bluuebunny/crossref_metadata_2025 huggingface dataset:
Community Psychiatric Nurse Teams: Intensive Support Versus Generic Care
Authors: Muijen Matt , Cooney Margaret , Strathdee Geraldine , Bell Ray , Hudson Annette
Published: October 2008

Background.

This study evaluated whether a community psychiatric nurse (CPN) team providing a comprehensive aftercare service, using a case management approach, improves psychopathology and social functioning of the long-term mentally ill, and reduces hospital use compared with a generic CPN team.

Method.

Patients suffering from severe and persistent mental health problems were randomised to intensive aftercare or generic care after referral to the CPN manager. Each group contained 41 patients who were assessed at baseline and at 6, 12 and 18 months by an independent research psychologist. Outcome measures included the GAS, PSE, SAS, patient and relatives' satisfaction, number of admissions, and length of stay.

Results.

No difference between the groups was found on any of the outcome measures, despite the much higher number of contacts of the intensive (n = 52) versus generic CPNs (n = 13) and the much greater range of interventions.

Conclusions.

Intensive aftercare for people with persistent mental health problems was not found to be of greater benefit than generic CPN care. Many factors need to be considered for aftercare to be effective, including community resources, process of care, and staff training.
Community Psychiatric Nurses in Primary Health Care
Authors: Gournay Kevin , Brooking Julia
Published: October 2008

Background.

Community psychiatric nurses (CPNs) are increasingly working in primary health care with non-psychotic patients. This study was designed to test the efficacy of this work.

Method.

The study was carried out in six health centres in north London with a total of 36 participating general practitioners (GPs) and 11 CPNs. Using a randomised controlled trial, 177 patients were referred by their GP and randomly allocated to continuing GP care, immediate community psychiatric nursing intervention, or placed on a 12-week waiting-list, after which time the patient was offered CPN intervention. A range of measures of symptoms and social function were used, and ratings were carried out at assessment and at 24 weeks.

Results.

Patients improved on all measures over time (P < 0.001 for all measures). However, there was no difference between the group of patients receiving GP care and patients seen by the CPN. Improvements seemed to be independent of the amount of contact. Drop-out rates from CPN intervention were high (50%). CPN drop-outs were more disabled to start with, but did as well as CPN treatment completers. Patients were more likely to drop out with trained than untrained CPNs. There was no evidence that referral to a CPN saved GP time.

Conclusions.

The results add weight to the argument that CPNs should refocus their activity on people with serious mental health problems, and indicate that CPN education should focus on skill acquisition and interventions of proven effectiveness.
A Twin Study of Depressive Symptoms in Childhood
Authors: Thapar Anita , McGuffin Peter
Published: October 2008

Background.

Although depression in childhood appears to be familial, transmission of symptoms could be genetic or environmental. Twin studies enable us to separate these effects. Our aim was to assess the importance of genetic and environmental factors on depressive symptoms during childhood and adolescence in an epidemiological sample of twins.

Method.

Questionnaires (including the Mood and Feelings questionnaire) were mailed to a systematically ascertained sample (411 twin pairs) aged between 8 and 16 years. The overall response rate was 77%.

Results.

Data for the whole sample were best explained by an additive genetic model, with heritability of depressive symptom scores estimated at 79%. However, on splitting the sample, symptoms in children (aged 8 to 11) could be explained by shared environmental factors only, while symptoms in adolescents (aged 11 to 16) remained highly heritable.

Conclusions.

The results suggest that although depressive symptoms appear to be largely heritable, the influence of genetic and environmental factors may vary with age.
Needs Assessment
Authors: Slade Mike
Published: October 2008

The National Health Service and Community Care Act 1990 defines needs as “the requirements of individuals to enable them to achieve, maintain or restore an acceptable level of social independence or quality of life” (Department of Health Social Services Inspectorate, 1991). Other definitions of need have also been used by researchers, based on different theoretical perspectives. Psychological theories have used the concept of need as a basis for understanding action. Psychiatry, by contrast, often employs the construct to inform service provision, and plan individual care. These issues are important because implementing the NHS and Community Care Act in a consistent manner will involve agreement on defining and prioritising need.
The Clinical Diagnosis and Misdiagnosis of Senile Dementia of Lewy Body Type (SDLT)
Authors: Mckeith I. G. , Fairbairn A. F. , Perry R. H. , Thompson P.
Published: October 2008

Background

Current clinical classifications do not contain specific diagnostic categories for patients with senile dementia of the Lewy body type (SDLT), recently proposed as the second commonest neuropathological cause of dementia in the elderly. This study determines how existing clinical diagnosis systems label SDLT patients and suggests how such patients may be identified.

Method

A range of clinical diagnostic criteria for dementia were applied to case notes of autopsy-confirmed SDLT (n = 20), dementia of Alzheimer type (DAT; n = 21) and multi-infarct dementia (MID; n = 9) patients who had received psychogeriatric assessment. The predictive validity of each set of clinical criteria was calculated against the external criterion of neuropathological diagnosis.

Results

Many SDLT patients erroneously met criteria for MID (35% with Hachinski scores ≥ 7) or for DAT (15% by NINCDS ‘probable AD’, 35% by DSM–III–R DAT and 50% by NINCDS ‘possible AD’). Up to 85% of SDLT cases could be correctly identified using recently published specific criteria.

