Familial Psychiatric Illness and Obstetric Complications in Early-Onset Affective Disorder
Authors: Guth Christian , Jones Peter , Murray Robin
Published: October 2008

Early-onset affective disorder is associated with obstetric complications and a high familial risk of psychiatric illness, in particular psychosis. In a matched case-control study, we investigated 47 adult in-patients with major depressive disorder or bipolar 1 disorder, who had earlier in life presented to a child psychiatry department. Cases were matched on sex, social class and ethnic group with 47 controls, who were admitted to hospital for affective disorders in adult life but had no psychiatric contact before the age of 21. We found that both psychiatric disorder in first-degree relatives and a history of obstetric complications were associated with early onset. Childhood symptoms did not predict the type of adult affective disorder.
Psychopathology and Quality of Life Among Mentally Ill Patients in the Community
Authors: Warner Richard , Huxley Peter
Published: October 2008

Sixty-nine mentally ill patients in treatment in an intensive community support system in Boulder, Colorado, were evaluated using the same measures of quality of life and psychopathology as were used in assessing mentally ill patients in hospital and community facilities in Manchester. Psychopathology was greater in the Boulder samples, but quality-of-life scores were no worse for the American patients. The relationship of these findings to systems of care and availability of psychiatric hospital beds is discussed.
Epidemiological Evidence that Maternal Influenza Contributes to the Aetiology of Schizophrenia
Authors: Adams W. , Kendell R. E. , Hare E. H. , Munk-Jørgensen P.
Published: October 2008

The epidemiological evidence that the offspring of women exposed to influenza in pregnancy are at increased risk of schizophrenia is conflicting. In an attempt to clarify the issue we explored the relationship between the monthly incidence of influenza (and measles) in the general population and the distribution of birth dates of three large series of schizophrenic patients - 16 960 Scottish patients born in 1932–60; 22 021 English patients born in 1921–60; and 18 723 Danish patients born in 1911–65. Exposure to the 1957 epidemic of A2 influenza in midpregnancy was associated with an increased incidence of schizophrenia, at least in females, in all three data sets. We also confirmed the previous report of a statistically significant long-term relationship between patients' birth dates and outbreaks of influenza in the English series, with time lags of - 2 and - 3 months (the sixth and seventh months of pregnancy). Despite several other negative studies by ourselves and others we conclude that these relationships are probably both genuine and causal; and that maternal influenza during the middle third of intrauterine development, or something closely associated with it, is implicated in the aetiology of some cases of schizophrenia.
Schizophrenia – Falling Incidence and Better Outcome?
Authors: Harrison Glynn , Mason Peter
Published: October 2008

It has been suggested that schizophrenia is a disappearing disease. The evidence for this assertion is reviewed, and also for a parallel theory advanced in recent years that the disorder may be undergoing a benign metamorphosis in its course and outcome. It is concluded that the evidence is presently unconvincing given the methodological problems inherent in most follow-up studies; changes have taken place in clinicians' assumptions, in treatments, and in the quality of follow-up studies, rather than in the disorder itself. Nevertheless, possible time trends in the incidence and outcome of schizophrenia call for further scientific investigation.
Predictors of Response to Lithium and Triiodothyronine Augmentation of Antidepressants in Tricyclic Non-responders
Authors: Joffe Russell T. , Levitt Anthony J. , Bagby R. Michael , MacDonald Cathy , Singer William
Published: October 2008

Although both lithium and triiodothyronine (T3) augmentation strategies may be rapid, safe, and effective ways of treating patients who fail to respond to tricyclics, little is known about the clinical or biochemical correlates of response. We examined clinical and endocrine variables which distinguished T3 and lithium responders from each other and from non-responders in a post-hoc analysis of two studies involving 51 subjects who had received these augmentation strategies under double-blind conditions. Lithium non-responders were more severely depressed and had more insomnia and weight loss than responders. T3 responders could be distinguished from lithium responders by greater weight loss. There were no reliable clinical differences between T3 responders and non-responders. Thyroid function tests did not differ between any of the treatment or response groups. Our findings suggest that clinical but not endocrine variables may distinguish responders to these two augmentation strategies.
Schizophrenia in Nottingham: Lifelong Residential Mobility of a Cohort
Authors: Dauncey Karen , Giggs John , Baker Karen , Harrison Glynn
Published: October 2008

