bluuebunny/crossref_metadata_2025 huggingface dataset:
Social Deprivation and Psychiatric Admission Rates Among Different Diagnostic Groups
Authors: Harrison Judy , Barrow Steve , Creed Francis
Published: October 2008

Background

In the search for population-based indicators of need for mental health services, psychiatric admission rates have been correlated with sociodemographic variables. We explored such correlations for different diagnostic groups.

Method

Admissions data for the 19 districts in the North West Region were derived from the Korner Episode System for 1992/3 and divided into eight broad diagnostic groups using ICD–9 codes. Admission rates per 1000 were correlated with measures of deprivation derived from the 1991 census data and with standardised mortality ratios. For the two largest diagnostic groups, correlations with age-standardised admission rates were also calculated.

Results

For schizophrenia/delusional disorder, eight of the 10 sociodemographic measures were significantly correlated with admission rates (Pearson'sr0.52–0.79). On all measures these correlations were greater than those seen for total mental illness. Significant positive correlations of a lower order were seen for organic brain syndromes and mania. Admission rates for depression, personality disorder and substance misuse were not significantly correlated with any of the sociodemographic measures. Admission rates for neurotic illness were negatively correlated with all deprivation measures, with the negative correlation statistically significant at the 5% level for ethnic composition and overcrowding. Standardising admission rates for age and repeating the analysis after removal of influential data points did not greatly alter these findings.

Conclusions

The association between psychiatric admission rates and measures of deprivation varies considerably with diagnosis. Measures of social deprivation may indicate need for services for patients with psychotic disorders; admission rates for non-psychotic illnesses may reflect the availability of beds rather than need.
Long-Term Follow-up after a Drug Trial for Panic Disorder
Authors: Katschnig Heinz , Amering Michaela , Stolk Jon M. , Klerman Gerald L. , Ballenger James C. , Briggs Andrew , Buller Raimund , Cassano Giovanni , Garvey Michael , Roth Sir Martin , Solyom Carol
Published: October 2008

Background

This study investigates the naturalistic course of panic disorder over four years and attempts to identify predictors for outcome.

Method

423 DSM–III–R panic disorder patients who had taken part in an international multicentre drug trial were selected for follow-up; we were able to re-interview 367 (87%). For panic attacks, phobic avoidance and disabilities the same rating scales were administered as had been used for the clinical trials.

Results

While 61 % of all patients experienced at least occasional panic attacks at follow-up, few suffered from serious phobic avoidance (16.7%) or serious disabilities (work 7.9%; family 8.7%; social 13.9%). Panic attack frequency at baseline, original trial medication and continuous use of psychotropic medication during follow-up are not related to outcome, whereas longer duration of illness and more severe phobic avoidance at baseline are unfavourable.

Conclusion

The course of panic disorder is not uniform. Since long duration of illness and severe phobic avoidance at baseline are predictors for an unfavourable outcome, more rigorous efforts should be undertaken to detect and treat panic disorder at an early stage.
Incorporating Psychological Debriefing Techniques within a Brief Group Psychotherapy Programme for the Treatment of Post-Traumatic Stress Disorder
Authors: Busuttil Walter , Turnbull Gordon J. , Neal Leigh A. , Rollins John , West Adrian G. , Blanch Nick , Herepath Ronald
Published: October 2008

Background

The Royal Air Force Wroughton Post-Traumatic Stress Disorder (PTSD) Rehabilitation Programme is described. It comprised a 12-day structured in-patient ‘course’ of group psychotherapy and day-case group follow-up sessions over a one-year period. Psychological debriefing was the main therapeutic technique employed.

Method

This is a ‘before and after’ open outcome study. A comprehensive assessment protocol confirmed the presence and severity of PTSD and measured co-morbid psychopathological status, occupational and social function longitudinally.

Results

A highly significant global response to treatment is demonstrated in the 34 subjects included in the study, with 85.3% not fulfilling the DSM–III–R criteria for PTSD at one year after treatment.

Conclusions

Further controlled studies assessing the value of psychological debriefing techniques in the treatment of established PTSD are required.
Selective Serotonin Reuptake Inhibitors and Tricyclic Antidepressants in Combination
Authors: Taylor David
Published: October 2008

Background

The selective serotonin reuptake inhibitors (SSRIs) are now widely used in the treatment of depressive illness. Interest has grown in the use of SSRIs as alternatives to tricyclic antidepressants (TCAs) and in the therapeutic use of combinations of SSRIs and TCAs in refractory depression.

Method

MEDLINE and PSYCLit literature searches were conducted. Reference sections from papers retrieved were scrutinised for other relevant reports.

Results

Of 41 relevant articles identified, 35 were selected for review.

