bluuebunny/crossref_metadata_2025 huggingface dataset:
A Placebo-Controlled Trial of d-Fenfluramine in Bulimia Nervosa
Authors: Fahy Thomas A. , Eisler Ivan , Russell Gerald F. M.
Published: October 2008

d-Fenfluramine is a 5-HT agonist which decreases food intake and excessive carbohydrate intake in humans. A placebo-controlled trial of d-fenfluramine (45 mg/day) was conducted in 43 patients with bulimia nervosa. The patients entered an eight-week trial of medication during which they also received cognitive-behavioural therapy. Treatment response was assessed using food diaries to record eating behaviour, and self-rating questionnaires to measure psychopathology. The drug trial, and a follow-up assessment after a further eight weeks, were completed by 39 patients. Abnormal eating behaviour and psychopathology improved significantly in both the d-fenfluramine and placebo groups during the treatment trial. The study failed to show that the addition of d-fenfluramine affords an advantage over brief psychotherapy alone. Although d-fenfluramine is effective in suppressing the overeating, excessive snacking, and excessive carbohydrate consumption which are frequently found in overweight or obese patients, this study suggests that the drug is not an effective treatment for bulimia nervosa.
Child and Adult Depression: A Test of Continuities with Data from a Family Study
Authors: Harrington R. C. , Fudge H. , Rutter M. L. , Bredenkamp D. , Groothues C. , Pridham J.
Published: October 2008

The summaries of clinical data on children attending the Maudsley Hospital during the years 1968-72 were used to identify 80 children meeting operational criteria for depression, and 80 matched psychiatric control children. At follow-up, on average 18 years after the initial contact, information was obtained on the adult outcomes of 62 of the depressed children and 69 of the controls. At least one first-degree relative of 111 (85%) of these probands was interviewed; the great majority of interviews with relatives were conducted ‘blind’ to the proband's symptoms in both childhood and adulthood. The lifetime prevalence of RDC depression was significantly higher in the 128 interviewed relatives of the depressed children than in the 151 relatives of the controls. Higher rates of depression were found among the female relatives of both the depressed and control probands. These findings suggest that depression in young people resembles depression in adults in two key respects: it tends to run in families, and there are higher rates of depression among the female than among the male first-degree relatives.
Comment on the London/Toronto Study of Alprazolam and Exposure in Panic Disorder with Agoraphobia
Authors: Spiegel David A. , Roth Martin , Weissman Myrna , Lavori Philip , Gorman Jack , Rush John , Ballenger James
Published: October 2008

The study reported by Marks et al is of considerable importance, since it is the largest clinical trial to date comparing the combination of a benzodiazepine and behaviour therapy to either component alone, and the first combined treatment trial to use alprazolam as the pharmacological agent. It was an ambitious project that was apparently well run, and the findings should be of wide interest. However, the potential value of the study is limited by the method, the patient sample, and the analysis and presentation of the data.
Concepts of Disease and the Abuse of Psychiatry in the USSR
Authors: Fulford K. W. M. , Smirnov A. Y. U. , Snow E.
Published: October 2008

There is a strong prima facie case linking the abuse of psychiatry with difficulties about the concept of mental illness. However, a survey of recent Soviet literature showed that the concept of disease employed in the former USSR (where abuse was for a time widespread) was similar to its counterparts in the UK and USA in being strongly scientific in nature. A number of factors - legal, bureaucratic and professional - are important in abuse becoming widespread. These, however, fail to explain why psychiatry, rather than physical medicine, should be vulnerable to abuse. It is here that the concept of disease could be important. A scientific model of disease suggests that a significant vulnerability factor is the relatively underdeveloped status of psychiatry as a science. This leaves room for poor standards of scientific work in clinical research and practice, factors which are recognised as important in the Soviet case. In addition to the scientific element, there is an evaluative element of meaning in the concept of disease. Hence a second vulnerability factor could be the evaluatively problematic nature of judgements. of mental illness. It is concluded that a failure to recognise this factor greatly increases the vulnerability of psychiatry, not only to gross abuses, but also to inadvertent misuses of involuntary treatment in everyday practice. This conclusion, far from undermining the role of science in psychiatry, is a step towards clarifying its proper role.
Multiple Personality Disorder Following Childbirth
Authors: O'Dwyer J. M. , Friedman T.
Published: October 2008

A case of multiple personality disorder is described as a coping mechanism protecting the patient from the abuse to which she was subjected throughout her life. The multiple personalities became more prominent following the birth of a severely handicapped child.
A Controlled Trial of Home-Based Acute Psychiatric Services
Authors: Burns Tom , Beadsmoore Alan , Bhat Ashok V. , Oliver Andrew , Mathers Carola
Published: October 2008