Conclusions

DLT usually has a discernible clinical syndrome and existing clinical classifications may need revision to diagnose correctly such patients.
Cerebral Hemiatrophy and Schizophrenia
Authors: Puri B. K. , Hall A. D. , Lewis S. W.
Published: October 2008

Background

Neuroimaging of a treatment-resistant patient with schizophrenia revealed the existence of cerebral hemiatrophy. The association of schizophrenia with cerebral hemiatrophy has not previously been reported.

Results

Neuroimaging with X-ray computerised tomography showed marked reduction in the volume of the left cerebral hemisphere with secondary enlargement of the left lateral fissure and cortical sulci. High resolution cranial single-photon emission computerised tomography showed a functional deficit of the regional cerebral blood flow in the left lateral parietal and left temporal lobes.

Conclusions

Cerebral hemiatrophy may belong to the lengthening list of neurodevelopmental cerebral anomalies associated with schizophrenia.
Transsexualism and Gender Reassignment
Authors: Snaith R. P. , Hohberger A. D.
Published: October 2008

Gender reassignment for carefully assessed transsexual patients is now an established and accepted practice in many parts of the world. In other areas customary attitudes to those with sexual differences prevents consideration. A large number of autobiographies by reassigned patients have been published and all throw light on the experience of the writers. The one which may be recommended is that by Morris (1974). For the interested layperson enquiring about the nature of transsexualism the brief book by Hodgkinson (1987) may be recommended.
Predicting Symptomatic and Behavioural Outcomes of Community Care
Authors: Wykes Til
Published: October 2008

Background

Many studies of community care show little overall improvement in patient functioning. This study investigated whether cognitive impairment mediates the effect of the increased opportunities offered by the community.

Method

Behaviour, symptoms, sociodemographic variables and information processing of a random sample of chronic psychiatric patients were examined. Six years later, social and behavioural outcomes were measured.

Results

The overall change in the group was negligible. Individual variation can be accounted for by two factors: time since transfer to the community, and initial information processing problems. Patients transferred for at least three years showed significant improvements. Schizophrenic patients without information processing problems improved, but those with deficits got worse.

Conclusions

The identification of mediating factors should allow better rehabilitation plans, and alleviate the toxic effects that transfer has on some patients' functioning.
Personality Disorder in Later Life: A Community Study
Authors: Cohen Bruce J. , Nestadt Gerald , Samuels Jack F. , Romanoski Alan J. , McHugh Paul R. , Rabins Peter V.
Published: October 2008

Background

This exploratory study compares the prevalence of personality disorders and traits in people over and under 55 years of age. The comorbidity between personality and other psychiatric disorders is also examined.

Method

Psychiatrists examined 810 subjects in a two-stage community survey. The semi-structured Standardized Psychiatric Examination was used to diagnose all DSM-III personality disorders and other psychiatric disorders.

Results

The older subjects were significantly less likely than the younger subjects to have any personality disorder (6.6% v. 10.5%; relative odds = 0.42, 95% confidence interval = 0.25–0.70, P<0.001). Antisocial and histrionic personality disorders were much less prevalent in the older than younger subjects (P < 0.05). The older subjects also had significantly fewer maladaptive personality traits (x2 = 88.9, d.f. = 3, P < 0.001). The patterns of comorbidity between personality disorders and other psychiatric disorders were different in the two age groups.

Conclusions

It is important to evaluate personality in patients of all ages. While some older patients no longer meet criteria for personality disorder, maladaptive traits may become evident during times of stress.
A Controlled Psychiatric Study of Individuals at Risk for Huntington's Disease
Authors: Shiwach Raj S. , Norbury C. Gail
Published: October 2008

Background

The study tested specific hypotheses that (a) there is an increased incidence of psychiatric disorders in asymptomatic heterozygotes for Huntington's disease (HD) compared with the normal homozygotes, and (b) there is an increased incidence of psychiatric disorders in the adult offspring of Huntington's disease patients compared with their partners.

Method

A controlled study was made of 93 apparently healthy individuals (at 50% risk), who had given DNA samples for the predictive test, and 70 of their partners. Current and past psychopathology was assessed and compared with the DNA predictive test results based on linkage analyses. The results of psychiatric assessments of the two groups were compared.

Results

DNA test results were available for 53 subjects (of 93). Five subjects at risk for HD were omitted from the study. The asymptomatic heterozygotes (n = 20) showed no significant increase in the incidence of any psychiatric episode, depression, schizophrenia or behavioural disorder when compared with the normal homozygotes (n = 33). The whole tested group showed a significantly greater number of psychiatric episodes than their partners (n = 43).

Conclusions

Asymptomatic HD gene carriers do not have a greater incidence of psychiatric disorders than the non-gene carriers born to a HD parent.
Propofol Anaesthesia in Electroconvulsive Therapy
Authors: Fear Christopher F. , Littlejohns Carl S. , Rouse Eryl , McQuail Paul
Published: October 2008

Background

The induction agent propofol is known to reduce electroconvulsive therapy (ECT) seizure duration. It is assumed that outcome from depression is adversely affected by this agent. This study compares propofol and methohexitone as induction agents for ECT.

