bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence of post‐stroke depression during the first year in a large unselected stroke population determined using a valid standardized rating scale
Authors: Andersen G. , Vestergaard K. , Riis J. Ø. , Lauritzen L.
Published: August 2007

This study describes the development of post‐stroke depression (PSD) prospectively during the first year post‐stroke in 285 unselected stroke patients. An appropriate unselected population‐based control group without cerebral pathology is included for comparison. Psychiatric assessment with the Hamilton Depression Rating Scale (HDRS) was undertaken unmodified. PSD was defined as HDRS ≥ 13. The one‐year incidence of PSD among the 209 survivors able to communicate reliably at 1 month was 41%. Most cases develop within the first months following stroke (79%), the frequency of new cases of PSD at one year being 5%, a level comparable to that in the control group. Depressed and nondepressed stroke patients consistently scored 4 points greater on total HDRS than in the corresponding controls.
D2‐dopamine receptor occupancy differs between patients with and without extrapyramidal side effects
Authors: Scherer J. , Tatsch K. , Schwarz J. , Oertel W. H. , Konjarczyk M. , Albus M.
Published: August 2007

To investigate whether the occurrence of extrapyramidal side effects was related to D2 dopamine receptor occupancy, iodobenzamide single positron emission computed tomography was carried out in 27 schizophrenic patients and 10 controls. Eighteen patients were treated with haloperidol; 9 patients were treated with clozapine. Our data suggest a relationship between D2 receptor occupancy and extrapyramidal side effects as well as the existence of a neuroleptic threshold of a striatal:frontal cortex ratio of 1.2, below which drug‐induced exptrapyramidal side effects can be expected.
Dissociation and child abuse histories in an eating disorder cohort in Japan
Authors: Berger D. , Saito S. , Ono Y. , Tezuka I. , Shirahase J. , Kuboki T. , Suematsu H.
Published: August 2007

Dissociation and childhood abuse were studied in female eating disorder outpatients in Japan. A self‐report version of the Dissociative Disorders Interview Schedule (DDIS), which includes data on physical and sexual abuse, and the Dissociative Experiences Scale (DES) were used. Nine of 41 subjects who completed the DDIS reported symptoms suggesting DSM‐III‐R multiple personality, and 6 of the 39 subjects who completed the DES scored over 30 (reflecting a high likelihood of posttraumatic stress or multiple personality). Subjects’ sexual abuse history rates were considerably greater then those in the Japanese general population. Though physical abuse history was associated with high dissociation, no difference was seen between the high and low dissociators in sexual abuse histories.
Relationship between brain structure and function in disorders of the schizophrenic spectrum: single positron emission computerized tomography, computerized tomography and psychopathology of first episodes
Authors: Rubin P. , Hemmingsen R. , Holm S. , Møller‐Madsen S. , Hertel C. , Povlsen U. J. , Karle A.
Published: August 2007

Fifty newly diagnosed, briefly treated or drug‐naive patients with schizophrenia or schizophreniform disorder were examined by psychopathology scales for positive (SAPS), negative (SANS) and overall psychotic symptoms (PSE and BPRS). CT‐scan and regional cerebral blood flow (rCBF) measurement by 99mTc‐HMPAO SPECT during rest and mental activation by Wisconsin Card Sorting Test was performed as well. Twenty‐five age‐matched normal healthy volunteers served as controls. Thought disorders and fundamental symptoms correlated positively with relatively high, though subnormal prefrontal (PFC) rCBF and high rCBF in temporal cortex; positive symptoms correlated positively with high rCBF in the striatum and temporal cortex during activation. Negative symptoms correlated with high prefrontal rCBF. The patients had sulcal enlargement and smaller brain volume compared with the healthy volunteers. There were no signs of ventricular enlargement. Neither total negative symptoms, thought disorder nor fundamental symptoms correlated with any CT measurements. Total positive symptoms correlated negatively with the size of the temporal horns. The relatively high rCBF in PFC and temporal cortex of cases with pronounced positive and negative symptoms and thought disorder may imply that an aberrant cortical network has to be active to express a malattuned clinical output. The striatal hyperfunction mainly in productive cases may be a secondary phenomenon and more pronounced in cases where no signs of subcortical atrophy has (yet?) ensued.
Serum‐soluble interleukin‐2 receptors in neuroleptic‐naive schizophrenic subjects and in medicated schizophrenic subjects with and without tardive dyskinesia
Authors: Rapaport M. H. , Lohr J. B.
Published: August 2007

There is a growing body of literature suggesting that some schizophrenic subjects have evidence of immune activation. One marker that has been consistently elevated in studies is the serum‐soluble interleukin‐2 receptor (SIL‐2R). This article reports the results of 2 experiments: the first compares concentrations of serum SIL‐2R in neuroleptic‐naive schizophrenic patients and matched controls, and the second study contrasts serum SIL‐2R concentrations in medicated schizophrenic subjects with and without tardive dyskinesia. Serum SIL‐2R concentrations were elevated in neuroleptic‐naive schizophrenic subjects as compared with controls (1705.7 (SD 1124.2) U/mlvs739.8 (SD 325.5) U/ml). Medicated subjects with tardive dyskinesia had increased serum SIL‐2R levels (2385.5 (SD 1822.0) U/ml) compared with medicated subjects without tardive dyskinesia (1259.6 (SD 1365.3) U/ml). Thus, elevations in serum SIL‐2R levels are present prior to neuroleptic treatment, and there may be an association between serum SIL‐2Rs and tardive dyskinesia.
Ten‐year course of schizophrenia—the Madras longitudinal study
Authors: Thara R. , Henrietta M. , Joseph A. , Rajkumar S. , Eaton W. W.
Published: August 2007

