bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic fatigue and anxiety/depression: A twin study
Authors: Roy-Byrne Peter , Afari Niloofar , Ashton Suzanne , Fischer Mary , Goldberg Jack , Buchwald Dedra
Published: August 2002

Background

Up to three-quarters of patients with fatigue syndromes have comorbid mood or anxiety disorders, suggesting that chronic fatigue is a forme fruste of anxiety or depressive states.

Aims

To establish whether the association of chronic fatigue with psychological distress is causal or due to a common genetic or environmental factor.

Method

69 monozygotic (MZ) and 31 dizygotic (DZ) female twin pairs, with only one co-twin reporting at least 6 months of fatigue, completed questions on fatigue, the General Health Questionnaire (GHQ) and a structured psychiatric interview. We examined the effects of three progressively more stringent definitions of chronic fatigue on four GHQ sub-scales.

Results

Fatigued MZ and DZ twins by all definitions were significantly more depressed, anxious, somatically preoccupied and socially dysfunctional than their non-fatigued co-twins. Intrapair differences were similar in DZ and MZ twins, but non-significant differences were observed for the somatic symptoms and anxiety/insomnia sub-scales.

Conclusions

In this sample, chronic fatigue and psychological distress are strongly associated without evidence for genetic covariation, implying that the association is environmental, or due to overlapping definitions. Any genetic covariation missed is likely to involve anxiety rather than depression.
Heritability of Schneider's first-rank symptoms
Authors: Cardno Alastair G. , Sham Pak C. , Farmer Anne E. , Murray Robin M. , McGuffin Peter
Published: August 2002

Background

Schneider's first-rank symptoms are given particular weight when making a diagnosis of schizophrenia, but the nuclear syndrome, characterised by one or more first-rank symptoms, has been found previously to have no heritability.

Aims

To estimate the heritability of the nuclear syndrome.

Method

A total of 224 twin pairs (106 monozygotic, 118 same-gender dizygotic) were ascertained from the Maudsley Twin Register in London via probands with any psychosis. Lifetime-ever first-rank symptoms were rated using the OPCRIT checklist. Probandwise concordance rates were calculated for the nuclear syndrome and a heritability estimate was derived from biometric model fitting.

Results

Probandwise concordance rates were 13/49 (26.5%) for monozygotic and 0/45 to 2/46 (0.0–4.3%) for dizygotic pairs. The heritability estimate for the best-fitting model was 71% (95% CI 57–82).

Conclusions

These results indicate that the nuclear syndrome shows substantial heritability, although this is slightly lower than that for schizophrenia as defined by the DSM and ICD systems.
Region-specific changes in phospholipid metabolism in chronic, medicated schizophrenia
Authors: Jensen J. Eric , Al-Semaan Yousef M. , Williamson Peter C. , Neufeld Richard W. J. , Menon Ravi S. , Schaeffer Betsy , Densmore Maria , Drost Dick J.
Published: August 2002

Background

Membrane phospholipid abnormalities in people with schizophrenia, measured with 31P magnetic resonance spectroscopy (31P-MRS), have been previously reported in brain regions involved in this disorder.

Aims

In this 4.0 Tesla 31P-MRS study of people with schizophrenia, membrane phospholipid metabolism was examined in brain regions previously inaccessible due to their small volumes.

Method

Three-dimensional chemical-shift imaging (3D–CSI) examined 15 cc volumes in 12 brain regions in 11 people with chronic schizophrenia and 11 healthy control volunteers.

Results

Glycerophosphoethanolamine was decreased in the anterior cingulate, right prefrontal cortex and left thalamus, but increased in the left hippocampus and cerebellum in those with schizophrenia. Phosphoethanolamine and glycerophosphocholine were decreased in the right prefrontal region and phosphocholine was decreased in the anterior cingulate. No significant difference in membrane phospholipid levels existed between groups in the parieto-occipital and posterior cingulate regions.

Conclusions

Altered membrane phospholipid metabolism was demonstrated in all regions implicated in schizophrenia.
Remembering delirium
Authors: Fleminger Simon
Published: August 2002

Delirium is now the preferred term to describe acute confusional states and related organic mental disorders associated with acute impairment of consciousness (Gill & Mayou, 2000). No longer is delirium reserved for those states in which overactive behaviour, often with visual hallucinations, is dominant. To accommodate the broader usage, hypoactive states of delirium have been emphasised (Lipowski, 1990), particularly as these are the states most easily missed.
Signs and Symptoms of Psychotic Illness (SSPI): A rating scale
Authors: Liddle Peter F. , Ngan Elton T. C. , Duffield Gary , Kho King , Warren Anthony J.
Published: August 2002

Background

In the rating scales commonly used for assessing response to antipsychotic treatment, individual items embrace symptoms that apparently arise from distinguishable pathophysiological processes and might be expected to respond differently to treatment.

Aims

To test the reliability sensitivity to change and factor structure of a new scale for the assessment of the Signs and Symptoms of Psychotic Illness (the SSPI).