Conclusions

Fluoxetine, fluvoxamine, paroxetine and sertraline may substantially increase TCA plasma levels when given concurrently. Such interactions may give rise to adverse effects. The effect of sertraline may be less profound than that of fluoxetine, fluvoxamine and paroxetine. Limited data suggest that citalopram may not affect TCA serum levels. There is scant literature evidence to support the use of SSRIs in combination with TCAs as a treatment for refractory depression.
The Camberwell Assessment of Need: The Validity and Reliability of an Instrument to Assess the Needs of People with Severe Mental Illness
Authors: Phelan Michael , Slade Mike , Thornicroft Graham , Dunn Graham , Holloway Frank , Wykes Til , Strathdee Geraldine , Loftus Linda , McCrone Paul , Hayward Peter
Published: October 2008

Background

People with severe mental illness often have a complex mixture of clinical and social needs. The Camberwell Assessment of Need (CAN) is a new instrument which has been designed to provide a comprehensive assessment of these needs. There are two versions of the instrument: the clinical version has been designed to be used by staff to plan patients' care; whereas the research version is primarily a mental health service evaluation tool. The CAN has been designed to assist local authorities to fulfil their statutory obligations under the National Health Service and Community Care Act 1990 to assess needs for community services.

Method

A draft version of the instrument was designed by the authors. Modifications were made following comments from mental health experts and a patient survey. Patients (n= 49) and staff (n= 60) were then interviewed, using the amended version, to assess the inter-rater and test-retest reliability of the instrument.

Results

The mean number of needs identified per patient ranged from 7.55 to 8.64. Correlations of the inter-rater and test-retest reliability of the total number of needs identified by staff were 0.99 and 0.78 respectively. The percentage of complete agreement on individual items ranged from 100–81.6% (inter-rater) and 100–58.1% (test-retest).

Conclusions

The study suggests that the CAN is a valid and reliable instrument for assessing the needs of people with severe mental illness. It is easily learnt by staff from a range of professional backgrounds, and a complete assessment took, on average, around 25 minutes.
The Nithsdale Schizophrenia Surveys. XIV: Plasma Lipid Peroxide and Serum Vitamin E Levels in Patients with and Without Tardive Dyskinesia, and in Normal Subjects
Authors: McCreadie Robin G. , MacDonald Elizabeth , Wiles David , Campbell Graham , Paterson John R.
Published: October 2008

Background

Tardive dyskinesia (TD) may be mediated through free radical damage to neurons. Plasma lipid peroxide levels are a measure of radical damage to fats. Vitamin E is a free radical scavenger.

Method

One hundred and twenty-eight schizophrenic patients were examined for TD using the Abnormal Involuntary Movements Scale. Blood samples were taken to measure plasma lipid peroxide, serum vitamin E and cholesterol, and vitamin Exholesterol ratios. Twenty-four patients were also examined in October 1993, January 1994, and April 1994. Biochemical results were compared in 81 patients and 79 normal subjects.

Results

Patients with and without TD did not differ in median plasma lipid peroxide and serum vitamin E levels, or vitamin Exholesterol ratios. Correlations between seasonal change scores in TD and biochemical measurements were low. Lipid peroxide levels were higher and vitamin Exholesterol ratios lower in patients than in normal subjects. Vitamin E levels were lowest in in-patients and in those living in supported accommodation.

Conclusions

The results do not support the hypothesis that TD is mediated through free radical damage to neurons, but suggest increased free radical activity in schizophrenia.
Long-term Effects of Cognitive-Behavioural Therapy and Lithium Therapy on Depression in the Elderly
Authors: Wilson K. C. M. , Scott M. , Abou-Saleh M. , Burns R. , Copeland J. R. M.
Published: October 2008

Background

We examine the effects of cognitive-behavioural therapy (CBT) as an adjuvant to acute physical treatment and lithium maintenance therapy in reducing depression severity over a follow-up year in elderly depressed patients.

Method

The study consists of three phases. During the acute treatment and continuation phase, 17 of 31 patients received CBT as an adjuvant to treatment as usual. During the maintenance phase of 1 year, subjects were entered into a double-blind, placebo-controlled study of low-dose lithium therapy.

Results

Receiving adjuvant CBT significantly reduced patients' scores on the Hamilton Rating Scale for Depression during the follow-up year (repeated measures analyses of variance; P = 0.007). No significant differences were found between lithium and placebo maintenance therapy.

Conclusions

CBT can be adapted as an adjuvant therapy in the treatment of severely depressed elderly patients and reduces depression severity during follow-up. The prophylactic failure of long-term lithium therapy may be explained through poor compliance.
The use of Statistics in the British Journal of Psychiatry
Authors: McGuigan S. M.
Published: October 2008

Background

Statistical error rates in the medical literature are generally high.

Method

All papers published in the British Journal of Psychiatry in 1993 which presented numerical results were reviewed by the author for statistical errors.

Results

A total of 248 papers were published, of which 164 (66%) presented numerical results.

Sixty-five (40% of 164) papers contained statistical errors. Many errors were not serious in nature, but some were serious enough to cast doubt on conclusions. The error rates are similar to those found in an earlier study.

