bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychometric properties of the Social Phobia Inventory (SPIN)
Authors: Connor Kathryn M. , Davidson Jonathan R. T. , Churchill L. Erik , Sherwood Andrew , Weisler Richard H. , Foa Edna
Published: August 2002

Background

Of available self-rated social phobia scales, none assesses the spectrum of fear, avoidance, and physiological symptoms, all of which are clinically important. Because of this limitation, we developed the Social Phobia Inventory (SPIN).

Aims

To establish psychometric validation of the SPIN.

Method

Subjects from three clinical trials and two control groups were given the 17-item, self-rated SPIN. Validity was assessed against several established measures of social anxiety, global assessments of severity and improvement, and scales assessing physical health and disability.

Results

Good test – retest reliability, internal consistency, convergent and divergent validity were obtained. A SPIN score of 19 distinguished between social phobia subjects and controls. The SPIN was responsive to change in symptoms over time and reflected different responses to active drugsv.placebo. Factorial analysis identified five factors.

Conclusions

The SPIN demonstrates solid psychometric properties and shows promise as a measurement for the screening of, and treatment response to, social phobia.
Subjective imagery in obsessive–compulsive disorder before and after exposure therapy
Authors: Marks Isaac M. , O'Dwyer Anne-Marie , Meehan Oscar , McGuire Philip , Greist John , Baer Lee
Published: August 2002

Background

Distressing mental imagery is hard to study experimentally in obsessive–compulsive disorder (OCD).

Aims

To develop a way to assess mental imagery in OCD during functional magnetic resonance imaging (fMRI).

Method

A small randomised study, controlled for type and order of mental imagery and for treatment condition (exposure therapy guided by a computer or by a therapist, or relaxation guided by audio-tape). Before and after treatment, during fMRI scanning, patients imagined previously-rehearsed scenarios that evoked an urge to ritualise or non-OCD anxiety or a neutral state, and rated their discomfort during imagery.

Results

The method evoked greater discomfort during OCD imagery and anxiety (non-OCD) imagery than during neutral imagery. Discomfort was reduced by cancelling imagery. Discomfort during OCD imagery (but not during anxiety non-OCD imagery) fell after exposure therapy but not after relaxation.

Conclusions

Results showed differences between OCD and non-OCD images and their change after successful treatment, and confirmed clinical suggestions that cancelling images reduced OCD discomfort. The method's success paves the way for further studies of mental imagery in OCD: for instance, during fMRI.
“Every cloud …”
Authors: Robertson Ian H.
Published: August 2002

Those involved in research or clinical work related to brain function will be used to the dinner party question “we only use 50% of the brain, don't we?” The scientist's dismissive sneer is usually well enough concealed, depending on how much he or she has had to drink. Where on earth did this lay myth arise, we chuckle over coffee in the common room on Monday morning? But scientists and clinicians are not immune to myths also. For many decades, neuroscientists preached the doctrine that the adult brain is ‘hard-wired’. Perhaps in very early childhood, we conceded, plastic changes in the brain were possible, but after the age of three or four years connections were indelibly made.
Treatment interventions and findings from research: bridging the chasm in child psychiatry
Authors: Graham Philip
Published: August 2002

Background

Along with all other branches of medicine, child and adolescent psychiatry is faced with the need to consider its evidence base and justify its activities accordingly.

Aims

To consider critically the use of the term ‘evidence’, to suggest limits to the value of conventionally defined evidence and to point to possible ways forward to bridge the gap between research findings and clinical practice.

Method

A review of the literature relating to the use of evidence-based methods.

Results

The term ‘evidence’ needs to be used more widely than is conventionally the case. Substantial evidence exists from controlled trials, but there are barriers to its use.

Conclusions

A move away from non-validated methods of intervention is both desirable and feasible. The use of qualitative methods of enquiry, both in situations where controlled trials are unlikely to be feasible and as adjuncts to quantitative methods, should be considered more seriously.
Meta-analysis of randomised controlled trials of fluoxetine v. placebo and tricyclic antidepressants in the short-term treatment of major depression
Authors: Bech P. , Cialdella P. , Haugh M. C. , Birkett M. A. , Hours A. , Boissel J. P. , Tollefson G. D.
Published: August 2002

Background

Previous meta-analyses of fluoxetine as an antidepressant have many methodological problems, including diagnosis of major depression, validity of outcome measures and lack of intention-to-treat analyses.

Aims

To provide an estimate of the effect of fluoxetine compared with placebo and tricyclic antidepressants (TCAs), and to investigate reasons for early discontinuation from acute treatment.

Method

Randomised trials were analysed using both intention-to-treat, efficacy and end-point.

Results

Fluoxetine was superior to placebo but effect size was low. In trials comparing fluoxetine v. TCA, the results for all trials and for the USA trials showed a trend in favour of fluoxetine. Those for the non-USA trials showed a trend in favour of TCA. When combined, the results showed that significantly fewer patients on fluoxetine discontinued treatment because of adverse events.

