bluuebunny/crossref_metadata_2025 huggingface dataset:
Schizophrenia – a Brain Disease? a Critical Review of Structural and Functional Cerebral Abnormality in the Disorder
Authors: Chua S. E. , McKenna P. J.
Published: October 2008

Background

With genetic and neurochemical findings pointing to a biological aetiology, considerable effort has been devoted to finding direct evidence of brain abnormality in schizophrenia.

Method

T, MRI, post-mortem and functional imaging studies are reviewed to assess which structural and/or functional brain abnormalities have been consistently demonstrated.

Results

The only well-established structural abnormality in schizophrenia is lateral ventricular enlargement; this is modest and there is a large overlap with the normal population. There is no consensus on the presence of any localised structural abnormality from MRI and post-mortem studies, but the most promising findings concern temporal lobe limbic structures. Hypofrontality is not a well-replicated finding in schizophrenia under resting conditions, but the evidence is stronger for a selective association with negative symptoms. A number of studies have found hypofrontality under conditions of neuropsychological task activation. However, findings in these studies are divided and a recent methodologically sophisticated study has failed to confirm it, although this study suggested a decoupling of prefrontal and temporal function.

Conclusion

Schizophrenia is characterised by minor structural abnormality which, in the case of lateral ventricular enlargement, may be better understood as a risk factor than a causative lesion. The functional imaging findings are not transparent but suggest that, as a disorder, schizophrenia shows complex alterations in regional patterns of activity rather than any simple deficit in prefrontal function.
Socio-economic Mobility among Patients with Schizophrenia or Major Affective Disorder a 17-Year Retrospective Follow-Up
Authors: Aro Seppo , Aro Hillevi , Keskimäki Ilmo
Published: October 2008

Background

Social mobility among patients with schizophrenia or major affective disorder was compared with that among the general population.

Method

Mobility was studied retrospectively from 1970 to 1987. Socio-economic status (SES) was defined by occupation as in the population census (upper white-collar, lower white-collar, blue-collar, entrepreneur, farmer, unemployed). All patients aged 30–60 years at discharge (2901 men and 3620 women) in 1987–88 in Finland were included in the study. The SES structure of the general population was used for comparisons.

Results

Among patients with schizophrenia there was a constant downward drift, commonly to unemployment. This risk was higher among men than women. In the youngest age group a marked decline from the parents' social status was observed. Among patients with major affective disorder the distribution of SES in 1970 was similar to that of the general population. By 1987, a downward drift was again observed, mainly to unemployment regardless of the initial SES group. The number of patients in occupational categories were usually 30–50% lower than expected.

Conclusions

Schizophrenic patients had a high risk of social drop-out. Among patients with major affective disorder the downward drift was much less.
Autonomic Failure, Depression and Anxiety in Parkinson's Disease
Authors: Berrios G. E. , Campbell C. , Politynska B. E.
Published: October 2008

Background

The study tested the hypothesis that subjects with Parkinson's disease (PD) have more autonomic complaints and more attenuation of autonomic reflexes than controls, and that both clusters of variables are related to the presence of anxiety and depression.

Method

Thirty-two subjects and 32 healthy controls matched by age and sex were prospectively compared on psychiatric, cognitive and autonomic tests.

Results

‘Autonomic’ symptoms: were more frequent in PD patients than in healthy controls; were not related to age or changes in autonomic reflexes; were significantly associated with depression and anxiety (medication was not relevant to the association); and did not correlate with motor symptoms.

Conclusions

The diagnosis of anxiety and depression in some PD subjects is likely to be a behavioural phenocopy caused by autonomic failure. This explains why antidepressant medication is often unhelpful in PD subjects diagnosed as depressed.
Termination of Pregnancy and Psychiatric Morbidity
Authors: Gilchrist Anne C. , Hannaford Philip C. , Frank Peter , Kay Clifford R.
Published: October 2008

Background

We investigated whether reported psychiatric morbidity was increased after termination of pregnancy compared with other outcomes of an unplanned pregnancy.

Method

This was a prospective cohort study of 13 261 women with an unplanned pregnancy. Psychiatric morbidity reported by GPs after the conclusion of the pregnancy was compared in four groups: women who had a termination of pregnancy (6410), women who did not request a termination (6151), women who were refused a termination (379), and women who changed their minds before the termination was performed (321).

Results

Rates of total reported psychiatric disorder were no higher after termination of pregnancy than after childbirth. Women with a previous history of psychiatric illness were most at risk of disorder after the end of their pregnancy, whatever its outcome. Women without a previous history of psychosis had an apparently lower risk of psychosis after termination than postpartum (relative risk RR = 0.4, 95% confidence interval CI = 0.3–0.7), but rates of psychosis leading to hospital admission were similar. In women with no previous history of psychiatric illness, deliberate self-harm (DSH) was more common in those who had a termination (RR 1.7, 95%CI 1.1–2.6), or who were refused a termination (RR 2.9, 95%CI 1.3–6.3).