While research has shown community-based psychiatric care to be as good as, or better than, hospital-based care, generalisation to clinical practice has been difficult. This prospective, randomised controlled study examined a community-based approach feasible within NHS conditions. Ninety-four patients were randomly allocated to experimental and 78 to control treatments and followed for one year. The groups were well matched apart from an excess of psychotic control patients. No differences in clinical or social functioning outcome were found. Both groups improved substantially on clinical measures in the first six weeks, with some slow consolidation thereafter. There were three suicides in the control group and one in the experimental group. Access to care was better in the experimental group (93% attended assessment) than in the control group (75% attended assessment).
Seasonal Variations of Current Symptoms in a Healthy Population
Authors: Schlager David , Schwartz Joseph E. , Bromet Evelyn J.
Published: October 2008

Among a large workplace population interviewed over a year, current symptoms were assessed using the Hopkins Symptom Checklist (HSCL). Variation in symptoms by date of assessment was observed among the 314 women but not the 1556 men. Among women, symptoms were greatest during late autumn and winter, and significant inverse correlations were found between available daylight at the time of assessment and standard symptom dimensions of anxiety and somatisation, as well as an expanded mood scale more inclusive of depressive symptoms within the check-list. The amplitude of the seasonal effect was such that the prevalence of female ‘cases', as defined by HSCL criteria, was twice as high during winter than during the rest of the year. The data are consistent with a role for light-dark exposure in eliciting or synchronising annual mood rhythms. The sex-by-season interactions may contribute to the sex differences in overall prevalence of depression.
Seasonal Affective Disorder: Response to Light as Measured by Electroencephalogram, Melatonin Suppression, and Cerebral Blood Flow
Authors: Murphy D. G. M. , Murphy D. M. , Abbas M. , Palazidou E. , Binnie C. , Arendt J. , Costa D. Campos , Checkley S. A.
Published: October 2008

This study was designed to test the hypothesis that patients with SAD have significantly different physiological responses to light than healthy age- and sex-matched controls. We studied retinal contrast sensitivity, visual evoked EEG responses, and melatonin suppression by, and cerebral blood flow response to, full-spectrum artificial daylight. There was no significant difference between 10 patients and 11 controls in retinal contrast sensitivity, or amplitude or latency of N2, P2, P100 or P300 on EEG. We compared melatonin suppression in 12 SAD patients and 12 controls. During exposure to 500 lux and 1500 lux artificial daylight both the SAD patients and controls had a significant melatonin percentage suppression; however, the percentage suppression did not differ significantly between the SAD patients and the controls. In addition, we carried out a small pilot study into the effect of light on cerebral blood flow in four SAD patients and four controls. Before exposure to 1500 lux artificial daylight there was no significant difference between patients and controls in global, regional or cerebral hemispheric blood flow. After light exposure the SAD patients and controls had a significantly different percentage change in cerebral blood flow. We suggest that patients with SAD do not have significantly physiological responses to light than controls, except perhaps in cerebral blood flow. Furthermore, mechanisms other than supersensitivity of melatonin suppression must explain both the pathophysiology of the disorder and its response to treatment with light.
Melatonin Rhythms in Seasonal Affective Disorder
Authors: Checkley S. A. , Murphy D. G. M. , Abbas M. , Marks M. , Winton F. , Palazidou E. , Murphy D. M. , Franey C. , Binme C. , Arendt J. , Costa D. Campos
Published: October 2008

We examined 24-hour melatonin rhythms from 20 patients with seasonal affective disorder (SAD) and 20 healthy volunteers. Patients and controls were individually matched for age, sex, and month of study. Plasma samples were taken at hourly intervals, and were assayed for melatonin by radio-immunoassay. The 24-hourly melatonin estimations for each individual were fitted to a cosine curve, and the significance of the curve fits was calculated. Two analyses were performed. In analysis 1 the following were calculated: (a) cosine fit, (b) significance of fits, (c) mean amplitude and acrophase (peak) and (d) mean melatonin levels. The curve fits were highly significant for all but three subjects (two patients, one control), but there were no significant differences in any measure between the two groups. In analysis 2 the comparisons were repeated and restricted to the 18 patients and 19 controls in whom there was a statistically significant melatonin rhythm. Again there were no significant differences between groups. These results suggest that the circadian rhythm of melatonin is not abnormal in SAD, and that the therapeutic effect of light in SAD is not mediated by phase shifts in melatonin secretion.
A Comparative Study of 470 Cases of Early-Onset and Late-Onset Schizophrenia
Authors: Howard Robert , Castle David , Wessely Simon , Murray Robin
Published: October 2008

The presence or absence of 22 schizophrenic symptoms was recorded with the age at onset of illness in 470 patients with non-affective, non-organic psychoses. Positive and negative formal thought disorder, affective symptoms, inappropriate affect, delusions of grandiosity or passivity, primary delusions other than delusional perception, and thought insertion and withdrawal were all more common in early-onset cases (age at onset 44 years or less;n= 336). Persecutory delusions with and without hallucinations, organised delusions, and third-person, running commentary and accusatory or abusive auditory hallucinations were all more common in late-onset cases (age at onset 45 years or more;n= 134). There was no difference between cases of early and late onset in the prevalence of delusions of reference, bizarre delusions, delusional perception, or lack of insight. We conclude that although there are clinical similarities between cases of schizophrenia with early and late onset, there are sufficient differences between them to suggest that they are not phenotypically homogeneous.
A Community Study of Depression in Adolescent Girls
Authors: Goodyer Ian , Cooper Peter J.
Published: October 2008