Ninety first‐episode patients fulfilling ICD‐9 criteria for schizophrenia were followed up prospectively for 10 years. Complete assessments were possible on 76. The pattern of illness was good in 67% of the cases, and the commonest patterns was one with recurrent episodes. Predictors of poor course and longer time spent in psychosis were identified. All positive and negative symptoms showed a steep decline at the end of 10 years. The results are discussed in the context of longitudinal research on the course of schizophrenia in developing countries.
Suicide in South Africa
Authors: Flisher A. J. , Parry C. D. H.
Published: August 2007

Nationally registered suicide mortality data for South Africa (1984–1986) were analysed. There were 5448 deaths (1.3%) due to suicide in this period. Proportional mortality and mean annual suicide mortality rates were highest for whites, followed by Asians and then coloureds. The proportional mortality for blacks was similar to that of coloureds. Suicide was relatively prominent as a cause of death for Asian females (15–24 years). For whites, the most commonly used method of suicide was firearms. Except for coloured females, hanging was the most common method used for the other population groups. Political, economic, and religious factors may account for some of the differences. Cultural factors may explain the findings for young Asian females. There is a need for strict gun control legislation.
Personality disorders in patients with winter depression
Authors: Reichborn‐Kjennerud T. , Lingjærde O. , Dahl A. A.
Published: August 2007

Sixty‐six patients satisfying the criteria for seasonal affective disorder (SAD) winter depression type (n= 57) or subsyndromal SAD (n= 9), were interviewed in a nondepressed state with the Structured Interview for DSM‐III‐R Personality Disorders (SIDP‐R). Twenty‐three percent of the patients in the SAD sample met DSM‐III‐R criteria for one or more categorical diagnosis of personality disorder (PD). Disorders in cluster C occurred in 18% of the sample, while 12% had cluster B PDs and 5% a cluster A disorder. The relative number of positive criteria, as a dimensional measure of PD, were higher for all cluster C disorders than for any PD in the other clusters. Our data indicate that the pattern of personality disorders in patients with winter SAD are similar to that previously reported for outpatients with non‐SAD major depression. We explored the relationship between lifetime severity and clinical manifestation of SAD and dimensional measures of PD with multiple regression analyses. No significant association was found. This is in accordance with the hypothesis that the two disorders are distinct conditions with independent causes.
A 35% carbon dioxide challenge in simple phobias
Authors: Verburg C. , Griez E. , Meijer J.
Published: August 2007

Twenty‐eight subjects meeting the DSM‐III‐R criteria for simple phobia and 30 normal controls were subjected to a 35% carbon dioxide panic provocation challenge. Simple phobics were subdivided into two groups, animal phobics and situational or natural phenomena phobics. Animal phobics were not more vulnerable to carbon dioxide than normal controls. However, situational or natural phenomena phobics reacted significantly more strongly to the challenge than normal controls. The increase in anxiety in this group was comparable to the increase of anxiety of panic disorder patients from previous studies. Our results suggest the existence of a constitutional predisposition that may not only lead to panic disorder but also to the development of certain specific phobias.
Incidence and risk factors in neuroleptic malignant syndrome
Authors: Naganuma H. , Fujii I.
Published: August 2007

Between October 1981 and September 1989, 564 patients admitted to the Department of Psychiatry of the Hospital of Oita Medical University received antipsychotic treatment. Ten (1.8%) of these patients developed neuroleptic malignant syndrome. This incidence is significantly greater than that reported in a group of other studies (27/17,811, 0.2%). We compared the characteristics of this sample with known risk factors for neuroleptic malignant syndrome. It is possible that Japanese people are at an increased risk for developing neuroleptic malignant syndrome. Psychomotor excitement, refusal of food, a weight loss of greater than 1 kg per week and oral administration of haloperidol at 15 mg/day or above were found to be risk factors for developing the neuroleptic malignant syndrome.
Reliability, validity and factor structure of the 12‐item General Health Questionnaire among young males in Italy
Authors: Politi P. L. , Piccinelli M. , Wilkinson G.
Published: August 2007

