bluuebunny/crossref_metadata_2025 huggingface dataset:
An Investigation of Family Environmental Alteration Affecting Short-Term Recovery from Schizophrenia in China
Authors: Rong-Min Chen
Published: October 2008

Background

It has been hypothesised that change in the family environment affects short-term recovery from schizophrenia.

Method

Observation and study of 210 schizophrenic patients who were influenced by family environmental alteration show that the prognosis of schizophrenia caused suddenly by family environmental alteration is better than that of schizophrenia caused by a persistently unfavourable family environment.

Results

Hence, we think sudden family environmental alterations do not cause psychorrhoea, but slow family environmental alteration may cause change in the mental state of patients. The prognosis is worse in the countryside than in the city. From the study group, we conclude that the first cure rate was 28%, and that 26% of patients were able to work. This indicates that there were no typical cases of the core pattern of schizophrenia, and that there was a certain potential for recovery.

Conclusion

In the future, the emphasis of prevention and treatment must be placed on the countryside, and attention should be paid to the improvement of living and working conditions there, to the correct administration of patients, and to the improvement of recovery measures and therapy. We advocate that efforts should be made in the countryside to raise the national educational and cultural level.
Prevalence of Depression After Stroke: The Perth Community Stroke Study
Authors: Burvill P. W. , Johnson G. A. , Jamrozik K. D. , Anderson C. S. , Stewart-Wynne E. G. , Chakera T. M. H.
Published: October 2008

Background

The Perth Community Stroke Study (PCSS) was a population-based study of the incidence, cause, and outcome of acute stroke.

Method

Subjects from the study were assessed initially, by examination and interview, and at four- and 12-month follow-ups to determine differences in prevalence of depression between the sexes and between patients with first-ever and recurrent strokes.

Results

The prevalence of depressive illness four months after stroke in 294 patients from the PCSS was 23% (18–28%), 15% (11–19%) major depression and 8% (5–11 %) minor depression. There were no significant differences between the sexes or between patients with first-ever and recurrent strokes. With a non-hierarchic approach to diagnosis of those with depression, 26% of men and 39% of women had an associated anxiety disorder, mainly agoraphobia. Nine per cent of male and 13% of female patients interviewed had evidence of depression at the time of the stroke. Twelve months after stroke 56% of the men were still depressed (40% major and 16% minor), as were 30% of the women (12% major and 18% minor).

Conclusion

The prevalence of depression after stroke was comparable with that reported from other studies, and considerably less than that reported from in-patient and rehabilitation units.
A Comparison of Community-Based Care for Schizophrenia in South Verona and South Manchester
Authors: Gater Richard , Amaddeo Francesco , Tansella Michele , Jackson Gayle , Goldberg David
Published: October 2008

Background

The community-oriented mental illness services providing care to defined populations in south Verona, Italy (17 628 adults) and south Manchester, England (12 021 adults) have been compared to explore relationships between service organisation and patterns of service use.

Method

The composition and function of the two services and the sociodemographic characteristics of the two centres are described and related to epidemiological data on service use in the community, out-patient clinic, day hospital and in-patient care.

Results

Treated incidence of all psychiatric diagnoses and of schizophrenia were significantly higher in south Manchester than south Verona, indicating that the referral filter between primary and secondary care is more permeable in Manchester. Patients known to the service were more likely to be admitted and to have shorter in-patient stays in south Verona, indicating that the filter between in-patient care and the community is more permeable in Verona than Manchester.

Conclusions

The organisation of services in Verona results in a smaller load on the mental health service; the shorter hospital stays can be related to better integration between hospital and community resources. The organisation of services in Manchester provides care for a greater proportion of the population, but would be likely to require increased resources for the mental health services over time.
The Illusion of Reality or the Reality of Illusion
Authors: Al-Issa Ihsan
Published: October 2008

Background

The aim of this review is to integrate research findings on the role of sociocultural factors in hallucinations and to relate these factors to current psychological theory and research.

Method

The literature was surveyed by manual search, and the more reliable studies selected for the review.

Results

One hundred and thirteen publications were scrutinised and 30 of them were included in this review.

Conclusions

Cross-cultural concepts of reality are related to the development and the threshold of hallucinations. Attitudes toward hallucinations tend to affect the emotional reaction to, and the degree of control of, these experiences. Awareness of these attitudes may help the diagnostician to distinguish between pathological and culturally sanctioned hallucinations. It is important that therapists consider the functional significance and meaning of hallucinations as well as the social context and the stimuli associated with them.
Recurrent Affective Syndromes in Bipolar and Unipolar Mood Disorders at Follow-Up
Authors: Goldberg Joseph F. , Harrow Martin , Grossman Linda S.
Published: October 2008

Background

It is in dispute whether affective relapse disrupts psychosocial functioning to the same extent in depressed and manic patients.

Method

A prospective, naturalistic, longitudinal follow-up of 84 unipolar and bipolar affectively disordered in-patients was conducted to examine the extent of recurrent affective syndromes and their relationship to overall outcome. Global adjustment relative to relapse was assessed at 2- and 4.5-year follow-ups.