Method

In a prospective, randomised, double-blind study 20 subjects with major depressive disorder (DSM-III-R criteria) received propofol or methohexitone anaesthesia. The Hamilton Depression Rating Scale and Beck Depression Inventory were used to assess depression before therapy, at every third treatment, and at the end of therapy. Seizure duration was measured using the cuff technique.

Results

Mean seizure durations (P < 0.01) and mean total seizure duration (P < 0.01) were shorter in the propofol group. There was no difference in outcome.

Conclusions

Use of propofol may not adversely affect outcome from depression and it is not necessarily contraindicated as an induction agent for ECT. Our results should be interpreted cautiously, and larger studies are needed.
Psychiatric Disorders in a Paediatric Primary Care Clinic
Authors: Gureje O. , Omigbodun O. O. , Gater R. , Acha R. A. , Ikuesan B. A. , Morris J.
Published: October 2008

Background

The proportion of children with psychiatric disorders treated in primary care is not known in most developing countries.

Method

In a two-stage epidemiological study, 990 children aged between 7 and 14 years were screened with the parents' version of the Rutter scale. Of these, a stratified sample of 227 was interviewed jointly with their mothers, using the children's version of the Schedule for Affective Disorders and Schizophrenia (K-SADS).

Results

We obtained a weighted prevalence of 19.6 ± 2.5% for the presence of one or more DSM-III-R disorders. Depressive disorders were present in 6.0%, anxiety-related disorders in 4.7%, and conduct disorders in 6.1%.

Conclusion

Psychiatric disorders in children are common in primary care. Doctors working at this level of care need the skills to detect and treat them.
Psychiatric Morbidity in Primary Health Care in Santiago, Chile Preliminary Findings
Authors: Araya Ricardo , Wynn Robert , Leonard Richard , Lewis Glyn
Published: October 2008

Background

The aims were to determine the prevalence of psychiatric morbidity among primary care attenders in a poor suburb of Santiago and to study the relationship with health service use.

Method

A cross-sectional survey was made of 163 consecutive attenders to a primary care clinic.

Results

Eleven per cent of the sample gave a psychological reason for consultation and the prevalence of psychiatric morbidity was 53%, defined using the revised Clinical Interview Schedule. Women and those of lower socio-economic status were at higher risk. Physicians recognised 14% of the psychiatric morbidity. Attenders with psychiatric morbidity consulted more frequently.

Conclusions

There is a need to improve the recognition and management of psychiatric morbidity in primary care in Chile and other less developed countries. This could lead to the more efficient use of scarce health care resources in primary care.
Psychosurgery: Stereotactic Subcaudate Tractotomy
Authors: Bridges P. K. , Bartlett J. R. , Hale A. S. , Poynton A. M. , Malizia A. L. , Hodgkiss A. D.
Published: October 2008

Background

Stereotactic subcaudate tractotomy (SST) is the only type of psychosurgery performed at the Geoffrey Knight Unit, London, where nearly 1300 operations have been done since 1961. Statistically reliable data are not available to prove the effectiveness of SST. A detailed statement about contemporary psychosurgery is given.

Method

Relevant publications from the Unit and via Medline are discussed. The outcome figures are reviewed. The outcome is assessed at the Unit in global and clinical terms, associated with results of self-completed questionnaires.

Results

ST allows 40–60% of patients to live normal or near-normal lives, perhaps with continuation of medication. A reduction in suicide rate to 1% postoperatively, from 15% in cases of uncontrolled affective disorders is seen.

Conclusion

As a treatment of last resort, no controlled trial against a comparable treatment is possible. It appears reasonable to offer SST to patients with suicidal and deluded depression or with frequently swinging moods, not responding to other treatments.
Sexual Murder
Authors: Grubin Don
Published: October 2008

Background

Little is known about men who kill in a sexual context. The present study compares a group of sexual murderers with a group of men who had raped but not killed.

Method

Twenty-one men who murdered women in the course of a sexual attack and 121 men convicted of rape were interviewed in six prisons. Victim statements were obtained in 103 cases (73%). Assessment consisted of a 90-minute semi-structured interview, the Eysenck 1–7 questionnaire, and the Schonell reading test.

Results

The most notable characteristic distinguishing the men who killed was their lifelong isolation and lack of heterosexual relationships.

Conclusions

A better understanding of the social and emotional isolation commonly found in sexual murderers may provide important insights into why some sexual offenders go on to kill.
Prediction of Outcome Following a First Episode of Schizophrenia
Authors: Geddes John , Mercer Gavin , Frith C. D. , MacMillan Fiona , Owens David G. C. , Johnstone Eve C.
Published: October 2008

Background

Although previous studies have attempted to identify predictors of outcome in schizophrenia, few have prospectively studied first episode patients for an adequate follow-up period.

Method

The psychopathological predictors of outcome were investigated in a subgroup of 51 subjects, originally included in the Northwick Park study of first episode schizophrenia who were followed up 7.3 years (s.d. 1.1, range 5.3– 10.3) after first admission in the Harrow study. Forty-four subjects (24 men, 20 women) were traced. Outcome measures were time to first readmission, occupational level and total duration of hospital admission at five years after first admission.