The clinical characteristics of two subsamples of 11–16-year-old girls were determined from direct interview: those who met DSM-III-R criteria for an episode of major depressive disorder within the past month (n = 28); and those who did not currently meet these criteria but had done so at some time in the previous 12 months (n = 13). The symptom profiles of these cases were compared with a subsample of girls who reported depressive symptoms but did not meet DSM-III-R criteria and were designated as having a ‘partial syndrome’ (n = 93), and a sample of non-depressed controls (n = 129). Phobias and worry about peer acceptance were common in controls suggesting that these symptoms constitute normal adolescent concerns. The symptom profile of depressed cases altered across three age bands (11–12, 13–14, and 15–16 years), suggesting developmental influences on clinical presentation. Comorbidity for anxiety, behavioural, and obsessional disorders was found in 40% of the depressed cases. None of the cases of major depressive disorder was known to the clinical services.
A Hormonal Component to Postnatal Depression
Authors: Harris Brian
Published: October 2008

Disorders of the thyroid gland are associated with disorders of mood (Thomas et al, 1970; Van Uitert & Russakoff, 1979; Folks, 1984; Young, 1984; Jadresic, 1990). Both hypothyroid and hyperthyroid states can be associated with depression, which is sometimes accompanied by psychotic features such as delusions and hallucinations (Wilson & Jefferson, 1986). Similarly, primary affective disorders can be accompanied by changes in thyroid function, with low thyroid-stimulating hormone (TSH) levels and elevated thyroxine (T4) (Kirkegaard & Faber, 1980), and in major depressive illness there is often a blunted TSH response to thyrotrophin releasing hormone (TRH) (Prange et al, 1972; Loosen, 1987).
Postnatal Emotional Disorders in Nigerian Women
Authors: Aderibigbe Y. A. , Gureje Oye , Omigbodun O.
Published: October 2008

One hundred and sixty-two women were evaluated for psychiatric morbidity in the second trimester of pregnancy and also six to eight weeks postnatally. A sizeable proportion of the women also had a second prenatal assessment in their third trimester and in the lying-in ward shortly after giving birth. Assessments were conducted with the 28-item GHQ. This was initially validated using a subsample of 106 women, taken from the original group, who were interviewed with the PAS. Thirty per cent of the women were ‘cases' at the first prenatal assessment, while only 14% were ‘cases' six to eight weeks postnatally. Thus, even though there was an overlap between prenatal and postnatal morbidity, there was also substantial difference between the groups that were symptomatic at both periods. This observation was reinforced by the low correlation between the mean GHQ scores at both periods. Both prenatal and postnatal morbidities were associated with recent adverse life events, with the latter more likely to be associated with marital and family events. This observation is in support of the view that neurotic problems, prenatally or postnatally, are caused mainly by psychosocial factors.
Serum Iron Abnormalities in Neuroleptic-Induced Akathisia in Schizophrenic Patients
Authors: Soni Som D. , Tench David , Routledge R. C.
Published: October 2008

Twenty-two schizophrenic patients (DSM-III-R criteria) with clinically significant akathisia were matched with 22 schizophrenic patients without akathisia on the following variables: age, sex, diagnosis, duration of illness, and current treatment. Both groups were assessed using a variety of clinical rating scales and several parameters of serum iron status. The akathisic patients showed greater severity of clinical psychopathology, particularly positive symptoms, and an excess of extrapyramidal side-effects. We were unable to confirm any association between low serum iron and neuroleptic-induced akathisia in our sample of community-based patients.
Psychiatric Presentation of a Third Ventricular Colloid Cyst in a Mentally Handicapped Woman
Authors: Jones Alison M.
Published: October 2008

A 42-year-old mentally handicapped woman presented with symptoms of affective disorder which resolved completely on excision of a colloid cyst of the third ventricle.
Personality Disorders in Patients with Somatisation Disorder
Authors: Stern Julian , Murphy Michael , Bass Christopher
Published: October 2008

Twenty-five women with somatisation disorder (SD) were compared with matched patient controls for the presence of personality disorders. Personality was assessed with the Personality Assessment Schedule (PAS). Interviewers were unaware of the patients' diagnoses. All controls had DSM–III–R axis I diagnoses of depressive or anxiety disorders. The prevalence of personality disorders among patients with somatisation disorder was 72% compared with 36% among controls. Certain personality disorders, including passive–dependent, histrionic, and sensitive–aggressive, occurred significantly more often in the SD patients than controls.
Poppy Tea Dependence
Authors: Unnithan Sujata , Strang John
Published: October 2008