The lifetime geographical mobility of a group of 67 patients suffering from schizophrenia was investigated and related to the ecological structure of the city of Nottingham, where they first presented between 1978 and 1980. The study aimed to investigate the processes leading to a threefold rate of schizophrenia in the most socioeconomically deprived area of the city compared to the area of least deprivation. Results suggest that this skewed distribution begins early in the lives of the patients and is well established at least five years before initial contact with the psychiatric services.
Remands and Psychiatric Assessments in Holloway Prison
Authors: Dell Susanne , Robertson Graham , James Katie , Grounds Adrian
Published: October 2008

Remand prisoners diagnosed as psychotic by Holloway's psychiatrists were followed up to time of sentence. Most were referred to outside psychiatrists and then offered beds. Courts invariably enabled the beds to be used. Few women had committed serious offences, and most had been remanded because the courts thought they needed help. The study showed custodial remands to be an unsatisfactory way of seeking treatment for psychotic offenders. Alternatives need to be developed urgently. For psychotic people who continue to be remanded in custody, transfers rather than court orders should initially be used to effect admission.
State-Dependent Pain in Winter Depression
Authors: Dilsaver Steven C. , Del Medico Valerie J. , Qamar Amjed B.
Published: October 2008

The incidence and nature of state-dependent pain were investigated in 43 consecutively presenting patients with recurrent autumn/winter episodes of major depression followed by spontaneous recovery in the spring. Twenty-two (51.2%) experienced state-dependent pain, which appears to be a common concomitant of wintertime depression.
Handedness in Mental Handicap: Investigation into Populations of Down's Syndrome, Epilepsy and Autism
Authors: Lewin J. , Kohen D. , Mathew G.
Published: October 2008

The handedness in three randomly sampled groups of people with learning disabilities consisting of patients with Down's syndrome, epilepsy, and autism were studied using a validated instrument. All subjects were controlled for neurological and other medical disorders. A statistically significant increase in left-handedness and ambiguous handedness compared with the general population was found in all groups. There was no significant difference in the rate of left-handedness between the three groups.
Soviet Special Psychiatric Hospitals
Authors: Adler Nanci , Gluzman Semyon
Published: October 2008

The subversion of psychiatric intervention for political purposes in the USSR during the 1970s and 1980s resulted in both intra-psychic and subsequent adaptational dysfunction in those dissidents who physically survived it. Incarceration in special psychiatric hospitals subjected the inmates to a sense of helplessness under the control of a malevolent power, futility, despair, danger from close and contentious contact with hardened criminals and the violently insane, overdosage with mind-altering and body-distorting neuroleptic drugs, and a Kafkaesque ambiguity concerning the specific terms of institutionalisation. Discharge did not bring release from continued threats and the eroded social networks to which the inmates returned subjected them to a new set of stressors. While some families remained intact and provided necessary support during the re-entry period, many families had been destroyed either by the circumstances of the family member's incarceration or by the length of the victim's stay in the psychiatric hospital. Wives left, people died, friends deserted, jobs evaporated, and often there was not even a home to accept them. Social agencies were either hostile or indifferent to their plight. Many felt like they had been thrown overboard from a prison ship without a life preserver. It was the proverbial transition from the frying pan into the fire.
Childhood Sexual Abuse and Mental Health in Adult Life
Authors: Mullen Paul E. , Martin Judy L. , Anderson Jessie C. , Romans Sarah E. , Herbison G. Peter
Published: October 2008

The relationship between childhood sexual abuse and mental health in adult life was investigated in a random community sample of women. There was a positive correlation between reporting abuse and greater levels of psychopathology on a range of measures. Substance abuse and suicidal behaviour were also more commonly reported by the abused group. Childhood sexual abuse was more frequent in women from disrupted homes as well as in those who had been exposed to inadequate parenting or physical abuse. While elements in the individual's childhood which increased the risks of sexual abuse were also directly associated to higher rates of adult psychopathology, abuse emerged from logistic regression as a direct contributor to adult psychopathology. Severity of abuse reported was related to the degree of adult psychopathology. The overlap between the possible effects of sexual abuse and the effects of the matrix of disadvantage from which it so often emerges were, however, so considerable as to raise doubts about how often, in practice, it operates as an independent causal element. Further, many of those reporting childhood sexual abuse did not show a measurable long-term impairment of their mental health. Abuse correlated with an increased risk for a range of mental health problems, but in most cases its effects could only be understood in relationship to the context from which it emerged.
Otago Women's Health Survey 30-Month Follow-Up
Authors: Romans S. E. , Walton V. A. , McNoe B. , Herbison G. P. , Mullen P. E.
Published: October 2008