Method

Interrater reliability was evaluated by determining the intraclass correlation for the ratings of 63 patients. Sensitivity to change was assessed in a longitudinal study of 33 patients. Factor structure was determined from scores for 155 patients.

Results

The intraclass correlation was satisfactory for all individual items and excellent for the total score. Scores were sensitive to change. A change in Clinical Global Impression of one unit corresponded to an SSPI total score change of 31%. Factor analysis revealed five clusters of symptoms.

Conclusions

The SSPI provides a sensitive and reliable measure of the five major clusters of symptoms that occur commonly in psychotic illness.
Towards a standardised brief outcome measure: Psychometric properties and utility of the CORE–OM
Authors: Evans Chris , Connell Janice , Barkham Michael , Margison Frank , McGrath Graeme , Mellor-Clark John , Audin Kerry
Published: August 2002

Background

An acceptable, standardised outcome measure to assess efficacy and effectiveness is needed across multiple disciplines offering psychological therapies.

Aims

To present psychometric data on reliability, validity and sensitivity to change for the CORE–OM (Clinical Outcomes in Routine Evaluation – Outcome Measure).

Method

A 34-item self-report instrument was developed, with domains of subjective well-being, symptoms, function and risk. Analysis includes internal reliability, test–retest reliability, socio-demographic differences, exploratory principal-component analysis, correlations with other instruments, differences between clinical and non-clinical samples and assessment of change within a clinical group.

Results

Internal and test–retest reliability were good (0.75–0.95), as was convergent validity with seven other instruments, with large differences between clinical and non-clinical samples and good sensitivity to change.

Conclusions

The CORE–OM is a reliable and valid instrument with good sensitivity to change. It is acceptable in a wide range of practice settings.
The Commission for Health Improvement (CHI) review of North Birmingham Mental Health Trust: What can we hope for from the CHI?
Authors: Burns Tom
Published: August 2002

If you are working in mental health, you get used to being inspected and commented upon – the Mental Health Act Commission, Audit Commission, Social Services Inspectorate, Health Advisory Service (HAS, as was) and public inquiries into patient homicides. Working in multidisciplinary teams has made us used to operating with a variety of perspectives and for most of us this is a necessary and welcome part of the job. Few psychiatrists, however, are so sanguine about the former HAS or about homicide inquiries. The repeated complaint has been their inconsistency. Their quality and tone (potentially as damaging as their findings) have varied to quite an indefensible degree.
Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS–LD)
Authors: Roy Ashok , Matthews Helen , Clifford Paul , Fowler Vanessa , Martin David M.
Published: August 2002

Background

The Health of the Nation Outcomes Scales (HoNOS) have been developed to measure outcomes in people with mental health problems.

Aims

Frequent impaired social functioning, problems with communication and associated physical conditions meant that a bespoke instrument was needed for people with learning disabilities. We describe the development of the Health of the Nation Outcomes Scales for People with Learning Disabilities (HoNOS–LD).

Method

HoNOS-LD was piloted at 26 sites. Two raters, at two points in time, rated 372 subjects. Analysis determined acceptability, ease of use, interrater reliability, sensitivity to change and reliability with the Aberrant Behavior Checklist (ABC).

Results

The resulting 18-item instrument demonstrated good reliability and validity characteristics and is generally acceptable to clinicians.

Conclusions

HoNOS-LD is an appropriate instrument for measuring outcome in people with learning disabilities with additional mental health needs.
Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS–LD)
Authors: Roy Ashok , Matthews Helen , Clifford Paul , Fowler Vanessa , Martin David M.
Published: August 2002

rating instructions: (a) Complete the front sheet including ICD–10 diagnoses and subjective rating. (b) Rate each in order from item 1 to 18. (c) Do not include information rated in an earlier item. (d) Rate the person over the previous 4 weeks. (e) Rate the most severe problem that has occurred during the period rated. (f) All items follow the five-point rating format similar to other HoNOS instruments: 0=no problem during the period rated; 1=mild problem; 2=moderate problem; 3=severe problem; 4=very severe problem.
Subjective experience of a confusional state
Authors: Crammer J. L.
Published: August 2002

Background

Confusional states associated with medical and surgical conditions require more study and biochemical explanation.

Aims

To understand impairment of consciousness, cognition and memory.

Method

A psychiatrist reports experience of his changing mental state over 5 days from notes made immediately on recovery.

Results

A prodromal phase of declining consciousness, understanding and memory registration over perhaps 48 h was difficult to detect. During unconsciousness there were four brief partial reversals with arousal, and some mental functioning (memory, formation of beliefs) occurred.

Conclusions

Self-report can be a useful addition in clinical study and patients with renal failure require psychological and psychiatric study. Comparison with the mental effects of benzodiazepine or of an anaesthetic such as nitrous oxide might throw light on the pathology.
Impact of a mother–infant intervention in an indigent peri-urban South African context
Authors: Cooper Peter J. , Landman Mireille , Tomlinson Mark , Molteno Christopher , Swartz Leslie , Murray Lynne
Published: August 2002

Background

A high rate of maternal depression and associated disturbance in the mother–infant relationship has been found in an indigent peri-urban South African community Khayelitsha. The question arises whether a community-based intervention could be beneficial.