The internal consistency, validity and factor structure of the 12‐item General Health Questionnaire (GHQ‐12) were investigated in a homogeneous sample consisting of 18‐year‐old males in Italy. The GHQ‐12 proved to be a reliable instrument, as indicated by a Cronbach's alpha of 0.81. When the screening characteristics of the GHQ‐12 (scored by the Likert method) were evaluated against the psychiatrist's ratings, the best balance between sensitivity and specificity was found at the GHQ cut‐off score of 8/9: at this threshold, sensitivity was 0.68 and was paired to a specificity of 0.59 and an overall misclassification rate of 0.40. Validity coefficients based on a single severity score were rather low compared with those reported in other settings. When a principal components analysis with varimax (and oblimin) rotation was performed, two factors were identified: factor A (general dysphoria) was defined by 7 items related to anxiety and depression; factor B (social dysfunction) included 6 items testing the ability to perform daily activities and to cope with everyday problems. The identified factors revealed distinct ability in the discrimination between subjects with and without emotional disturbance according to the psychiatrist's ratings and correlated differently with 3 Minnesota Multiphasic Personality Inventory subscales (depression, D; conversion hysteria, Hy; psychasthenia, Pt). Thus, the factor structure of the GHQ‐12 might provide useful information along with that offered by a single severity score, and the detection of cases might be improved by examining an individual's profile of scores on different subscales derived from factor analysis.
Temporal variation of validity of self‐rating questionnaires: repeated use of the General Health Questionnaire and Zung's Self‐rating Depression Scale among women during antenatal and postnatal periods
Authors: Kitamura T. , Shima S. , Sugawara M. , Toda M. A.
Published: August 2007

The 30‐item General Health Questionnaire (GHQ) and Zung's Self‐Rating Depression Scale (SDS) were distributed to 120 pregnant women 4 times – in early and late pregnancy and 5 days and 1 month after the child was born. The validity of the questionnaires was assessed against the subjects’ Research Diagnostic Criteria (RDC) diagnoses. Both the GHQ and SDS sufficiently identified cases of minor mental disorder and depressive disorders respectively in early pregnancy; they lost their validity on the subsequent two occasions, but gained it again 1 month after the birth; the optimal cut‐off points varied accordingly. This study suggests that the optimal cut‐off point for a questionnaire should be validated against an externally determined clinical diagnosis whenever the instrument is used repeatedly on the same population.
L‐Tryptophan and the eosinophilia‐myalgia syndrome: a clinical and laboratory study
Authors: McKeon P. , Swanwick G. , Manley P.
Published: August 2007

Case notes of 202 patients who were prescribed a single brand of L‐tryptophan (Optimax®, manufactured by Merck) between January 1987 and December 1991 were examined. Fourteen patients’ notes indicated that they had clinical or laboratory findings suggestive of a diagnosis of eosinophilia‐myalgia syndrome (EMS). However, results of clinical examination and measurement of serum aldolase, total eosinophil count and antinuclear antibodies did not support the diagnosis of EMS in any of the 14 patients. Although a further study of 50 consecutive patients on L‐tryptophan at the time of the investigation revealed that 5 had mild eosinophilia, none reached the criteria for EMS established by the US Centers for Disease Control and Prevention.
Obsessive‐Compulsive Disorder
Authors: Kolada J.L. , Bland R.C. , Newman S.C.
Published: August 2007

3258 randomly selected adult household residents of Edmonton were interviewed by trained lay interviewers using the Diagnostic Interview Schedule (DIS). One of the diagnostic categories studied was obsessive‐compulsive disorder (OCD). The lifetime and six month prevalence rates of OCD were 2.9% and 1.6% respectively. The morbidity risk, was equal in males and females at 5.4%. The peak age of risk of onset for both sexes was from the ages of 10 to 19 and, closely followed by the decade 20–29. Obsessions were found to be more frequently experienced than compulsions. Having a lifetime diagnosis of OCD is associated with an increased likelihood of developing depression, alcohol abuse, drug abuse, phobic disorders, and antisocial personality disorder. The significance of these findings is discussed for clinical practice.
Phobic Disorders
Authors: Dick C.L. , Sowa B. , Bland R.C. , Newman S.C.
Published: August 2007

3258 randomly selected adult household residents of the city of Edmonton were interviewed by trained lay interviewers using the Diagnostic Interview Schedule (DIS). Using DMS‐III criteria, hierarchy‐free, the lifetime prevalence for all phobias was 8.9%. Rates for women (11.7%) were almost twice those for men (6.1%). The age at which first phobic symptoms had been reported by 50% of subjects was 12 years for men and 6 years for women. High rates of comorbidity with depression, alcohol abuse/dependence, drug abuse/dependence and obsessive‐compulsive disorder were found in all types of phobia, an important point in clinical management.
Deficit symptoms in schizophrenia: negative symptoms versus neuroleptic‐induced deficits
Authors: Schooler N. R.
Published: August 2007

Definitions of negative symptoms and deficit syndromes are reviewed in this article; rating scale criteria (the Scale for Assessment of Negative Symptoms and the Positive and Negative Syndrome Scale); Crow's type II syndrome; Carpenter's deficit syndrome; and the draft of DSM‐IV. The core negative symptoms identified by these investigators also describe the neuroleptic‐induced deficit syndrome (NIDS). Study designs and assessment methods to distinguish NIDS from the symptoms of schizophrenia are presented. Assessment methods include rating scales and a novel method that uses descriptive symptom vignettes. Designs include neuroleptic discontinuation studies, dose comparisons and comparison of atypical antipsychotic medicines to typical neuroleptic drugs.
Subjective response to neuroleptics and the quality of life: implications for treatment outcome
Authors: Awad A. G. , Hogan T. P.
Published: August 2007