Women who showed new psychiatric morbidity after a 30-month follow-up of a random community sample of New Zealand women were compared with those who were free of psychiatric disorder at follow-up. There were 25 new cases among the 215 women who were originally not psychiatric cases and who were re-interviewed. Using the weighted back population data to obtain prevalence figures for the general population, 6.9% became new cases over the two and a half years. Those who developed psychiatric disorder initially showed more psychiatric symptoms at a subdiagnostic level. Baseline factors that preceded the onset of psychiatric disorder were being separated or divorced, coming from a large family, having poor social networks, living alone, having few social role responsibilities such as paid employment or motherhood, and having poor physical health. An additional cross-sectional association at follow-up was poor financial security. Good social networks were closely linked with the number of a woman's social roles and appeared to protect her against the onset of psychiatric disorder. Consistent with the initial cross-sectional study, the follow-up data provide no support for marriage and child-care being risk factors for female psychiatric disorder. However, in New Zealand, these factors indicate social integration and are associated with superior mental health.
Do Psychosocial Factors Influence Outcome in Severely Depressed Female Psychiatric In-patients?
Authors: Andrew Bernice , Hawton Keith , Fagg Joan , Westbrook David
Published: October 2008

Fifty-nine women admitted to hospital because of severe depression were studied prospectively during hospital admission and nine months following hospital discharge in order to identify psychosocial and illness factors associated with prognosis. Outcome was measured in terms of both depression scores and recovery at the time of follow-up. In keeping with the findings of other studies, the outcome was often poor, with only 54% having recovered nine months after discharge, poorer outcome being associated with more negative self-esteem measured when the women were depressed and with suicidal ideas. The findings indicate that in severely depressed women likely to be admitted to hospital, psychosocial factors may have less relevance to outcome, at least in the short term, than in less severely depressed patients studied in community or out-patient samples.
Negative Symptoms as a Risk Factor for Tardive Dyskinesia in Schizophrenia
Authors: Liddle Peter F. , Barnes Thomas R. E. , Speller Jeremy , Kibel David
Published: October 2008

Investigation of the relationships between negative schizophrenic symptoms, abnormal involuntary movements and age in 179 chronic schizophrenic patients confirmed that both orofacial and trunk and limb dyskinesia are associated with negative symptoms, but only orofacial dyskinesia showed a significant increase in prevalence with increasing age. Estimation of the mean age of onset of orofacial dyskinesia from the observed variation in prevalence of orofacial dyskinesia with age indicated that patients having negative symptoms tend to develop orofacial dyskinesia at an earlier age. The estimated mean age of onset was 43.6 years in patients with substantial negative symptoms, and 54.6 years in patients without substantial negative symptoms. These findings support the proposal that the pathological process underlying negative symptoms can contribute to the occurrence of both orofacial and trunk and limb dyskinesia, but, in the case of orofacial dyskinesia, there is a synergistic interaction between the pathological process underlying negative symptoms and age-related neuronal changes.
The Effect of Activation Procedures on Neuroleptic-Induced Akathisia
Authors: Fleischhacker W. Wolfgang , Miller Carl H. , Barnas Christian , Bergmann Ken , Perovich Robert , Alvir Jose Ma. J. , Lieberman Jeffrey A. , Kane John M.
Published: October 2008

Two studies have been performed to evaluate the effect of activation tasks on neuroleptic-induced akathisia (NIA). In the first sample (30 patients) we found a consistent increase of symptoms during mental activation while motor activation led to a decrease. In a second study 34 patients with the same diagnosis were evaluated, using slightly different statistical procedures: while the effects of motor activation were corroborated, mental activation did not change NIA. Since mental and motor activation are usually considered to increase tardive dyskinesia and Parkinsonism, these measures might be helpful in differentiating NIA from other antipsychotic-induced movement disorders.
Psychiatric Morbidity in Sentenced Segregated HIV-Positive Prisoners
Authors: Dorman Arthur , O'Connor Art , Hardiman Eamonn , Freyne Aideen , O'Neill Helen
Published: October 2008