Results

Nearly half of the bipolar patients had subsequent syndromes, which were often associated with uniformly poor psychosocial functioning. Fewer than one-quarter of those with recurrences had steady work performance. Bipolar patients taking lithium alone had fewer recurrences than those taking lithium as well as neuroleptics (P<0.05). Bipolar and unipolar patients relapsed with equal frequency, but unipolar relapse was less often associated with readmission to hospital, work impairment, or uniformly poor functioning.

Conclusion

Affective relapse in bipolar disorders was more detrimental to overall functioning than was recurrence in unipolar depression.
Efficacy of Drug Treatment in Obsessive–Compulsive Disorder: a Meta-Analytic Review
Authors: Piccinelli Marco , Pini Stefano , Bellantuono Cesario , Wilkinson Greg
Published: October 2008

Background

A review of the efficacy of antidepressant drug treatment in patients with obsessive–compulsive disorder (OCD), using a meta-analytic approach.

Method

Randomised double-blind clinical trials of antidepressant drugs, carried out among patients with OCD and published in peer-reviewed journals between 1975 and May 1994, were selected together with three studies currently in press. Forty-seven trials were located by searching the Medline and Excerpta Medica – Psychiatry data bases, scanning psychiatric and psychopharmacological journals, consulting recent published reviews and bibliographies, contacting pharmaceutical companies and through cross-references. Hedges'gwas computed in pooled data at the conclusion of treatment under double-blind conditions or at the latest reported point of time during this treatment period. For each trial, effect sizes were computed for all available outcome measures of the following dependent variables: obsessive–compulsive symptoms considered together; obsessions; compulsions; depression; anxiety; global clinical improvement; psychosocial adjustment; and physical symptoms.

Results

Clomipramine was superior to placebo in reducing both obsessive–compulsive symptoms considered together (g= 1.31; 95% CI = 1.15 to 1.47) as well as obsessions (g= 0.89, 95% CI = 0.36 to 1.42) and compulsions (g= 0.79; 95% CI = 0.34 to 1.24) taken separately. Also, selective serotonin re-uptake inhibitors (SSRIs) as a class were superior to placebo, weighted meangbeing respectively 0.47 (95% CI = 0.33 to 0.61), 0.54 (95% CI = 0.34 to 0.74) and 0.52 (95% CI = 0.34 to 0.70) for obsessive–compulsive symptoms considered together, and obsessions and compulsions taken separately. Although on Y–BOCS the increase in improvement rate over placebo was 61.3%, 28.5%, 28.2% and 21.6% for clomipramine, fluoxetine, fluvoxamine, and sertraline respectively, the trials testing clomipramine against fluoxetine and fluvoxamine showed similar therapeutic efficacy between these drugs. Finally, both clomipramine and fluvoxamine proved superior to antidepressant drugs with no selective serotonergic properties.

Conclusion

Antidepressant drugs are effective in the short-term treatment of patients suffering from OCD; although the increase in improvement rate over placebo was greater for clomipramine than for SSRIs, direct comparison between these drugs showed that they had similar therapeutic efficacy on obsessive–compulsive symptoms; clomipramine and fluvoxamine had greater therapeutic efficacy than antidepressant drugs with no selective serotonergic properties; concomitant high levels of depression at the outset did not seem necessary for clomipramine and for SSRIs to improve obsessive–compulsive symptoms.
One Hundred Cases of Suicide in Elderly People
Authors: Cattell Howard , Jolley David J.
Published: October 2008

Background

The White Paper The Health of the Nation targets a reduction in suicide rates. Preventive strategies must be guided by an understanding of the demography and antecedents of suicide. These issues are examined in relation to suicide by old people in Manchester.

Method

One hundred consecutive coroners' inquisitions on people aged over 65 occurring between 1980 and 1991 in which the verdict was suicide were scrutinised and related to Health Service notes.

Results

Suicides were rare, numbers ranging from 0 to seven per annum per Health District. Rates did not vary between district but did within smaller sub-populations. Most individuals died at home; 65% were physically ill, of whom 23% had been hospitalised within the previous year. At least 60% were clinically depressed, with 25% being prescribed antidepressants. A total of 43% had seen their general practitioner in the previous month but only 14% were in contact with psychiatric services.

Conclusions

Many elderly people who commit suicide are not in close contact with primary care services; those who are may not be prescribed appropriate treatment, and few are referred for specialist care. Specialist services will fail to reduce suicide rates unless they embark upon programmes to increase public awareness of therapeutic possibilities and work more closely with primary care agencies to realise these possibilities.
The Limitations of Official Suicide Statistics
Authors: O'Donnell Ian , Farmer Richard
Published: October 2008

Background

This study explored some of the problems associated with current procedures for the ascertainment of suicide.

Method

A sample of 242 deaths which were known to have been self-inflicted was followed up through the coroners' courts where causes of death were legally established.

Results

Verdicts other than suicide were returned on half of the men, and on one-quarter of the women.

Conclusions

For suicide statistics to become valid indicators of suicide rates it might be more appropriate to apply the civil, rather than the criminal, standard of proof during inquest proceedings.
Anorexia Nervosa
Authors: Fombonne Eric
Published: October 2008

Background

This paper examines the evidence that rates of anorexia nervosa have increased over time.