Aims

To train community workers to deliver an intervention to mothers and infants in Khayelitsha, and to compare mothers and infants receiving this intervention with a sample receiving no such intervention.

Method

Four Khayelitsha women were trained in a mother-infant intervention, which they delivered to 32 women recruited in late pregnancy. At 6 months post-partum, maternal mood, the mother–infant relationship and infant growth were assessed. The findings were compared with a matched group of 32 mothers and infants.

Results

There was no reliable impact of the intervention on maternal mood. However, compared with the comparison sample, the quality of mother – infant engagement was significantly more positive for those who had received the intervention.

Conclusions

The pilot study produced preliminary evidence of a benefit of a community-based mother – infant intervention delivered by trained, but otherwise unqualified, community workers, sufficient to warrant a formal controlled evaluation of this treatment.
The case against ‘the evidence’: A different perspective on evidence-based medicine
Authors: Williams D. D. R. , Garner Jane
Published: August 2002

Background

An evidenced-based approach to psychiatry is playing an increasingly prominent role in treatment decision-making for individual patients and for populations. Many doctors are now critical of the emphasis being placed on ‘the evidence’ and concerned that clinical practice will become more constrained.

Aims

To demonstrate that evidence-based medicine is not new, sources of evidence are limited and psychosocial aspects of medicine are neglected in this process.

Method

Some of the literature is reviewed. Ideas and arguments are synthesised into a critical commentary.

Results

These are considered under four headings: evidence-based medicine is not new; what evidence is acceptable; the doctor as therapist; and the emergence of a new utilitarian orthodoxy.

Conclusions

It is agreed that a degree of professional consensus is necessary. However, too great an emphasis on evidence-based medicine oversimplifies the complex and interpersonal nature of clinical care.
Patient adherence in the treatment of depression
Authors: Pampallona S. , Bollini P. , Tibaldi G. , Kupelnick B. , Munizza C.
Published: August 2002

Background

Non-adherence with antidepressant treatment is very common. Increasing adherence to pharmacological treatment may affect response rate.

Aims

To review and summarise quantitative evidence on factors associated with adherence and of adherence-enhancing interventions.

Method

A systematic review of computerised databases was carried out to identify quantitative studies of adherence in depression. Papers retained addressed unipolar depression and considered adherence as the primary end-point.

Results

Of studies published between 1973 and 1999, 32 met the review criteria: epidemiological descriptive studies (n=14): non-random comparisons of control and intervention groups (n=3); randomised interventions (n=14); and meta-analysis (n=1). Patient education and medication clinics were the interventions most commonly tested, combined with a variety of other interventions.

Conclusions

The studies did not give consistent indications of which interventions may be effective. Carefully designed clinical trials are needed to clarify the effect of single and combined interventions.
The distinction between personality disorder and mental illness
Authors: Kendell R. E.
Published: August 2002

Background

Proposals by the UK Government for preventive detention of people with ‘dangerous severe personality disorders' highlight the unresolved issue of whether personality disorders should be regarded as mental illnesses.

Aims

To clarify the issue by examining the concepts of psychopathy and personality disorder, the attitudes of contemporary British psychiatrists to personality disorders, and the meaning of the terms ‘mental illness'and ‘mental disorder’.

Method

The literature on personality disorder is assessed in the context of four contrasting concepts of illness or disease.

Results

Whichever of the four concepts or definitions is chosen, it is impossible to conclude with confidence that personality disorders are, or are not, mental illnesses; there are ambiguities in the definitions and basic information about personality disorders is lacking.

Conclusions

The historical reasons for regarding personality disorders as fundamentally different from mental illnesses are being undermined by both clinical and genetic evidence. Effective treatments for personality disorders would probably have a decisive influence on psychiatrists' attitudes.
Old age psychiatry and the law
Authors: Jacoby Robin
Published: August 2002

Background

Old age psychiatry is no less subject to increasing legal and quasi-legal restraint than other branches of the profession, but the emphases are different. Two themes predominate: first, that of capacity or competence; and second, to what extent formal legal measures should be implemented in cases where incapacitated patients do not dissent from, as opposed to giving active consent to, admission to hospital or receiving treatment.

Aims

To discuss the issues of capacity or competence, especially in relation to recent legislation and judgements and to proposed legislation in England and Wales.

Method

Selective review and discussion of recent case law and current and proposed statute law.

Results and conclusions

The Bournewood case threatened but ultimately failed to upset the status quo. However, the European Convention on Human Rights and the British Human Rights Act 1998 may yet do so.
Costs and cognitive disability: modelling the underlying associations
Authors: Kavanagh Shane , Knapp Martin
Published: August 2002

Background

The high support needs of elderly people with cognitive disability raise questions about the cost-effectiveness of different treatments. Associations between costs and cognitive disability could be influenced by other factors, particularly comorbidities.