Conclusions

The statistical error rate is unacceptably high. There is no evidence of a change in the statistical error rate over time.
Improving the Quality of Statistics in Psychiatric Research
Authors: Hand David , Sham Pak
Published: October 2008

David Hand

The paper by McGuigan in this issue of the BJP examines the frequency of errors in statistical methods presented in papers published in the BJP in 1993. In that year, 248 papers appeared, 164 contained numerical results, and 65 of these contained statistical errors. So, one might infer, some 26% of the papers in the BJP draw potentially doubtful conclusions. Moreover, the level of misunderstanding implied by some of the examples McGuigan cites is frightening.
Media Influence on Parasuicide
Authors: Simkin Sue , Hawton Keith , Whitehead Linda , Fagg Joan , Eagle Matthew
Published: October 2008

Background

Paracetamol self-poisoning, which carries a significant risk of fatal liver damage, is increasing in the UK, especially among adolescents. There is concern that media portrayal of suicidal behaviour may influence its occurrence. We have investigated the effects of two broadcasts of a television drama showing a teenage girl's overdose of paracetamol.

Method

Data from the Oxford Monitoring System for Attempted Suicide were used to examine changes in the number of overdoses and the use of paracetamol in the three week period before and after both broadcasts. An analysis of log-linear models was carried out, using additional data from two previous years, in order to control for the effects of gender, age group, time period, season, year and drug. A questionnaire was used to ascertain whether the programme had influenced patients' decisions to take an overdose or their choice of drug.

Results

An increase in paracetamol overdoses occurred following the first broadcast, but when data from the two previous years were examined and the log-linear analysis was used there was no evidence of significant effects attributable to the broadcasts. The questionnaire study revealed that very few people had seen either episode, and only two claimed that it had influenced them (one in terms of getting help).

Conclusions

It is important to use sound methodology to avoid interpreting chance fluctuations as a media effect. The potential positive benefits of such programmes should also be investigated.
Correlates and Short-Term Course of Self-Poisoning in Adolescents
Authors: Kerfoot Michael , Dyer Elizabeth , Harrington Val , Woodham Adrine , Harrington Richard
Published: October 2008

Background

The features of adolescents who had taken an overdose were assessed to determine the focus for a treatment trial.

Method

Overdose cases were compared with psychiatric and community controls who had not taken an overdose in respect of mental disorders and family background.

Results

Overdose cases had high rates of major depression, but most of them recovered from depression within six weeks of the overdose. There was a specific association between taking an overdose and family dysfunction.

Conclusions

Family dysfunction could be a useful focus in a clinical trial of the aftercare of adolescents who have taken an overdose.
Psychopathology, Social and Cognitive Functioning in a Hostel for Homeless Women
Authors: Adams Clive E. , Pantelis Christos , Duke Peter J. , Barnes Thomas R. E.
Published: October 2008

Background

This study surveyed all residents in a hostel for homeless women. Demographic data, and information on past and present psychiatric and social morbidity and current and premorbid cognitive functioning were collected.

Method

A four week prevalence study using: SCID–PD; a semi-structured interview; GHQ; SBS; Manchester Scale; MMSE; and NART; the data were analysed using SPSS.

Results

The women originated from across the social spectrum and disruption of early family life was common. Fifty per cent had a ‘severe mental illness’ and most were not receiving drug treatment. High levels of active psychotic symptoms were present. Women with psychosis had suffered a greater intellectual decline from their premorbid levels of functioning than those without psychosis.

Conclusions

The study affirmed findings of earlier studies employing case-series methodology. Women with high levels of psychiatric morbidity and social dysfunction were being managed by care workers in a way that may promote stability rather than a drift into street-life.
Perceptions of the Significant Other of the Effects of Psychodynamic Psychotherapy
Authors: Roberts Jane
Published: October 2008

Background

Clinical practice suggests that partners of psychotherapy patients often have powerful feelings about the therapy and therapist. The repercussions of psychotherapy on those close to the patient are rarely considered. A small exploratory study was therefore conducted.

Method

All patients who had completed at least two months of weekly psychodynamic psychotherapy in 1990 at an out-patient unit of a psychiatric hospital (n = 35) and had a partner with whom they were living at the time of starting therapy (n = 23) were contacted. Eight gave permission for their partner to be contacted directly. All eight partners agreed to participate in a semi-structured interview exploring their perceptions of the effects of the therapy on a number of family relationships. The impact of the process of the study was also investigated by means of a questionnaire sent to all partners some weeks after the interview.

Results

Considerable changes were perceived to have taken place in association with therapy affecting not only the relationship between the couple but also their parenting relationship, the children, and at times members of the extended family. Partners' views about the direction of such changes seemed to influence other perceptions about the therapy.

Conclusions

The repercussions of individual psychotherapy may well spread extensively within a family. This further blurs the boundary between individual and family therapy, both theoretically and clinically. Research procedures are themselves a major intervention and may have a considerable emotional impact on participants.
Minor Physical Anomalies and their Relationship to the Aetiology of Schizophrenia
Authors: Murphy Kieran C. , Owen Michael J.
Published: October 2008

Background

Previous reports have suggested an increased prevalence of minor physical anomalies (MPAs) in schizophrenia.

Method

A review of the literature was performed to examine the relationship between MPAs, schizophrenia and other disorders.

Results

Previous studies demonstrate a number of methodological shortcomings. Moreover, MPAs are found in several other psychiatric disorders. Proponents of the neurodevelopmental model of schizophrenia have focused on an environmental explanation for the increased prevalence of MPAs. We argue that this may be overly simplistic and propose various ways in which genetic factors may also be involved.