In this comparative study with a control group of prisoners, psychiatric morbidity was measured in two groups of sentenced prisoners, each group completing the GHQ-30 and 21-item Beck Depression Inventory (BDI). Group 1 consisted of 40 segregated HIV-positive prisoners and group 2 a matched control group in the main prison who had no history of HIV seropositivity. All members of group 1 had a history of intravenous drug abuse. The mean GHQ-30 and BDI scores were significantly higher in group 1, and 90% of group 1 were psychiatric ‘cases’ compared with just over 42% of group 2. Levels of psychiatric morbidity present in a third group, consisting of HIV-positive prisoners who had not been segregated (prison authorities were unaware of their seropositivity) are an interesting pointer for further research.
Stress Among Police Body Handlers
Authors: Alexander David A.
Published: October 2008

Thirty-five police officers were followed up three years after they had been first assessed following their involvement in the retrieval and identification of human remains after a major disaster. Most of these officers were free from signs of psychiatric morbidity. Organisational and managerial practices appear to be powerful antidotes to adverse post-traumatic reactions. In this study the use of a longitudinal design, with a pre-disaster baseline and a control group, suggests that these are robust findings.
Treatment of Hysterical Aphonia with Hypnosis and Prokaletic Therapy
Authors: Neeleman J. , Mann A. H.
Published: October 2008

A patient with chronic refractory hysterical aphonia was treated by prokalesis (challenge) and hypnosis within a psychotherapeutic relationship. A temporary remission was achieved but this was followed by subsequent relapse. This report Mustrates the therapeutic effectiveness of prokaletic techniques. It also emphasises that these potent interventions are unlikely to achieve abiding change unless they are applied within the context of a longer-term relationship with a clinical team.
A Case of Delayed Post-traumatic Stress Disorder with ‘Organic Memories’ Accompanying Therapy
Authors: Briggs Andrew C.
Published: October 2008

A case of post-traumatic stress disorder (PTSD) following a road traffic accident in which the onset of symptoms was delayed for 18 months until a widely reported major disaster occurred is described. A severe major depressive episode was precipitated, requiring treatment in its own right. During psychotherapy sessions, extreme emotions, heightened sensations, and ‘organic memories’ relating to the original accident were experienced.
Psychiatric Disorder in Women Serving a Prison Sentence
Authors: Maden Tony , Swinton Mark , Gunn John
Published: October 2008

The paper describes a case-note and interview study of a cross-sectional sample comprising 25% of all women serving a prison sentence in England and Wales. A 5% sample of the male sentenced prison population was used for comparison. Diagnoses were assigned on clinical grounds and an assessment was made of the treatment needs of all ‘cases’. The prevalence of psychosis, around 2%, was similar in the two groups but women had higher rates of mental handicap (6% v. 2%), personality disorder (18% v. 10%), neurosis (18% v. 10%) and substance abuse (26% v. 12%). There is a need for closer links between the NHS and prison health services. Women's prisons lack a therapeutic community of the Grendon type, which may be of benefit to a substantial minority of inmates.
Assaultiveness Among Institutionalised Adults with Mental Retardation
Authors: Linaker Olav M.
Published: October 2008

In an institution, 57 people with mental retardation who had shown assaultive behaviour during the last year were compared with a control group of 57 people in the same institution, matched by sex, level of retardation and age. The study group were younger and had more people with a moderate level of mental retardation than the total population of the institution. Compared with the controls, the assaultive group had more resources available, had more psychopathology, consumed more psychotropic drugs, and had a higher frequency of other problem behaviour. We found no group differences in personal skills, including communication. Generally, the observed covariates of assaultive behaviour resembled that seen in other populations with assaultive behaviour.
Ten-Year Follow-Up of 50 Patients with Bulimia Nervosa
Authors: Collings Sunny , King Michael
Published: October 2008