Conclusion

Fluoxetine is superior to placebo, irrespective of the analytical approach use, whereas the results obtained v. TCAs depend on the approach used. Hence, the results should be interpreted in this light.
Sixteen-year mortality in patients with affective disorder commenced on lithium
Authors: Brodersen A. , Licht R. W. , Vestergaard P. , Olesen A. V. , Mortensen P. B.
Published: August 2002

Background

Lithium treatment is claimed to reduce mortality in patients with affective disorder, but the evidence is conflicting.

Aim

To estimate mortality rates from a cohort of patients with affective disorder commenced on lithium with an observation period of two years and a follow-up after 16 years.

Method

The mortality rates of patients were compared with those of the general Danish population, standardised for age, gender and calendar time with respect to death from all causes, suicide and death from cardiovascular disease.

Results

Forty of the study's 133 patients died during the 16-year observation period (11 from suicide). Mortality among patients commenced on lithium was twice that of the general population. The statistically significantly elevated mortality was due largely to an excess of suicides; mortality from all other causes was similar to the background populations. Thirty-two patients died after the first two years of observation and were included in the analysis of the association between death and treatment compliance. Suicide occurred more frequently among those patients not complying with treatment.

Conclusion

Mortality, especially suicide, was significantly increased in unselected patients with affective disorder commenced on lithium relative to the general population.
Complementary approaches to the assessment of personality disorder
Authors: Hill Jonathan , Fudge Hazel , Harrington Richard , Pickles Andrew , Rutter Michael
Published: August 2002

Background

Current concepts and measures of personality disorder are in many respects unsatisfactory.

Aims

To establish agreement between two contrasting measures of personality disorder, and to compare subject–informant agreement on each. To examine the extent to which trait abnormality can be separated from interpersonal and social role dysfunction.

Method

Fifty-six subjects and their closest informants were interviewed and rated independently. Personality functioning was assessed using a modified Personality Assessment Schedule (M–PAS), and the Adult Personality Functioning Assessment (APFA).

Results

Subject–informant agreement on the M–PAS was moderately good, and agreement between the M–PAS and the APFA, across and within subjects and informants, was comparable to that for the M–PAS. This was equally the case when M–PAS trait plus impairment scores and trait abnormality scores were used.

Conclusions

The M–PAS and the APFA are probably assessing similar constructs. Trait abnormalities occur predominantly in an interpersonal context and could be assessed within that context.
How mental illness is portrayed in children's television
Authors: Wilson Claire , Nairn Raymond , Coverdale John , Panapa Aroha
Published: August 2002

Background

There are no published studies concerning the depiction of mental illness in children's television programmes.

Aims

To determine whether mental illness was depicted in children's television.

Method

Sample of one complete week of children's television (57 hours, 50 minutes; 128 series episodes: 69 cartoon animations, 12 non-cartoon animations, 47 real life) provided for children under the age of 10 years. Disclosure analysis of portrayals of mental illness through repeated viewings identified patterns in the use of linguistic, semiotic and rhetorical resources.

Results

Of the 128 episodes, 59 (46%) contained one or more references to mental illness, predominantly in cartoons (n=47, 80%) compared with other episode types (χ2=17.1, d.f.=2, P<0.05). Commonly occurring terms such as ‘crazy’ (n=28), ‘mad’ (n=19) and ‘losing your mind’ (n=13) were employed to denote loss of control. The six consistently mentally ill characters were almost entirely devoid of admirable attributes.

Conclusion

Young viewers are being socialised into stigmatising conceptions of mental illness.
Camberwell Assessment of Need for the Elderly (CANE)
Authors: Reynolds Tom , Thornicroft Graham , Abas Melanie , Woods Bob , Hoe Juanita , Leese Morven , Orrell Martin
Published: August 2002

Background

There exists no instrument specifically designed to measure comprehensively the needs of older people with mental disorders.

Aim

To develop such an instrument which would take account of patients', staff and carers' views on needs.

Method

Following an extensive development process, the assessment instrument was subjected to a test–retest and interrater reliability study, while aspects of validity were addressed both during development and with data provided by sites in the UK, Sweden and the USA.

Results

The Camberwell Assessment of Need for the Elderly (CANE) comprises 24 items (plus two items for carer needs), and records staff, carer and patient views. It has good content, construct and consensual validity. It also demonstrates appropriate criterion validity. Reliability is generally very high: κ > 0.85 for all staff ratings of interrater reliability. Correlations of interrater and test–retest reliability of total numbers of needs identified by staff were 0.99 and 0.93, respectively.

Conclusions

The psychometric properties of the CANE seem to be highly acceptable. It was easily used by a wide range of professionals without formal training.
Three-year prognosis of depression in the community-dwelling elderly
Authors: Denihan Aisling , Kirby Michael , Bruce Irene , Cunningham Conal , Coakley Davis , Lawlor Brian A.
Published: August 2002

Background

Depression is the most common mental disorder in the community-dwelling elderly.

Aims

To determine the three-year prognosis of depression in a cohort of 127 community-dwelling elderly subjects and identify factors relevant to outcome.

Method

The subjects, diagnosed depressed at year 0 using the GMS–AGECAT package, were followed up three years later. A number of factors were investigated for an association with recovery from, or persistence of, depression.

Results

At follow-up, 30.2% of the depressed subjects had died, 34.9% had persistent or relapsed case-level depression, 24.5% had other case- or subcase-level mental illness and 10.4% had recovered completely. Physical ill-health, bereavement and positive family history of depression were associated with poor outcome, whereas treatment with antidepressant medication significantly improved prognosis.