The concept of subjective response to neuroleptics in schizophrenic patients is reviewed in terms of its measurement and validity. Evidence is presented to link negative subjective response to neuroleptics to noncompliance and less favourable therapeutic outcome. The relevance of the construct of subjective responses to neuroleptics is examined in terms of its impact on the functional status and quality of life of patients. There is a great need for improved methods in researching subjective responses as well as better understanding of the factors that contribute to its genesis. The advent of new neuroleptics with superior risk‐benefit ratios should encourage such research developments.
Schizophrenia ‐ a national emergency: preliminary observations on SANELINE
Authors: Wallace M.
Published: August 2007

In May 1992 the British mental health charity SANE inaugurated a telephone helpline for people suffering from or coping with severe mental illness. From its first days the line has been inundated by people needing information and help about their illness. The line is open from 1400 to midnight every day of the year, and is manned by almost 100 trained volunteers supervised by professional staff. In total more than 100,000 people have called the SANELINE number since it opened. For every call taken, a detailed log is written up immediately. The service is, of course, confidential. We recognized even before the line was opened that these logs would provide unique information on which a wide range of research could be based. One of the most frequent problems about which callers told us was dissatisfaction with the medication they were given. Many callers complained about the negative symptoms of schizophrenia. We have been working on a pilot study to determine the problems sufferers find with their medication, which may throw light on the concept of the neuroleptic‐induced deficit syndrome.
Preclinical findings with new antipsychotic agents: what makes them atypical?
Authors: Jackson D. M. , Ryan C. , Evenden J. , Mohell N.
Published: August 2007

Many early antipsychotics such as haloperidol, while effective in treating the symptoms of schizophrenia, cause detrimental side effects and moreover induce nonspecific sedation in many patients. Newer drugs such as remoxipride are as effective as the classical antipsychotics but induce fewer debilitating side effects. These clinical properties are reflected to some extent in their preclinical pharmacology, with drugs such as remoxipride having effects on various preclinical behavioural and biochemical models that are quite different to those exerted by drugs such as haloperidol. This article reports some new behavioural data and discusses the various mechanisms that can underlie the effect of new atypical antipsychotics.
Psychomotor impairment and cognitive disturbances induced by neuroleptics
Authors: King D. J.
Published: August 2007

Reviews of the literature have failed to demonstrate any consistent effects of typical or atypical neuroleptics on psychomotor or cognitive function in schizophrenic patients. Better methods and study designs are required, and healthy volunteer studies are necessary to control for variables due to schizophrenic psychopathology. Eye movements are a sensitive, reliable and relatively pure measure of attention and arousal. Two volunteer studies of the effects of single doses of haloperidol (2, 4 and 6 mg), chlorpromazine (50 mg) and remoxipride (100 and 150 mg) on saccadic and smooth pursuit eye movements are described. All drugs impaired both eye movement measures, but the doses used were not clinically equivalent. No available test is yet able to distinguish between benzodiazepines and neuroleptics.
New antipsychotics in schizophrenia: the French experience
Authors: Vanelle J. M. , Olié J. P. , Lévy‐Soussan P.
Published: August 2007

Since the beginning of the neuroleptics in 1952, French psychiatrists have proposed a classification of neuroleptics, taking into account the pharmacological and therapeutic differences between these drugs. They distinguished 3 different clinical effects of neuroleptics: sedative effects, effects on the positive symptoms of schizophrenia and effects on the negative symptoms. The effect of some neuroleptics on negative symptoms is recognized by the international community, which considers clozapine to be effective. In France, in most cases, the indication of clozapine is still refractory paranoid schizophrenia. The effect of this atypical neuroleptic on other types of schizophrenic patient is not well known. Remoxipride appears to be as effective in treating psychotic symptoms and to have fewer side effects than haloperidol. Remoxipride is effective for both positive and negative symptoms. Loxapine has been prescribed in France since 1980. Its pharmacological profile is close to that of clozapine: it has dopamine (D2), histamine (H1), serotonin (5‐HT2) and adrenergic (α1)‐blocking activities. Its best indication seems to be paranoid schizophrenia, although some data suggest bipolar action. The bipolar action of some new neuroleptics is illustrated by amisulpride, a substitute benzamide derivative. The originality of this molecule lies in its two opposite actions at two distinct doses. Doses of 600–1200 mg/day are effective against positive symptoms; 50–150 mg/day improves negative symptoms. This latter effect could be mediated by activation of the dopamine system. Risperidone binds to 5‐HT2, D2, αl and H, receptors. At a daily dose of 5 mg, risperidone would probably act on both negative and positive symptoms, inducing fewer extrapyramidal symptoms than classical neuroleptics. Carpipramine is neither antidepressant nor neuroleptic; carpipramine is a specific 5‐HT, antagonist and is the only known disinhibitor drug. The St. Anne Hospital School, following Deniker, recommends its use for hebephrenic patients. Amineptine is a very potent dopaminergic antidepressant that can be effective on negative symptoms such as loss of affect and anergia. All the drugs are empirically prescribed. Their use would be justified by a serotonin and/or dopamine hypothesis of schizophrenia.
Cost‐effectiveness in the treatment of patients with schizophrenia
Authors: Goldberg D.
Published: August 2007