Long-term outcome studies for people suffering from bulimia nervosa are few. Ten years after presentation, we followed up 50 patients (49 women, 1 man) who were originally involved in a double-blind, controlled trial of the antidepressant mianserin. Standardised interviews and questionnaires were used to assess eating attitudes and behaviour, psychiatric status and social functioning. A DSM–III–R diagnosis was given where appropriate. Sufficient information to make a diagnosis was obtained for 44 subjects (88%). Of patients traced, 52% had recovered fully and only 9% continued to suffer the full syndrome; 39% continued to experience some symptoms. Significant predictors of favourable outcome were younger age at onset, higher social class and a family history of alcohol abuse. Outcome for bulimia nervosa continues to improve over ten years with the majority of patients eventually making a full recovery or suffering only moderate abnormalities in eating attitudes. Although predictors of recovery were few, it would appear that intervention has a significant impact on ultimate outcome.
Clinical use of High-Dose Neuroleptics
Authors: Hirsch Steven R. , Barnes Thomas R. E.
Published: October 2008

There has been increasing public concern about the risks of high-dose antipsychotic (neuroleptic) treatment, arising in part from an, as yet unproven, association between high-dose treatment and death in a small minority of patients. The clinical issues related to the use of neuroleptics in doses exceeding the maximum recommended in theBritish National Formulary(BNF) were discussed at the Psychopharmacology Subcommittee. When, if ever, should the recommended doses be exceeded?
Folnegović & Folnevogić-Šmalc's “Schizophrenia in Croatia: Inter-regional Differences in Prevalence and a Comment on Constant Incidence”
Authors: Cooper Brian , Eagles John M.
Published: October 2008

“Study objective - The aim was to examine why differences exist in schizophrenia prevalence and risk in some areas of Croatia, when schizophrenia incidence rates do not appear to vary. Design - Areas differing by schizophrenia admission rates in patients born in 1953 and admitted by the age of 31 years are compared using a number of indicators relating both to general population characteristics and to those of schizophrenic cases in these populations. Setting - The study covers the whole of Croatia (4 601 469 inhabitants, 1981 census). Subjects - By the age of 31 years, out of 80 445 individuals born in Croatia in 1953, 464 were admitted for and diagnosed as having schizophrenia. Main results - Admission risk rates are higher in those parts of Croatia where emigration rates are high and lower where immigration rates are high. There is also a positive correlation with schizophrenia prevalence and manic depressive psychosis rates. There is a negative correlation with age of onset of schizophrenia and with schizophrenic reproduction rates. In the study areas, hospital incidence rates are not significantly different. Conclusions - Economic migration and negative selection in the domestic population are likely to be the most significant factors leading to differences in schizophrenia prevalence. The approximately equal incidence rates in the population, with different prevalence and admission risks, are linked to differences in the disease onset among schizophrenics with a positive family history for this condition. In other words, these patients, when part of the population with a greater prevalence and a greater hereditary loading, experience the onset more often at an earlier age. Thus they have a lower reproduction rate than in a population with a lower prevalence and a lower hereditary loading. Thus incidence rates in populations with different prevalences and different hereditary loads are maintained roughly equal over generations.”
An Examination of Linkage of Schizophrenia and Schizoaffective Disorder to the Pseudoautosomal Region (Xp22.3)
Authors: Crow Timothy J. , Delisi Lynn E. , Lofthouse Raymond , Poulter Mark , Lehner Thomas , Bass Nicholas , Shah Tarulata , Walsh Catherine , Boccio-Smith Angela , Shields Gail , Ott Jurg
Published: October 2008

We investigated linkage between schizophrenia and the loci DXYS14, DXYS17, and MIC2 within the pseudoautosomal region in 85 families with two or more siblings suffering from schizophrenia or schizoaffective disorder. A maximum lod score of 2.44 was reached at MIC2, with a dominant model of inheritance at a recombination fraction of 0.367 in females and 0.046 in males (a F: M sex ratio > 1, i.e. opposite to that expected with a pseudoautosomal locus). Evidence consistent with linkage (P = 0.01) was also obtained with a sibling pair analysis at the MIC2 locus. These data do not support (although they do not definitively exclude) a locus within the pseudoautosomal region; they are consistent with the presence of a gene that predisposes to schizophrenia in the sex-specific regions of the X and Y chromosomes.
Culture and Schizophrenia: the DOSMD Challenge
Authors: Edgerton Robert B. , Cohen Alex
Published: October 2008