Conclusions

Late-life depression in community-dwelling subjects is a chronic condition. However, the positive response to antidepressant medication suggests that it should be vigorously treated.
Functional correlates of musical and visual ability in frontotemporal dementia
Authors: Miller Bruce L. , Boone Kyle , Cummings Jeffrey L. , Read Stephen L. , Mishkin Fred
Published: August 2002

Background

The emergence of new skills in the setting of dementia suggests that loss of function in one brain area can release new functions elsewhere.

Aims

To characterise 12 patients with frontotemporal dementia (FTD) who acquired, or sustained, new musical or visual abilities despite progression of their dementia.

Method

Twelve patients with FTD who acquired or maintained musical or artistic ability were compared with 46 patients with FTD in whom new or sustained ability was absent.

Results

The group with musical or visual ability performed better on visual, but worse on verbal tasks than did the other patients with FTD. Nine had asymmetrical left anterior dysfunction. Nine showed the temporal lobe variant of FTD.

Conclusion

Loss of function in the left anterior temporal lobe may lead to facilitation of artistic or musical skills. Patients with the left-sided temporal lobe variant of FTD offer an unexpected window into the neurological mediation of visual and musical talents.
Low blood pressure and risk of depression in the elderly
Authors: Paterniti Sabrina , Verdier-Taillefer Marie-Hélène , Geneste Catherine , Bisserbe Jean-Claude , Alpérovitch Annick
Published: August 2002

Background

The relationship between depression and low blood pressure is unclear.

Aims

To examine the temporal relation between low blood pressure and depression in a two-year follow-up.

Method

The study group consisted of 1389 subjects aged 59–71 years; 1272 (92%) were examined after two years. Subjects completed the Center for Epidemiological Studies–Depression (CES–D) and the Spielberger inventory scales to assess depressive and anxiety symptoms respectively. Data were collected on socio-demographic characteristics, smoking and drinking habits, medical history, drug use and blood pressure measures.

Results

Among 1112 subjects who were considered as non-depressed at baseline, logistic regression models showed that low diastolic blood pressure (DBP) and decrease of blood pressure were predictors of high depressive symptomatology at follow-up. Baseline high CES–D scores did not predict low blood pressure two years after.

Conclusions

In our study, low blood pressure was a risk factor for, but not a consequence of, high depressive symptomatology.
APOE ε4 influences the manifestation of Alzheimer's disease in adults with Down's syndrome
Authors: Deb Shoumitro , Braganza John , Norton Nadine , Williams Hywel , Kehoe Patrick G. , Williams Julie , Owen Michael J.
Published: August 2002

Background

Recent studies of the relationship between the apolipoprotein E (APOE) gene and Alzheimer's disease in adults with Down's syndrome have revealed inconsistent results.

Aims

To assess the role of the APOE gene in the manifestation of Alzheimer's disease in adults with Down's syndrome.

Method

We studied the APOE genotypes of 24 adults with dementia and 33 non-demented adults with Down's syndrome over 35 years of age, and an additional group of 164 non-learning disabled adults. We also carried out a meta-analysis of all previously published studies of association between APOE and Down's syndrome, incorporating the current data.

Results

We observed a non-significant excess of APOE ε4 and a reduction of ε2 in adults with dementia compared with non-demented adults with Down's syndrome in our sample. However, meta-analysis showed a significantly higher frequency of ε4 in adults with dementia compared with non-demented adults with Down's syndrome (odds ratio=2.02, 95% CI 1.33–3.07, P=0.001), but no significant reduction in the frequency of ε2.

Conclusions

The APOE ε4 allele acts as a risk factor for the age-specific manifestation of Alzheimer's disease in people with Down's syndrome.
Reliability and validity of the CANDID – a needs assessment instrument for adults with learning disabilities and mental health problems
Authors: Xenitidis K. , Thornicroft G. , Leese M. , Slade M. , Fotiadou M. , Philp H. , Sayer J. , Harris E. , McGee D. , Murphy D. G. M.
Published: August 2002

Background

People with learning disabilities and mental health problems have complex needs. Care should be provided according to need.

Aim

To develop a standardised needs-assessment instrument for adults with learning disabilities and mental health problems.

Method

The Camberwell Assessment of Need for Adults with Developmental and Intellectual Disabilities (CANDID) was developed by modifying the Camberwell Assessment of Need (CAN). Concurrent validity was tested using the Global Assessment of Functioning (GAF) and the Disability Assessment Schedule (DAS). Test–retest and interrater reliability were investigated using 40 adults with learning disabilities and mental health problems.

Results

CANDID scores were significantly correlated with both DAS (P<0.05) and GAF scores (P<0.01). Correlation coefficients for interrater reliability were 0.93 (user), 0.90 (carer), and 0.97 (staff ratings); for test–retest reliability they were 0.71, 0.69 and 0.86 respectively. Mean interview duration was less than 30 minutes.