Conclusions

Better studies should be performed to examine more precisely the nature of MPAs in schizophrenia and other disorders and also the relationship between MPAs and other developmental abnormalities. At present, it is unclear if MPAs are directly related to the pathogenesis of the disorder or even if they are related to the timing of critical events.
Moclobemide in Elderly Patients with Cognitive Decline and Depression: An International Double-blind, Placebo-controlled Trial
Authors: Roth M. , Mountjoy C. Q. , Amrein R. ,   The International Collaborative Study Group
Published: October 2008

Background

The new reversible MAOI moclobemide was compared with placebo in the treatment of elderly patients with DSM–III diagnosis of dementia and/or of major depression.

Method

Six hundred and ninety-four elderly patients with symptoms of depression and cognitive decline entered an international, multi-centre, double blind trial in which they were randomly allocated to treatment with either moclobemide 400 mg daily or placebo for 42 days. Five hundred and eleven patients met DSM–III criteria for dementia and were also depressed (DEM+D); 183 did not meet DSM–III criteria for dementia but met the criteria for DSM–III major depressive episode and also suffered from cognitive decline (MDE+CD).

Results

Analysis of the 17 and 24-item Hamilton Depression Scale scores showed that moclobemide, compared with placebo, produced significantly greater improvement in both the demented and depressed groups (P= 0.001 both diagnostic groups). There was an improvement in cognitive function as measured by the SCAG Factor 1 in moclobemide treated patients (P= 0.005 DEM+D;P= 0.02 MDE+CD). There was no evidence of decline in cognitive function as the result of treatment Clinical global assessment of tolerance was ‘excellent’ and ‘good’ in 88% of the moclobemide and in 92% of the placebo treated patients. The proportion of patients discontinuing treatment prematurely was similar in both treatment groups. There were no significant differences in side-effects between treatment groups. There were no significant changes in vital signs, ECG or laboratory findings in either treatment group. There were no dietary restrictions and no report of any tyramine reaction.

Conclusions

Moclobemide was shown to be a safe, well tolerated and effective antidepressant, which did not cause impairment of cognitive function in elderly patients with a DSM–III diagnosis of dementia and/or DSM–III major depression.
Social Phobia in General Health Care: An Unrecognised Undertreated Disabling Disorder
Authors: Weiller E. , Bisserbe J. -C. , Boyer P. , Lepine J. -P. , Lecrubier Y.
Published: October 2008

Background

This study explored the prevalence of social phobia (SP) in general health care, sociodemographic characteristics of patients with SP, the age at onset and severity of SP, its comorbidity with other psychiatric disorders, and the recognition by general practitioners.

Method

The study was conducted in Paris as part of the WHO study on Psychological Problems in General Health Care. Among 2096 consecutive primary care patients, 405 were interviewed using the CIDI. DSM–III–R diagnoses, severity and disability were assessed.

Results

The one-month prevalence of SP is high (4.9) in primary care, although underdiagnosed by GPs. It has an early onset and leads to substantial disability. Patients with SP are at risk of developing further depression, alcoholism or suicidal behaviour.

Conclusion

SP appears to be a true and frequently severe pathological condition. The awareness of GPs and the general population should be improved.
Community Knowledge of Mental Illness and Reaction to Mentally Ill People
Authors: Wolff Geoffrey , Pathare Soumitra , Craig Jom , Leff Julian
Published: October 2008

Background

We test the hypothesis that negative attitudes to mentally ill people may be fuelled by a lack of knowledge.

Method

A census of knowledge of mental illness was conducted in two areas prior to the opening of long-stay supported houses for the mentally ill in each area. Three attitudinal factors (Fear and Exclusion, Social Control and Goodwill) which had been extracted by factor analysis of the Community Attitudes toward the Mentally III (CAMI) inventory (see previous paper) were analysed in respect of their associations with knowledge of mental illness.

Results

Most respondents (80%) knew of somebody who had a mental illness but a substantial proportion of respondents had little knowledge about mental illness. Social Control showed an association with knowledge of mental illness. Groups who showed more socially controlling attitudes (especially those over 50 years old, those of lower social class, and those of non-Caucasian ethnic origin) had less knowledge about mental illness. Regression analysis revealed that when knowledge was taken into account age had no effect on Social Control, and the effect of social class and ethnic origin was diminished Respondents with children, who showed more Fear and Exclusion, were not less knowledgeable about mental illness.

Conclusions

The results support the hypothesis that negative attitudes, especially in older people, are fuelled by a lack of knowledge. Negative attitudes among people with children are not related to a lack of knowledge.
The Impact of Education Groups for People with Schizophrenia on Social Functioning and Quality of Life
Authors: Atkinson Jacqueline M. , Coia Denise A. , Gilmour W. Harper , Harper Janice P.
Published: October 2008

Background

Education groups for people with schizophrenia have tended to concentrate on compliance with medication. This study examines impact on social behaviour and quality of life.

Method

A catchment-wide service was set up for community-based patients. Patients who indicated an interest in education groups were randomly allocated to either an education group or a waiting list control group. Those who attended groups were compared with the control group.