The World Health Organization's International Pilot Study on Schizophrenia (IPSS) and subsequent Determinants of Outcomes of Severe Mental Disorder (DOSMD) studies have reported that the course of schizophrenia is more favourable in ‘developing’ than ‘developed’ societies. The 1992 DOSMD study attributes this difference to culture. We review studies concerning the course of schizophrenia and conclude that the evidence for a more favourable course in developing societies is not conclusive. Indeed, a favourable course has also been reported in various industrialised societies. We also raise questions about the findings reported in the recent DOSMD study, including the conclusion that the putatively more favourable course is a product of culture. Finally, we argue that longitudinal, direct observation of patients in their natural environments must be carried out before variations in the course of schizophrenia can be adequately understood.
Delusions of Pregnancy
Authors: Michael Albert , Joseph Anil , Pallen Alphie
Published: October 2008

We report five cases of delusions of pregnancy of whom three were women and four had chronic schizophrenia. We draw the attention of clinicians to this symptom which is not as rare as has previously been thought.
Beneficial Sexual Side-effects from Fluoxetine
Authors: Power-Smith Parsley
Published: October 2008

We report cases of several side-effects from the antidepressant fluoxetine. We suggest that, at therapeutic doses, fluoxetine may have a beneficial effect on sexual function in some men with erectile failure and premature ejaculation.
Outcome of Depression in Psychiatric Settings
Authors: Piccinelli Marco , Wilkinson Greg
Published: October 2008

We reviewed follow-up studies of adults with depressive disorders seen in psychiatric settings, and noted outcomes in terms of recovery, recurrence, and persistent depression, at six months, one year, two to five years, and ten or more years after an index episode of depression. Recovery increased with time: about half recovered at least briefly by six months, and a large majority did so in the long term. Only about a quarter recovered from an index episode and remained well more than ten years thereafter. A quarter of patients suffered recurrence of depression within a year of an index episode, and three-quarters did so at least once during follow-up periods lasting more than ten years. For more than one in ten patients, the depression proved persistent, the proportion affected remaining relatively stable over time. The review highlighted a relative paucity of conclusive investigations on the outcome of the commonest psychiatric disorder in clinical settings.
The Peer Review of “Outcome of Depression in Psychiatric Settings”
Authors: Lee Alan , Parker Gordon
Published: October 2008

To facilitate the introduction of this new section, designed to shed light on the peer review process, the Editor has used the review of a paper of which he is a co-author. The referees for this paper were originally anonymous, but they both agreed to be named for the purposes of this article. The original article was twice the length of the published version. The effect of the assessment should be readily apparent. Editorial decisions were undertaken by members of the Editorial Board other than the current Editor.
Heterogeneity of Depression
Authors: Merikangas Kathleen Ries , Wicki Werner , Angst Jules
Published: October 2008

This paper describes the application of prospective longitudinal data from an epidemiological sample of young adults to define subtypes of major depression. Depression was classified on a spectrum from subthreshold manifestation of symptoms and duration at one end, to cases with recurrent episodes of depression meeting duration criteria for major depressive episodes at the other. There was a direct relationship between the severity of depression over the longitudinal course and both duration and recurrence of depressive episodes. The subgroup of depression with recurrence of both brief and longer duration episodes could be discriminated on most of the indicators of validity including symptoms, impairment, family history, and suicide attempts. In light of the young age of this cohort, the strong history of suicide attempts and other complications of depression among the subjects with recurrent depression was striking. These findings underscore the importance of employing course as a classification criterion of depression, and the inclusion of subthreshold episodes of depression in the characterisation of course.
Personality Traits During Depression and After Clinical Recovery
Authors: Peselow Eric D. , Sanfilipo Michael P. , Fieve Ronald R. , Gulbenkian Gary
Published: October 2008