Method

Epidemiological studies that have provided time trends in incidence rates in specific countries or psychiatric registers and prevalence surveys were reviewed to assess whether or not prevalence estimates are higher in the most recent studies.

Results

Estimated trends in incidence rates showed an increase but no study ruled out plausible alternative explanations. Studies showing no upward trend were as numerous and were generally based on larger samples. Analysis of 29 cross-sectional surveys conducted over the last 25 years indicated that the median prevalence rate was 1.3 per 1000 females. There was no indication that more recent surveys yielded higher prevalence rates.

Conclusion

Anorexia nervosa remains a rare disorder and there is no evidence of a secular increase in its incidence.
Bereavement after Homicide
Authors: Rynearson E. K.
Published: October 2008

Background

This brief report presents initial findings from a prospective descriptive study of adults after the homicide of a family member. Within the first year of bereavement, the responses and risk factors associated with unrecovered grief and post-traumatic stress disorder in subjects who requested or refused supportive psychotherapy were compared.

Method

Fifty-two adult members of 237 families contacted within three months of a homicide attended a specialised out-patient clinic (32 requested, and 20 refused, supportive therapy) after a structured interview and completion of measures of grief (TRIG), trauma (RIES and DES), and death imagery.

Results

Only two risk factors (childhood history of sexual abuse and lack of religious faith) were associated with treatment seeking. Treatment-seeking subjects also scored significantly higher (P<0.001) on all measures of grief, trauma, and intrusive re-enactment imagery of the dying.

Conclusion

Adults who seek therapy after the homicide of a family member are highly reactive to all measures of trauma, grief, and death imagery.
Ondansetron and Opiate Craving
Authors: Sell L. A. , Cowen P. J. , Robson P. J.
Published: October 2008

Background

Pharmacological approaches to opiate addiction have for the most part been limited to a role in detoxification. A high percentage of patients who complete detoxification programmes relapse.

Method

In the present study, we used a simple laboratory method to investigate suggestions from preclinical studies that 5-(hydroxytryptamine) HT3 receptor antagonists have a role in the treatment of addiction.

Results

We showed that addicts stably maintained on methadone experienced significant craving, dysphoria, and withdrawal-like symptoms when exposed to a video containing drug-related cues. The craving was not lessened by treatment with the 5-HT3 receptor antagonist, ondansetron (4 mg orally).

Conclusion

Our current findings do not support a role for 5-HT3 receptor agonists in the reduction of craving in opiate addicts.
Post-Traumatic Stress Disorder (PTSD) after Childbirth
Authors: Ballard C. G. , Stanley A. K. , Brockington I. F.
Published: October 2008

Background

There has been discussion about the possible occurrence of post-traumatic stress disorder (PTSD) in mothers after difficult childbirth.

Method

Four cases with a symptom profile suggestive of PTSD commencing within 48 hours of childbirth are presented.

Results

The PTSD was in each case associated with the delivery. In each case, there was an associated depressive illness. All four had persistent disorders, and two had difficulties with mother/infant attachment.

Conclusion

As confirmed by other reports, the prevalence of PTSD associated with childbirth is a matter of concern.
In the Shadow of Adversity: the Evolution and Resolution of Anxiety and Depressive Disorder
Authors: Surtees P. G.
Published: October 2008

Background

It was proposed to explore the longitudinal relationship between adverse experience and mental health; in particular, whether particular adverse experiences influence the form of subsequent expression of morbidity.

Method

Three groups of women were selected: 64 whose marital partner had recently died, 143 whose husbands had recently experienced a myocardial infarction and a third group of 32 women who had sought protection in a Women's Aid refuge. An initial interview assessed psychiatric status according to the RDC for the six months before the event and up to the time of interview, and a second interview was completed four months after the event had occurred. The course was assessed using the Longitudinal Interval Follow-up Evaluation.

Results

For the coronary group, the prevalence of psychiatric disorder doubled following the experience of the event, and was most pronounced for anxiety disorder. For the bereaved, rates increased over eight times for major depressive disorder and more than twice for anxiety disorder, following the loss; for the refuge group, prevalence rates were lower after entering the refuge than those before. Analyses that took account of the timing of the onset of disorders showed that in almost half of those experienced by the coronary group, and about 40% of the bereaved group, onset pre-dated the timing of the event.

Conclusions

The results further advance knowledge of the evolution and form of psychiatric conditions following the experience of severe adversity.
Childbirth: Life Event or Start of a Long-Term Difficulty?
Authors: Murray Declan , Cox John L. , Chapman Gail , Jones Peter
Published: October 2008

Background

This paper reports further data from the Stoke study of postnatal depression and examines whether psychosocial characteristics and symptom profiles differ between postnatal and control depression.

Method

Two hundred and thirty-two postnatal and non-postnatal control women were screened with the Edinburgh Postnatal Depression Scale; all high scorers and a sample of low scorers were interviewed with the Standardised Psychiatric Interview and modified Social Maladjustment Schedule. Depression was diagnosed using the Research Diagnostic Criteria.

Results

Postnatal but not control depression was associated with a poor relationship with the woman's own mother and greater occupational instability. Depression in control women was associated with low income, having three or more children, performing manual work and occupational dissatisfaction, but postnatal depression was not. There were no differences in the symptom profiles of the postnatal and control women nor between early and late onset postnatal depression.