A patient presenting with dependence on opium poppy tea infusion is reported. Poppy tea drinking, although previously described in certain parts of the UK, rarely presents in the form of a dependence syndrome. Issues relating to the management of poppy tea dependence are discussed, including the results of existing laboratory urinalysis for drugs of abuse, the calculation of opiate dose equivalence, and the likelihood of transition (or not) from use of poppy tea to use of other opiates.
D2 Dopamine Receptor Binding in the Basal Ganglia of Antipsychotic-Free Schizophrenic Patients
Authors: Pilowsky L. S. , Costa D. C. , Ell P. J. , Verhoeff N. P. L. G. , Murray R. M. , Kerwin R. W.
Published: October 2008

We used SPECT to examine striatal D2 receptor binding in 20 antipsychotic-free DSM–III–R schizophrenic patients and 20 age- and sex-matched normal controls. Dynamic single-slice SPECT, at a slice chosen to include the basal ganglia, began immediately following intravenous injection of 185 MBq of 123I-IBZM. A semiquantitative approach was used to generate indices of specific D2 receptor binding in the basal ganglia. There was no overall elevation of D2 receptor binding between patients and controls. A male sex-specific left lateralised asymmetry of striatal D2 receptor binding was found in the patient group. Age-dependent decline of striatal D2 receptors was confirmed in controls, but not in patients. These results suggest that alterations in striatal D2 receptor distribution and density do occur in schizophrenia, and possibly reflect wider disruptions in prefrontal-striatal-limbic circuits.
Obstetric Complications and Schizophrenia a Case-Control Study
Authors: Günther-Genta Flavia , Bovet Pierre , Hohlfeld Patrick
Published: October 2008

Schizophrenics have been repeatedly found to experience more obstetric complications (OCs) at birth. The meaning of such a finding is debated, and the aim of this study is to contribute to the understanding of OCs' aetiological role in schizophrenia. We compared a group of schizophrenic patients with their siblings and controls, on the basis of obstetric files stemming from the same University Hospital Maternity Ward. Schizophrenic patients had more frequent umbilical cord complications and atypical presentations, as well as higher scores on a scale measuring OCs linked to possible neonatal asphyxia.
Evidence for a Gender-Specific Decline in the Rate of Schizophrenia in Rural Ireland over a 50-Year Period
Authors: Waddington John L. , Youssef Hanafy A.
Published: October 2008

The issue of whether the incidence rate of schizophrenia may have declined over recent decades has generated considerable controversy. This study sought to ascertain and interview all patients who satisfied contemporary diagnostic criteria for schizophrenia within a defined and unusually homogeneous region of rural Ireland having a total population of 25 178 people; morbid risk for schizophrenia was then examined by quinquennia of birth from 1920–24 to 1965–69. Morbid risk appeared essentially constant for persons born between 1920 and 1939 but fell by 37% for those born between 1940 and 1969, the fall being considerably more prominent in females (–56%) than in males (–19%). Attention is focused on sexual dimorphism in cerebral development and on temporal changes in endogenous or exogenous factors that influence the rate of occurrence of schizophrenia in females.
Akathisia: Prevalence and Associated Dysphoria in an In-patient Population with Chronic Schizophrenia
Authors: Halstead Simon M. , Barnes Thomas R. E. , Speller Jeremy C.
Published: October 2008

In a sample of 120 long-stay in-patients who fulfilled DSM–III–R criteria for schizophrenia, chronic akathisia and pseudoakathisia were relatively common, with prevalence figures of 24% and 18%, respectively. Compared with patients without evidence of chronic akathisia, those patients with the condition were significantly younger, were receiving significantly higher doses of antipsychotic medication, and were more likely to be receiving a depot antipsychotic. Patients who experienced the characteristic inner restlessness and compulsion to move of akathisia also reported marked symptoms of dysphoria, namely tension, panic, irritability and impatience. The findings support the suggestion that dysphoric mood is an important feature of akathisia. Male patients appeared to be at an increased risk of pseudoakathisia. No significant relation was found between chronic akathisia and tardive dyskinesia, although there was a trend for trunk and limb dyskinesia to be commonest in patients with chronic akathisia while orofacial dyskinesia was most frequently observed in those with pseudoakathisia. Akathisia may mask the movements of tardive dyskinesia in the lower limb. There was no evidence that akathisia was associated with positive or negative symptoms of schizophrenia nor with depression.
The Nature of Depression Among Older People in Inner London, and the Contact with Primary Care
Authors: Blanchard M. R. , Waterreus A. , Mann A. H.
Published: October 2008

Ninety-six people of pensionable age from an inner-London electoral ward who had been identified by short-CARE screening as having ‘probable pervasive depression’ were interviewed further to ascertain their GMS-AGECAT and self-CARE status, comorbid features, and current primary-care psychiatric management. Estimated incidence rates of 30.8 per 1000 per year for ‘probable pervasive depression’ and 15.4 per 1000 per year for GMS diagnostic depression were calculated using results from a short-CARE screen in 1988. Among GMS diagnostic depression cases, anxiety was the major psychiatric comorbid feature (95%) and organic features were uncommon (8.4%). Of 66 self-CARE cases, 48 (73%) were also GMS–AGECAT cases; of 24 self-CARE non-cases, 15 (62.5%) were not GMS–AGECAT cases. Among subjects who had ‘probable pervasive depression’, 38% said that they had declared their symptoms to their general practitioner. Only 14% of subjects were prescribed antidepressants; 24% were prescribed hypnotics. Half the GMS–AGECAT-case subjects who stated that they had declared to their general practitioner were on specific therapy. Screening for depression and health education aimed at increasing psychological declaration are seen as ways forward in the management of this depression.
Induction of Mania with Selective Serotonin Re-uptake Inhibitors and Tricyclic Antidepressants
Authors: Peet Malcolm
Published: October 2008