Conclusions

The CANDID is a brief, valid and reliable needs assessment instrument for adults with learning disabilities and mental health problems.
Changing patterns in the use of the Mental Health Act 1983 in England, 1984–1996
Authors: Hotopf Matthew , Wall Sharon , Buchanan Alec , Wessely Simon , Churchill Rachel
Published: August 2002

Background

The Mental Health Act 1983 (MHA) is due to be revised by Parliament in the near future.

Aims

To explore changes in the use of the Act since its introduction.

Method

The Department of Health and the Home Office routinely collect data on the numbers of patients admitted to psychiatric hospitals under the MHA. We present absolute figures, by year, for the total numbers admitted under each section of the Act. We used the total psychiatric hospital admissions and total prison populations as denominator data.

Results

Formal admissions rose from 16 044 in 1984 to 26 308 in 1996, a 63% increase. Admissions under the MHA have increased as a proportion of all admissions. The increase is mainly accounted for by changes in the use of Part II of the Act, in particular sections 2 and 3. The use of forensic sections (Part III) has also increased, with a marked increase of sections 47 and 48. Use of Part X of the Act (sections 135 and 136) declined in the late 1980s but rose again in the 1990s.

Conclusions

Formal admissions are more common than they were in 1984, despite there being fewer psychiatric beds. This is probably due to changes in the provision of psychiatric services, and changing societal pressures on psychiatrists away from libertarianism and towards coercion.
Cassel Personality Disorder Study
Authors: Chiesa Marco , Fonagy Peter
Published: August 2002

Background

The effectiveness of hospital-based treatment models for personality disorder is still uncertain.

Aims

To compare effectiveness of two models of psychosocial intervention for personality disorder.

Method

Two samples of people with personality disorder allocated to a one-stage treatment model (in-patient treatment with no after care) and to a two-stage model (shorter in-patient admission followed by outreach therapy) are prospectively compared.

Results

Subjects in the two-stage sample did significantly better on global assessment of mental health (according to the Global Assessment Score (GAS)) at 6 and 12 months and on social adjustment (according to the Social Adjustment Scale (SAS)) at 12 months. Significant differences in rates of reliable improvement on the GAS (43% v. 17%) and SAS (39% v. 15%) in favour of the two-stage condition were found at 12 months. Subjects with borderline personality disorder (BPD) allocated to the two-stage model improved significantly more than such patients in the one-stage model.

Conclusions

A long-term phased model which combines hospital-based and community-based strategies has advantages over a purely in-patient model for the treatment of BPD.
Obstetric complications and schizophrenia
Authors: Kendell R. E. , McInneny K. , Juszczak E. , Bain M.
Published: August 2002

Background

Most previous case–control studies of obstetric complications in schizophrenia have been small scale and many have relied on retrospective information.

Aims

To determine which obstetric complications are more common in probands with schizophrenia than matched controls.

Method

Two hundred and ninety-six probands with an in-patient diagnosis of schizophrenia who had been born in Scotland in 1971–74, and a further 156 born in 1975–78, were closely matched with controls and the incidence of obstetric complications in the two compared using obstetric data recorded in a set format shortly after birth.

Results

Not a single complication of pregnancy or delivery was significantly more common in the probands with schizophrenia than the controls in the 1971–74 birth cohort and only emergency Caesarean section and labour lasting over 12 hours were significantly more common in the schizophrenia probands in the 1975–78 cohort.

Conclusion

The evidence that schizophrenia is associated with a raised incidence of obstetric complications is weaker than has recently been assumed.
Obstetric complications and affective psychoses
Authors: Bain M. , Juszczak E. , McInneny K. , Kendell R. E.
Published: August 2002

Background

Unlike schizophrenia, little interest has been taken in the incidence of obstetric complications in affective psychoses.

Aims

To find out whether obstetric complications are more common in affective psychoses than matched controls.

Method

Two hundred and seventeen probands with an in-patient diagnosis of affective psychosis who had been born in Scotland in 1971–74, and a further 84 born in 1975–78, were closely matched with controls and the incidence of obstetric complications in the two compared using obstetric data recorded in a set format shortly after birth.

Results

Abnormal presentation of the foetus was the only complication significantly more common in the affective probands in the 1971–74 birth cohort and artificial rupture of the membranes was the only event more common in the probands in the 1975–78 cohort. Both are probably chance findings.

Conclusion

It is unlikely that the incidence of obstetric complications is raised in people with affective psychoses of early onset.
Labour and delivery complications and schizophrenia
Authors: Byrne Majella , Browne Roy , Mulryan Niamh , Scully Ann , Morris Mary , Kinsella Anthony , Takei Noriyoshi , McNeil Tom , Walsh Dermot , O'Callaghan Eadbhard
Published: August 2002

Background

Controversy continues regarding an association between obstetric complications and risk of schizophrenia in early adult life.

Aims

To compare the rate of labour and delivery complications among persons who developed schizophrenia with controls; to establish whether any complication is associated with later schizophrenia.

Method

We located the labour ward records of 431 individuals with schizophrenia and of same-gender controls from the same hospital birth series. Mothers were matched by age, socio-economic group and parity. Individual complications were evaluated blindly using two obstetric complication scales.

Results

Overall, the rate of labour and delivery complications for those who developed schizophrenia did not differ from that of controls. Males who had presented to psychiatric services before the age of 30 had a greater frequency of and more severe labour/delivery complications than their matched controls.