Results

A survival analysis of time to first relapse revealed that the presence of subjective feelings of depression (CATEGO syndrome SD) during the first admission was associated with early relapse while the presence of depressive delusions (CATEGO syndrome DD) and higher educational attainment protected against early relapse. Total duration of hospitalisation at five years after first onset was positively associated with the presence of CATEGO syndromes SD and OD (biological features of depression) and negatively associated with female sex. Poor occupational outcome was not significantly associated with any psychopathological predictors.

Conclusions

Our findings challenge the conventional view that symptoms of depression are associated with better outcome in schizophrenia.
Inner London Collaborative Audit of Admissions in Two Health Districts
Authors: Bebbington P. E. , Feeney S. T. , Flannigan C. B. , Glover G. R. , Lewis S. W. , Wing J. K.
Published: October 2008

Background

Twenty-six per cent of patients in two Inner London districts were admitted to acute wards under the provisions of the Mental Health Act. Compared with those not under compulsion, they were young, male, more likely to be of black Caribbean origin, and to have a diagnosis of schizophrenia of short duration. The hypothesis is tested that ethnicity determines rates of compulsory admission independently of the other factors.

Method

Sampling and data collection methods were described in the first paper. Statistical analyses included a log-linear analysis of six key variables: compulsory admission, challenging behaviour, diagnosis, ethnicity, age, and sex.

Results

There were no substantial differences between districts. Analysis provided two similar statistical models. In both, admission under the Act was strongly associated with challenging behaviour and diagnosis of schizophrenia. In the model of best fit there was no significant interaction term for ethnicity and compulsion. In the second model there was a weak association.

Conclusions

Ethnicity did not appear to be of outstanding importance in decisions to use the Mental Health Act. There was a strong link between ethnicity and diagnosis, independent of compulsion. Differences between the districts made no major contribution to the rates of compulsory admission.
Predictors of Treatment Outcome in the Behavioural Treatment of Obsessive-Compulsive Disorder
Authors: Keijsers Ger P. J. , Hoogduin Cees A. L. , Schaap Cas P. D. R.
Published: October 2008

Background

An investigation to determine which prognostic variables are associated with behavioural treatment failure in obsessive-compulsive disorder (OCD). Empirically established prognostic variables measured at the start of treatment may lead to adjusted treatment programmes for these patients.

Method

Forty patients, diagnosed with OCD, received a standardised treatment consisting of 18 sessionsin vivoexposure and response prevention. Compulsive behaviour (MOCI) and obsessive fear (ADS) were the outcome measures. Prognostic variables included were initial severity of OC complaints, initial level of depression, problem duration, patients' motivation for treatment, quality of the therapeutic relationship, and marital dissatisfaction.

Results

Greater initial severity of complaints (P< 0.01), and depression (P= O.03) predicted poorer outcome for compulsive behaviour. Greater initial severity of complaints (P< 0.01), and the conjoint variables higher level of depression, longer problem duration, poorer motivation for treatment, and dissatisfaction with the therapeutic relationship predicted poorer outcome for obsessive fear (P< 0.01).

Conclusions

The complaint-related variables of initial severity, initial depression, and problem duration, and the non-specific treatment variables of patients' motivation and quality of the therapeutic relationship, affect behavioural treatment outcome in OCD.
Survival Analysis and Readmission in Mood Disorder
Authors: Pridmore Saxby , Hornsby Helen , Hay David , Jones Ivor
Published: October 2008

Background

This is an exploratory study of readmission in mood disorder.

Method

The study is naturalistic and employs survival analysis. We identified 821 individuals with ICD–9 diagnoses, drawn from the Tasmanian Mental Health Register.

Results

No demographic variables influence the time to readmission. Two groups emerge: those with affective psychoses, and those with neurotic depression, brief depressive reaction and depressive disorders not elsewhere classified. The former group demonstrated shorter times to readmission than the latter. There was no support for a unipolar–bipolar distinction.

Conclusions

Affective psychoses have a less favourable outcome than expected. There was support for an endogenous-neurotic distinction.
The East York Health Needs Study
Authors: Katz R. , Stephen J. , Shaw B. F. , Matthew A. , Newman F. , Rosenbluth M.
Published: October 2008

Background

This study reports the prevalence of psychiatric disorder in women from a Canadian community. The GHQ and the CES–D were compared for their utility.

Method

A thousand women over the age of 18 were mailed the GHQ and the CES–D. Our return rate was 44.4%; 24% were personally interviewed by interviewers blind to screening information. The CIDI was used to establish DSM–III–R diagnoses. Four versions of the GHQ and one version of the CES–D were calibrated against the CIDI.

Results

The prevalence of general psychiatric disorder was estimated as between 15% and 19%, anxiety disorders between 10% and 13%, and depression occurring with anxiety between 3% and 4%. The calibrated GHQ was the most reliable instrument.

Conclusions

Prevalence of DSM–III–R psychiatric disorder can be reliably determined with the calibrated GHQ. Anxiety disorders are most prevalent in this community, and were best detected using calibrated versions of the longer form GHQ.
Social Support, Negative Life Events and Mental Health
Authors: Dalgard Odd Steffen , Bj⊘rk Sven , Tambs Kristian
Published: October 2008

Background

In a 10-year follow-up of a survey from Oslo, 503 persons were reinterviewed using the same questionnaire.

Method

The questionnaire includes information about social support, ‘locus of control’ and mental health as well as negative life events and long-lasting mental strain during the year prior to the follow-up.