The rate of treatment-emergent switch into mania has been calculated from all available clinical trial data on the selective serotonin re-uptake inhibitors (SSRIs) fluoxetine, fluvoxamine, paroxetine, and sertraline, relative to comparative groups treated with tricyclic antidepressants (TCAs) or placebo. In predominantly unipolar depressives, the rate of manic switch is less than 1% and differences between drugs and placebo are statistically but not clinically significant. In bipolar depressives, manic switch occurs substantially more often with TCAs (11.2%) than with SSRIs (3.7%) or placebo (4.2%).
Multiple Personality Disorder
Authors: Piper August
Published: October 2008

Five aspects of the diagnosis and treatment of multiple personality disorder (MPD) were examined. The following five conclusions were made: the contemporary diagnostic criteria are vague and overinclusive; the recent alleged increase in prevalence of the disorder is almost certainly artefactual; legal proceedings involving MPD patients raise disturbing questions about personal responsibility; there is little literature support for the theory that MPD results from childhood trauma; and many of the techniques used to diagnose and treat the condition reinforce its symptoms. A careful revision of diagnostic criteria for the disorder is recommended.
Gender Differences in Age at Onset of Schizophrenia
Authors: Faraone Stephen V. , Chen Wei J. , Goldstein Jill M. , Tsuang Ming T.
Published: October 2008

Numerous studies have found that male schizophrenic patients have earlier ages at onset than females. However, none of these studies have corrected the observed ages for known gender differences in the age distribution of the population. Using a pre-existing data set, we applied a non-parametric method to correct the male and female distributions of observed age at onset for sex-specific age distributions. The distributions of observed age at onset indicated earlier onset among males. After correction, the age-at-onset distributions shifted toward older ages, but the difference between males and females remained statistically significant. Thus, gender differences in the age at onset of schizophrenia are not artefactual.
Evidence Against Maternal Influenza as a Risk Factor for Schizophrenia
Authors: Selten J.-P. C. J. , Slaets J. P. J.
Published: October 2008

We tested the hypothesis that second-trimester exposure to influenza is a risk factor for schizophrenia in the child. The dates of birth of Dutch schizophrenic in-patients were examined for any effect of the 1957 A2 influenza epidemic. Individuals who were in their second trimester of foetal life at the peak of the epidemic were at no greater risk of developing schizophrenia than controls. As the present study has a larger sample size than all previous European studies, and is supported by a large study in the USA, it provides strong evidence against the hypothesis that second-trimester exposure to influenza is a risk factor for schizophrenia.
Cannabis Consumption as a Prognostic Factor in Schizophrenia
Authors: Martinez-Arevalo M. J. , Calcedo-Ordoñez A. , Varo-Prieto J. R.
Published: October 2008

Data were analysed from 62 schizophrenic patients between 18 and 30 years of age, treated at the community mental health centres in Navarra, who had relapsed and then completed a one-year follow-up study. Factors influencing the course of illness during follow-up were: continuing cannabis consumption; previous cannabis intake; non-compliance with treatment; and stress.
Family Grief
Authors: Kissane David W. , Bloch Sidney
Published: October 2008

As grief is both an individual and shared experience, adopting a systemic perspective is most appropriate for health-care professionals seeking to assist the bereaved. Within this framework, the family virtually always constitutes the most significant social group in which grief is experienced. In this paper we review the literature on family grief, covering clinical case reports, the observations of family therapists, systematic family bereavement research and family intervention studies. An understanding of patterns of family grief and vulnerability factors for morbid grief is pivotal to both preventive intervention and treatment of an established disorder.
Disturbed Attachment and Negative Affective Style an Intergenerational Spiral
Authors: Diamond Diana , Doane Jeri A.
Published: October 2008

The relationship between the quality of parents' attachment to their own parents and the quality of affective style was examined with a sample of 49 severely disturbed young adults and adolescents and their families receiving long-term in-patient treatment. Measures reflecting disturbances in attachment of parents to their own parents, derived from a five-minute speech sample task, were strongly associated with measures of negative affective style (e.g., criticism, intrusiveness and guilt induction) in face-to-face interactions with the disturbed offspring, as assessed through videotaped discussions of conflictual family issues after three months of treatment. The most significant findings involved the linkages between disturbances in the mother's attachment to her own mother and the degree of negative affect directed at the child patient. The association between disturbed intergenerational parental attachments and negative affective style supports the hypothesis that the parent's own internal burdens, stemming from disturbed attachment representations, particularly of the same-sex parent, may be a driving force behind the negative affect they display in interactions with their disturbed offspring.
ICD, Mental Disorder and British Nosologists: An assessment of the uniquely British contribution to psychiatric classification
Authors: Shepherd Michael
Published: October 2008

