bluuebunny/crossref_metadata_2025 huggingface dataset:
Cognitive Processes in Delusional Disorders
Authors: Fear Christopher , Sharp Helen , Healy David
Published: October 2008

Background

Studies of schizophrenics with persecutory delusions have shown cognitive biases in subjects who are deluded. It has been suggested that their delusions defend against depression. This study challenges the assumption that delusional disorder (DD) patients are covertly depressed.

Method

Clinical and demographic data and responses to questionnaires designed to assess schizotypy, depression, dysfunctional attitudes, attributional and attention biases were collected from 29 patients satisfying DSM–III–R criteria for DD. These were compared with 20 matched normal controls and results from published studies of schizophrenics.

Results

DD subjects did not show abnormal levels of overt or covert depression or schizotypy. They showed high levels of dysfunctional attitudes (P < 0.0001), a distinctive attributional style (P = 0.01), and increased attention to threat-related stimuli (P = 0.01).

Conclusions

DD is a distinct disorder predicated upon sensitivity to threat and biases of attention and attribution. These findings may have implications for the cognitive therapy of these disorders.
Childhood Emotional Abuse
Authors: Thompson Anne E. , Kaplan Carole A.
Published: October 2008

Background

The assessment and management of childhood emotional abuse is of increasing importance in psychiatric practice. At present there are no consensus views about the definition of emotional abuse and information from research is limited.

Method

Information about emotional abuse from the medical, psychological, social science and legal literature is summarised. Definitions and proposed mechanisms of damage are discussed. Current research data and an overview of childhood and adult sequelae are presented. Proposals for clinical and medico-legal practice are made.

Results

Theoretical models of emotional abuse and its consequences are derived from theories of childhood psychological development. Empirical research is beginning to show that emotional abuse may have a profound effect on aspects of psychological development in children.

Conclusions

The developmental theories and methods of assessment well established in psychiatry are useful approaches to the clinical assessment and further understanding of emotional abuse.
Psychological Markers in the Detection of Autism in Infancy in a Large Population
Authors: Baron-Cohen Simon , Cox Antony , Baird Gillian , Swettenham John , Nightingale Natasha , Morgan Kate , Drew Auriol , Charman Tony
Published: October 2008

Background

Investigation to see if there are key psychological risk indicators for autism in a random population study of children at 18 months of age; and to assess how well these discriminate children who receive a diagnosis of autism from other forms of developmental delay.

Method

Sixteen thousand children in the southeast of England were screened for autism by their health visitor or GP, during their routine 18-month-old developmental check-up, using the CHAT (Checklist for Autism in Toddlers). From a previous high-risk study we predicted that children at 18 months of age who failed three items (‘protodeclarative pointing‘, ‘gaze-monitoring‘, and ‘pretend play’) would be at risk for receiving a diagnosis of autism. From other evidence, we further predicted that those 18-month-olds who failed one or two of the key items (either pretend play, or protodeclarative pointing and pretend play) would be at risk for developmental delay without autism.

Results

Twelve children out of the total population of 16 000 consistently failed the three key items. Of these, 10 (83.3%) received a diagnosis of autism. Thus, the false positive rate was 16.6% (2 out of 12 cases), and even these 2 cases were not normal. When the 10 children with autism were reassessed at 3.5 years of age, their diagnosis remained the same. Thus the false positive rate among the cases diagnosed with autism was zero. In contrast, of 22 children who consistently failed either protodeclarative pointing and/or pretend play, none received a diagnosis of autism, but 15 (68.2%) received a diagnosis of language delay.

Conclusions

Consistent failure of the three key items from the CHAT at 18 months of age carries an 83.3% risk of autism; and this pattern of risk indicator is specific to autism when compared to other forms of developmental delay.
The Treatment of Depression: Prescribing Patterns of Antidepressants in Primary Care in the UK
Authors: Donoghue J. M. , Tylee A.
Published: October 2008

Background

Consensus has been achieved about how depression should be treated in primary care, and guidelines have been issued by the Royal Colleges of General Practitioners and Psychiatrists, and by the British Association for Psychopharmacology. One of the principal recommendations is to prescribe antidepressant medicine at effective doses. This study was established to investigate how current prescribing practices in primary care compared with these guidelines.

Method

Information on prescribing of antidepressant medicines was obtained using three independent data sources: Prescribing Analysis and Cost (PACT) data; medical notes; and a large, computerised patient record database.

Results

Data were obtained on populations in excess of 1.5 million people, and over 80 000 prescriptions were reviewed. All three data sources showed very similar patterns of prescribing, in particular that as many as 88% of prescriptions for older tricyclic antidepressants are prescribed by GPs at doses below those recommended by the consensus guidelines. Newer antidepressants – lofepramine and the SSRIs – are prescribed comparatively well.