Three sorts of economic studies have addressed the treatment of schizophrenia. Studies of the total costs of the illness to whole communities have examined the economic effects of changes in both the illness and its treatment; naturalistic studies of cohorts of patients have addressed relationships between costs, needs and clinical outcomes; and randomized controlled trials of various kinds of community care and traditional care have produced data on the relative cost effectiveness of the new treatments. The Madison model of training in community living is generally cheaper for society than traditional care, consistently produces better satisfaction and, in some studies, has produced better clinical outcomes as well. Other models of care have produced similar outcomes at lower cost. A study that includes home‐based rehabilitation for patients with established schizophrenic illnesses has produced better outcomes at similar costs. In general terms, cost savings are achieved by shortening the length of stay in hospital. Day care — often preceded by a short admission — has been shown to be cost‐effective as an alternative to traditional hospitalization. The results of randomized control trials cannot be generalized to all those needing acute admission to hospital, since all studies have excluded many patients from the trials. There is some evidence that higher community costs are associated with better outcomes.
Dysthymia: clinical and external validity
Authors: Akiskal H. S.
Published: August 2007

This paper reviews current evidence in support of dysthymia as a subaffective disorder that precedes major affective episodes, often by more than a decade. In cases beginning in childhood or adolescence, dysthymia is associated with high familial rates of mood disorders, and a recurrent pattern of superimposed major depression. At least two trait‐like markers, sleep electro‐encephalographic and thyroid axis abnormalities — similar to those in major affective disorder — have been reported. These data indicate a common pathophysiological substrate for both dysthymia and major depressive illness. All classes of antidepressants — most recently the serotonin re‐uptake and the reversible MAO inhibitors — have been shown to be effective. Dysthymia was fairly recently included in the US(DSM) and WHO(ICD) classifications of mental disorders, because it characterises a prevalent clinical presentation of depression in both psychiatric and general medical settings. Patients given this diagnosis, instead of presenting with acute or full‐blown episodes, often complain of low‐grade chronic affective malaise for as long as they remember, yet without clinically observable signs of depression. As a result, questions have been raised about its validity, but from fundamentally opposite positions: (i) Is dysthymia better conceptualised as a personality (or neurotic) rather than mood disorder? (ii) Can dysthymia be distinguished from major depressive illness? This paper examines these and related questions along both clinical and external validating strategies, and in particular, the more recent accumulated evidence in support of the utility of the concept of dysthymia.
Intrafamilial relationships and the course of schizophrenia
Authors: Goldstein Michael J. , Rosenfarb Irwin , Woo Stephanie , Nuechterlein Keith
Published: August 2007

This paper describes efforts to explicate the significance of schizophrenic patients' sub‐clinical psychopathology (SCP) to affective attitudes expressed by relatives about these patients. Using data from two 10‐minute interactions between patients and close relatives (usually parents), verbal and non‐verbal behaviors were scored for signs of SCP by the patient. Scores reflective of more overt signs of SCP were highly related to relatives' expressed emotion status and their affective style when interacting with the patient, suggesting that a complex transactional model best explains the connection between high EE status of a relative and the risk for patient relapse.
The rationale for consultation with the families of schizophrenic patients
Authors: Wynne Lyman C.
Published: August 2007

Mental health professionals have approached families that have a schizophrenic member with four quite different expectations about how the family can aid patient recovery: the family as a source of information; the family as caretaker for the patient; the family as patient stressor, needing family education; and the family as a dysfunctional system requiring family therapy. Overall, professionals have been negligent in attending to the needs of families, seen less for themselves than as agents to aid patient recovery. As an alternative or supplement to Family self‐help groups, a family consultation model provides professionals with an orientation for working collaboratively with diverse families in their efforts to cope with serious mental illness.
Can psychoanalytic theory contribute to the understanding and treatment of schizophrenia?
Authors: Haugsgjerd Svein
Published: August 2007

A discontinuity between the study of the brain and study of the mind is discussed. Mental phenomena emerge from the level of individuals interacting through language. Mental life as based in interindividuality is nevertheless experienced solitary. Bion's notion of psychosis as a fantasy of omniscience taking over consciousness. Two clinical vignettes.
Discussion of B.P. Dohrenwend: “Psychology, psychologists and psychiatric epidemiology”
Authors: Robins Lee N.
Published: August 2007

The author emphasizes the importance of an adequate appreciation of the clinical syndromes that are the topics of the psychiatric epidemiology as well as skills in interview construction. She focuses on the difficult problem of drawing lines between non‐cases and current and past cases, and the problem of estimating unmet needs for treatment in the population. The methodology for linking survey responses to estimates of the consumer market for care needs further development.
Sociology in the context of social psychiatry
Authors: Cooper Brian
Published: August 2007