Results

The study confirms the “buffer hypothesis”, that social support protects against the development of mental disorder only when the individual is exposed to stressors, like negative life events. This buffering effect was especially strong for depression.

Conclusions

The buffering effect only applies to the ‘externals’ –those who have personality-related feelings of powerlessness and lack of control over their own lives. The ‘internals’ do not have the same need for social support to cope with life stressors, and have low symptom scores even when negative life events are combined with relative weak social support.
Negative Symptoms at Discharge and Outcome in Schizophrenia
Authors: Hwu Hai-Gwo , Tan Happy , Chen Chu-Chang , Yeh Ling-Ling
Published: October 2008

Background

The clinical significance in schizophrenia of positive and negative symptoms at discharge was assessed.

Method

Of schizophrenic patients fulfilling DSM–III criteria, 113 were recruited for this study. Personal, social and psychopathological data were collected and all cases were followed up at one and two years after discharge.

Results

The presence of positive symptoms (64 cases), without concomitant negative symptoms, did not predict the follow-up social function and positive symptom score. Conversely, the presence of negative symptoms (31 cases) predicted worse social functioning (P < 0.05 to P < 0.005) and higher positive symptom scores (P < 0.01) at follow-up using MANOVA. Eighteen cases (15.9%) had neither positive nor negative symptoms and had the best clinical outcome.

Conclusions

Negative, but not positive, symptoms assessed at discharge are an important predictor of poor outcome. In addition, negative symptoms may themselves expose a biological vulnerability to the presence of positive symptoms.
Treatment of Negative Symptoms in Schizophrenia with Amisulpride
Authors: Boyer P. , Lecrubier Y. , Puech A. J. , Dewailly J. , Aubin F.
Published: October 2008

Background

The efficacy of low doses of certain neuroleptics in improving negative symptoms is still controversial. This study assessed the efficacy of amisulpride, a benzamide which increases dopaminergic transmission at low doses via presynaptic dopamine receptor blockade, on negative symptoms of schizophrenia.

Method

The study was designed as a parallel-group, double-blind, placebo-controlled trial. Patients had to fulfil DSM–III criteria for schizophrenia, Andreasen's criteria for negative schizophrenia, and to have a total score of at least 75 on the SANS; those treated with neuroleptics or antidepressants underwent a six-week placebo wash-out. One hundred and four in-patients were randomly assigned to amisulpride 100 mg/d, amisulpride 300 mg/d, or placebo for six weeks; 85 patients completed the study.

Results

Both amisulpride doses were significantly more effective than placebo on the primary evaluation criterion (SANS total score, MANOVAP< 0.02). No significant changes were found in positive symptoms or in extrapyramidal symptoms.

Conclusions

Negative symptoms can be improved by low doses of amisulpride, favouring the hypothesis of dopaminergic hypofunction as one of the causes of negative symptoms.
Dopamine Supersensitivity and Hormonal Status in Puerperal Psychosis
Authors: Meakin Christopher J. , Brockington Ian F. , Lynch Se , Jones Stephen R.
Published: October 2008

Background

We examine the dopamine receptor supersensitivity hypothesis of puerperal psychosis, and explore puerperal changes in the functional sensitivity of this receptor system.

Method

Dopamine receptor sensitivity was estimated using growth hormone (GH) response to apomorphine challenge following delivery in 37 control women, and 11 deliveries in 10 women at ‘high risk’ of puerperal psychosis (previous history of puerperal affective or nonpuerperal manic psychosis). Tests were on days 4 or 5, 11 or 12 and at six weeks postpartum.

Results

Three women developing puerperal psychosis had subsensitive GH responsiveness on day 4. GH response to 67 challenge tests (in control and ‘high risk’ women) increased between days 4 or 5 and six weeks postpartum (P < 0.05). GH response at six weeks correlated with free thyroxine levels (P < 0.01).

Conclusions

These three cases do not support the stated hypothesis. Hypothalamic dopamine receptor sensitivity increases during the puerperium; thyroxine might influence this.
Course and Recurrence of Postnatal Depression
Authors: Cooper Peter J. , Murray Lynne
Published: October 2008

Background

It is unclear whether the causative factors of non-psychotic postnatal depression are the same as those of depression at other times.

Method

The course and recurrence of postnatal depression was studied in two groups of primiparous women experiencing an index episode of postnatal depression: those for whom the mood disorder had arisen de novo (n = 34), and those for whom it was a recurrence of previous affective disturbance (n = 21). The mental state of these two groups, together with a psychiatrically well control group (n = 40), was studied for five years.

Results

It was found that those for whom the index episode was a recurrence of depression were at raised risk of further non-postpartum episodes but not postpartum episodes, and that those for whom the index episode had arisen de novo were at raised risk for further episodes of postnatal depression but not for non-postpartum episodes.

Conclusion

These findings suggest a specific nosologic reference for the concept of postnatal depression.
Effect of Fluoxetine on Melatonin in Patients with Seasonal Affective Disorder and Matched Controls
Authors: Childs P. A. , Rodin I. , Martin N. J. , Plaskett L. , Thompson C. , Allen N. H. P. , Smythe P. J.
Published: October 2008

Background

The aim was to investigate the secretion profile of melatonin and seasonal affective disorder before and after treatment with fluoxetine.