We investigated whether and how acute depressive symptoms affect the self-report of maladaptive personality traits. Sixty-eight acutely depressed patients underwent the Structured Interview for DSM–III Personality Disorder (SIDP) before and after pharmacological treatment, allowing us to determine whether self-reported maladaptive personality traits are different during depression and after successful clinical recovery. After the initial SIDP administration (during an episode of major depression), patients received desipramine treatment (dose range 150–300 mg/day) over a course of 4–5 weeks before readministration of the SIDP. For those who recovered from their depression (n = 39), cluster III trait scores were significantly lower than those assessed at baseline, and there was a lower frequency of cluster III categorical diagnoses for a personality disorder after treatment than before treatment. Recovered patients also had significantly lower cluster I personality trait scores after treatment as compared with baseline ratings. For those who did not recover from their depression after treatment (n = 29), cluster I trait scores were in fact higher than those measured at baseline, but there were no differences in categorical diagnoses before and after treatment. Cluster II personality traits and categorical diagnoses were not different between those who did and did not recover from their depression. Thus, depression may have a significant effect on the assessment of cluster I and cluster III personality traits. It is possible that cluster I and III ‘personality traits’ may be interwoven with depressive features and therefore subject to state influences, whereas cluster II personality traits may entail enduring, long-term characteristic modes of thinking, feeling, and behaving.
Familial Cosegregation of Major Affective Disorder and Darier's Disease (Keratosis Follicularis)
Authors: Craddock Nick , Owen Mike , Burge Susan , Kurian Bobby , Thomas Phil , McGuffin Peter
Published: October 2008

Darier's disease is a rare autosomal dominantly inherited keratosis. This is an account of one family in which there is co-occurrence of major affective disorder and Darier's disease in five members and absence of both disorders in five members. The pedigree is consistent with genetic linkage between the Darier gene and a major autosomal dominant susceptibility locus for major affective disorder. When the Darier's disease gene has been mapped, its chromosomal location will be an interesting candidate locus for linkage studies of major affective disorder.
Affective Symptoms in Women Attending a Menopause Clinic
Authors: Hay Alistair G. , Bancroft John , Johnstone Eve C.
Published: October 2008

All new attenders at the Menopause Clinic in Edinburgh over six months were interviewed to detect current depressive disorder (MADRS) and past psychiatric disorders (SADS-L), to find out whether women who were depressed at the time of clinic attendance had a history of depression. Of the 95 subjects who entered the study, 78 had gone through a natural menopause and 17 had undergone hysterectomy with or without oophorectomy. Of the 78 who had experienced a natural menopause, 35 were found to be depressed at the time of clinic attendance and 43 were not. A strong association was found between current and past depressive illness, 29 of the patients depressed at the time of clinic attendance having had depression previously. However, a clear peak of illness was seen in the perimenopausal period (four years either side of the last menstrual period): 35% of all patients with past or current depressive illness experienced their first episode of illness in this period.
Prevalence and Associated Features of Epilepsy in Adults with Down's Syndrome
Authors: McVicker R. W. , Shanks O. E. P. , McClelland R. J.
Published: October 2008

The aim of this study was to establish the prevalence of epilepsy in persons with Down's syndrome aged 19 years and over. A total of 191 adults with Down's syndrome were identified, giving a prevalence of 0.76/1000 (95% CI 0.75 to 0.77). Of these, 18 had epilepsy, giving a prevalence of 9.4% (95% CI 5.3% to 13.5%). The prevalence of epilepsy increased with age, reaching 46% in those over 50. The neurophysiological (EEG) findings of the epilepsy group were compared with those of a control group of Down's syndrome adults without epilepsy. Paroxysmal abnormalities consistent with a diagnosis of epilepsy were found in 80% of the epilepsy group, compared with only 13% of controls (P < 0.001). Epilepsy of late onset was associated with diffuse EEG abnormalities and clinical evidence of dementia. The age distribution and EEG findings suggest two independent processes in the causation of epilepsy: late-onset epilepsy associated with clinical evidence of dementia, and early-onset epilepsy in the absence of dementia.
Hidden Alcohol Abuse Among Women
Authors: Seppä Kaija , Löf Kari , Sinclair David , Sillanaukee Pekka
Published: October 2008

Seven years ago the authors examined 64 consecutive female out-patients with macrocytosis (erythrocyte mean cell volume ⩾ 100 fl). The cause remained undetermined in 23 (35.9%). Their patient histories were evaluated in 1992, and the new highly specific alcohol marker, serum carbohydrate-deficient transferrin, from the frozen sera taken during the initial study was examined. It was elevated in 6 of the 23 women. Furthermore, four of these six had visited the health centre after 1985 and they all had clinical records indicative of alcohol problems. Because early intervention has proved to be effective, information about the risks of alcohol abuse (intervention) should be given to women with suspect alcohol-induced symptoms or signs.
Successful Treatment of Night Terrors and Somnambulism with Paroxetine
Authors: Lillywhite A. R. , Wilson S. J. , Nutt D. J.
Published: October 2008