The author addresses various aspects of the interface between sociology and social psychiatry, among them the labelling process related to mental deviance, problems related to diagnosis and social ethology. The need for interdisciplinary work is emphasized, not least in the context of prevention. It is underlined that effective preventive measures can precede the full causal elucidation of a disease.
Understanding who improves after psychiatric hospitalization
Authors: Rabinowitz J. , Modai I. , Inbar‐Saban N.
Published: August 2007

This study attempts to identify variables associated with improved functioning after psychiatric hospitalization. The relationship between 25 clinical and demographic variables and improvements and functioning at discharge of 309 consecutive patients in an open ward over 2 years were studied using stepwise logistic regression. Measures of patient functioning at discharge were score above or below 50 on the (Global Assessment of Functioning scale) (GAF) and 3‐point scale of functioning 1 week after discharge (needs constant supervision, functions independently at home, functions on the job). We created a logistic regression model of outcome based on the information available at admission and one based also on information at time of discharge (i.e., medication, therapy and length of stay etc.). Discharge models predicted 6–10% better than admission models. Discharge models correctly predicted whether GAF level was above 50 in 72% of the cases and return to preadmission functioning in 71% of the cases. We also created a model of functioning at discharge using a hierarchical logistic regression model. It correctly predicted 74% of the lowest level of functioning, 47% of the middle level and 68% of the highest level. The best predictors of improved functioning after discharge were preadmission levels of functioning, psychotherapy in hospital, absence of organic brain syndrome, attendance at occupational therapy and hospitalization less than 4 months. Diagnosis had almost no discernible effect on outcome of hospitalization.
Interrater reliability of the Structured Clinical Interview for the Positive and Negative Syndrome Scale for schizophrenia
Authors: Lindström E. , Wieselgren I.‐M. , von Knorring L.
Published: August 2007

The Swedish version of the Positive and Negative Syndrome Scale for schizophrenia (PANSS) has been tested and construct validity, internal reliability and interrater reliability have been demonstrated to be quite satisfactory. However, the interrater reliability of the negative symptoms was unsatisfactory low. In this study, the Swedish version of the Structured Clinical Interview for the PANSS has been tested. The interrater reliability is increased as compared with the inter‐rater reliability achieved by means of the PANSS. As concerns the positive scale, the intraclass coefficients increased to 0.98–0.99 with the SCID‐PANSS. For the negative scale, the intraclass coefficients increased to 0.83–0.90 with the SCID‐PANSS, and for the general scale the increase was to 0.95–0.98 with the SCID‐PANSS. It was also demonstrated that the interrater reliability is higher for the positive and the negative factors derived from the PANSS than for the positive and the negative scales.
Relevance of reversible inhibitors of monoamine oxidase type A and of reuptake inhibition for noradrenaline turnover
Authors: Hartmann D. , Cesura A. M. , Schmid‐Burgk W. , Amrein R.
Published: August 2007

Noradrenaline (NA) and serotonin, monoamines that increase neurotransmission at the monoaminergic synapses, remain primary targets for antidepressant drugs. To help elucidate NA's role in the action of antidepressants, a model was set up allowing for a simulation of NA turnover under various conditions examining 3 compartments: newly synthesized vesicular NA, released synaptic NA, and vesicular NA reuptake across neuronal membranes. We compared the influence of the reversible MAO inhibitor, moclobemide, and the NA reuplake inhibitor, desipramine, both useful in regaining baseline synaptic NA concentrations. Moclobemide appears less sensitive to fluctuations either in drug concentrations and/or physiological determinants of NA turnover; we conclude that it may influence brain function in a more regulatory way than reuptake inhibitors.
The negative component in schizophrenia
Authors: Möller H‐J.
Published: August 2007

Many conflicts in the literature about negative symptoms arise because different authors use different definitions of negative symptoms. If narrow definitions are used, it appears that drugs have little effect against negative symptoms, although those who use broader definitions tend to conclude that negative symptoms do respond to drugs. Another complication is that negative symptoms may be secondary to other causes, such as psychotic symptoms, the side effects of drugs, depression and understimulation as a result of hospitalisation.

Attempting to measure drug effects on negative symptoms can be complicated by such factors as different co‐medication in the test and control groups and different pharmacological profiles of test and standard drugs, in particular in terms of extrapyramidal side effects or antidepressant effects.

Several approaches to dissecting the direct effect of drugs from their indirect effects on negative symptoms have included analyses of covariance, regression analyses and path analyses. Applying path analysis to the data from the North American clinical trial of risperidone suggests that a significant component of the advantageous effect of risperidone on negative symptoms, compared with haloperidol, is due to a direct effect that cannot be accounted for by the effect of risperidone on positive symptoms and its superior side‐effect profile.

Although it is possible to analyse studies retrospectively in this way, the best approach is probably to design future clinical trials so that the effects of drugs on negative symptoms are more easily determined than has been the case in the past.
New pharmacotherapeutic modalities for negative symptoms in psychosis
Authors: Lindenmayer J.P.
Published: August 2007

Negative symptoms in schizophrenia comprise a psychopathologic and pathophysiologic syndrome which is absent from normal mental function. Renewed interest in negative symptoms has led to the development of better measuring instruments, among which is the Positive And Negative Syndrome Scale (PANSS), which provides a way of measuring and reporting positive and negative symptoms in a balanced and convenient form.