Conclusions

The findings on DSH are probably explicable by confounding variables, such as adverse social factors, associated both with the request for termination and with subsequent self-harm. No overall increase in reported psychiatric morbidity was found.
Russian Literature and Psychiatry
Authors: Kachaeva M.
Published: October 2008

The subject of this paper is psychiatry, forensic psychiatry and Russian literature. It is well-known that people with literary talent often possess unusually keen psychological insight. Their literary portrayals of psychological analysis, descriptions of how the human mind and consciousness work and depiction of different psychic states, both normal and pathological, are of great value for psychology and psychiatry and have always attracted the active attention of specialists.
Psychotherapy for Bipolar Disorder
Authors: Scott Jan
Published: October 2008

Background

Psychosocial factors may contribute 25–30% to the outcome variance in bipolar disorders. Sufferers have identified benefits from psychotherapy, but biological models and treatments dominate the research agenda. The author reviews research on psychosocial issues and interventions in this disorder.

Method

Research on adjustment to the disorder, interpersonal stressors and obstacles to treatment compliance were located by computerised searches and the author's knowledge of the literature. All published outcome studies of psychosocial interventions in bipolar disorder are reviewed.

Results

There is an inadequate database on psychosocial factors associated with onset and maintenance of bipolar disorder. While the outcome studies available are methodologically inadequate, the accumulated evidence suggests that psychosocial interventions may have significant benefits for bipolar sufferers and their families.

Conclusions

Given the significant associated morbidity and mortality, there is a clear need for more systematic clinical management that addresses psychosocial as well as biological aspects of bipolar disorder. The author identifies appropriate research strategies to improve knowledge of effective psychosocial interventions.
Psychiatric Patients and HIV Infection: a New Population at Risk?
Authors: Stefan Martin D. , Catalán José
Published: October 2008

Background

We assess the evidence that psychiatric patients are at increased risk of infection with HIV and discuss some of the clinical implications.

Method

Surveys of HIV seroprevalence and risk behaviours among psychiatric patients were obtained from a manual and computer search (Medline and AIDSline).

Results

Most studies report an increased prevalence of HIV infection among psychiatric patients compared to the general population. Risk behaviours, and obstacles to risk reduction, are identified.

Conclusions

There is a strong case for investigating the seroprevalence of HIV in psychiatric settings in the UK. Issues relating to HIV and AIDS are likely to assume increasing importance in general psychiatric practice.
Effectiveness of Clozapine in Hospitalised People with Chronic Neuroleptic-Resistant Schizophrenia
Authors: Avnon Moshe , Rabinowitz Jonathan
Published: October 2008

Background

Clozapine's effectiveness in reducing symptoms and facilitating discharge among patients with chronic schizophrenia who were resistant to neuroleptics was studied.

Method

All 169 such patients in a public psychiatric hospital were given clozapine. BPRS ratings (0–5 scale) were completed before treatment and 21 months later. Patients were followed for about 2.5 years.

Results

Clozapine was discontinued in 37.8% of cases due to non-compliance, non-response, or side-effects. At follow-up 41 % of clozapine recipients and 25.9% of the drop-outs were discharged and remained so, and 33% of recipients and 24.1% of drop-outs were being prepared for discharge. Longer treatment was associated with more improvement. Decline in average BPRS total scores of recipients was significantly more than drop-outs (32.7, s.d. 16.8 v. 12.1, s.d. 14.1, d.f. = 155, t = 7.5, P = 0.000).

Conclusions

Clozapine appears to be effective for treating some chronic neuroleptic non-responding schizophrenic patients.
Pathways to Care for Patients with a First Episode of Psychosis
Authors: Cole Eleanor , Leavey Gerard , King Michael , Johnson-Sabine Eric , Hoar Amanda
Published: October 2008

Background

It is reported that patients from ethnic minority groups, in particular Afro-Caribbeans, are more likely to enter less desirable pathways to psychiatric care. We aimed to determine whether ethnicity significantly affected time to presentation, type of first contact, rates of compulsory admission and police and primary care involvement, in patients with their first episode of psychosis.

Method

As part of a prospective epidemiological study, patients and their carers were interviewed using a semi-structured questionnaire to trace the various persons and agencies seen en route to their first contact with psychiatric services.

Results

While compulsory admission was more likely for Black patients, the excess was less striking than in previous studies. Black patients were no more likely than other patients to have police involvement. The most important factors in avoiding an adverse pathway were having a supportive family member or friend and the presence of a general practitioner to assist in gaining access to psychiatric services.

Conclusions

The routes to psychiatric services for first onset patients are different to those for chronic patients. Variables associated with social support were more important than ethnicity in determining pathways to care. Police involvement and compulsory admissions were strongly associated with the absence of GP involvement and the absence of help-seeking by a friend or relative. It may be that ethnicity becomes an important variable after the patient has come into contact with psychiatric services.
Community Attitudes to Mental Illness
Authors: Wolff Geoffrey , Pathare Soumitra , Craig Tom , Leff Julian
Published: October 2008

Background

The baseline findings from a controlled study of the effect of a public education campaign on community attitudes to mental illness are presented.