A patient with a 30-year history of somnambulism and night terrors is described. The use of a home ambulatory sleep electroencephalogram (EEG) recording in clarifying the diagnosis and in monitoring the results of treatment is illustrated and successful treatment using a selective serotonin re-uptake inhibitor is reported.
Koro: Culture-Bound Disorder or Universal Symptom?
Authors: Adeniran R. A. , Jones J. R.
Published: October 2008

A case report is presented of koro associated with a depressive illness in a 31-year-old male Briton. The specificity or otherwise of koro as culture bound and a distinct nosological entity is discussed.
The Strength of the Genetic Effect
Authors: Mcguffin Peter , Asherson Philip , Owen Michael , Farmer Anne
Published: October 2008

The evidence for a genetic contribution to schizophrenia is compelling. However, the pattern of inheritance is complex and it is usually assumed that environmental factors also have a role that will eventually be identified. We argue that this is not necessarily the case. While a hypothesis combining genetic diathesis with environmental stress cannot be disproved, it is also possible that ‘non-genetic’ factors consist entirely of stochastic events affecting gene expression or structure.
Psychiatry and Learning Disability
Authors: Reid Andrew H.
Published: October 2008

My involvement with the psychiatry of learning disability began in 1968 when Professor Batchelor, then Professor of Psychiatry at the University of Dundee, suggested that mental illness in people with learning disability was a clinically interesting and under-researched topic which merited further investigation. At that time, mental illness was not usually considered even a part of the medical specialty of learning disability – or at least, not in Scotland. People in mental handicap hospitals who developed signs of mental illness were normally passed on to colleagues in general psychiatry who were considered to have the investigative and treatment expertise. If admission to in-patient care was considered necessary, it was usually to the local general psychiatry service.
Prevalence of Postnatal Psychiatric Morbidity in Mothers and Fathers
Authors: Ballard C. G. , Davis R. , Cullen P. C. , Mohan R. N. , Dean C.
Published: October 2008

In the first study to systematically examine postnatal depression in fathers, we examined depression in 200 postnatal couples, using a two-stage design. The prevalence of depression ascertained by the 13-item Edinburgh Postnatal Depression Scale (EPDS), using a cut-off score for ‘caseness’ of 13 or more in an unselected postnatal sample, was 27.5% in mothers at six weeks postpartum, 25.7% in mothers at six months postpartum, 9.0% in fathers at six weeks postpartum, and 5.4% in fathers at six months postpartum. The prevalence did not differ significantly in either mothers or fathers from a control group of parents with children between three and five years of age. As expected, mothers had a significantly higher prevalence of psychiatric ‘caseness’ at both six weeks and six months postpartum than fathers. Fathers were significantly more likely to be cases if their partners were also cases. The hypothesis that different aetiological factors would be important in brief and persistent disorders in mothers was upheld.
Combined Chlorpromazine and Electroconvulsive Therapy in Mania
Authors: Sikdar Sudip , Kulhara Parmanand , Avasthi Ajit , Singh Hariwir
Published: October 2008

We report the efficacy of combined chlorpromazine and electroconvulsive therapy (ECT) in the treatment of mania. Two groups of 15 manic patients received eight ECT sessions either actual or simulated, in a double-blind, controlled study. All patients also received 600 mg of chlorpromazine daily until the sixth session. Results indicate that the group receiving the combination of chlorpromazine and ECT did significantly better than the other group.
Childhood Abuse in First-Episode Psychosis
Authors: Greenfield Shelly F. , Strakowski Stephen M. , Tohen Mauricio , Batson Susan C. , Kolbrener Meredith L.
Published: October 2008

Of 38 adult patients admitted for first-episode psychosis, 20 reported childhood abuse, with equal prevalence in men and women. Patients with histories of childhood abuse had significantly more dissociative symptoms, but not more severe psychiatric symptoms. Childhood abuse was not related to rate of recovery and was only marginally related to longer stays in hospital. Although childhood abuse did not affect recovery during first-episode psychosis, it may contribute to a chronic course in some patients.