Conclusion

Depression is a common and socially disabling disorder affecting mothers of young children. Postnatal depression is more contingent on acute biopsychosocial stresses caused by the arrival of a new family member. Depression in women with older children is more closely related to longer term social adversity.
Dementia and Cognitive Impairment in the Oldest Old in the Community Prevalence and Comorbidity
Authors: Fichter M. M. , Meller I. , Schröppel H. , Steinkirchner R.
Published: October 2008

Background

The study focuses on the prevalence of dementia in the oldest old.

Method

A community sample (n = 402) of the oldest old in Munich (≥ 85 years) was assessed with different methods. Four instruments and a clinical examination were used for case identification: (a) the Geriatric Mental State Interview (GMS-A); (b) the Structured Interview for the Diagnosis of Dementia (SIDAM); (c) the Global Deterioration Scale (GDS); and (d) the Mini Mental State Examination (MMSE). The clinical examination was performed by the interviewing physicians, who made their diagnoses according to ICD–10 and DSM–III–R.

Results

The structured interviews (GMS-A: 25.4%; SIDAM/SISCO: 28.0%; SIDAM/DSM–III–R: 27.8%; SIDAM/ICD–10: 16.1 %) gave lower point prevalence rates of dementia than physicians' clinical diagnoses (43.1 %). The rates were 21.2% based on the MMSE. Depressive syndromes and anxiety syndromes were the most frequent psychiatric disturbances associated with dementia in the very old.

Conclusion

Dementia rates were high in the oldest old, showed an increase with age but no sex differences. Interview methodology has a major impact on results.
Effect of Clozapine on d-Fenfluramine-Evoked Neuroendocrine Responses in Schizophrenia and its Relationship to Clinical Improvement
Authors: Curtis Vivienne A. , Wright Pádraig , Reveley Adrianne , Kerwin Robert , Lucey James V.
Published: October 2008

Background

Clozapine is an effective antipsychotic that has high affinity for serotonin type 2 (5-HT2) receptors. The importance of 5-HT antagonism in the overall clinical efficacy of clozapine is unclear. Using a neuroendocrine strategy we tested the hypothesis that clinical response to clozapine is related to alteration in 5-HT function.

Method

Ten treatment-resistant schizophrenic subjects were treated with clozapine for a mean of 10.3 (s.e. 0.9) weeks; d-fenfluramine (DFEN) challenge tests were performed before and after treatment with concurrent clinical ratings (BPRS, SAPS, SANS) made at the time of testing.

Results

All patients showed clinical improvement following treatment with clozapine. In addition, clozapine produced a significant attenuation of prolactin (PRL) and cortisol (CRT) response to DFEN challenge. Change in symptom ratings correlated significantly with reduction in PRL response to DFEN challenge.

Conclusions

These data show that functional alterations occur in the 5-HT system following response to clozapine and lend support to studies suggesting that 5-HT is an important component to the spectrum of action of clozapine.
A Self-Rating Scale for Measuring Neuroleptic Side-Effects
Authors: Day Jennifer C. , Wood Graham , Dewey Mike , Bentall Richard P.
Published: October 2008

Background

A study was conducted to validate a comprehensive self-rating scale for measuring side-effects of neuroleptic drugs.

Method

The Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS), which includes ‘red herring’ items, was twice administered to 50 DSM–III–R schizophrenic patients, who were also interviewed using the UKU side-effect rating scale; 50 unmedicated controls also completed the LUNSERS.

Results

The test-retest reliability of the LUNSERS was good (r = 0.811, P< 0.001) as was its concurrent validity against the UKU (r = 0.828, P< 0.001). Scores correlated with chlorpromazine equivalent doses (r = 0.310, P< 0.02). ROC analysis demonstrated that the scale discriminated between patients and non-medicated controls, who scored differently for real side-effects but not for ‘red herring’ items.

Conclusions

The LUNSERS is an efficient, reliable and valid method of assessing neuroleptic side-effects.
Mental Disorders and Criminal Behaviour
Authors: Modestin Jiri , Ammann Roland
Published: October 2008

Background

Using improved methods, findings of higher criminality in a psychiatric population were tested.

Method

An unselected sample of 1265 Swiss in-patients and a matched control group drawn from the general population were studied. Detailed accounts of conviction records served as a measure of criminal behaviour.

Results

Apart from traffic law violations by men, and violent crimes and sexual offences by women, patients were more frequently registered in all crime categories. However, there were significant differences between the diagnostic groups. Alcoholics and drug users of both sexes had a significantly higher criminality rate. A higher rate was also found among female, but not male, patients suffering from schizophrenia or related disorders and other, mostly organic, disorders.

Conclusions

Alcoholism and drug abuse contribute significantly to criminal behaviour, independent of sociodemographic factors; however, with a few exceptions, mental disorders such as schizophrenia and affective disorders do not contribute to criminal behaviour.
Risperidone in the Treatment of Patients with Chronic Schizophrenia: a Multi-National, Multi-Centre, Double-Blind, Parallel-Group Study versus Haloperidol
Authors: Peuskens J.
Published: October 2008

Background

This study was performed in order to evaluate the short-term efficacy and safety of fixed risperidone doses compared to haloperidol.