Method

A census of attitudes to mental illness was conducted in two areas, prior to the opening of supported houses for the mentally ill Factor analysis of the Community Attitudes toward the Mentally III (CAMI) inventory revealed three components: Fear and Exclusion, Social Control and Goodwill.

Results

The only determinant of Fear and Exclusion was having children. The main determinants of Social Control were social class, ethnic origin, age, having suffered mental illness and having children. The main determinant of Goodwill was educational level The attitude factors were predictive of respondents' behavioural intentions toward the mentally ill. Respondents with children and non-Caucasians were more likely to object to the mentally ill living in their neighbourhood.

Conclusions

Any intervention aimed at changing attitudes to mentally ill people in the community should be targeted at people with children and non-Caucasians, as these groups are more likely to object.
Emotional Disorder in Chronic Illness: Psychotherapeutic Interventions
Authors: Guthrie Elspeth
Published: October 2008

Background

Emotional disorder associated with physical illness falls into two main groups: ‘psychological reaction to physical illness’ and ‘somatic presentation of psychological disorder’. Psychological treatments are becoming more widespread in the general hospital setting, but there are few systematic evaluations.

Method

A manual and computer (MEDLINE) literature search was performed. Studies which provided insight into clinical practice were selected for discussion, and randomised controlled trials of at least 6 weeks duration and inclusion of 30 or more subjects were selected for review.

Results

Fourteen empirical studies were found: six involving patients with chronic organic disorder and eight involving patients with somatisation.

Conclusions

There is little empirical evidence that psychotherapeutic interventions are of benefit when applied indiscriminately to patients with organic disease. Further work is required to delineate subgroups of patients who may be responsive. There is mounting evidence that psychotherapy is beneficial in patients with somatisation disorders. Patients with very chronic symptoms may require intensive treatment approaches.
A Systematic Review on Gender-Specific Suicide Mortality in Medical Doctors
Authors: Lindeman Sari , Läärä Esa , Hakko Helinä , Lönnqvist Jouko
Published: October 2008

Background

So far no comprehensive systematic review has been published about epidemiologic studies on suicides among medical practitioners. The aim here is to describe the variation of published estimates of relative risk of doctors to die from suicide.

Method

A systematic review of published original articles on population-based studies, registered mainly in MEDLINE and fulfilling specific methodological requirements. Incidence rates and standardised mortality ratios were calculated for male and female doctors in relation to the reference groups.

Results

The estimated relative risk varied from 1.1 to 3.4 in male doctors, and from 2.5 to 5.7 in female doctors, respectively as compared with the general population, and from 1.5 to 3.8 in males and from 3.7 to 4.5 in females, respectively, as compared with other professionals. The crude suicide mortality rate was about the same in male and female doctors.

Conclusion

In all studies the suicide rates among doctors were higher than those in the general population and among other academic occupational groups.
Phenomenology and Course of Generalised Anxiety Disorder
Authors: Yonkers Kimberly A. , Warshaw Meredith G. , Massion Ann O. , Keller Martin B.
Published: October 2008

Background

The diagnostic category of generalised anxiety disorder (GAD) was originally intended to describe residual anxiety states. Over the years clinical criteria have been refined in an attempt to describe a unique diagnostic entity. Given these changes, little is known about the clinical course of this newly defined disorder. This study investigates the longitudinal course, including remission and relapse rates, for patients with DSM–III–R defined GAD.

Method

Analysis of the 164 patients with GAD participating in the Harvard Anxiety Research Program. Patients were assessed with a structured clinical interview at intake and re-examined at six month intervals for two years and then annually for one to two years. Psychiatric Status Ratings were assigned at each interview point. Kaplan–Meier curves were constructed to assess likelihood of remission.

Results

Comorbidity was high, with panic disorder and social phobia as the most frequently found comorbid disorders. The likelihood of remission was 0.15 after one year and 0.25 after two years. The probability of becoming asymptomatic from all psychiatric symptoms was only 0.08.

Conclusions

This prospective study confirms the chronicity associated with GAD and extends this finding to define the one and two year remission rates for the disorder. Likelihood of remission for GAD and any other comorbid condition after one year was half the annual remission rate for GAD alone.
The Dimensions of Schizophrenia Phenomenology Not one or two, at least three, perhaps four
Authors: Lenzenweger Mark F. , Dworkin Robert H.
Published: October 2008

Background

This confirmatory investigation examined the underlying structure of schizophrenia phenomenology through examination of the fit of several prominent dimensional models to observed symptom data.

Method

Confirmatory factor analysis was conducted on a correlation matrix of schizophrenia signs and symptoms derived from case history ratings of 192 individuals with schizophrenia who were the subjects in the major twin studies of schizophrenia.

Results

Schizophrenia phenomenology appears best described by four underlying factors, namely negative symptoms, premorbid social adjustment deficits, reality distortion, and disorganisation. Of interest, the premorbid deficit dimension was directly associated with negative symptoms and disorganisation, but was inversely associated with reality distortion.