A number of strategies are being investigated for treating negative symptoms. Dopamine agonists such as levodopa, amphetamines and bromocriptine have been shown to produce improvements in negative symptoms, although good, well‐controlled clinical trials arc lacking. Partial dopamine agonists, such as MAR 327, are also currently under investigation and results arc expected soon.

Tricyclic, selective serotonin reuptake inhibitors and monoamine oxidase antidepressants appear to be able to modify negative symptoms in schizophrenia, although, once again, carefully designed trials are nccdcd. Modification of GABAergic transmission has shown little promise, but the use of glycine to augment transmission at N‐methyl‐D‐aspartate (NMDA) synapses suggests that the strategy may be beneficial. These results also imply that altered glutamate receptor function may be partly responsible for negative symptoms.

One strategy that has been shown to have a beneficial effect against negative symptoms is combined serotonin/dopamine antagonism. Clozapine was found to have this profile after its introduction, and the recently introduced antipsychotic, risperidone was developed intentionally to be a combined 5‐HT2/D2 antagonist. Both risperidone and clozapine have been shown to be effective against negative symptoms.

One problem associated with the assessment of drug effects on negative symptoms, however, is that drugs can act on both primary and secondary negative symptoms. However, a post hoc analysis of covariance of the North American risperidone clinical trial data suggested that the drug was effective against primary negative symptoms.
Use and misuse of antidepressant drugs in a random sample of the population of Rome, Italy
Authors: Arpino C. , Da Cas R. , Donini G. , Pasquini P. , Raschetti R. , Traversa G.
Published: August 2007

Prescribing patterns of antidepressant drugs were studied, over a period of 30 months, in a random sample of 8743 residents of the area of Rome, Italy. Data from the regional outpatient drug monitoring system were used. The proportion of subjects receiving, during the study period, at least one prescription of antidepressant drugs, was 5.4%; the female‐to‐male ratio was 2.1. Consumption prevalence increased with age. The single most prescribed drug was fluoxetine followed by amitriptyline and ademetionine. For a surprisingly high proportion of subjects, the observed length of treatment was shorter than expected on the basis of current knowledge in clinical pharmacology. Inappropriate diagnostic and therapeutic procedures are likely explanations.
Cost comparison of psychiatric outpatient clinics based in hospitals and in primary care (general practice health center)
Authors: Shah A.
Published: August 2007

The first study to compare the costs of hospital‐based and primary care (general practice health center)‐based psychiatric outpatient clinics is reported. The operating costs of both clinic settings were estimated to be similar. There are many advantages of primary care‐based clinics compared with hospital‐based clinics. However, as there are no evaluative studies of the comparative efficacy of either clinic setting, before policy decisions to encourage primary care clinics are made such evaluative studies should take place.
Significant reversibility of alcoholic brain shrinkage within 3 weeks of abstinence
Authors: Trabert W. , Betz T. , Niewald M. , Huber G.
Published: August 2007

Chronic alcoholism is often associated with brain shrinkage or atrophy. During recent years, it has been demonstrated that this shrinkage is, at least in part, reversible when abstinence is maintained. There are different hypotheses concerning the mechanisms for this reversibility, but many questions are still open. Especially the time conditions for these reversible changes are subject of discussion. Twenty‐eight male patients with severe alcohol dependence were investigated in a computed tomographic study at the beginning of abstinence and 3 weeks later. Planimetric evaluation of 5 selected slices revealed a significant decrease in liquor areas and an increase of brain volume. The densitometric analysis showed an increase in brain tissue density. In a multiple regression approach it was shown that the reversibility was mostly influenced by the age of the patients. Our results support neither the hypothesis of an increase in brain water as the most important principle for reversibility in alcoholic brain shrinkage nor the hypothesis of augmented dendritic growth. Other mechanisms like reduced (during chronic intoxication) and normalized (during abstinence) cerebral hemoperfusion have to be considered as possible mechanisms for the reversibility of alcoholic brain shrinkage.
Smooth pursuit eye movements and neuropsychological impairments in schizophrenia
Authors: Gråwe R. W. , Levander S.
Published: August 2007

Smooth pursuit eye movements (SPEM) and neuropsychological performance were examined in a sample of 29 drug‐treated schizophrenic patients and 22 healthy controls. Patients had impairment in SPEM as well as in a wide range of neuropsychological tests (Wechsler Adult Intelligence Scale, Wisconsin Card Sorting Test. Finger Tapping, Reaction time, Selective attention, Trail‐Making and Simultaneous Capacity). Performance indices were more affected than strategy‐executive indices. Drug type (clozapine vs typical) and dose (chlorpromazine units) were not related to neuropsychological impairment among the patients. Indices from the whole range of tests accurately predicted a subjects’ group identity (patient vs control). Impaired SPEM was predicted more accurately by tests assessing frontal functions. Seven patients, all men, had only marginal neuropsychological impairments.
Are the renal effects of lithium modified by frequency of administration?
Authors: Abraham G. , Waldron J. J. , Lawson J. S.
Published: August 2007