Method

In a multi-national, parallel-group, double-blind study, patients with chronic schizophrenia (DSM–III–R) were randomly assigned to risperidone 1, 4, 8, 12 or 16 mg or haloperidol 10 mg daily for 8 weeks. Efficacy was assessed by the Positive and Negative Syndrome Scale for schizophrenia (PANSS) and clinical global impression (CGI), and safety primarily by the Extrapyramidal Symptom Rating Scale (ESRS).

Results

One thousand three hundred and sixty-two patients were evaluated. The optimum risperidone doses were 4 mg and 8 mg, with response rates of 63.4% (56.8%; 69.7%) and 65.8% (59.2%; 71.9%) respectively. Response rate in haloperidol-treated patients was 58.7% (52.0%; 65.3%); the 95% confidence intervals (CI) of the differences between risperidone 4 mg or 8 mg and haloperidol were (–4.3%; 13.7%) and (–1.9%; 16.0%) respectively. There were no significant differences in CGI scores at endpoint between risperidone 4 mg, 8 mg, 12 mg and 16 mg and haloperidol (3.0, 3.0, 3.2, 3.1 and 3.1 respectively); the 95% CI of the differences between risperidone 4 mg or 8 mg and haloperidol were (–0.4; 0.1) and (–0.3; 0.2) respectively. Mean shifts to the maximum total ESRS scores versus baseline (mean (confidence interval)) were significantly greater in haloperidol-treated patients (5.1 (4.0; 6.2)) than in the risperidone 1, 4, 8 and 12 mg groups (1.1 (0.3; 1.9); 1.8 (0.9; 2.7); 2.7 (1.8; 3.6) and 3.2 (2.3; 4.1) respectively (P< 0.05)).

Conclusion

Risperidone is an effective antipsychotic for the treatment of chronic schizophrenia; doses of 4 and 8 mg seem to be optimal and have a lower incidence of side-effects than haloperidol.
Increased Intracerebral Cerebrospinal Fluid Spaces Predict Unemployment and Negative Symptoms in Psychotic Illness a Prospective Study
Authors: Van Os Jim , Fahy Thomas A. , Jones Peter , Harvey Ian , Lewis Shôn , Williams Maureen , Toone Brian , Murray Robin
Published: October 2008

Background

It has been suggested that the dimensions of cerebral ventricles are a risk factor for poor outcome in psychotic illness.

Method

A cohort of 140 patients with functional psychoses of recent onset who had undergone CT scanning, were followed up for an average of 46 months and assessed on six dimensions of course and outcome of illness.

Results

Left and right sylvian fissure volumes and, to a lesser extent, third ventricular volume predicted negative symptoms and unemployment over the course of follow-up, the latter association being mediated by poor cognitive functioning. There was a significant linear trend in risk over the distribution of sylvian fissure volumes in the cohort, and associations were especially evident in schizophrenic patients. No associations were found with global severity of illness, duration of hospital stay, homelessness, or affective symptoms.

Conclusions

These findings support the notion that dimensions of the cerebral ventricles are a continuous risk factor for some measures of outcome in the functional psychoses.
The Omnipotence of Voices II: the Beliefs About Voices Questionnaire (BAVQ)
Authors: Chadwick Paul , Birchwood Max
Published: October 2008

Background

We describe the development and psychometric investigation of the Beliefs About Voices Questionnaire (BAVQ), a self-report measure of how people understand and respond to their voices. The measure is unique in being driven by and gathering data essential to a cognitive formulation of voices.

Method

Sixty subjects with chronic hallucinatory voices took part.

Results

Psychometric properties of the scales were established, including test-retest reliability (mean = 0.89), internal reliability (mean Cronbach's α = 0.85), and construct validity using factor analysis and the criterion group method.

Conclusions

The BAVQ was found to be easy to complete and the scale may aid clinical assessment of voices, not least because of the possible value of cognitive therapy as a treatment approach.
Mortality Among Patients with Psychiatric Illness a Ten-Year Case Register Study in an Area with a Community-based System of Care
Authors: Amaddeo Francesco , Bisoffi Giulia , Bonizzato Paola , Micciolo Rocco , Tansella Michele
Published: October 2008

Background

Most studies which showed an excess mortality in psychiatric patients have been conducted on hospitalised samples.

Method

This was a case register study. All South Verona patients with an ICD diagnosis who had psychiatric contacts with specialist services in 1982–1991 were included. Mortality was studied in relation to sex, age, diagnosis, pattern of care and interval from registration. Standardised Mortality Rates (SMRs) and Poisson regression analysis were calculated.

Results

The overall SMR was 1.63 (95% CI = 1.5–1.8), which is the lowest value reported so far. Mortality was higher among men (SMR = 2.24; 95% CI = 1.9–2.6), among patients who were admitted to hospital (SMR = 2.23; 95% CI = 1.9–2.6), among younger age groups (SMR = 8.82; 95% CI = 4.9–14.6) and in the first year after registration (SMR = 2.32; 95% CI = 1.8–2.9). Higher mortality was found in patients with a diagnosis of alcohol and drug dependence (SMR = 3.87; 95% CI = 3.0–4.9). The SMR for suicide was 17.41. Using a Poisson regression model, diagnosis, pattern of care and interval from registration were all found to be significantly associated with mortality. When all these variables were entered together in the model, each maintained its predictive role.