Conclusions

These data clearly support the multidimensionality of schizophrenia phenomenology and provide objective support for a four-factor model over other models. This four-factor model may be useful in organising existing and future data concerning the genetic, neurobiological, neurological, and psychosocial features of schizophrenia.
The Galway Study of Panic Disorder III
Authors: O'rourke D. , Fahy T. J. , Brophy J. , Prescott P.
Published: October 2008

Background

The aim was to evaluate long-term outcome of DSM–III–R panic disorder at a mean of 5.3 years following a controlled trial of treatment that included antidepressants and behavioural counselling.

Method

Sixty-eight (86%) subjects were evaluated by lengthy research interview.

Results

Thirty-four per cent recovered and remained well, 46% were minimally impaired and 20% had persistent panic disorder of whom half remained significantly impaired. Anxious–fearful personality dysfunction was the most important predictor of poor outcome, followed by poor clinical status at discharge and inability at baseline to recall vividly the initial panic attack. Those who dropped out from the original trial did badly.

Conclusions

Complete recovery can occur even after many years of severe illness in a large minority of subjects who receive both antidepressants and behavioural counselling in the acute stage of treatment. The comparative prognostic value of personality, severity and chronicity need to be more fully addressed in future studies.
A Magnetic Resonance Imaging Study of White Matter Lesions in Depression and Alzheimer's Disease
Authors: O'brien John , Desmond Patricia , Ames David , Schweitzer Isaac , Harrigan Susan , Tress Brian
Published: October 2008

Background

White matter changes, as revealed by magnetic resonance imaging (MRI), may occur in depression and Alzheimer's disease.

Method

T2-weighted MRI scans were performed in 39 control subjects, 61 subjects with NINCDS/ADRDA Alzheimer's disease and 60 subjects with DSM–III–R major depression. Deep white matter lesions (DWML) and periventricular lesions (PVL) were rated on a standard 0–3 scale by two radiologists blind to clinical diagnosis.

Results

After controlling for differences in vascular risk factors and current blood pressure, DWML were significantly more common in depressed subjects and PVL in Alzheimer's disease subjects compared to controls. DWML were most common in those presenting in late life with their first ever depression and 50% of such subjects had severe (grade 3) DWML.

Conclusion

An association between DWML and depression and PVL and Alzheimer's disease is supported. The increase with DWML that occurs with ageing may predispose some elderly subjects to depression.
Seasonal Changes in Affective State Measured Prospectively and Retrospectively
Authors: Nayyar Kausar , Cochrane Raymond
Published: October 2008

Background

The study was designed to investigate whether seasonal mood and behavioural changes are detectable prospectively in a non-clinical population in the way they have been reported in retrospective studies. The specificity of any seasonal fluctuation in affective state was also investigated by measuring anxiety as well as depression.

Method

To measure seasonal fluctuations in affect and behaviour prospectively, 25 women were interviewed every month for one year using four scales (depression, anxiety, stress, and behavioural change). Retrospective accounts of mood and behaviour at the end of the year were collected with the Seasonal Pattern and Assessment Questionnaire (SPAQ).

Results

Seasonal depression peaked in winter as did atypical behaviour when measured either prospectively or retrospectively, but the difference between winter and summer was much more pronounced in the retrospective data. No seasonal effect was found for anxiety or psychosocial stressors.

Conclusions

The results obtained by retrospective techniques have limited reliability. In future, more prospective studies with unbiased, standardised instruments are recommended to measure seasonal variations in affect and behaviour.
Psychosocial Study of Depression in Early Pregnancy
Authors: Kitamura Toshinori , Sugawara Masumi , Sugawara Kensuke , Toda Mari Aoki , Shima Satoru
Published: October 2008

Background

The psychosocial correlates of depression during pregnancy were explored.

Method

Pregnant women attending the antenatal clinic of a general hospital (n=1329) received a set of questionnaires including Zung's Self-Rating Depression Score (SDS). SDS high scorers (>49) (the cases: n=179) were compared with low scorers (<38) (the controls; n=343).

Results

The cases were characterised by: first delivery; more nausea, vomiting, and anorexia; more menstrual pains and premenstrual irritability; early paternal loss; lower maternal care and higher paternal overprotection; higher public self-consciousness score; more smoking and use of medication in pregnancy; unwanted pregnancy; negative psychological response to the pregnancy by the woman and husband; poor intimacy by the husband; and having remarried.

Conclusions

Depression in early pregnancy is determined mainly by psychosocial factors.
Cardiff Puerperal Mood and Hormone Study. III. Postnatal Depression at 5 to 6 Weeks Postpartum, and its Hormonal Correlates Across the Peripartum Period
Authors: Harris Brian , Lovett Lisetta , Smith Jonathan , Read Graham , Walker Richard , Newcombe Robert
Published: October 2008

Background

We assessed associations of mood at 5–6 weeks postpartum with peripartum saliva cortisol and progesterone profiles.

Method

A prospective study involved 120 primiparous women free of major marital, socioeconomic and health problems, who collected saliva twice daily from 2 weeks before delivery to day 35 postpartum. This allowed intensive characterisation of cortisol and progesterone profiles. At the conclusion of the study, mood was assessed according to standard criteria.