Aims

To examine the links between costs and cognitive disability in the context of covariates.

Method

Secondary analyses of data from the UK Office of Population Censuses and Surveys disability surveys for over 4500 elderly people living in households were used to examine associations between cost and cognitive disability.

Results

Costs varied considerably, and were associated with severity of disability along a number of dimensions. The cost-raising effects of cognitive disability were smaller when the analyses controlled for levels of disability in other domains.

Conclusions

Cognitive disability is significantly associated with higher costs, but these analyses highlight the need to examine a range of disabilities.
Frail old people at the margins of care: some recent research findings
Authors: Challis David , Hughes Jane
Published: August 2002

Background

Community-based care at the margin is a substitute for institutional care. Three factors are considered critical: definitions of eligibility, assessment procedures and balance of care.

Aims

To examine determinants of the margin between institutional and home-based care, review current practice, identify the implications and contribute to planning of integrated long-term care services.

Method

A selective review was made of findings from research conducted after the community care reforms.

Results

Marked variability and inconsistency in eligibility and assessment processes may contribute to misplacement of frail older people. There remains capacity to shift the balance of care from institutional to home-based care within reasonable cost parameters, particularly with more integrated services.

Conclusions

Greater standardisation of approaches to the determination of eligibility for social care and to assessment of need is required. Providing care at home for some of those currently entering care homes is feasible, but will require different service structures and staff roles, including specialist clinicians.
Genotype and phenotype in Alzheimer's disease
Authors: Holmes Clive
Published: August 2002

Background

Patients with Alzheimer's disease show a wide variation in clinical phenotype. Genetic research has been largely concerned with the role of mutations or common variants as risk factors for the disease. Do genetic factors also influence clinical phenotype?

Aims

To examine the evidence that genetic factors influence the clinical expression of the disease in addition to influencing risk.

Method

A selective review was made of the key literature.

Results

Mutations in three genes, coding for amyloid precursor protein, presenilin-1 and presenilin-2, and a common variation (ε4) in another gene, APOE, have been shown to lead to an earlier development of the disease. More recently, genetic association and twin studies have suggested a role for genetic factors in the development of other aspects of clinical phenotype, notably the appearance of non-cognitive symptoms.

Conclusions

In Alzheimer's disease genetic variation influences a number of aspects of clinical phenotype.
New drugs for Alzheimer's disease and other dementias
Authors: Bullock Roger
Published: August 2002

Background

Alzheimer's disease management involves symptomatic drug treatments passed by the National Institute for Clinical Excellence. Disease modification is now the goal.

Aims

To review current and developmental drugs for Alzheimer's disease, their usage, and the clinical context of known facts and proposed specific models.

Method

A brief evidence-based review was made, using literature where available, or evidence from consensus groups where it was absent.

Results

There is good evidence to support the use of cholinesterase inhibitors, and perhaps vitamin E. Oestrogen and anti-inflammatory agents show possibility, but there is not enough evidence to support routine use.

Conclusions

Symptomatic treatments exist for Alzheimer's disease. Observational studies and increasing knowledge of brain biology are leading towards further treatment options. Old age psychiatrists have valuable treatments they now have to learn to use.
Frontotemporal dementia
Authors: Snowden Julie S. , Neary David , Mann David M. A.
Published: August 2002

Background

Frontotemporal dementia accounts for up to 20% of cases of dementia in the presenium, yet remains poorly recognised. Diagnostic criteria have been devised to aid clinical diagnosis.

Aims

To provide an overview of clinical and pathological characteristics of frontotemporal dementia and its nosological status.

Methods

The review summarises consensus diagnostic criteria for frontotemporal dementia and draws on the authors'clinical experience of 300 frontotemporal dementia cases, and pathological experience of 50 autopsied cases.

Results

Frontotemporal dementia is characterised by pronounced changes in affect and personal and social conduct. Some patients also develop motor neuron disease. Mutations in the tau gene account for some but not all familial cases of frontotemporal dementia.

Conclusions

Frontotemporal dementia is a focal form of dementia, which is clinically and pathologically distinct from other dementias. It represents an important model for understanding the functions of the frontotemporal lobes.
Dementia with Lewy bodies
Authors: McKeith Ian G.
Published: August 2002

Background

Dementia with Lewy bodies (DLB) is a common dementia subtype that has only been recognised in the past decade and that remains widely underdiagnosed.

Aims

To review the pathological and clinical features of DLB, to consider methods of investigation and diagnosis, and to recommend safe and effective management strategies.

Method

A selective review was made of the key literature.

Results

Using operationalised criteria, DLB can be clinically diagnosed with an accuracy similar to that achieved for Alzheimer's disease or Parkinson's disease. Underdetection is largely due to poor definition of the criterion of cognitive fluctuation. Ancillary investigations, particularly neuroimaging, can aid in differential diagnosis. Extreme caution in the use of neuroleptic medication is advised. Cholinesterase inhibitors may be particularly effective in DLB.