Conclusions

The overall mortality of psychiatric patients treated in a community-based system of care was higher than expected, but lower than the mortality reported in other psychiatric settings. The highest mortality risk was found in the first year after registration.
The Belmarsh Scheme a Prospective Study of the Transfer of Mentally Disordered Remand Prisoners from Prison to Psychiatric Units
Authors: Banerjee Sube , O'Neill-Byrne Kiki , Exworthy Tim , Parrott Janet
Published: October 2008

Background

Contracting in psychiatric services from the NHS into prisons has been advocated to improve the care of the mentally disordered in custody. The Belmarsh Scheme is such a service.

Method

A prospective study investigating the characteristics of a six-month cohort of remand prisoners requiring transfer to hospital and evaluating the service's effectiveness.

Results

Fifty-three (4.3%; 95% CL 3.2% to 5.6%) of the 1229 new remands required transfer to hospital; all were accepted. The transfer group contained a higher proportion of black men (51%) than all other remands (30%) (difference 21%; 95% CL 8% to 35%, P = 0.002). Transfer times were lower than those reported for a neighbouring prison.

Conclusions

The Belmarsh Scheme secured in-patient psychiatric care rapidly for all those identified as needing it.
The Social Disablement of Men in Hostels for Homeless People
Authors: Hamid Walid Abdul , Wykes Til , Stansfeld Stephen
Published: October 2008

Background

Studies of mental health problems of homeless people have used diagnosis as the sole measure of these problems. In this study, the feasibility and reliability of measuring social disablement in the psychiatric assessment of homeless people was investigated.

Method

A random sample of 101 homeless men living in four long-stay hostels was assessed for their social disablement by the Social Behaviour Schedule (SBS). The prevalence of SBS problems in these men and the interobserver reliability were assessed.

Results

The results show that the SBS is a reliable screening instrument which is relatively easy to use. The most frequent SBS problems were ‘Other problems’, ‘Hostility’ and ‘Depression’. Less than 10% of the hostel sample had disablement items similar to those of patients in long-stay wards.

Conclusions

The SBS is a useful and reliable tool in the psychiatric assessment of men in hostels for the homeless.
An Evaluation of Community-Based Psychiatric Care for People with Treated Long-Term Mental Illness
Authors: Wilkinson Greg , Piccinelli Marco , Falloon Ian , Krekorian Haroutyon , McLees Sheila
Published: October 2008

Background

We evaluated integrated, multidisciplinary, community-based care for a cohort of people with treated long-term mental illness over two years in a field trial set in a semi-rural setting. The aim was to organise local psychiatric services on an extramural basis with general practitioner teams as the key element.

Method

Trained research workers used a structured interview to collect standardised baseline and three-monthly socio-demographic, clinical, social, family adjustment and burden, and treatment measures from patients, informants, and key-workers. Analysis included descriptive statistics and, for longitudinal data, analysis of best-fitted straight lines.

Results

We studied 34 patients (14 with schizophrenia, 11 with major affective disorders, and 9 with minor (non-major) affective disorders and anxiety disorders) who had a mean of 12 years continuous illness. At baseline, they were mainly characterised by research workers as mildly ill with fair social adaptive functioning, and by lay informants as having moderate target symptom severity and disturbance of social performance. Over two years, there were statistically significant, slight improvements in clinical global impressions ratings by research workers, and in informants ratings of target symptoms and social performance. Most patients continued to receive prescriptions for psychotropic drugs throughout follow-up, and they had a mean of 47 therapeutic contacts, mainly from nurses. Two patients were admitted to psychiatric hospital. There were few differences between patients in different diagnostic groups.

Conclusions

Integrated, multidisciplinary, community-based psychiatric care for people with treated long-term mental illness is feasible in a semi-rural setting: patients receiving pharmacotherapy and regular psychosocial treatments remained relatively stable on clinical and social measures over two years. The unique way in which the service was monitored, by making regular, systematic assessments of patients and carers, serves as an example for other services.
A Pilot Study of Exposure Control of Chronic Auditory Hallucinations in Schizophrenia
Authors: Persaud Rajendra , Marks Isaac
Published: October 2008

Background

Many patients complain less of their auditory hallucinations per se than of lack of control of the experiences. There is reason to believe that a non-distraction (exposure) approach could help patients gain more control over persistent auditory hallucinations and teach them that their experience is a form of thinking and has no external source. This study is a pilot test of that idea.

Method

Five DSM–III–R schizophrenic outpatients with medication-resistant auditory hallucinations improved with a mean of 31 hour-long sessions over 3 months of therapist-guided exposure to their hallucinations and situations likely to evoke them.

Results

Improvement was greatest in patients' anxiety and sense of control over their hallucinations, less in social use of leisure and hallucinating time.