During several recent international meetings on classification, there have been frequent references to national systems of classification developed and used in Europe, North America and many other countries. The UK has been notably absent from this list. As Professor Kendell, in his brief historical survey of the subject, points out: “British psychiatry does not have, and indeed never has had, any important diagnostic concepts of its own in the way that French, American, and Scandinavian psychiatry still do” (Kendell, 1985).
Schizophrenia and Substance Abuse
Authors: Smith Jeanette , Hucker Stephen
Published: October 2008

Background

Recent research from North America has demonstrated higher than expected rates of drug and alcohol abuse among the seriously mentally ill. Schizophrenics appear to be particularly susceptible to the negative effects of substance abuse. These include psychiatric and social complications, with antisocial behaviour, particularly violence emerging as one of the most worrying features. This review examines the strength of the association and explores the possible explanations for the apparent link between schizophrenia, substance abuse and violence.

Method

The literature was searched using Medline, supplemented with a manual literature search.

Results

Very few articles specifically approached the problem of violence among substance abusing schizophrenics, but over 80 papers were identified which were helpful in exploring the link between dangerous behaviour and substance abuse by schizophrenics.

Conclusions

While there is circumstantial evidence to support the hypothesis that schizophrenics who abuse drugs or alcohol are at an increased risk of behaving violently, longitudinal studies are required to facilitate a better understanding of the mediating mechanisms.
Psychopathy – a Neurobiological Perspective
Authors: Dolan Mairead
Published: October 2008

Background.

Diagnostic and conceptual issues relating to psychopathy are widely debated, but advances in our understanding of the aetiology are limited.

Method.

A PSYCHLIT computerised database search of publications covering five decades was supplemented by tracing back through references from existing review work.

Results.

Over 200 articles were extracted, and 95 were selected for review.

Conclusions.

It is timely to evaluate the rôle of brain dysfunction. Biological determinants are under-researched and the lack of consistency in operational definitions in published research precludes anything more than tentative conclusions about the genetic, biochemical or electrophysiological correlates of psychopathy and antisocial behaviour. A multi-modal research programme is required in the search for a comprehensive model of psychopathy that can guide both research efforts and clinical interventions.
Implications of Historical Evidence for the Classification of Eating Disorders
Authors: Parry-Jones William Li. , Parry-Jones Brenda
Published: October 2008

Successive editions of the ICD and DSM classification systems have exercised a major influence over contemporary diagnostic practice and perceptions of the form and structure of disorders. Periodic revision has been based on clinical and epidemiological research, and minimal attention has been given to any possible contribution from historical evidence. To test the potential value of such evidence, the historical manifestations of four eating disorders (anorexia, bulimia, rumination and pica) were considered in relation to the clinical descriptions and diagnostic criteria of DSM–III–R (American Psychiatric Association, 1987) and ICD–10 (World Health Organization, 1992). For each disorder, evidence is presented of continuities and discontinuities with the phenomena recognised currently. Instances of symptom overlap between disorders and the implications of the historical findings for some current classificatory issues are discussed. When spread over several centuries, case numbers remain relatively small, the amount of clinical detail is highly variable, and temporal distribution is uneven. The conclusions that can be drawn, therefore, are necessarily somewhat tentative and subjective.
The Nithsdale Schizophrenia Surveys
Authors: McCreadie R. G. , Williamson D. J. , Athawes R. W. B. , Connolly M. A. , Tilak-Singh D.
Published: October 2008

Background

A population of adult schizophrenic patients was assessed to discover how the patients viewed their childhood, whether their view differed from non-schizophrenic adults, and to determine any association between parental rearing practices as perceived by the patient, childhood personality as perceived by the mother, and current symptoms. Type and level of expressed emotion shown by parents towards patients was also examined.

Method

Parental attitudes, as perceived by 50 schizophrenic patients, were assessed by the EMBU scale. Patients' premorbid personality and social adjustment were assessed through interviews with patients' mothers by the Scale for the Assessment of Premorbid Schizoid and Schizotypal Traits and the Premorbid Social Adjustment Scale. Current symptoms were assessed by the Positive and Negative Syndrome Scale and Subjective Deficit Syndrome Scale.

Results

Patients saw little difference between fathers' and mothers' attitudes. There was a positive correlation between parental rejection and overprotection, and a negative correlation between rejection and warmth. There were no significant correlations between parental rearing attitudes and patients' childhood personality; there was a significant correlation between parental attitudes and current symptoms. Rejection and overprotection were associated with more severe, warmth with less severe symptoms, especially so for positive schizophrenic symptoms and general psychopathology. Although there was no association between the general level of expressed emotion shown by the parent towards the adult patient, and patients' perceived parental rearing attitudes, parents with high expressed emotion on the basis of hostility had higher rejection scores on the parental rearing attitudes scale.