Results

Seven women developed major depression according to DSM–III–R criteria No associations emerged between progesterone and mood at 5 to 6 weeks. Lower levels of evening cortisol in the immediate peripartum period, were associated with postnatal depression.

Conclusion

The study provides no support for the treatment strategy of progesterone augmentation following delivery, as a prophylactic against postnatal depression. The HPA axis and its associations with postnatal mood warrants further investigation.
The Reliability and Validity of the Bethlem Mother–Infant Interaction Scale
Authors: Stocky Andrew J. , Tonge Bruce J. , Nunn Russell J.
Published: October 2008

Background

The Bethlem Scale was designed as a validated measure of mother–infant adjustment in mother–baby units.

Method

A multi-centre trial was conducted to investigate aspects of the reliability, validity and clinical usefulness of the Bethlem Mother–infant Interaction Scale within five in-patient psychiatric mother–baby units.

Results

This revealed good inter-rater, test-retest and inter-item reliability. Correlations of the scale items with psychiatrist's ratings and changes in scoring over time suggest reasonable validity, despite some design problems with individual items.

Conclusion

Mother–infant interaction scales may have an important role in improving the quality of care for mothers and their babies in the psychiatric setting. The development of a more extensive scale, the Monash Mother–infant Interaction Scale, is discussed.
Hospitalisation for Deliberate Self-Poisoning in Scotland from 1981 to 1993: Trends in Rates and Types of Drugs Used
Authors: McLoone Philip , Crombie Iain K.
Published: October 2008

Background

Rates of self-poisoning fell during the 1980s, although recent reports suggest this trend may have reversed.

Methods

Data on all hospital discharges with a diagnosis of deliberate self-poisoning were obtained from the Information and Statistics Division of the NHS in Scotland. Rates of self-poisoning were investigated by overall trend, and for trends by age and by type of drug.

Results

Deliberate self-poisoning rates for men and women began increasing in the late 1980s, and did so steadily during the early 1990s. Because the rates are increasing faster in men, the traditional excess of self-poisoning among women is being eroded. For men rates increased in all age groups up to the age of 60, but the greatest rise occurred between ages 15–29. For women the increase was largely restricted to 15–24-year-olds, and rates fell among women over the age of 50. Self-poisoning with paracetamol increased most rapidly; in contrast to aspirin which showed little change. Opiate analgesics, antirheumatics, antidepressants and antipsychotics have also shown some increase in their use in both genders. There has been a substantial fall in the use of benzodiazepines in women, but little change among men.

Conclusion

Rapid increases in self-poisoning particularly among young adults present a serious public health problem. Controlling this epidemic is made difficult because the principal drug involved, paracetamol, is readily available.
Symptoms of the Schizophrenic Negative Syndrome
Authors: Peralta Victor , Cuesta Manuel J.
Published: October 2008

Background

The aim was an investigation of the symptom composition of the negative syndrome of schizophrenia.

Method

A hundred schizophrenic patients were assessed with various rating scales for positive and negative symptoms and typological criteria. A subgroup with a negative syndrome was defined, and a discriminant analysis performed using symptoms from the Scale for the Assessment of Negative Symptoms (SANS) as discriminant variables.

Results

The discriminant function classified 92% of patients correctly. All but four SANS symptoms (inappropriate affect, both attentional items and blocking) were significantly correlated with the discriminant function.

Conclusions

With the exception of some items, the SANS seems to capture adequately the negative syndrome of schizophrenia.
Pharmacological Treatment of Depression in Cancer Patients
Authors: Van Heeringen Kees , Zivkov Milana
Published: October 2008

Background

Depression has a reported mean prevalence of 24% in patients diagnosed with cancer. However, little systematic research on the efficacy of antidepressants in patients with cancer has been performed.

Method

The efficacy and safety of mianserin were studied in 55 depressed women with breast cancer (stage I or II and without known metastases), in a randomised, double-blind, six-week, placebo-controlled study.

Results

Statistically significant differences in the decrease in score from baseline on the Hamilton Rating Scale for Depression and the number of responders, favouring mianserin, were present after 28 and 42 days of treatment Significantly more placebo-treated patients prematurely terminated the study due to lack of efficacy while the safety profile of mianserin was similar to that of placebo.

Conclusions

Treatment with mianserin resulted in a significant improvement in depressive symptoms in cancer patients, and was well tolerated.
Monitoring Psychosis in General Practice: A Controlled Trial
Authors: Nazareth Irwin , King Michael , Tai Sharon See
Published: October 2008

Background

This trial evaluated the feasibility, acceptability and effectiveness of a structured approach to the management of schizophrenia in general practice.

Method

All patients with non-affective psychosis (mainly schizophrenia) in four inner-city general practices were recruited. A check-list and a set of outcome measures were used by the general practitioner and the practice nurses. Information on attendances at the general practice and psychiatric out-patient departments was also collected.