Conclusions

Clinicians should be aware of DLB as part of a spectrum of Lewy body disorders. Neuroleptic sensitivity reactions and good response to cholinergic therapies are important aspects of management.
Subcortical dementia
Authors: Turner Mark A. , Moran Nicholas F. , Kopelman Michael D.
Published: August 2002

Background

Drawing a distinction between cortical and subcortical dementias seems both useful and justified. Recent research has, however, cast doubt on the clinical, neuropsychological, neuroimaging and neuroanatomical basis of the distinction.

Aims

To arrive at a reasoned conclusion about the relationship between the two types of dementia and the validity of distinguishing between them.

Method

The historical and recent clinical and scientific literature on subcortical dementia was reviewed.

Results

The traditional claim that subcortical dementia has distinct clinical manifestations, neuroimaging findings and a neuropathological profile is not altogether borne out by the literature. Some studies show that frontal executive dysfunction and the profile of memory deficits are not significantly different from those seen in Alzheimer's disease. Neuropathological findings also overlap.

Conclusions

The category of subcortical dementia may be clinically useful in highlighting the likelihood that an individual with dementia is more likely to suffer from bradyphrenia and motor difficulties. As neuroscience advances a preoccupation with the distinction may hinder the assessment and treatment of individual cases.
Vascular dementia: A diagnosis running out of time
Authors: Stewart Robert
Published: August 2002

Background

The concept of vascular dementia has a long history but its usefulness as a diagnostic category has been called into question.

Aims

To evaluate vascular disease as a risk factor for dementia and the interface between cerebrovascular pathology and Alzheimer's disease.

Method

The literature on this topic was selectively reviewed and synthesised.

Results

Risk factors for cerebrovascular disease are also risk factors for dementia. However, the course of dementia, once it has developed, appears to be frequently determined by Alzheimer's disease.

Conclusions

As a public health measure, modification of vascular risk represents a potentially powerful means to prevent dementia through delaying its onset. However, an effect on progression of dementia, once it has developed, has yet to be established. The traditional view of vascular dementia and Alzheimer's disease as distinguishable conditions is becoming steadily less tenable.
Vascular basis of late-onset depressive disorder
Authors: Baldwin Robert C. , O'Brien John
Published: August 2002

Background

Growing evidence suggests that there may be a subtype of depression arising in later life that is characterised by a distinct clinical presentation and an association with cerebrovascular disease. This has been termed ‘vascular depression’.

Aims

To review the evidence for associations between cardiovascular disease and depression and between cerebrovascular disease and depression, and to examine implications for clinical practice and research.

Method

The authors reviewed the medical literature covering the past 5 years.

Results

There is strong evidence for an association between cardiovascular disease and depression, but this is not confined to older people. The causal pathway may be bi-directional. There is also a convergence of evidence suggesting a causal link between cerebrovascular disease and depression, especially that occurring later in life. The major focus has been on neuroradiological findings thought to be due to vascular disease, although the pathology may be heterogeneous.

Conclusions

Although there are gaps in the evidence there is strong support for the concept of vascular depression, characterised by reduced depression ideation, subcortical neurological dysfunction, apathy and psychomotor change. This has implications for both treatment and prevention.
Rating scales in old age psychiatry
Authors: Burns Alistair , Lawlor Brian , Craig Sarah
Published: August 2002

Background

There is a vast array of scales available to assess all aspects of mental and physical health in older people which may be of relevance to the work of old age psychiatrists.

Aims

To summarise some of the scales that may be commonly used in clinical and research practice and to give the reader guidelines as to where further information can be obtained.

Method

The scales were selected on the basis of the authors' own clinical and research knowledge and information was gathered from a comprehensive text on assessment scales in old age psychiatry.

Results

The selected scales are described in brief and a table outlines the purposes for which they are most suitable.

Conclusions

Although many scales are available, the choice of the individual scale relies specifically on the question that is to be asked. The ideal scale does not exist.
Bio-social origins of depression in the community
Authors: Strickland Paul L. , Deakin J. F. William , Percival Carol , Dixon Joanne , Gater Richard A. , Goldberg David P.
Published: August 2002

Background

Social adversity may be a risk factor for depression, by increasing Cortisol secretion, which impairs serotonin (5-HT) neurotransmission.

Aims

To examine this causal pathway in a community setting.

Method

Women who were currently ICD–10 depressed (n=94), vulnerable to depression but not depressed (n=166) and non-vulnerable controls (n=177) were recruited. We assessed social adversity and vulnerability (Life Eventsand Difficulties Schedule; Self Evaluation and Social Support Scales) and psychiatric state (Schedules for Clinical Assessment in Neuropsychiatry). Salivary cortisol concentrations were measured at 09.00 and 23.00 h. Serotonin function was assessed using prolactin responses to dexfenfluramine.