Conclusions

Schizophrenic patients saw their parents as showing much less warmth, and the severity of current symptoms was associated with perceived parental rearing attitudes. The hostility component of high expressed emotion may be a parental trait which exists before the illness begins.
Lifetime Comorbidity of Panic Attacks and Major Depression in a Population-Based Study
Authors: Andrade Laura , Eaton William W. , Chilcoat Howard
Published: October 2008

Background

The co-occurrence of panic disorder and major depression in the same individual is common. A question to be answered is whether the comorbid disorder is a distinct one or may resemble one or other disorder. In this paper we examine whether the comorbid disorder is a distinct condition.

Method

We examined the symptom profiles and rates of comorbidity of panic attacks and DIS/DSM–III major depressive disorder in a population-based sample from four sites of the National Institute of Mental Health (NIMH) Epidemiologic Catchment Area Program (n= 12 668).

Results

The co-occurrence of panic attacks and major depression over the lifetime was 11 times higher than expected by chance (OR = 11.4, 95% CI 9.5 to 13.6). Subjects with both panic and depression had worse symptoms than those who had only one disorder. However, the pattern of symptoms was remarkably similar, after overall severity was taken into account. Depressive symptoms associated with more severe forms of depression (e.g. guilt, suicidal thoughts or attempts, and motor disturbance) were more frequent in the comorbid group.

Conclusions

These findings may indicate a worse severity when the two disorders occur in the same individual.
Seasonal and Weather Factors in Parasuicide
Authors: Barker Andrew , Hawton Keith , Fagg Joan , Jennison Chris
Published: October 2008

Background

Seasonal variation in suicide and parasuicide has previously been reported. Few investigations have examined whether meteorological factors could influence suicidal behaviour, and the inconclusive results produced may be due to a variety of methodological problems. The present study overcomes some previous difficulties and tested whether parasuicide admisson rate is related to weather variables.

Method

Over 12 000 admissions for parasuicide were analysed by month, season, and in relation to meteorological data, which were measured close to the admitting hospital.

Results

Marked seasonal (P < 0.001) and monthly (P < 0.001) variations in mean daily parasuicide numbers were seen in women but not men. Small but highly significant correlations were demonstrated between parasuicide rate and weather parameters (P < 0.01), which were more marked in women (P < 0.01). These effects were additional to the monthly variation (P < 0.05).

Conclusions

Weather has a small influence on parasuicide. Gender differences in body temperature regulation might account for the sex difference seen.
Childhood Sexual Experiences with Adults: Adult Male Psychiatric Patients and General Practice Attenders
Authors: Palmer Robert L. , Bramble David , Metcalfe Michael , Oppenheimer Rhoda , Smith Jennifer
Published: October 2008

Background

Sexual abuse of male children is now believed to be common, and there may be links to adult psychiatric disorders.

Method

Recollections of sexual experiences with adults in childhood were studied systematically in 115 men attending general practice surgeries and 100 male psychiatric patients.

Results

The latter reported more frequent and more serious events before the age of 13 than the general practice attenders. No significant difference was detected for events between the ages of 13 and 15.

Conclusions

Childhood sexual abuse before the age of 13 may be associated with later psychiatric disorders, although the nature of the association remains uncertain.
Amok
Authors: Kon Yan
Published: October 2008

Background

Amok is reviewed from a historical standpoint, tracing how it has changed from the Hindu states of India where it was a war tactic to the sudden incomprehensible violence and mass murder by a single individual associated with the syndrome today.

Method

A typical amok attack is described and the criteria for amok discussed. Amok in Malaysia, New Guinea, Laos, North America and other countries are presented. The possible motives for such violent killings and a possible psychiatric diagnosis in relation to contemporary diagnostic criteria is discussed.

Conclusion

Classification of amok remains unresolved. The reason for its frequency in and around Malaysia remains unknown.

British Journal of Psychiatry (1994),165, 685–689
Formal Communication Disorder
Authors: Thacker Alice. J.
Published: October 2008

Background

This study investigates whether anomalies in the sign language of prelingually deaf schizophrenics can be elicited and described systematically.

Method

Thirty schizophrenic and seven manic adults were recruited on the basis of a British Sign Language (BSL) version of the Present State Examination. Thirty-seven controls were matched for sex, age and ethnicity. Each participant became deaf before the age of two, and uses BSL as the primary means of communication.

Results

Analysis reveals: (a) anomalies which are similar to those occurring in the spoken language of hearing schizophrenics; and (b) another series which is closely related to the life experience of deaf subjects and to the visuo-spatial medium itself.

Conclusions

There is evidence that formal communication disorder does occur in sign language. This has implications for more efficient diagnosis and management of deaf persons presenting to psychiatric services, as well as for the mechanisms of schizophrenic symptomatology itself.
Depot Antipsychotics in the Prophylaxis of Bipolar Affective Disorder
Authors: Littlejohn R. , Leslie F. , Cookson J.
Published: October 2008

Background

The efficacy of depot antipsychotic drugs in the prophylaxis of bipolar affective disorder was investigated.