It has been claimed that the unwanted effects and toxicity of lithium can be minimized by changes in the dosing schedules. Twenty consecutive psychiatrically stable patients were investigated in a cross‐over study to determine whether renal function and other biochemical tests change significantly with changes from once to twice or multiple doses per day or vice versa. There were no significant differences between the 3 study conditions on the mood rating scales or a side effect scale (UKU). Urine volume, test of renal function and other biochemical and hematological indices were similar in all study conditions. We thus conclude that dosing strategy does not consistently affect renal function in lithium ‐ treated patients.
A double‐blind comparison of moclobemide and doxepin in depressed general practice patients
Authors: Lingjaerde O. , Jørgensen J. , Steren R. , Thomle S. , Raeder L. Wendt , Ruud L. E. , Schetelig E. , Sveaas H. K. , Leivestad Ø.
Published: August 2007

A total of 56 patients attending a general practitioner for treatment of depression, most of whom met the criteria for major depression, were included in this double‐blind, parallel group, 6‐week study, in which the selective MAO‐A inhibitor moclobemide (MOC; maximum dose 600 mg) was compared with the tricyclic antidepressant doxepin (DOX; maximum dose 250 mg). Thirty patients on MOC and 23 on DOX were assessed after treatment for at least 1 week and are included in the response evaluation. Improvement was assessed primarily with the Montgomery‐Asberg Depression Rating Scale (MADRS). There were only 4 drop‐outs in the MOC group and three in the DOX group after 1 week. Overall improvement measures showed a nonsignificant difference in favor of DOX. Two factors were found to have prognostic significance: (1) previous or present panic attacks (10 patients in the MOC group and – by chance – only one in the DOX group) were associated with significantly lower improvement within the MOC group. Since we had no a priori hypothesis about this effect, it could be a chance finding. (2) Improvement was negatively correlated with age; this was statistically significant in the total group as well as in the MOC group, with a nonsignificant trend in the same direction in the DOX group. Side effects differed little between the two groups; only dryness of mouth appeared with markedly higher frequency in the DOX group.
Abulia and impulsiveness revisited: a conceptual history
Authors: Berrios G. E. , Grli M.
Published: August 2007

Historical analysis suggests that the decline and fall of the will was due not to any major piece of empirical work demonstrating that the concept was unsound but to general changes in philosophical fashion, and to the temporary influence of the anti‐mentalistic tenets of behaviorism and the anti‐volitional assumptions of psychoanalysis. Clinical disorders like abulia and impulsiveness share conceptual features that 19th‐century alienists captured well in their clinical category of disorder of the will. Current accounts, which include semi‐explanatory concepts such as “drive”, “motivation” or frontal lobe “executive” are not conceptually better than the old notion of will nor are they superior as correlational variables for neurobiological studies. It is suggested that the will, updated according to modern work in the philosophy of action, be re‐adopted as a research category in current psychiatry.
Gender, premorbid characteristics and negative symptoms in schizophrenia
Authors: Fennig S. , Putnam K. , Bromet E. J. , Galambos N.
Published: August 2007

The interrelationships among gender, premorbid functioning, and negative symptoms were examined in a first‐admission inpatient sample with DSM‐III‐R schizophrenia. Fifty‐two subjects were assessed with the Schedule for the Assessment of Negative Symptoms (SANS) at baseline and 6‐month follow‐up. Three indicators of premorbid functioning were examined: the Premorbid Adjustment Scale, the Quick Test, and the GAF for the best month in the year prior to the baseline interview. Men and women had relatively similar ratings on each of the 5 SANS global subscales at both times; they were also relatively similar on most of the indicators of premorbid functioning. The men and women were categorized into low vs moderate‐high negative symptom groups at baseline, and no differences in premorbid functioning were detected. When the sample was classified into those with and without consistent negative symptoms at baseline and 6‐month follow‐up, the enduring negative men and women had significantly poorer premorbid functioning in several areas than the consistently non‐negative patients. Our findings support the importance of assessing negative symptoms longitudinally and suggest that gender is not strongly associated with negative symptoms and premorbid functioning in patients ascertained at early stages of schizophrenia.
Analysis of positive and negative symptoms in schizophrenia. A study from a population of long‐term outpatients
Authors: Palacios‐Araus L. , Herran A. , Sandoya M. , de la Huebra E. González , Vázquez‐Barquero J. L , Díez‐Manrique J. F.
Published: August 2007

Sixty‐seven schizophrenic chronic outpatients (DSM‐III‐R criteria) were examined to study the relationship between symptoms through intercorrelational and factor analysis. Three factors were identified and associated with clusters of symptoms: factor 1 (affective flattening, alogia, avolition‐apathy and anhedonia‐asociality), factor 2 (formal thought disorder and bizarre behaviour) and factor 3 (hallucinations and delusions). Strong associations between factor 1 and high functional impairment were found. In this population, the segregation of the symptoms could fit into a three‐syndrome model, these results agree with findings obtained from samples in which acute symptoms predominated.