Conclusions

Other than among young-onset males we found no increase in labour and delivery complications among cases.
Cost-effectiveness of intensive v. standard case management for severe psychotic illness
Authors:   UK700 Group, Byford Sarah , Fiander Matthew , Torgerson David J. , Barber Julie A. , Thompson Simon G. , Burns Tom , Van Horn Elizabeth , Gilvarry Catherine , Creed Francis
Published: August 2002

Background

Intensive case management is commonly advocated for the care of the severely mentally ill, but evidence of its cost-effectiveness is lacking.

Aims

To investigate the cost-effectiveness of intensive compared with standard case management for patients with severe psychosis.

Method

708 patients with psychosis and a history of repeated hospital admissions were randomly allocated to standard (case-loads 30–35) or intensive (case-loads 10–15) case management. Clinical and resource use data were assessed over two years.

Results

No statistically significant difference was found between intensive and standard case management in the total two-year costs of care per patient (means £24 550 and £22 700, respectively, difference £1850, 95% Cl – £1600 to £5300). There was no evidence of differential effects in African–Caribbean patients or in the most disabled. Psychiatric in-patient hospital stay accounted for 47% of the total costs, but neither such hospitalisation nor other clinical outcomes differed between the randomised groups.

Conclusion

Reduced case-loads have no clear beneficial effect on costs, clinical outcome or cost-effectiveness. The policy of advocating intensive case management for patients with severe psychosis is not supported by these results.
Factors predicting the clinical course of generalised anxiety disorder
Authors: Yonkers Kimberly A. , Dyck Ingrid R. , Warshaw Meredith , Keller Martin B.
Published: August 2002

Background

Cross-sectional data show that generalised anxiety disorder (GAD) is a chronic condition with episodes lasting much longer than the six-month minimum required by DSM–III–R and DSM–IV. Although GAD is chronic, little is known about factors influencing illness duration.

Aims

To investigate variables that influence the clinical course of GAD.

Method

A total of 167 patients with GAD participated in the Harvard–Brown Anxiety Research Program. Patients were assessed at intake and re-examined at six- to twelve-month intervals for five years. Kaplan–Meier curves were constructed to assess the likelihood of remission. Regression analysis was used to investigate factors predicting full or partial remission.

Results

The rate of remission was 0.38 after five years. Diminished likelihood of remission was associated with low overall life satisfaction, poor spousal or family relationships, a concurrent cluster B or C personality disorder and a low global assessment score.

Conclusions

Full or partial remissions were less likely to occur in patients with poor relationships and personality disorders. These patients should be given more intensive and possibly multi-modal therapy.
Cerebral perfusion in chronic fatigue syndrome and depression
Authors: Machale Siobhan M. , Lawrie Stephen M. , Cavanagh Jonathan T. O. , Glabus Mike F. , Murray Catherine L. , Ebmeier Klaus P. , Goodwin Guy M.
Published: August 2002

Background

Patients with chronic fatigue syndrome (CFS) and depressive illness share many, but not all, features.

Aims

To test the hypothesis that patients with CFS have abnormal cerebral perfusion, that differs from that in patients with depressive illness.

Method

We recruited 30 patients with CFS who were not depressed, 12 depressed patients and 15 healthy volunteers. Regional cerebral perfusion at rest was assessed using region of interest (ROI) and voxel-based statistical parametric mapping (SPM) techniques.

Results

On SPM analysis there was increased perfusion in the right thalamus, pallidum and putamen in patients with CFS and in those with depressive illness. CFS patients also had increased perfusion in the left thalamus. Depressed patients differed from those with CFS in having relatively less perfusion of the left prefrontal cortex. The results were similar on ROI analysis.

Conclusions

Abnormal cerebral perfusion patterns in CFS subjects who are not depressed are similar but not identical to those in patients with depressive illness. Thalamic overactivity may be a correlate of increased attention to activity in CFS and depression; reduced prefrontal perfusion in depression may be associated with the greater neuropsychological deficits in that disorder.
Effectiveness of cognitive–behavioural family intervention in reducing the burden of care in carers of patients with Alzheimer's disease
Authors: Marriott Alison , Donaldson Catherine , Tarrier Nicholas , Burns Alistair
Published: August 2002

Background

The majority of patients with Alzheimer's disease live outside institutions and there is considerable serious psychological morbidity among their carers.

Aims

To evaluate whether family intervention reduces the subjective burden of care in carers of patients with Alzheimer's disease and produces clinical benefits in the patients.

Method

A prospective single-blind randomised controlled trial with three-month follow-up in which the experimental group received family intervention and was compared with two control groups.

Results

There were significant reductions in distress and depression in the intervention group compared with control groups at post-treatment and follow-up. There were significant reductions in behavioural disturbance at post-treatment and an increase in activities at three months in patients in the intervention group. Based on an improvement on the General Health Questionnaire resulting in a carer converting from a case to a non-case, the number to treat was three immediately post-treatment and two at follow-up.