Results

About one-quarter of community-based patients showed interest in attending education groups. Those who attended showed no change in mental state or compliance with medication (already high) but significant gains in quality of life, social functioning and social networks.

Conclusions

For patients who choose to attend education groups significant gains in social functioning and quality of life are possible without specific skills training.
Testing the Effect of Season of Birth on Familial Risk for Schizophrenia and Related Disorders
Authors: Hettema John M. , Walsh Dermot , Kendler Kenneth S.
Published: October 2008

Background

An excess of late winter and early spring births in schizophrenia has been repeatedly demonstrated. Previous evidence has suggested that the risk for schizophrenia may differ in relatives of schizophrenic probands born in this high risk period v. at other times of the year.

Method

In an epidemiologically based family study conducted in the west of Ireland, we examined the relationship between season of birth in schizophrenia and schizophrenia spectrum probands and the risk for schizophrenia and related disorders in first-degree relatives. Risk was assessed using the Cox proportional hazard method. We examined four birth seasons previously shown to significantly predict risk for schizophrenia.

Results

Neither the risk for schizophrenia nor that for schizophrenia spectrum disorders in relatives was significantly associated with season of birth in probands.

Conclusions

Season of birth does not, in this sample, identify schizophrenic probands with particularly high or low familial vulnerability to illness.
Quality of Life as an Evaluative Measure in Assessing the Impact of Community Care on People with Long-Term Psychiatric Disorders
Authors: Barry Margaret M. , Crosby Charles
Published: October 2008

Background

The impact of community resettlement on the quality of life of people with long-term psychiatric disorders, is evaluated in a longitudinal study.

Method

A repeated measures design was used to examine the sensitivity of an adapted version of Lehman's Quality of Life Interview in evaluating change. Completed interviews were carried out with 29 of the original cohort at one year post-discharge. The relationship between quality of life and ratings of client functioning is explored.

Results

Significant changes in the objective quality of life indices include improved living conditions (F = 40.00, P < 0.001), higher levels of social contact (F = 29.52, P < 0.01) and increased leisure activities (F = 4.57, P < 0.05). Apart from increased satisfaction with living situation (F = 6.94, P < 0.01), there were no significant changes in the subjective indices. Ratings of psychiatric state and social functioning did not significantly correlate with global quality of life at one year post-discharge.

Conclusions

Concerns in relation to the sensitivity of life satisfaction ratings in evaluating programme interventions are raised.
Abnormal Movements in Never-Medicated Indian Patients with Schizophrenia
Authors: McCreadie R. G. , Thara R. , Kamath S. , Padmavathy R. , Latha S. , Mathrubootham N. , Menon M. S.
Published: October 2008

Background

Historical records suggest dyskinesia was observed in severely ill institutionalised patients with schizophrenia in the pre-neuroleptic era More recent work has not found dyskinesia in never-medicated younger and middle aged patients. The present study complements this recent work and avoids the confounders of severity of illness and institutionalism by examining elderly patients in a wide variety of community settings.

Method

Movement disorders were examined in 308 elderly individuals in Madras, India, using the Abnormal Involuntary Movements Scale, the Simpson and Angus Parkinsonism Scale and the Barnes Akathisia Scale. Patients' mental state was assessed by the Positive and Negative Syndrome Scale.

Results

Dyskinesia was found in 15% of normal subjects (n=101, mean age 63 years), 15% of first degree blood relatives of younger schizophrenic patients (n=103, mean age 63 years), 38% of never medicated patients (n=21, mean age 65 years) and 41 % of medicated patients (n=83, mean age 57 years). The respective prevalences for Parkinsonism were 6%, 11 %, 24% and 36%; and for akathisia 9%, 5%, 21 % and 23%. Dyskinesia was associated with negative schizophrenic symptoms.

Conclusions

Dyskinesia in elderly schizophrenic patients is an integral part of the illness and not associated with antipsychotic medication.
Prolactin Response to Fenfluramine and Suicide Attempt Lethality in Major Depression
Authors: Malone Kevin M. , Corbitt Elizabeth M. , Li Shuhua , Mann J. John
Published: October 2008

Background

This study employed an alternative method for assessing serotonergic function to further evaluate our finding that cerebrospinal fluid (CSF) 5-hydroxyindole acetic acid (5-HIAA) in depressed suicide attempters with a lifetime history of higher lethality suicide attempts is significantly lower compared to depressed patients who have a history of low lethality suicide attempts.

Method

We used dl-fenfluramine (60 mg) as a neuroendocrine probe to examine the serotonin system in 41 in-patients with a DSM–III–R major depressive episode, divided into two groups on the basis of a lifetime history of high or low lethality suicide attempts. Fenfluramine challenge test outcome was defined as the maximum prolactin response in the five hours following fenfluramine.

Results

Patients with a history of a higher lethality suicide attempt had a significantly lower prolactin response to fenfluramine, even when controlling for cortisol, age, sex, weight, comorbid cluster B personality disorder, pharmacokinetic and menstrual cycle effects.