Results

Two practices took part in the intervention and two served as control practices. Sixty-seven patients with non-affective psychosis were identified. Thirty-three (81%) of the 41 patients in the two intervention practices attended the initial assessment by the doctor and nurse, but only 13 (32%) attended the first review assessment. The attendance for the second review, after six months, was six out of 15 (40%) in one practice, but rose to 16 out of 18 (89%) in the other practice. Significant improvements were recorded in the intervention group on the Global Assessment Scale (GAS) and the Behaviour, Speech and Other Syndromes (BSO) subscore of the Present State Examination (PSE). The absolute risk reduction and relative risk reduction as a result of the intervention as measured by the GAS scores, was 29% (95% CI 4% to 54%) and 36% (95% CI 5% to 66%), respectively, and in the case of the BSO subscores of the PSE, this was 23% (95% CI – 1.8% to 47.2%) and 28% (95% CI – 2.2% to 57%), respectively. For one patient to show an improvement in GAS and BSO scores 3.5 patients (95% CI 1.85 to 25) and 4.3 patients (95% CI – 55 to 2.1), respectively, would need to receive the intervention. There was a significant increase in consultation rates for patients in the intervention practices.

Conclusions

Health surveillance of patients with non-affective psychosis is possible in general practice.
Childhood/early adolescence-onsetand adult-onset schizophrenia
Authors: Maziade Michel , Martinez Maria , Rodrigue Caroline , Gauthier Benoît , Tremblay Guy , Fournier Christiane , Bissonnette Luc , Simard Carl , Roy Marc-André , Rouillard Eric , Mérette Chantal
Published: October 2008

Background

The dopamine D3 receptor gene (DRD3) is a meaningful candidate gene because it unifies the dopamine and the limbic hypotheses for schizophrenia. We tested for an allelic association between schizophrenia and the DRD3 Mscl alleles, hypothesising heterogeneity between childhood/early adolescence-onset schizophrenia (CO-SZ) and adult-onset schizophrenia (A-SZ).

Method

The frequencies of the DRD3 alleles were compared between 70 DSM-III-R schizophrenics (35 CO-SZ and 35 A-SZ) and 79 controls.

Results

Compared with the controls, the subsample of A-SZ, but not CO-SZ, showed an over-proportion (P = 0.025) of allele 1. The association was not found in the total sample, combining the two subsamples.

Conclusions

Consistently with former studies, our data suggest an aetiological heterogeneity between CO-SZ and A-SZ and a possible specificity of the excess of allele 1 to the familial form of schizophrenia and to schizophrenia with a better outcome.
Evaluating models of working at the interface between mental health services and primary care
Authors: Gask Linda , Sibbald Bonnie , Creed Francis
Published: October 2008

Background

This paper examines the feasibility of evaluating innovative models of working at the interface between primary care and secondary mental health services.

Method

Methodological problems relevant to evaluation of innovative models of working at the interface are discussed.

Results

Although there is some evidence that neurotic disorders can be more cost-effectively treated in primary care, many general practitioners (GPs), and possibly some patients, prefer referral to community mental health teams and community psychiatric nurses, which are provided by the secondary health care services. Since the latter are provided with the intention of improving serious mental illness their involvement in the care of neurotic illness can lead to tensions between GPs, local health authorities and service providers. There is little evidence to suggest that psychiatrists working in health centres using the ‘shifted out-patient’ model have eased this problem. By contrast the ‘consultation-liaison’ (C-L) model has a number of theoretical advantages; referrals to secondary care should be limited to those most in need of this level of expertise and GP management skills should improve, so leading to better quality of care for patients who are not referred.

Conclusion

Studies comparing the different models of service delivery are required to address the tensions that have arisen following changes in government policy. Further work is also needed to develop the necessary research tools.
Neuropsychological performance in Lewy body dementia and Alzheimer's disease
Authors: Walker Zuzana , Allen Ruth L. , Shergill Sukhwinder , Katona Cornelius L. E.
Published: October 2008

Background

Lewy body dementia (LBD) is emerging as a common cause of degenerative dementia. However, LBD cannot yet be diagnosed with certainty in life. There is some preliminary evidence that the pattern of cognitive impairment in LBD is different from that in Alzheimer's disease (AD). We set out to compare the performance on different subtests of the Cambridge Cognitive Examination (CAMCOG) of LBD patients and AD patients who were similar in overall degree of cognitive impairment.

Methods

All patients were recruited from a memory clinic LBD (n = 17) was diagnosed according to the McKeith clinical criteria. AD (n = 17) was diagnosed according to NINCDS-ADRDA criteria. The performances of LBD and AD patients on the neuropsychological subscales of the CAMCOG were compared by applying Hotelling's multivariate test of significance and subsequent univariate F tests.

Results

There were no statistically significant differences between the two groups on Mini-Mental State Examination and global CAMCOG rating. Hotelling's test with LBD and AD as the between-group factor and the neuropsychological subtests from CAMCOG as dependent variables revealed a statistically significant group effect (P < 0.05). Univariate F tests showed that recall (P < 0.02) and praxis (P < 0.003) significantly contributed to this effect.