Method

A six-week case-controlled study with repeated overnight blood sampling was conducted. Ten patients fulfilling the criteria for major depressive disorder, seasonal type, with a 29-item Hamilton Depression Rating Scale (HDRS) score of at least 20 were compared with ten age- and sex-matched healthy controls in a clinical laboratory. The effects of fluoxetine (20 mg/day) on the HDRS and melatonin concentration were measured.

Results

Fluoxetine significantly reduced melatonin levels in both groups. There was no significant difference in melatonin secretion between the groups.

Conclusions

The effect of fluoxetine differs from tricyclics and fluvoxamine, both of which increase melatonin.
Diagnosis of Depression in Alcohol Dependence: Changes in Prevalence with Drinking Status
Authors: Davidson Kate M.
Published: October 2008

Background

Depression and alcohol dependence are frequently found to co-exist but the relationship between these disorders requires further elucidation. This study tested several hypotheses related to the relevance of whether the diagnosis of depression was made before admission or after detoxification in the current episode for those with alcohol dependence.

Method

The Schedule for Affective Disorders and Schizophrenia (SADS) was administered to obtain Research Diagnostic Criteria (RDC) on 82 randomly selected alcohol dependent in-patients. Alcohol-related (Severity of Alcohol Dependence Questionnaire (SADQ), alcohol consumption and alcohol-related problems), socio-demographic variables and treatment for depression were assessed.

Results

For the episode of drinking which led to admission, a diagnosis of major depression was found in the majority of patients (67%). Once detoxification from alcohol took place, only the minority (13%) met criteria for major depression.

Conclusions

It is suggested that depression is largely associated with the episode of drinking which led to admission in patients who are dependent on alcohol and may be due to the effect of chronic alcohol intoxication. Socio-demographic and alcohol-related characteristics appear to bear little relation to the presence of depression. Clinicians exercise appropriate judgement in not prescribing antidepressant treatments to patients whose depression may remit with abstinence from alcohol.
Psychotic States Arising in Late Life (Late Paraphrenia)
Authors: Almeida Osvaldo P. , Howard Robert J. , Levy Raymond , David Anthony S.
Published: October 2008

Background

This study explored the psychopathological state of a sample of ‘late paraphrenic’ patients and the reliability of their diagnosis according to the most widely used systems of classification of mental disorders.

Method

The presence and severity of psychiatric symptoms were assessed with the Present State Examination (PSE), the Scale for the Assessment of Positive Symptoms (SAPS), and the High Royds Evaluation of Negativity (HEN) scale. Patient signs and symptoms were classified according to the PSE9–CATEGO4, DSM–III–R, DSM–IV, and ICD–10 diagnostic systems. Agreement among the 11 most widely used criteria for the diagnosis of schizophrenia was assessed for these patients. These included DSM–III–R, DSM–IV, ICD–10, Schneider, Langfeldt, New Haven Schizophrenia Index, Carpenter, Research Diagnostic Criteria (RDC), Feighner, Taylor & Abrams, and PSE9–CATEGO4. The study assessed 47 patients, including in-patients, out-patients, day-patients, and those in the community. Thirty-three elderly controls were recruited from luncheon clubs in Southwark and Lambeth (London, UK).

Results

Patients showed a wide range of delusional ideas, most frequently involving persecution (83.0%) and reference (31.9%). Eighty-three per cent of patients reported some sort of hallucination, most frequently auditory (78.7%). Formal thought disorder was very rare, only one patient showing mild signs of circumstantial speech. No patients exhibited catatonic symptoms or inappropriate affect. Shallow, withdrawn, or constricted affect was found in only 8.5% of patients. The various systems of classification indicated that most patients displayed typical schizophrenic symptoms, although up to one-third of them did not meet criteria for the diagnosis of schizophrenia. There was poor agreement among the different diagnostic schedules as to whether to classify patients as schizophrenic (0.02 < k < 0.45).

Conclusion

Psychotic states arising in late life are accompanied by various psychiatric symptoms that are not entirely typical of early-onset schizophrenia. The current trend to include ‘late paraphrenia’ into the diagnosis of schizophrenia or delusional disorder has poor empirical and theoretical bases.
Mental Status Examination of an Exceptional Case of Longevity
Authors: Ritchie Karen
Published: October 2008

Background

The mental status examination of an extreme case of longevity, J. C., aged 118 years and 9 months, is documented in order to further knowledge regarding profiles of morbidity in the extremely elderly. J. C. is presently considered to have the longest authenticated life-span in the history of the human species.

Method

Neuropsychological tests were improvised taking into account the subject's severe perceptual deficits. The examination was carried out over a six-month period. A CT scan was also conducted.

Results

The subject's performance on tests of verbal memory and language fluency is comparable to that of persons with the same level of education in their eighties and nineties. Frontal lobe functions are relatively spared and there is no evidence of depressive symptomatology or other functional illness. Cognitive functioning was found to slightly improve over a six-month period.

Conclusions

The subject shows no evidence of progressive neurological disease. A high initial level of intellectual ability may have constituted a protective factor.
Late-Life Depressive Disorder in the Community
Authors: Ojen Rob Van , Hooijer Chris , Bezemer Dick , Jonker Cees , Lindeboom Jaap , Tilburg Willem Van
Published: October 2008

Background

In previous studies cognitive impairment in depressed elderly in-patients tends to be associated with a late onset of depression. This study tests the hypothesis that cognitive impairment is associated with depression only in elderly individuals with no history of psychiatric illness.