Conclusions

The data provide further support for the hypothesis that serotonin dysfunction is associated with more lethal suicide attempts, and suggests that higher lethality suicide attempters or failed suicides resemble completed suicides both behaviourally and biochemically.
The Reliability and Characteristics of the Brief Syntactic Analysis
Authors: Thomas Philip , Kearney Gabby , Napier Elizabeth , Ellis Elin , Leudar Ivan , Johnston Margaret
Published: October 2008

Background

Linguistic analysis is of great potential benefit to psychiatry as a research and assessment tool, but the skill and time it demands means that it has not been widely used. This paper describes a much simplified form of syntactic analysis.

Method

A detailed protocol for the Brief Syntactic Analysis (BSA) was written, based on earlier work by Morice and Ingram. Three psychiatrists were trained in its use, and inter-rater reliability established through independent ratings of 12 transcripts taken from a mixed group of psychiatric patients and a group of non-psychiatric controls. Concurrent reliability of the BSA against the Morice and Ingram analysis was established by comparing measures from the two methods on 16 transcripts of mixed patients.

Results

There were high levels of agreement between the three psychiatrists and between the BSA and the Morice and Ingram analysis, although one-way ANOVA indicated that for some variables there were small but statistically significant absolute differences between the two. The reasons for this were discussed. A principal components analysis confirmed the presence of three factors corresponding closely to the three families of linguistic variables.

Conclusions

The results indicate that psychiatrists can be trained to use a syntactic analysis with high levels of agreement. The BSA, which takes much less time to complete, produces measures that are comparable with the original analysis from which it was derived.
Somatisation in Primary Care in Spain
Authors: Lobo Antonio , García-Campayo Javier , Campos Ricardo , Marcos Guillermo , Pérez-Echeverria Ma Jesus ,   the GMPPZ
Published: October 2008

Background

This is the first attempt to study the prevalence and clinical characteristics of somatisation (ST) in a representative primary care sample in Spain.

Method

The sample consisted of 1559 consecutive patients attending eight randomly selected health centres in Zaragoza, Spain, examined by two-phase screening. First phase (lay interviewers): Spanish versions of GHQ–28, CAGE questionnaire, substance abuse, Mini-Mental State Examination. Second phase (research clinicians and psychiatrists): Standardised Polyvalent Psychiatric Interview, which permits the reliable coding of Bridges & Goldberg's ST criteria.

Results

The prevalence of somatisers was 9.4% (34.5% of the cases) and most patients (68.7%) were diagnosed in the depression or anxiety DSM–IV categories. The severity was moderate in 40.1 % and 66.6% were chronic (six or more months). No significant demographic differences were found with non-cases. Backache was the most frequent somatic presentation (71.4%).

Conclusions

ST in primary care is a much broader phenomenon than categories such as somatoform disorders reflect. It may be less influenced by sociodemographic factors, but more chronic than previously reported.
Validity of the Schizophrenia Diagnosis of the Psychiatric Assessment Schedule for Adults with Developmental Disability (PAS–ADD)
Authors: Moss Steve , Prosser Helen , Goldberg David
Published: October 2008

Background

First rank symptoms are central to the diagnosis of schizophrenia, but their complexity makes it difficult to validly detect them in people with learning disability. This report investigates ability of PAS–ADD to detect schizophrenia, validated against expert clinical opinion.

Method

The sample consisted of 98 patients with learning disability, and a key informant for each sample member. Clinical opinions of the referring psychiatrists were sought using a symptom checklist. Reportage of remission, and the number of core schizophrenia symptoms identified, were used to estimate level of symptom activity at time of interview.

Results

The proportion of schizophrenia cases detected by PAS–ADD increases with the number of active core symptoms identified by the referrer. Where two or more core symptoms were indicated, PAS–ADD detected 71 % cases. The most frequently fulfilled criterion was third-person auditory hallucinations. Six schizophrenia diagnoses disagreed with the clinician, four of which were referred as being hypomania. Overall symptom frequency detected by PAS–ADD was positively correlated with IQ.

Conclusions

Results suggest there may be scope for modifying the ICD–10 diagnostic algorithm for use with learning disability, particularly in relation to thedelusionsandnegative symptomscriteria.
Residential Care in Hospital and in the Community – Quality of Care and Quality of Life
Authors: Shepherd Geoff , Muijen Matt , Dean Rachel , Cooney Margaret
Published: October 2008

Background

The reduction of beds in long-stay hospitals has led to concerns over the quality of care offered to the remaining residents as well as that provided in the community. This study seeks to compare the quality of care and quality of life (reported satisfaction) from residents in both types of setting.

Method

A cross-sectional comparison was made of community residential homes and hospital wards drawn randomly from lists provided by local authorities in the outer London area. Samples were drawn from all the main provider types (local authority, housing association, private and joint NHS/voluntary sector). Measures were taken of the quality of the physical environment, staff and resident characteristics, external management arrangements and internal management regimes, resident satisfaction and staff stress. Direct observations were also made of the amount and quality of staff-resident interactions.

Results

In general, the most disabled residents were found to be still living in hospital in the worst conditions and receiving the poorest quality of care. Although there were some problems with missing data, hospital residents also seemed most dissatisfied with their living situation. There were few differences between community providers regarding either the quality of care provided or the levels of reported satisfaction. Quality of care in the community homes seemed to be much more determined by the personality and orientation of project leaders.