Conclusions

These results suggest that there may be different neuropsychological profiles in the two conditions, with LBD subjects being better on recall but worse on praxis than those with AD.
Access to mental health care in an inner-city health district. I: Pathways into and within specialist psychiatric services
Authors: Commander M. J. , Dharan S. P. Sashi , Odell S. M. , Surtees P. G.
Published: October 2008

Background

Needs for mental health care are likely to be high in urban areas. Purchasers must assess the extent to which these are being met. The pathways to care model provides a framework for this purpose.

Method

Epidemiological surveys of adults living in deprived multi-ethnic innercity catchment area were undertaken in psychiatric services, primary care and community settings. Estimated prevalence rates were calculated and the association between clinical and demographic factors and the use of psychiatric services examined.

Results

Around a third of people with mental health problems did not consult a GP. and half failed to have their problems recognised by their doctor. Access to psychiatric services and especially to inpatient care was highly restricted. Diagnosis and ethnicity had a marked influence on the use of specialist services.

Conclusions

Many people with psychiatric morbidity are not receiving treatment either from primary care or specialist services. High levels of severe morbidity and compulsory admissions highlight the pressures placed on inner-city psychiatric services.
Access to mental health care in an inner-city health district. II: Association with demographic factors
Authors: Commander M. J. , Dharan S. P. Sashi , Odell S. M. , Surtees P. G.
Published: October 2008

Background

In addition to clinical and service factors, planners need to take account of the influence of demographic variables, especially ethnicity, on access to mental health care.

Method

Estimated prevalence rates were calculated from epidemiological surveys undertaken in three settings: psychiatric services, primary care and the general population. Associations between demographic factors and service use were examined using the pathways to care model.

Results

Considerable differences in access to mental health care were found, particularly according to ethnicity. The major impediment to Asians accessing care occurred at the interface between primary and secondary care, whereas the most striking feature for Blacks was the poor level of case recognition by GPs.

Conclusions

In order to improve the uptake of mental health care, new initiatives should target those who are most likely to be unwell but least likely to access services. Purchasers and providers need to address differential patterns of use when developing and reviewing services.
Road traffic accidents: Early psychological consequences in children and adolescents
Authors: Gallo Alain Dl , Barton Joanne , Parry-Jones William Li.
Published: October 2008

Background

Although road traffic accidents are a major cause of injury and death in children and adolescents, research into their psychological consequences consists mainly of case reports.

Method

A prospective study was made of young road traffic accident victims; 57 subjects, aged 5–18 years, who had been injured in road traffic accidents, and their parents, were interviewed 2–16 days post-accident and re-examined after 12–15 weeks.

Results

Post-accident stress symptoms occurred at both times. There was a decrease of symptom severity between the two interviews, but at the later time, 14% still suffered from moderate or severe post-traumatic stress disorder, 17% from serious traffic-related fears, and parents reported increased mood disturbance in their children compared with the pre-accident period. High levels of distress during and immediately after the accident were associated with severe post-traumatic stress symptoms.

Conclusions

There is an urgent need for healthcare staff working with children and adolescents involved in road traffic accidents to be aware of the potential psychological consequences and the importance of the immediate accident experience on subsequent coping.
Epidemiology of psychiatric disorders in elderly compared with younger adults with learning disabilities
Authors: Cooper Sally-Ann
Published: October 2008

Background

The literature regarding psychiatric illness among elderly people with learning disabilities is limited and conflicting because of methodological differences. There have been no recent studies comparing psychiatric epidemiology between younger and older adults with learning disabilities, using the same methodology and definitions.

Method

Comprehensive psychiatric examination using a semi-structured rating scale was undertaken on everyone with learning disabilities, aged 65 years or over (n= 134), living in a defined geographical area. Comparison was made with a randomly selected control group of adults with learning disabilities aged 20–65 years (n=73) drawn from the same geographical area.

Results

Elderly people with learning disabilities have a greater prevalence of psychiatric morbidity than younger controls (68.7v. 47.9%). Rates for depression and anxiety disorders are high, and dementia is common: there are equal rates for schizophrenia/delusional disorders, autism and behaviour disorders in the two groups.

Conclusions

The higher psychiatric morbidity among elderly (compared with younger) people with learning disabilities has not previously received adequate recognition. This warrants further investigation by service planners and clinicians.
Guilty but insane: the insanity defence in Ireland, 1850–1995
Authors: Gibbons Pat , Mulryan Niamh , O'Connor Art
Published: October 2008

Background

This is a retrospective study describing sociodemographic and clinical characteristics of an almost complete sample of insanity acquittees in Ireland between 1850 and 1995.

Method

Case records and legal files were examined for each of the 437 patients admitted to the Central Mental Hospital under guilty but insane criteria, and a profile of sociodemographic, forensic and clinical data completed on each.

Results

The number of insanity acquittees has fallen five-fold since the 19th century. Acquittees were usually single males from rural areas, aged in their 30s, who had committed a violent crime while suffering from a major psychiatric illness. Female insanity acquittées were relatively few in number and were equally likely to have been charged with violent crime, especially against their own children. The mean length of detention was 14.5 years.