Method

We investigated an age-stratified sample of 4051 elderly people living in the community, aged between 65 and 84 (AMSTEL). The relationship between depression (GMS-AGECAT diagnosis) and scores on the Mini Mental State Examination was studied in subjects with and without a reported psychiatric history (CAMDEX questionnaire).

Results

Low MMSE scores (MMSE ≤ 25) were only associated with depression in subjects with no psychiatric history (young/old: OR = 2.75, 95% CI = 1.83, 4.19; old/old: OR = 2.21, 95% CI = 1.61, 3.03).

Conclusions

We concluded that the combination of cognitive impairment and first-episode depression in elderly individuals may indicate cerebral deterioration. Depression as such may not be associated with cognitive impairment.
Positive Life Change and Recovery from Depression and Anxiety
Authors: Leenstra A. S. , Ormel J. , Giel R.
Published: October 2008

Background

The objective was to examine the relationship between positive life change (PLC) and recovery from depression and anxiety. Following Brown et al (1988, 1992), we hypothesised: (a) that an excess of PLC would be found in the 3-month period before recovery compared with base rates (‘excess hypothesis’) and (b) that fresh-start and anchoring subtypes of PLC would trigger recovery from depression and anxiety respectively (‘specificity hypothesis’).

Method

One hundred and seventy primary care patients with a depressive and/or anxiety disorder, selected from 1994 consecutive attenders, were assessed at baseline and at 1-year and 3.5-year follow-ups on life change (LEDS) and psychopathology (PSE and Course Interview).

Results

Our results appeared to confirm the excess hypothesis regarding depression and anxiety (twofold excess was found prior to recovery), but not regarding mixed anxiety/depression. They did not support the specificity hypothesis.

Conclusions

PLC facilitates recovery but is neither a necessary nor sufficient condition for remission. Difficulty reduction is the most important recovery-enhancing factor.
Organised Violence and the Stress of Exile
Authors: Hauff Edvard , Vaglum Per
Published: October 2008

Background

The prevalence and course of mental disorders among Vietnamese refugees were studied, using a model including variables from different research traditions.

Method

A consecutive community cohort of 145 Vietnamese boat refugees aged 15 and above were personally interviewed on their arrival in Norway and three years later.

Results

Three years later, there was, unexpectedly, no decline in self-rated psychological distress (SCL-90-R), almost one in four suffered from psychiatric disorder and the prevalence of depression was 17.7% (Present State Examination). Female gender, extreme traumatic stress in Vietnam, negative life events in Norway, lack of a close confidant and chronic family separation were identified as predictors of psychopathology.

Conclusions

The effects of war and persecution were long-lasting, and compounded by adversity factors in exile. A uniform course of improvement in mental health after resettlement cannot be expected in all contexts. The affected refugees need systematic rehabilitation.
Comparison of Carbamazepine and Lithium in the Prophylaxis of Bipolar Disorders
Authors: Dardennes R. , Even C. , Bange F. , Heim A.
Published: October 2008

Background

This meta-analysis assessed the equipotency of carbamazepine and lithium prophylaxis in bipolar disorder.

Method

We selected only randomised, double-blind, controlled studies comparing carbamazepine with lithium from a manual and computerised search, and subjected them to a quality inventory. Their statistical results were weighted by their quality score and combined. Results. Four studies met our criteria, yielding, overall, P = 0.15. This result is not straightforward because the studies showed significant heterogeneity (P < 0.01).

Conclusion

Differences in statistical power and sensitivity of outcome measure explain this heterogeneity and the conflicting results of the studies. Therefore, the prophylactic efficacy of carbamazepine remains questionable.
Assessment of the Prevalence of Psychiatric Disorder in Young Adults
Authors: Ferdinand Robert F. , van der Reijden Matthias , Verhulst Frank C. , Nienhuis Fokko J. , Giel Robert
Published: October 2008

Background

The effectiveness of different assessment procedures for determining prevalence rates of psychiatric disorder in young adults was investigated.

Method

In a two-stage multi-method procedure, the Young Adult Self-Report, the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), the Structured Interview for Personality Disorders (Revised), and the Global Assessment of Functioning (GAF) Scale were used to assess prevalence rates in 706 19–24-year-olds from the general population. Furthermore, individuals' subjective perception of distress and referral to mental health services were assessed.

Results

The prevalence of any SCAN/DSM–III–R disorder was 19.3% (95% confidence interval: 11.2–27.4%). Most subjects who received a SCAN/DSM–III–R diagnosis were only mildly impaired. The highest prevalence rates of dysfunctioning (GAF score below 61) without referral to mental health services were for dissociative disorder (2.3%), sleep disorder (2.1 %), alcohol dependence (1.3%) and affective disorder (1.8%).

Conclusion

Instruments that assess functional impairment in addition to DSM–III–R diagnoses are indispensable in prevalence studies.
Schizophrenic and Manic Brains in Nigerians Computerised Tomography Findings
Authors: Ohaeri Jude U. , Adeyinka Abiodun O. , Enyidah Solomon N. , Osuntokun Benjamin O.
Published: October 2008

Background

We highlight the profile of brain computerised tomography (CT) measures among Nigerian psychiatric patients for comparison with findings from developed countries, and study of the relationship between CT values and clinical variables.