Conclusions

Purchasers and providers still need to give attention to the problems of selectively discharging the most able residents to the community, leaving the most disabled being looked after in progressively deteriorating conditions. All residential providers need to review their internal management practices and try to ensure that residents are offered, as far as possible, the opportunity to make basic choices about where and how they will live. Staff training and quality assurance practices need to be reviewed in order to improve the direct quality of care offered to the most disabled individuals.
The Diagnosis and Prevalence of Hyperactivity in Chinese Schoolboys
Authors: Leung Patrick W. L. , Luk S. L. , Ho T. P. , Taylor Eric , Mak Felice Lieh , Bacon-Shone John
Published: October 2008

Background

This study was undertaken to examine the validity of different diagnostic definitions of hyperactivity in a Chinese population. Estimates of the prevalence of hyperactivity were made according to these different diagnostic definitions.

Method

In a two-stage epidemiological study of hyperactivity in Hong Kong, 3069 Chinese schoolboys were screened by questionnaires; and a stratified sample of 611 of them entered a second stage for more detailed diagnostic assessment.

Results

Children with hyperkinetic disorder (ICD–10) or ADDH (DSM–III) both displayed significant hyperactive symptoms, but with somewhat different external correlates; hyperkinetic disorder tended to show more neurodevelopmental impairments, ADDH more cognitive and educational difficulties. These findings raise the possibility of heterogeneity in the disorders present with hyperactivity. The DSM–III–R category of ADHD was more common, and those extra cases, that did not overlap with ADDH or hyperkinetic disorder, included children with no obvious behavioural, cognitive or neurodevelopmental impairments. Hence ADHD may be an over-inclusive category. Prevalence rates for hyperkinetic disorder, ADDH and ADHD were respectively 0.78%, 6.1% and 8.9%.

Conclusions

A disorder of hyperactivity does exist in the Chinese culture, displaying the same kinds of symptomatology and external correlates as in the West. The prevalence rates of hyperkinetic disorder and ADDH in Chinese schoolboys are on the low side when compared to those reported in Western studies.
Should Amenorrhoea be Necessary for the Diagnosis of Anorexia Nervosa?
Authors: Garfinkel Paul E. , Lin E. , Goering P. , Spegg C. , Goldbloom D. , Kennedy S. , Kaplan A. S. , Woodside D. Blake
Published: October 2008

Background

This study compares the characteristics of women with anorexia nervosa with those of women who have all the diagnostic features of that disorder except amenorrhoea.

Method

The study uses data from a large community epidemiological survey of the mental health status of household residents in Ontario, Canada. A multi-stage stratified sampling design generated a sample of 4285 females aged 15–64. DSM–III–R diagnoses were made using the Composite International Diagnostic Interview.

Results

Eighty-four out of 4285 female respondents met full or partial-syndrome criteria for anorexia nervosa. Comparison of these two groups revealed few statistically significant differences in terms of demographics, psychiatric comorbidity, family history or early experiences.

Conclusions

Amenorrhoea did not discriminate between women with anorexia nervosa and women with all the features except amenorrhoea across a number of relevant variables. The authors question the utility of amenorrhoea as a diagnostic criterion.
Abnormal Electroretinogram in Cocaine-Dependent Patients
Authors: Roy Monique , Smelson David A. , Roy Alec
Published: October 2008

Background

The retina contains high concentrations of dopamine. We previously reported that recently withdrawn cocaine-dependent patients had significantly reduced blue cone b wave amplitude responses on the electroretinogram (ERG). In this study we wished to examine if there was a relationship between cocaine craving and reduced blue cone b wave ERG responses.

Methods

A series of 14 recently withdrawn cocaine-dependent patients completed a 45-item cocaine craving questionnaire shortly before the ERG.

Results

Cocaine dependent patients who had a reduced (<0.5 microvolts) blue cone b wave ERG response had significantly higher cocaine craving scores than patients without a reduced blue cone ERG response. There was also a significant negative correlation between blue cone b wave amplitude responses and scores on the cocaine craving questionnaire.

Conclusion

A reduced blue cone b wave ERG response may identify recently withdrawn cocaine-dependent patients with biological dysregulation and increased cocaine craving.
Consent to Neuroleptic Medication for Schizophrenia: Clinical, Ethical and Legal Issues
Authors: Brabbins Clare , Butler Jonathan , Bentall Richard
Published: October 2008

Background

The effects of neuroleptic medication on schizophrenic patients are both positive (reduction in symptoms) and negative (adverse side-effects). Given that altered cognitive functioning may be a feature of schizophrenia, the use of neuroleptics raises important ethical and legal issues.

Method

A selective review was carried out of papers addressing ethical arguments for and against obtaining consent from schizophrenic patients, and the ethical and legal requirements which must be met for consent to occur.

Results

Although a balance must be met between arguments for and against obtaining consent, clinicians should seek informed consent in all but exceptional circumstances. Obtaining consent depends on the adequate presentation of information, the absence of duress and the patients' capacity to consent. Various tests of capacity to consent have been proposed.