Conclusions

The insanity defence is rarely used in Ireland, is largely confined to serious offences (especially homicide), and generally results in prolonged detention.
Autistic traits in adults with learning disabilities
Authors: Bhaumik Sabyasachi , Branford David , McGrother Catherine , Thorp Catherine
Published: October 2008

Background

Although many adults with learning disabilities show features of autistic syndrome, there have been very few population-based studies. We explored the prevalence of autistic traits and their association with maladaptive behaviours in a geographically defined population of adults with learning disabilities.

Method

The carers of 220l adults with learning disabilities were interviewed, and information was sought concerning aspects of their behaviour and ability. Individuals were scored according to the number of core autistic traits displayed. The prevalence of autistic traits was examined in respect of aspects of behaviour and ability.

Results

Autistic traits were common among adults with learning disabilities. Those with a higher number of autistic traits were more likely to be profoundly learning disabled and demonstrate awide range of challenging behaviours.

Conclusions

Many adults with learning disabilities demonstrate autistic traits. The relationship of autistic traits with challenging behaviour has major implications in service planning and delivery.
The effect of Citalopram in panic disorder
Authors: Wade A. G. , Lepola U. , Koponen H. J. , Pedersen V. , Pedersen T.
Published: October 2008

Background

Citalopram is a serotonin reuptake inhibitor which has been demonstrated to be highly selective and with a superior tolerability profile to the classical tricyclic antidepressants. This study was designed to test whether there was any difference in eff icacy in the management of panic disorder (PD) between Citalopram and placebo.

Method

This was a double-blind, placebo and clomipramine controlled, parallel group eight-week study. A total of 475 patients with PD, with or without agoraphobia, were randomised to treatment with either placebo, clomipramine 60 or 90 mg/day, or Citalopram 10 or 15 mg/day, 20 or 30 mg/day, or 40 or 60 mg/day. Doses were increased over the first three weeks, stabilised during the fourth week and fixed between weeks five and eight.

Results

Treatment with Citalopram at 20 or 30 mg, 40 or 60 mg and clomipramine were significantly superior to placebo, judged by the number of patients free of panic attacks in the week prior to the final assessment. All rating scales examined suggested that Citalopram 20 or 30 mg was more effective than Citalopram 40 or 60 mg.

Conclusion

The most advantageous benefit/risk ratio for the treatment of PD was associated with citalopram 20 or 30 mg/day.
Social networks and service use among representative cases of psychosis in South London
Authors: Becker Thomas , Thornicroft Graham , Leese Morven , McCrone Paul , Johnson Sonia , Albert Maya , Turner David
Published: October 2008

Background

Large social networks in patients with severe mental illness have been reported to be associated with a low rate of hospitalisation. We aim to determine whether social network size is related to the likelihood of hospitalisation and the amount of service use.

Method

As part of a prospective controlled study, baseline interview data for a random sample of one-year prevalent cases with non-organic psychosis were analysed with respect to social network characteristics and service use during a six-month period.

Results

The likelihood of hospitalisation decreased with an increase in network size, while the number of services used by patients grew as the social network size increased.

Conclusions

While larger social networks may be associated with a lower likelihood of hospitalisation, they may also be related to wider use of non-hospital services.
Cost of community care for older people
Authors: Livingston Gill , Manela Monica , Katona Cornelius
Published: October 2008

Background

There has been no published study that considers actual costs in a representative sample of people aged ???? 65 years. The present study describes the financial cost of formal community services for elderly people with dementia, depression, anxiety disorders or physical disability.

Method

Psychiatric morbidity, physical disability and services received were assessed by standardised questionnaire in randomly selected Islington enumeration districts. Subjects were interviewed at home (.=700).

Results

Dementia was the most expensive disorder per sufferer in terms of formal services. Those with depression were also high users of health services. Despite presenting to health services, 90% were not treated with appropriate drugs. In contrast, social services were received by people who were activity-limited or with dementia. The highest service cost for the population as a whole was for the physically disabled. In multivariate analysis the significant predictors of high service costs were living alone, being physically ill, depression, dementia and increasing age.

Conclusions

Failure to detect and treat depression and the anxiety disorders in older people, despite their presentation to medical services, may have major economic consequences as well as contributing to individual suffering.
Efficacy and safety of acamprosate in the treatment of detoxified alcohol-dependent patients
Authors: Pelc I. , Verbanck P. , Bon O. Le , Gavrilovic M. , Lion K. , Lehert P.
Published: October 2008

Background

Acamprosate is a newly registered drug that appears to reduce alcohol-drinking in both animal models and clinical conditions.

Method

In order to assess the efficacy and safety of the drug in the treatment of detoxified alcoholics, we performed a 90-day double-blind trial comparing two dosages of acamprosate (1332 mg/day and 1998 mg/day).

Results

For all efficacy parameters, acamprosate appeared to be significantly superior to placebo, with a trend towards a better effect at the higher dosage. Furthermore, acamprosate appeared to be extremely safe.

Conclusion

This study confirms that acamprosate could be an interesting adjuvant for maintaining abstinence in detoxified alcoholics.