Method

Seven brain ventricle measures of 50 schizophrenic patients, 14 manic patients, and 41 healthy control subjects were compared.

Results

Patients had a significantly higher mean Sylvian fissure area. The third ventricle of schizophrenic patients was significantly larger than those of control subjects. CT measures were not significantly correlated with duration of illness.

Conclusion

The so-called functional psychotic states are most probably associated with nonspecific brain abnormality.
Disordered Water Homeostasis in Schizophrenia and Cerebral Ventricular Size
Authors: Emsley Robin , Roberts Mimi , Smith Roger , Spangenberg Judora , Chalton Derek
Published: October 2008

Background

A possible association between disordered water homeostasis and cerebral ventricular size in patients with schizophrenia was investigated.

Method

In a cross-sectional study of hospitalised patients, cerebral ventricular size was measured in 16 schizophrenic patients with disordered water homeostasis and 16 matched schizophrenic controls by magnetic resonance imaging.

Results

Ventricle to brain ratio, third ventricular index, bicaudate index and bifrontal index tended to be greater in those with schizophrenia with disordered water homeostasis, although differences were significant only for the bifrontal index (P<0.05). Strong negative correlations were found between ventricular size and performance on neuropsychological testing in the disordered water homeostasis group.

Conclusion

These results provide evidence for an association between structural brain abnormality and disordered water homeostasis in a subset of schizophrenic patients.
Prediction of Dangerous Behaviour in Male Erotomania
Authors: Menzies Robin P. D. , Fedoroff J. Paul , Green Christopher M. , Isaacson Kari
Published: October 2008

Background

New cases of erotomania in men, plus cases from the literature, were analysed to explore any association between erotomania and dangerousness, and to identify possible predictors.

Method

Files at two in-patient facilities were examined to determine the presence of DSM–III–R delusional disorder, erotomanic type. The sample (13 cases) was divided into dangerous and benign groups on the basis of serious antisocial behaviour directly related to erotomanic delusions. These cases were combined with all reports of erotomania in men (16 cases), found in the English language psychiatric literature, to allow for statistical analysis.

Results

Two factors, multiple delusional objects (P < 0.0005) and serious antisocial behaviour unrelated to the delusions (P < 0.05), were found to be significantly associated with dangerousness. Using a combination of these two variables it was possible to predict dangerousness with an accuracy of 88.9% (weighted prediction accuracy or ‘hit rate’). We identified no false negatives but three false positives.

Conclusions

The presence of multiple objects, and a history of serious antisocial behaviour unrelated to the erotomanic delusions, are useful predictors of dangerous behaviour in men with erotomania.
The Longitudinal Stability of Cognitive Impairment in Schizophrenia
Authors: Harvey Philip D. , White Leonard , Parrella Michael , Putnam Katherine M. , Kincaid Margaret M. , Powchik Peter , Mohs Richard C. , Davidson Michael
Published: October 2008

Background

Severe cognitive impairment affects many patients with schizophrenia, especially geriatric in-patients. Little is known about the course of this impairment, however.

Method

Two hundred and twenty-four geriatric schizophrenic in-patients were examined for changes in cognitive functioning over a one-year follow-up period, and 45 of them were assessed over a two-year period. In addition, the subset of 45 patients participated in a one-week and one-month test-retest reliability study of the instrument used to assess cognitive impairment, the Mini-Mental State Examination (MMSE).

Results

The average MMSE scores did not change over a one- or two-year follow-up period. The test-retest reliability of the scale was extremely good at both retest intervals.

Conclusion

Among the implications of these data are that cognitive changes in geriatric schizophrenic patients are very slow and are more consistent with a neurodevelopmental process than a neurodegenerative course.
Positive and Negative Symptom Course in Chronic Community-Based Patients
Authors: Quinlan Donald M. , Schuldberg David , Morgenstern Hal , Glazer William
Published: October 2008

Background

The long-term symptom profile of chronic out-patients was studied.

Method. 242 out-patients receiving neuroleptic medications (109 with schizophrenia and 133 non-schizophrenics), were studied for positive (SAPS) and negative (SANS) symptoms at baseline and at 24 months to investigate whether these symptom groups changed over out-patient maintenance treatment.

Results

Overall and within groups, negative symptoms decreased and positive symptoms increased. While the sums of the SANS scores for the schizophrenic patients were initially higher, their mean SANS score dropped more over time (P< 0.001), to show no difference from non-schizophrenics at follow-up. Positive symptoms increased in both groups, although schizophrenics were higher at both times; sub-scales within the SANS showed different patterns of change.

Conclusion

Support is found for a multidimensional view of both positive and negative symptoms and for a reconsideration of the notion of ‘progressive downward course’ in schizophrenia.
Post-Traumatic Stress Disorder
Authors: Thompson James
Published: October 2008

I believe that we are witnessing a cultural change as regards the public perception of stress. In past decades an almost military heroism, or at the very least a reticence in discussing fear, appeared to be the cultural ideal. Memories of our imperial past impelled us to keep a stiff upper lip, and recollections of war-time privation and sacrifice tempered people's willingness to complain too much about the demands and dangers of everyday life.