Conclusions

It is proposed that clinicians employ a proforma to record attempts to obtain informed consent during routine clinical practice.
Verbal Creativity, Depression and Alcoholism
Authors: Post Felix
Published: October 2008

Background

An earlier study of 291 world famous men had shown that only visual artists and creative writers were characterised, in comparison with the general population, by a much higher prevalence of pathological personality traits and alcoholism. Depressive disorders, but not any other psychiatric conditions, had afflicted writers almost twice as often as men with other high creative achievements. The present investigation was undertaken to confirm these findings in a larger and more comprehensive series of writers, and to discover causal factors for confirmed high prevalences of affective conditions and alcoholism in writers.

Method

Data were collected from post-mortem biographies and, where applicable, translated into DSM diagnoses. The frequencies of various abnormalities and deviations were compared between poets, prose fiction writers, and playwrights.

Results

A high prevalence in writers of affective conditions and of alcoholism was confirmed. That of bipolar affective psychoses exceeded population norms in poets, who in spite of this had a lower prevalence of all kinds of affective disorders, of alcoholism, of personality deviations, and related to this, of psychosexual and marital problems, than prose fiction and play writers.

Conclusions

A hypothesis is developed, which links the greater frequency of affective illnesses and alcoholism in playwrights and prose writers, in comparison with poets, to differences in the nature and intensity of their emotional imagination. This hypothesis could be tested by clinical psychologists collaborating with experts in literature on random samples of different kinds of writers.
Idazoxan and Response to Typical Neuroleptics in Treatment-Resistant Schizophrenia
Authors: Litman Robert E. , Su Tung-Ping , Potter William Z. , Hong Walter W. , Pickar David
Published: October 2008

Background

We investigated whether antagonism of α2adrenergic receptors would augment treatment response in schizophrenia, by administering idazoxan, an α2antagonist drug, to treatment-resistant patients on typical neuroleptics.

Method

Seventeen hospitalised treatment-resistant patients with DSM–III–R schizophrenia or schizoaffective disorder were studied on typical neuroleptic treatment, on treatment with idazoxan plus typical neuroleptic, and after discontinuation of idazoxan, in fixed, non-random order, and under double-blind, placebo-controlled conditions.

Results

The addition of idazoxan to fluphenazine treatment resulted in significant reductions of global psychosis and total, positive and negative symptoms on the Brief Psychiatric Rating Scale, compared to neuroleptic treatment alone. Symptom improvement significantly correlated with idazoxan-induced changes in indices of noradrenergic function. In a subgroup of patients, idazoxan plus typical neuroleptic treatment compared favourably with clozapine treatment, when both were compared to typical neuroleptic treatment alone.

Conclusions

The antagonism of α2receptors augmented therapeutic response to typical neuroleptic treatment in treatment-resistant patients with schizophrenia. This antagonism may contribute to clozapine's superior antipsychotic effects.
Present Use of the Hamilton Depression Rating Scale: Observations on Method of Assessment in Research of Depressive Disorders
Authors: Snaith R. P.
Published: October 2008

Background

The Hamilton Depression Rating Scale retains its primacy in research. There have been recent important critiques. It is clear that instructions provided by its author are widely overlooked.

Method

A survey of the present use of the HDRS was conducted by inspection of five major journals publishing studies in the field of psychiatry. Note was especially made of whether a recognised version of the Scale was quoted; also of whether authors had selected specific scores on one or other of the versions to indicate a criterion for inclusion of a subject in a study, and likewise whether a specific score had been selected as an indication of recovery following some procedure or treatment.

Results

One hundred and fourteen articles were reviewed in which 71 had used a depression scale. This was the HDRS in 66% of the studies. There was considerable evidence that the instruction that the HDRS was only to be used in situations where the patient had received a diagnosis of a primary depressive illness had been ignored. There was considerable degree of arbitrary selection of Scale scores.

Conclusions

The survey causes concern about the methodology of much research in the field of assessment of severity of psychiatric disorder. The rationale of assessment by the rating scale method is considered and suggestion made for improvement in research practice.
Validity of the Arabic Version of the Eating Disorders Inventory (EDI)
Authors: Al-Subaie Abdullah S. , Bamgboye Elijah , Al-Shammari Sulaiman , Al-Sabhan Khalid N. , Al-Shehri Sulaiman Nasser , Bannah Azzah Ramadan Sayed
Published: October 2008

Background

We aimed to validate the Eating Disorders Inventory (EDI) in Arabic.

Methods

Subjects were chosen randomly from female school students. Only healthy Saudi students were included. They were asked to fill the EDI and undergo a semi-structured interview by a psychiatrist who was unaware of the EDI scores. Of 146 students approached 12 did not meet our criteria and were excluded; 16 other students were excluded for incomplete responses.

Results

The difference between the two diagnostic methods in the proportion of caseness was statistically significant (P < 0.0001). The scores on Perfectionism, Maturity Fears and Interoceptive Awareness were significantly higher in the Saudi students compared with Canadians (P < 0.05).

Conclusions

The EDI-DT subscale has a sensitivity of 100% and a specificity of 85%. Despite its low positive predictive value of 5%, it may be useful for screening large non-clinical groups for eating disorders.