Conclusions

Family intervention can have significant benefits in carers of patients with Alzheimer's disease and has a positive impact on patient behaviour.
Effects of a pharmacist's medication review in nursing homes
Authors: Furniss Lee , Burns Alistair , Craig Sarah Kathryn Lloyd , Scobie Susan , Cooke Jonathan , Faragher Brian
Published: August 2002

Background

Older people in nursing and residential homes often have complex disabilities and behavioural disturbances. Recent publicity has highlighted the dangers of medication in this group, and controls over prescribing have been suggested.

Aims

To investigate the effect of a review of medication by a pharmacist.

Method

An 8-month prospective trial of an active medication review by a pharmacist was carried out on 330 residents in nursing homes in Manchester.

Results

The intervention group experienced greater deterioration in cognitive function and behavioural disturbance than the control group, but the changes in depression and quality of life were similar for both groups. The number of drugs prescribed fell in the intervention group, but not in the control group, with a corresponding saving in drug costs. The number of deaths was significantly smaller in the intervention homes during the intervention period (4 v. 14) but not overall during the study period as a whole (26 v. 28).

Conclusion

This clinical intervention reduced the number of medicines prescribed to elderly people in nursing homes, with minimal impact on their morbidity and mortality.
Depression and risk of cognitive decline and Alzheimer's disease
Authors: Geerlings M. I. , Bouter L. M. , Schoevers R. A. , Beekman A. T. F. , Jonker C. , Deeg D. J. H. , Van Tilburg W. , Adèr H. J. , Schmand B.
Published: August 2002

Background

Depression may be associated with cognitive decline in elderly people with impaired cognition.

Aims

To investigate whether depressed elderly people with normal cognition are at increased risk of cognitive decline and Alzheimer's disease.

Methods

Two independent samples of older people with normal cognition were selected from the community-based Amsterdam Study of the Elderly (AMSTEL) and the Longitudinal Aging Study Amsterdam (LASA). In AMSTEL, depression was assessed by means of the Geriatric Mental State Schedule. Clinical diagnoses of incident Alzheimer's disease were made using a two-step procedure. In LASA, depression was assessed with the Center for Epidemiologic Studies Depression Scale. Cognitive decline was defined as a drop of ⩾ 3 on the Mini-Mental State Examination at follow-up.

Results

Both in the AMSTEL and the LASA sample, depression was associated with an increased risk of Alzheimer's disease and cognitive decline, respectively, but only in subjects with higher levels of education.

Conclusions

In a subgroup of more highly educated elderly people, depression may be an early manifestation of Alzheimer's disease before cognitive symptoms become apparent.
Duration of remitting psychoses with acute onset
Authors: Mojtabai Ramin , Susser Ezra , Varma Vijoy K.
Published: August 2002

Background

The acute and transient psychotic disorders (ATPD) in ICD–10 advanced the nosology of remitting psychoses with acute onset. But the proposed criteria for ATPD – especially in regard to duration – are tentative and need to be validated.

Aims

To evaluate: (a) the duration of remitting psychoses with acute onset; (b) the applicability of the ATPD criteria for these cases; and (c) differences in duration and ATPD diagnoses across sociocultural settings.

Method

Data from the World Health Organization Determinants of Outcome study were used.

Results

The 98 cases of remitting psychoses with acute onset had a modal duration of 2–4 months, with 43% falling in this range. Mainly because of this, few met the ATPD criteria. Duration and diagnostic findings were similar across settings.

Conclusions

ATPD criteria need refinement, especially in regard to duration. Further studies aimed at early detection and assessment of onset and duration of these disorders are needed.
Integration of mental health care into primary care
Authors: Chisholm D. , James S. , Sekar K. , Kumar K. Kishore , Murthy R. Srinivasa , Saeed K. , Mubbashar M.
Published: August 2002

Background

Targeting resources on cost-effective care strategies is important for the global mental health burden.

Aims

To demonstrate cost–outcome methods in the evaluation of mental health care programmes in low-income countries.

Method

Four rural populations were screened for psychiatric morbidity. Individuals with a diagnosed common mental disorder were invited to seek treatment, and assessed prospectively on symptoms, disability, quality of life and resource use.

Results

Between 12% and 39% of the four screened populations had a diagnosable common mental disorder. In three of the four localities there were improvements over time in symptoms, disability and quality of life, while total economic costs were reduced.

Conclusion

Economic analysis of mental health care in low-income countries is feasible and practicable. Our assessment of the cost-effectiveness of integrating mental health into primary care was confounded by the naturalistic study design and the low proportion of subjects using government primary health care services.
Psychological debriefing for road traffic accident victims
Authors: Mayou R. A. , Ehlers A. , Hobbs M.
Published: August 2002

Background

Psychological debriefing is widely used for trauma victims but there is uncertainty about its efficacy. We have previously reported a randomised controlled trial which concluded that at 4 months it was ineffective.

Aims

To evaluate the 3-year outcome in a randomised controlled trial of debriefing for consecutive subjects admitted to hospital following a road traffic accident.

Method

Patients were assessed in hospital by the Impact of Event Scale (IES), Brief Symptom Inventory (BSI) and questionnaire and re-assessed at 3 months and 3 years. The intervention was psychological debriefing as recommended and described in the literature.