Results

Cortisol concentrations were not increased in the depressed or vulnerable. Morning salivary and serum cortisol were reduced in depression. Evening cortisol was increased after recent life events. Life events and depression were associated with increased prolactin responses.

Conclusions

The hypothalamic–pituitary–adrenal axis is sensitive to social stress but does not mediate vulnerability to depression. Exaggerated 5-HT2 receptor responsiveness to stress may play a role in the evolution of depression.
Occurrence of hallucinatory experiences in a community sample and ethnic variations
Authors: Johns Louise C. , Nazroo James Y. , Bebbington Paul , Kuipers Elizabeth
Published: August 2002

Background

Hallucinations typically are associated with severe psychiatric illness but also are reported by individuals with no psychiatric history.

Aims

To examine the prevalence of hallucinations in White and ethnic minority samples using data from the Fourth National Survey of Ethnic Minorities.

Method

Interviews of 5196 ethnic minority and 2867 White respondents were carried out. The respondents were screened for mental health problems and the Psychosis Screening Questionnaire asked about hallucinations. Those who screened positive underwent a validation interview using the Present State Examination.

Results

Four per cent of the White sample endorsed a hallucination question. Hallucinations were 2.5-fold higher in the Caribbean sample and half as common in the South Asian sample. Of those who reported hallucinatory experiences, only 25% met the criteria for psychosis.

Conclusions

The results provide an estimate of the annual prevalence of hallucinations in the general population. The variation across ethnic groups suggests cultural differences in these experiences. Hallucinations are not invariably associated with psychosis.
Schizotypal components in people at high risk of developing schizophrenia: early findings from the Edinburgh High-Risk Study
Authors: Miller Patrick , Byrne Majella , Hodges Ann , Lawrie Stephen M. , Owens David G. Cunningham , Johnstone Eve C.
Published: August 2002

Background

The study of high-risk groups and the development of schizophrenia.

Aims

To investigate further schizotypy, measured by the Structured Interview for Schizotypy (SIS), and to examine relationships between schizotypal components, psychotic symptoms on the Present State Examination (PSE) and subsequent schizophrenia.

Method

The SIS and PSE were administered on entry. Schizophrenia onsets were recorded during follow-up.

Results

The SIS yielded four principal components labelled social withdrawal, psychotic symptoms, socio-emotional dysfunction and odd behaviour. On entry, these differentiated between controls, subjects at risk for schizophrenia with and without symptoms and patients with schizophrenia. Seven of 78 subjects at risk developed schizophrenia within 39 months. This was best predicted by combining the four SIS components.

Conclusions

Schizotypy is heterogeneous and may become psychosis, particularly if several of its components are present. As psychosis develops, odd behaviour gives way to psychotic symptoms and social function deteriorates.
The maturing of therapy
Authors: Marks Isaac M.
Published: August 2002

Background

Psychiatric therapy needs assessment regarding its maturation as a therapeutic science.

Aims

Judgement of whether such a science is emerging.

Method

Four criteria are used: efficacy; identification of responsible treatment components; knowledge of their mechanisms of action; and elucidation of why they act only in some sufferers.

Results

Brief behavioural, interpersonal, cognitive, problem-solving and other psychotherapies have a mature ability to improve anxiety and depressive disorders reliably and enduringly, often only with instruction from a manual or a computer. Therapy's cost-effectiveness and acceptability deserve more attention. We know little about which treatment components produce improvement, how they do so and why they do not help all sufferers.

Conclusions

Therapy is coming of age regarding efficacy for anxiety and depression, but is only a toddler regarding the scientific principles to explain its effects.
Impact of Event Scale: psychometric properties
Authors: Sundin Eva C. , Horowitz Mardi J.
Published: August 2002

Background

For more than 20 years, the Impact of Event Scale (IES) has been widely used as a measure of stress reactions after traumatic events.

Aims

To review studies that evaluated the IES's psychometric properties.

Method

Literature review.

Results

The results indicated that the IES's two-factor structure is stable over different types of events, that it can discriminate between stress reactions at different times after the event, and that it has convergent validity with observer-diagnosed post-traumatic stress disorder. The use of IES in many psychopharmacological trials and outcome studies is supportive of the measure's clinical relevance.

Conclusions

The IES is a useful measure of stress reactions after a range of traumatic events, and it is valuable for detecting individuals who require treatment.
Australia's National Mental Health Strategy
Authors: Whiteford Harvey , Buckingham Bill , Manderscheid Ronald
Published: August 2002

Background

Australia commenced a 5-year reform of mental health services in 1993.

Aims

To report on the changes to mental health services achieved by 1998.

Method

Analysis of data from the Australian National Mental Health Report 2000 and an independent evaluation of the National Mental Health Strategy.

Results

Mental health expenditure increased 30% in real terms, with an 87% growth in community expenditures, a 38% increase in general hospitals and a 29% decrease in psychiatric hospitals. The growth in private psychiatry, averaging 6% annually prior to 1992, was reversed. Consumer and carer involvement in services increased.