Conclusions

These mildly encouraging pilot results warrant a controlled study of exposure for drug-resistant chronic auditory hallucinations and other psychotic experiences which are associated with anxious avoidance.
Neuropsychological Function in Manic-Depressive Psychosis Evidence for Persistent Deficits in Patients with Chronic, Severe Illness
Authors: McKay A. P. , Tarbuck A. F. , Shapleske J. , McKenna P. J.
Published: October 2008

Background

While neuropsychological deficits are recognised to occur in manic-depressive psychosis during episodes of depression and to reverse with clinical recovery, it is uncertain whether they can ever be seen outside episodes of illness.

Method

Forty-five patients meeting DSM–III–R criteria for major depression or bipolar disorder were screened using tests of memory, executive function and overall intellectual function. All testing was carried out during remission of affective symptoms.

Results

None of 24 young patients and 11 elderly patients scored in the impaired range on any of the tests. However, five of ten patients with chronic, severe affective disorder were impaired on one or more of the measures. On more detailed neuropsychological investigation, these five patients were found to show a variable pattern of impairment, ranging from memory and executive deficits in relative isolation, to widespread poor performance.

Conclusions

Enduring neuropsychological deficits may be a feature of chronic, severe manic-depressive illness.
A Reanalysis of Data from the Epidemiologic Catchment Area Study
Authors: Hornig Christopher D. , McNally Richard J.
Published: October 2008

Background

Analysing data from the Epidemiologic Catchment Area (ECA) study, Weissman and colleagues reported that panic disorder was strongly associated with suicide attempt. However, they did not control optimally for comorbid disorders known to increase suicide risk.

Method

Reanalysing the ECA data, we controlled for comorbid disorders in the aggregate rather than one at a time when we estimated the association between panic disorder and suicide attempt.

Results

Panic disorder was not associated with an increased risk of suicide attempt.

Conclusions

Comorbid conditions strongly influence whether people with panic disorder are at especial risk of suicide attempt.
A Scale for the Assessment of Hedonic Tone the Snaith–Hamilton Pleasure Scale
Authors: Snaith R. P. , Hamilton M. , Morley S. , Humayan A. , Hargreaves D. , Trigwell P.
Published: October 2008

Background

Hedonic tone and its absence, anhedonia, are important in psychopathological research, but instruments for their assessment are lengthy and probably culturally biased.

Method

A new scale was constructed from the responses of a large sample of the general population to a request to list six situations which afforded pleasure. The most frequent items were reviewed and those likely to be affected by cultural setting, age, or sex were removed. A pilot study led to an abbreviated scale of 14 items, covering four domains of pleasure response. This questionnaire was subjected to psychometric evaluation in new samples from the general population and psychiatric patients.

Results

The scale was found to have a score range that would distinguish a ‘normal’ from an ‘abnormal’ response. Validity and reliability were found to be satisfactory.

Conclusions

The new scale, the Snaith-Hamilton Pleasure Scale (SHAPS), is an instrument which may be recommended for psychopathological research.
Two Faces of Emil Kraepelin
Authors: Shepherd Michael
Published: October 2008

Eponymous lecturers are expected to make some reference to the person in whose name the lecture is being delivered. In this case my task has been facilitated by the fact that the first Mapother lecture was devoted to Edward Mapother himself. It was given by his successor, Sir Aubrey Lewis, who, as was his wont, furnished a comprehensive account of his subject, demonstrating how this remarkable man laid the foundations of the institution to which he devoted his professional life. Lewis's lecture, entitled “Edward Mapother and the Making of the Maudsley Hospital” (Lewis, 1969), provides a link with this one via the mention of the visit paid by Frederick Mott in 1909 to Emil Kraepelin's Forschungsanstalt in Munich, where he was so impressed by what he saw that he resolved to use Henry Maudsley's bequest to found a corresponding institution in this country. Edward Mapother was to assume a major responsibility for this large enterprise which he justified as follows:

“The only hope for the sort of dispassionate long-term research which psychiatry needs, is the creation of teams of career investigators … most of whom should not be primarily psychiatrists at all, but real experts in various branches of science, who have brought its technique to the service of psychiatry and then received enough training in this to enable them to see its problems … Then we should get progress, not pot-boiling.”
The Incidence of First Contact Schizophrenia in Jamaica
Authors: Hickling Frederick W. , Rodgers-Johnson Pamela
Published: October 2008

Background

Afro-Caribbean immigrants are reported to have a high rate of schizophrenia compared with other population groups.

Method

In a prospective first contact study of schizophrenia in Jamaica in 1992, 335 patients were examined using the Present State Examination.

Results

285 patients were evaluated as having a PSE ‘restrictive’ S + diagnosis of schizophrenia, and 32 as having a ‘broad’ S?, P, or O diagnosis of schizophrenia. With a population of 2.46 million, this represents a first-contact incidence rate for ‘restrictive’ schizophrenia of 1.16 per 10 000 population, and an age-corrected (15–54) incidence rate of 2.09 per 10 000.