Results

The intervention group had a significantly worse outcome at 3 years in terms of general psychiatric symptoms (BSI), travel anxiety when being a passenger, pain, physical problems, overall level of functioning, and financial problems. Patients who initially had high intrusion and avoidance symptoms (IES) remained symptomatic if they had received the intervention, but recovered if they did not receive the intervention.

Conclusions

Psychological debriefing is ineffective and has adverse long-term effects. It is not an appropriate treatment for trauma victims.
Factor structure and familiality of first-rank symptoms in sibling pairs with schizophrenia and schizoaffective disorder
Authors: Loftus Josephine , Delisi Lynn E. , Crow Timothy J.
Published: August 2002

Background

Since their introduction as diagnostic criteria by Schneider in 1937, nuclear symptoms have played a key role in concepts of schizophrenia, but their relationship to each other and to genetic predisposition has been unclear.

Aims

To ascertain the factor structure and familiality of nuclear symptoms.

Methods

Nuclear (Schneiderian) symptoms were extracted from case notes and interviews in a study of 103 sibling pairs with DSM–III–R schizophrenia or schizoaffective disorder.

Results

Principal components analysis demonstrated two major factors: one, accounting for about 50% of the variance, groups thought withdrawal, insertion and broadcasting, with delusions of control; and the second, accounting for <20% of the variance, groups together third-person voices, thought echo and running commentary. Factor I was significantly correlated within sibling pairs.

Conclusions

The correlation within sibling pairs suggests that, contrary to the conclusion of some previous studies, some nuclear symptoms do show a degree of familiality and therefore perhaps heritability.
Causes of schizophrenia reported by patients' family members in China
Authors: Phillips Michael R. , Li Yongyun , Stroup T. Scott , Xin Lihua
Published: August 2002

Background

Better methods of assessing patients' and family members' causal models of illness are needed to improve adherence with biomedical interventions and to design services that meet the needs of consumers.

Aims

To develop a quantitative measure suitable for assessing the relationship of causal beliefs to expressed emotion, stigma, care-seeking and adherence.

Method

The Causal Models Questionnaire for Schizophrenia, which includes 45 causes identified during in-depth interviews with family members, was administered to 245 family members of 135 patients with DSM–III–R schizophrenia in Suzhou and Siping, China at the time of admission to hospital.

Results

Respondents, who identified a mean of 2.5 causes (range 1–10, mode 2), attributed 84% of the cause of schizophrenia to social, interpersonal and psychological problems. Hence, their beliefs do not concur with Chinese professionals' ideas about the biomedical causes of schizophrenia. Multivariate analyses identified the socio-economic factors that influence family members' causal beliefs.

Conclusions

Despite the complexity of causal models, measures can be developed that will help improve clinicians' communication with patients and understanding of help-seeking behaviours.
Cognitive and behavioural functioning in men with schizophrenia both before and shortly after first admission to hospital
Authors: Rabinowitz Jonathan , Reichenberg Avi , Weiser Mark , Mark Mordechai , Kaplan Zeev , Davidson Michael
Published: August 2002

Background

The extent of premorbid changes associated with the onset of schizophrenia are debated.

Aims

The study examined cognitive and behavioural functioning prior to, and after, first hospitalisation for schizophrenia.

Method

Data from the Israeli Draft Board Register of intelligence, social functioning and behaviour testing for all Israeli males aged 16–17 was linked with data from the National Psychiatric Hospitalisation Case Register. This identified 692 men who had been admitted to hospital for schizophrenia. Cases and non-cases matched on age and school were compared, as were cases aggregated by the time that had elapsed between testing and first admission to hospital.

Results

Cases performed worse than non-cases on all measures. On Social Functioning and on Raven's Progressive Matrices–R, differences between cases and non-cases were progressively greater for cases admitted closer to the time of testing. These differences were greatest for persons tested after first psychiatric hospitalisation.

Conclusions

The results confirm premorbid deficits associated with schizophrenia and support the hypothesis that decline is progressive.
Psychiatric patients at greatest risk and in greatest need
Authors: Bindman Jonathan , Beck Andrew , Thornicroft Graham , Knapp Martin , Szmukler George
Published: August 2002

Background

Mental health provider trusts in England were required in 1994 to establish local Supervision Registers of patients at risk.

Aims

To identify the factors associated with registration, and obtain clinicians' views on its effectiveness.

Method

At a random sample of 14 trusts data were collected from case notes, keyworkers and responsible medical officers.

Results

A sample of 133 registered patients were more disabled and had more extensive histories of violence and self-harm than 126 comparison patients on the upper tier of the Care Programme Approach (CPA). Those registered were a heterogeneous group. For some there was little evidence of risk. In most cases clinicians did not believe registration had improved care.

Conclusions

The Supervision Register policy has not resulted in the identification of a well-defined group. Its effectiveness is limited by the lack of operationalised measures of risk.
Schizophrenia is not disappearing in south-west Scotland
Authors: Allardyce J. , Morrison G. , Van Os J. , Kelly J. , Murray R. M. , McCreadie R. G.
Published: August 2002

Background

Recent work has reported a decline in the incidence of schizophrenia, but it is unclear if these findings reflect a true decrease in its incidence or are an artefact arising from methodological difficulties.

Aims

To take account of these methodological difficulties and report service-based incidence rates for schizophrenia in Dumfries and Galloway in south-west Scotland for 1979–98.