Conclusions

Major structural reform was achieved but there was limited evidence that these changes had been accompanied by improved service quality. The National Mental Health Strategy was renewed for another 5 years.
Mental health of teenagers who use cannabis
Authors: Rey Joseph M. , Sawyer Michael G. , Raphael Beverley , Patton George C. , Lynskey Michael
Published: August 2002

Background

There is concern in the community about increasing cannabis use and its potential effect on health.

Aims

To ascertain the prevalence of cannabis use among Australian adolescents, associations with mental health problems, risk behaviours and service use.

Method

Examination of data from a national representative sample of households comprising 1261 adolescents aged 13–17 years. Parents completed a psychiatric interview and questionnaires while adolescents completed questionnaires.

Results

One-quarter of the adolescents in the sample had used cannabis. There were no gender differences. Use increased rapidly with age, was more common in adolescents living with a sole parent and was associated with increased depression, conduct problems and health risk behaviours (smoking, drinking) but not with higher use of services.

Conclusions

Cannabis use is very prevalent. The association with depression, conduct problems, excessive drinking and use of other drugs shows a malignant pattern of comorbidity that may lead to negative outcomes.
Age, gender and ethnicity of those detained under Part II of the Mental Health Act 1983
Authors: Audini Bernard , Lelliott Paul
Published: August 2002

Background

Aggregate returns give limited information about those detained under the Mental Health Act 1983.

Aims

To use existing data-sets to examine detentions under Part II of the Act.

Method

Data from 26 areas, with a combined population of 9.2 million, were combined. Population census data were used to standardise rates of detention by age, gender and ethnicity.

Results

The 31 702 detentions are distributed bimodally with peaks at age 25–34 years and at over age 80 years. In the younger age group rates of detention are higher for men. The excess of women in the older group is no longer apparent when rates are standardised for age and gender. Detentions are over six times more likely to be of Black people than of White (450 v. 68 per standardised 100 000 population).

Conclusions

The difference in rates of detention between Black and White people is greater than previously thought. The excess of older women detained under Part II of the Act is largely due to the lower life expectancy of men.
Annual cost of bipolar disorder to UK society
Authors: Das Gupta Roben , Guest Julian F.
Published: August 2002

Background

The socio-economic impact of bipolar disorder in the UK is unknown.

Aims

To estimate the annual socioeconomic burden imposed by bipolar disorder on UK society.

Method

The annual cost of resource use attributable to managing bipolar disorder was calculated. Indirect societal costs were also calculated.

Results

The annual National Health Service (NHS) cost of managing bipolar disorder was estimated to be $199 million, of which hospital admissions accounted for 35%. The annual direct non-health-care cost was estimated to be $86 million annually and the indirect societal cost was estimated to be $1770 million annually.

Conclusions

The annual cost to UK society attributable to bipolar disorder was estimated to be $2 billion at 1999/2000 prices (estimated 297 000 people with the disorder). Ten per cent of this cost is attributable to NHS resource use, 4% to non-health-care resource use and 86% to indirect costs.
Psychotherapy for sexually abused girls: psychopathological outcome findings and patterns of change
Authors: Trowell J. , Kolvin I. , Weeramanthri T. , Sadowski H. , Berelowitz M. , Glasser D. , Leitch I.
Published: August 2002

Background

Controversy exists about the efficacy of psychotherapy for the mental health problems of sexually abused children.

Aims

To compare the relative efficacy of focused individual or group therapy in symptomatic sexually abused girls, and to monitor psychiatric symptoms for persistence or change.

Method

A multi-centre psychotherapy outcome study recruited 71 sexually abused girls aged 6–14 years who were randomly assigned to focused individual psychotherapy (up to 30 sessions) or psychoeducational group therapy (up to 18 sessions). Changes over the course of the study were monitored.

Results

Both treatment groups showed a substantial reduction in psychopathological symptoms and an improvement in functioning, but with no evident difference between individual and group therapy. However, individual therapy led to a greater improvement in manifestations of post-traumatic stress disorder (PTSD).

Conclusions

The beneficial effects on PTSD support the use of individual therapy. However, the small sample size and lack of a control group limit conclusions about changes attributable to treatment.
Frequent attenders with medically unexplained symptoms: service use and costs in secondary care
Authors: Reid Steven , Wessely Simon , Crayford Tim , Hotopf Matthew
Published: August 2002

Background

Frequent attenders in medical settings account for a disproportionate amount of health-care resources. Little is known about service use and costs of secondary care in those frequent attenders presenting with medically unexplained symptoms.

Aims

To compare health-care use and costs of patients with medically unexplained symptoms with other frequent attenders in secondary care.

Method

In a sample of 400 frequent attenders of secondary care services, those presenting with medically unexplained symptoms were identified by a review of medical records. Their use of health-care resources was compared with that of other frequent attenders.

Results

Of the frequent attenders 17% had at least two medically unexplained consultation episodes. These patients had a greater number of referrals to secondary care and were more likely to undergo particular investigations.