Conclusion

Incidence rates for schizophrenia in Jamaica are lower than those reported in Afro-Caribbean immigrants in the UK and Holland, and within the reported range for other population groups worldwide.
Magnetic Resonance Imaging and Single Photon Emission Tomography in Treatment-Responsive and Treatment-Resistant Schizophrenia
Authors: Lawrie Stephen M. , Ingle Gordon T. , Santosh Celestine G. , Rogers Andrew C. , Rimmington J. Ewen , Naidu Kaliprasad P. , Best Jonathan J. K. , O'Carroll Ronan E. , Goodwin Guy M. , Ebmeier Klaus P. , Johnstone Eve C.
Published: October 2008

Background

Patients with schizophrenia differ from controls in several measures of brain structure and function, but it is uncertain how these relate to clinical features of the illness. We dichotomised patient groups by treatment response to test the hypothesis that treatment-resistant patients exhibit more marked biological abnormalities than treatment-responsive parients.

Method

Twenty treatment-responsive and 20 treatment-resistant patients with schizophrenia, matched for sex, age, and illness duration, were compared by magnetic resonance imaging, single photon emission tomography, and detailed neuropsychological assessment.

Results

Brain-imaging variables were not statistically related to treatment response, although poorly responsive patients had lower volumes of most brain structures. Several highly significant differences emerged between patient groups on neuropsychological testing. Episodic memory functioning distinguished patient groups even after we controlled for global cognitive impairment.

Conclusions

Cerebral structure and blood flow have a limited effect on treatment response in schizophrenia, but long-term episodic memory impairment is associated with, and may predict, poor prognosis.
Relationship between Movement Planning and Psychopathology Profiles in Schizophrenia
Authors: Malla Ashok K. , Norman Ross M. G. , Aguilar Omar , Carnahan Heather , Cortese Leonard
Published: October 2008

Background

There has been evidence that psychopathology in schizophrenia consists of three separable syndromes: reality distortion, disorganisation, and psychomotor poverty. The objective of this study was to explore the relationship between planning and execution of movement and each of the syndromes in schizophrenia.

Method

Twenty-one right handed DSM–III–R schizophrenic patients performed a total of 80 trials of a motor movement task, varying distance of movement × size of the target × hand. Times taken to plan the movement (RT) and to carry it out (MT) were examined for their relationship with contemporaneous as well as lifetime profiles of the three syndromes in schizophrenia.

Results

Significant correlations are reported between RT and current as well as lifetime measures of disorganisation syndrome. Somewhat weaker correlations are reported between RT and psychomotor poverty, but only for the right-handed tasks. Partial correlations suggest that the influence of neuroleptic medication explains all but one of the correlations between psychomotor poverty and RT, but does not account for the relationship between disorganisation and RT. No other relationship emerged between any of the movement and symptom measures.

Conclusions

These findings indicate that dysfunction in movement planning is related primarily to concurrent disorganisation, as well as to the prominence of disorganisation over the patient's history.
Delineation of Acute and Transient Psychotic Disorders in a Developing Country Setting
Authors: Susser Ezra , Varma Vijoy K. , Malhotra Savita , Conover Sarah , Amador Xavier F.
Published: October 2008

Background

We examined whether acute transient psychoses can be distinguished from schizophrenia and the affective disorders.

Method

We studied 46 cases of nonaffective acute psychosis in the Chandigarh Acute Psychosis Study. With respect to separation from schizophrenia, we examined the distribution of duration of the episode. With respect to separation from affective disorders, we assessed the frequency of affective symptoms.

Results

Duration was bimodal, suggesting the presence of two distinct conditions of short and long duration. Affective symptoms were minimal, suggesting that these were not atypical affective syndromes.

Conclusions

Acute transient psychoses conform neither with schizophrenia of brief duration nor with atypical affective psychosis, and thus require separate classification as proposed in the ICD–10.
The Psychological Effects of Disaster at Sea
Authors: Dooley E. , Gunn J.
Published: October 2008

Background

In March 1987, the P&O car ferry Herald of Free Enterprise capsized killing 193 passengers. Seventy-five survivors and relatives were referred by their solicitors to the authors for assessment of psychological injury.

Method

Information was gathered retrospectively and systematically from clinical notes and legal reports.

Results

The commonest symptoms suffered were sleep disturbance, loss of concentration and increased anger. The commonest diagnoses were post-traumatic stress disorder, other anxiety states and depression. Depressive symptoms were commoner in those who had been bereaved, anxiety symptoms were commoner in those who had not. Reluctance to discuss symptoms and to attend a psychiatric clinic was a common feature.

Conclusions

As expected, bereavement led to grief and depressive symptoms, whilst passengers who were not bereaved were more likely to suffer anxiety symptoms. Contrary to expectations, the degree of immersion during the accident did not influence the type or degree of symptoms. Those with worse symptoms were more likely to attend the clinic. Women showed more affective symptoms and men more substance abuse.
In Vivo Magnetic Resonance Spectroscopy: Applications in Psychiatry
Authors: Maier Michael
Published: October 2008

Background

Nuclear magnetic resonance is a non-destructive and non-invasive technology that is highly suited for research in psychiatry. It is establishing itself as a versatile means of studying brain morphology, chemistry and function and is finding a place in the diagnosis of disease, monitoring of treatment and the study of basic brain processes.

Method

A literature review was undertaken.

Results

Magnetic resonance spectroscopy has been shown to distinguish between psychiatric disorders, and has provided evidence of their pathophysiological mechanisms.

Conclusions

Spectroscopy in particular opens a window, for the first time, on the study of in vivo brain chemistry.