Method

Life charts were constructed for 18 outpatients with bipolar disorder receiving prophylactic treatment with depot medication. The durations of affective episodes were compared during periods on or off medication.

Results

The subjects suffered fewer relapses and spent significantly less time in hospital (P = 0.001) for treatment of manic, depressive and mixed affective illness during treatment with depot antipsychotics.

Conclusions

Depot antipsychotic medication may be a useful prophylactic treatment for certain patients with bipolar affective disorder.

British Journal of Psychiatry (1994), 165, 827–829
Suicide in Oxford University Students, 1976–1990
Authors: Hawton Keith , Simkin Sue , Fagg Joan , Hawkins Michael
Published: October 2008

Background

The aim was to determine the extent, characteristics and timing of suicide in Oxford University students.

Method

Students who died from suicide or undetermined cause between October 1976 and September 1990 were identified through University records and individual colleges. Information about each student was sought from coroners, college staff, general practitioners and hospital case notes.

Results

There were 21 suicides (16 men and 5 women) and one open verdict (female). The observed number of suicides (0) was greater than the number expected (E = 11.09) on the basis of mortality statistics for England and Wales (O/E = 1.89; 95% CI 1.17 to 2.90). When deaths due to undetermined cause were included, however, the difference between O and E (17.03) was much reduced (O/E = 1.29; 95% CI 0.81 to 1.95). There was no evidence of an association with the Finals examination but two-thirds of the students had been worried about academic achievement or their courses. Nearly half appeared to have had a psychiatric disorder (mostly depression).

Conclusions

The much publicised apparent excess of Oxford University student suicides may be partly artefactual. Measures for preventing student suicides include careful induction upon arrival at university, means of alleviating academic stress and worries, and readily available and closely associated student counselling and psychiatric services.
Use of Drugs in Child and Adolescent Psychiatry
Authors: Kaplan Carole A. , Hussain Sharafat
Published: October 2008

Background

The prescription of psychotropic drugs for children is a sensitive and highly contentious subject which may explain the apparent lack of uniformity and consistency in clinical practice.

Method

This review is based on Medline and manual search of the literature.

Results

More than 1000 relevant references were found, and information has been culled from all these. Fifty particularly relevant articles have been selected for the reference list.

Conclusion

Recent years have seen considerable research in this field, and a clearer picture of the benefits and limitations of drug use in children is emerging.

Clinicians practising in the UK are generally conservative in their prescribing of psychotropic drugs for children. This cautious approach is generally justified by concern about toxic side-effects, the potential effects on growth and development, and the paucity of relevant clinical research.
Defining Subgroups of Dieting Disorder Patients by Means of the Eating Disorders Examination (EDE)
Authors: Beumont P. J. V. , Kopec-Schrader E. , Touyz S. W.
Published: October 2008

Background

It is important to determine the optimal manner of categorising eating disorder patients so as to aid in the understanding of their specific psychopathological state.

Method

We compared subgroups of eating disorder patients divided according to different sets of factors, using a structured interview which elicits the specific psychopathological features of these illnesses. The patients, comprising 116 consecutive women admitted to two university-affiliated eating disorder clinics, were grouped according to DSM–III–R criteria, clinical presentation (purging, binge eating), nutritional status, and age.

Result

The clearest separation of groups was afforded by the clinical dimension of purging as opposed to not purging. This was superior to DSM–III–R criteria. Other systems, such as presence of binge eating, and various levels of nutritional status and of age, were clearly inferior.

Conclusion

The presence or absence of purging behaviour appears to offer the most heuristic means of categorising eating disorder patients with respect to their specific psychopathological state.
Towards a Sociobiological Model of Depression a Marsupial Model (Petaurus breviceps)
Authors: Jones I. H. , Stoddart D. M. , Mallick J.
Published: October 2008

Background

This is a sociobiological approach to depression using hierarchy and its hypothesised relevance to self-esteem in the marsupial sugar glider (Petaurus breviceps).

Method

Differential access to resources between the dominant and submissive animal is measured by observation in four stable colonies. The dominant animals from two of these colonies are then introduced into the other two, resulting in the transferred former dominants becoming subordinate. Behavioural and biochemical measures relevant to depression and involving access to resources are then repeated. These measures include eating, drinking, social and sexual access, motility, grooming and biochemical estimates of cortisol and testosterone.

Results

Subordinate animals have significantly less access to resources, both in the stable colony and when the formerly dominant animals become subordinate.

Conclusions

A sociobiological approach using a hierarchy model equating resource-holding potential with self-esteem, exemplified by this study, may provide new concepts and insights into the phenomenology and pathophysiology of depression. It allows comparisons to be made between animal behaviour and cognition: the lack of such has been a major difficulty in animal studies hitherto. The findings are possibly more relevant to dysthymia than to affective disorder and imply a relationship between low resource-holding potential in sub-human animals as a phylogenetic antecedent of some of the cognitive and affective aspects of depression in man.