Conclusions

Frequent attenders with medically unexplained symptoms account for levels of service use and expenditure that are comparable with other frequent attenders, but the use and cost of medical investigations in this group are significantly greater.
Monitoring community psychiatric services in Italy: differences between patients who leave care and those who stay in treatment
Authors: Percudani Mauro , Belloni Giancarlo , Contini Agostino , Barbui Corrado
Published: August 2002

Background

Continuity of care has been monitored rarely in Italian community mental health centres.

Aims

To estimate the long-term probability of leaving care in first-contact patients attending an out-patient service, and to identify patients most likely to drop out.

Method

All patients who had a first contact with the community mental health centre of Magenta during a 1-year recruitment period were followed up for 24 months. Patients who failed to return after the last out-patient visit were regarded as ‘drop-outs'.

Results

During the 1-year recruitment period 330 subjects were at their first contact. The 1-year incidence of first-contact patients was nearly 33 per 10 000 inhabitants. At follow-up, 46% of patients had dropped out. In comparison with patients with psychoses, subjects suffering from neurotic (P=0.004) and personality disorders (P=0.029) were more likely to drop out.

Conclusions

In the Italian system of community psychiatric care nearly half of the patients are no longer in contact after 2 years. Those who stay in treatment are more likely to suffer from psychosis, suggesting a commitment of Italian outpatient facilities to tackling the needs of patients with more severe disorders.
Observer effects and heritability of childhood attention-deficit hyperactivity disorder symptoms
Authors: Martin Neilson , Scourfield Jane , McGuffin Peter
Published: August 2002

Background

Twin studies have found that childhood attention-deficit hyperactivity disorder (ADHD) has a strong genetic component. Estimates of heritability the extent of non-additive genetic effects and of ‘sibling contrast’ effects vary between different studies.

Aims

To use multiple informants to assess the extent to which observer effects influence such estimates in an epidemiological sample of twins.

Method

Questionnaire packs were sent to the families and teachers of twins aged 5–16 years in the Bro Taf region of South Wales. The twins were ascertained from community paediatric registers.

Results

Both parent— and teacher-rated data showed a high degree of heritability for ADHD measured as a symptom dimension, but the correlation between the two types of rater was modest. Bivariate analyses suggested that parent and teacher ratings reflect the effects of different genes. Self-report data from twins aged 11–16 years showed no evidence of genetic effects.

Conclusions

Although ADHD is shown to be highly heritable by both parent— and teacher-rated data, the underlying genotypes may be substantially different. This has implications for study designs aiming to find genes that contribute to the disorder.
Use of a routine, self-report outcome measure (HoNOSCA–SR) in two adolescent mental health services
Authors: Gowers Simon , Levine Warren , Bailey-Rogers Sarah , Shore Alison , Burhouse Emma
Published: August 2002

Background

The Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA) is an established outcome measure for child and adolescent mental health. Little is known of adolescent views on outcome.

Aims

To develop and test the properties of an adolescent, self-rated version of the scale (HoNOSCA–SR) against the established clinician-rated version.

Method

A comparison was made of 6-weekly clinician-rated and self-rated assessments of adolescents attending two services, using HoNOSCA and other mental health measures.

Results

Adolescents found HoNOSCA–SR acceptable and easy to rate. They rated fewer difficulties than the clinicians and these difficulties were felt to improve less during treatment, although this varied with diagnosis and length of treatment. Although HoNOSCA–SR showed satisfactory reliability and validity, agreement between clinicians and users in individual cases was poor.

Conclusions

Routine outcome measurement can include adolescent self-rating with modest additional resources. The discrepancy between staff and adolescent views requires further evaluation.
Islington study of dementia subtypes in the community
Authors: Stevens Tim , Livingston Gill , Kitchen Ginnette , Manela Monica , Walker Zuzana , Katona Cornelius
Published: August 2002

Background

Epidemiological studies of dementia subtypes have revealed widely varying distribution rates. There are almost no published community prevalence data for dementia with Lewy bodies (DLB) or the frontal lobe dementias (FLD).

Aims

To identify the distribution of dementia subtypes in a representative community population of older people.

Method

People aged ⩾65 years in randomised enumeration districts in Islington, north London, were screened using a reliable and valid questionnaire. People screened as having dementia were assessed in detail and diagnoses were made according to standard diagnostic criteria.

Results

Of 1085 people interviewed, 107 (9.86%) met screening criteria for dementia. Diagnoses were made for 72 people (67.3%). Distribution of subtypes varied according to the criteria used; the best-validated criteria yielding: Alzheimer's disease 31.3%; vascular dementia 21.9%; DLB 10.9%; and FLD 7.8%.

Conclusions

Alzheimer's disease is confirmed as the most common cause of dementia in older people, followed by vascular dementia. However, DLB and FLD occur sufficiently often to be seen frequently in clinical practice and should be incorporated into future editions of standard diagnostic criteria.