Method

Using both clinical diagnoses and diagnoses generated from the Operational Checklist for Psychotic Disorders (OPCRIT) computer algorithm for ICD–10 and DSM–IV schizophrenia, we measured change in the incidence rates over time. We used indirect standardisation techniques and Poisson models to measure the rate ratio linear trend.

Results

There was a monotonic and statistically significant decline in clinically diagnosed schizophrenia. The summary rate ratio linear trend was 0.77. However, using OPCRIT-generated ICD–10 and DSM–IV diagnoses, there was no significant difference over time.

Conclusions

OPCRIT-generated consistent diagnoses revealed no significant fall in the incidence of schizophrenia. Changes in diagnostic practice have caused the declining rates of clinically diagnosed schizophrenia in Dumfries and Galloway.
Stigmatisation of people with mental illnesses
Authors: Crisp Arthur H. , Gelder Michael G. , Rix Susannah , Meltzer Howard I. , Rowlands Olwen J.
Published: August 2002

Background

Recognition of the additional social handicaps and distress that people with mental illnesses experience as a result of prejudice.

Aims

To determine opinions of the British adult population concerning those with mental illnesses as baseline data for a campaign to combat stigmatisation.

Method

Survey of adults (n=1737 interviewed; 65% response) regarding seven types of common mental disorders. Responses evaluated concerned eight specified perceptions.

Results

Respondents commonly perceived people with schizophrenia, alcoholism and drug addiction as unpredictable and dangerous. The two latter conditions were also viewed as self-inflicted. People with any of the seven disorders were perceived as hard to talk with. Opinions about effects of treatment and prognosis suggested reasonable knowledge. About half the respondents reported knowing someone with a mental illness.

Conclusions

Negative opinions indiscriminately overemphasise social handicaps that can accompany mental disorders. They contribute to social isolation, distress and difficulties in employment faced by sufferers. A campaign against stigma should take account of the differences in opinions about the seven disorders studied.
Self-report quality of life measure for people with schizophrenia: The SQLS
Authors: Wilkinson Greg , Hesdon Bernadette , Wild Diane , Cookson Ron , Farina Carole , Sharma Vimal , Fitzpatrick Ray , Jenkinson Crispin
Published: August 2002

Background

Quality of life is the subject of growing interest and investigation.

Aims

To develop and validate a short, self-report quality of life questionnaire (the Schizophrenia Quality of Life Scale, SQLS).

Method

People with schizophrenia in Liverpool were recruited via the NHS. Items, generated from in-depth interviews, were developed into an 80-item self-report questionnaire. Data were factor analysed, and a shorter form measure was tested for reliability and validity. This measure was administered together with other self-report measures – SF–36, GHQ–12 and HADS – to assess validity.

Results

Data were analysed to produce a final 30-item questionnaire, comprising three scales (‘psychosocial’, ‘motivation and energy’, and ‘symptoms and side-effects’) addressing different SQLS dimensions. Internal consistency reliability of the scale was found to be satisfactory. There was a high level of association with relevant SF–36, GHQ–12 and HADS scores.

Conclusions

The SQLS was completed within 5–10 minutes. It possesses internal reliability and construct validity, and promises to be a useful tool for the evaluation of new treatment regimes for people with schizophrenia.
Critical approach to antidepressant trials
Authors: Even C. , Siobud-Dorocant E. , Dardennes R. M.
Published: August 2002

Background

Double-blind placebo-controlled trials are the academic standard for clinical psychopharmacology research.

Aims

To identify the potential defects of current double-blind procedures in trials involving antidepressants and to investigate whether safeguards for blindness protection are used.

Method

We reviewed the literature and devised a short seven-item checklist for evaluating the quality of blindness protection. We performed a computerised search for 1998 to identify the placebo-controlled studies that evaluated the efficacy of an antidepressant. The checklist was used to assess all traceable antidepressant trials published in 1998.

Results

Relevant criticisms question the blindness procedures. The available methods which may bolster blindness are very seldom used.

Conclusions

Improvement in the blindness procedures used for antidepressant trials is necessary, feasible and measurable.
Child and adolescent mental health service use
Authors: Garralda M. E. , Yates P. , Higginson I.
Published: August 2002

Background

HoNOSCA (Health of the Nation Outcome Scales for Children and Adolescents) is a recently developed measure of outcome for use in child and adolescent mental health services (CAMHS).

Aims

To examine HoNOSCA's sensitivity to change, convergent validity and clinical usefulness.

Method

Prospective study of new CAMHS attenders. Questionnaires completed by clinicians, parents and referrers at initial assessment and after 6 months.

Results

Follow-up HoNOSCAs on 203 children indicated statistically significant change. There were significant associations between change in HoNOSCA scores, changes in other clinician- and parent-rated scales (r=0.51 to 0.32) and in global outcome ratings by referrers, parents and clinicians. Intraclass correlation coefficients for the summated HoNOSCA scores were high. HoNOSCA change was positively correlated with initial HoNOSCA score (r=0.46, P<0.001) and it was linked to psychiatric diagnosis.

Conclusions

HoNOSCA is a sensitive, valid measure of change among CAMHS attenders.