Conclusions

Prescribing of antidepressants by GPs is not in line with the consensus recommendations on dosage. This may have major educational implications for GPs. A pragmatic approach to improve prescribing in the short term may be to advocate the use of lofepramine or the SSRIs as first line treatment for depression. This study validates the use of PACT data as a useful audit tool in this area of clinical practice.
Continuing Clozapine Despite Neutropenia
Authors: Wesson Michael L. , Finnegan David M. , Clark Peter I.
Published: October 2008

Background

A 40-year-old chronic schizophrenic patient whose psychosis and associated violent behaviour resolved on clozapine, required chemotherapy for a testicular teratoma with pulmonary metastases. His treatment was initially delayed due to refusal to consent.

Treatment

The patient finally agreed to orchidectomy and cytotoxic therapy, and following agreement by the CPMS, clozapine continued to be dispensed despite neutropenia and ‘red alert’ status on full blood count.

Discussion

This is the only patient to continue clozapine despite ‘red alert’ status, and as such is an exceptional case, but may open the way for such patients in the future.
Acute Frontal Lobe Syndrome and Dyscontrol Associated with Bilateral Caudate Nucleus Infarctions
Authors: Petty Richard G. , Bonner Deirdre , Mouratoglou Vassilis , Silverman Marisa
Published: October 2008

Background

A 67-year-old man presented with acute onset of spatial and temporal disorientation, memory loss and associated episodic dyscontrol. Investigations showed infarctions of both caudate nuclei. This patient presented a unique opportunity to study the relationship between the lesions, his behaviour, and neuropsychological testing.

Method

Single case report Investigations included interviews to determine cognitive impairment i.e. WAIS-R, MMSE, and neurological examination.

Results

Extensive neuropsychological testing revealed severe impairment on tasks requiring planning, memory or abstract thought. These findings are very similar to those seen in Huntington's disease.

Conclusions

A neurobiological hypothesis is proposed to account for his symptoms, and recent discoveries in the basic sciences used to inform his management.
Sensible Hypothesis Testing in Deluded, Depressed and Normal Subjects
Authors: Bentall Richard P. , Young Heather F.
Published: October 2008

Background

Previous research has indicated that deluded patients may experience difficulties when testing hypotheses. In this study, hypothesis-testing strategies were assessed in patients with persecutory delusions, depressed patients and normal controls.

Method

Subjects were presented problem items describing typical everyday situations with either positive or negative outcomes and were required to choose strategies to prove that one of three variables was responsible for the outcomes.

Results

Consistent with previous research into sensible reasoning, subjects chose to manipulate the variable hypothesised to be responsible for the outcome (disconfirmation strategy) more when the outcome was negative than when it was positive, and chose to manipulate the remaining variables (confirmation strategy) more when the outcome was positive. No group differences were observed.

Conclusions

No evidence was found of abnormal hypothesis-testing strategies in deluded patients.
Use of Clozapine in a Child with Treatment-Resistant Schizophrenia
Authors: MacEwan Thomas H. , Morton Michael J. S.
Published: October 2008

Background

Schizophrenia can be diagnosed in adults and requires treatment with antipsychotic medication. Clozapine is used effectively in adults with treatment-resistant schizophrenia but little is published on the use of clozapine in children.

Method

Supported by parental consent and a second opinion, standardised observations were used to chart the progress of treatment with clozapine in a child in-patient detained under mental health legislation with severe drug-resistant schizophrenia and tardive dyskinesia.

Results

Sixteen months of clozapine treatment led to significant reduction of symptomatology with marked improvement in social functioning and diminished tardive dyskinesia.

Conclusions

This case illustrates the successful use of clozapine in treatment-resistant childhood schizophrenia.
Patients with Schizophrenia Remember that an Event has Occurred, but not When
Authors: Rizzo Lydia , Danion Jean-Marie , Van Der Linden Martial , Grangé Danielle
Published: October 2008

Background

The context memory deficit hypothesis of schizophrenia postulates that the long-term deficit associated with this disorder is related to a memory impairment for contextual information.

Method

To test this hypothesis, memory for temporal context was assessed in 33 patients with schizophrenia and 33 normal subjects, using a recency discrimination task.

Results

Whereas patients were able to recall and recognise target items, they were unable to recognise from among the target items those which had been most recently learned.

Conclusions

Schizophrenia is associated with a temporal context memory deficit.
Public Education for Community Care
Authors: Wolff Geoffrey , Pathare Soumitra , Craig Tom , Leff Julian
Published: October 2008

Background

The findings from a controlled study of the effect of a public education campaign on community attitudes to mentally ill people are presented.

Method

A census of neighbours' attitudes toward mental illness was conducted in two areas before the opening of supported houses for the mentally ill. In one area an educational campaign was conducted The attitude survey was then repeated in both areas and patients' social contact with neighbours was recorded.

Results

Respondents exposed to the didactic component of the campaign showed only a small increase in knowledge about mental illness but there was a lessening of fearful and rejecting attitudes in the experimental area and not in the control area Neighbours in the experimental area were more likely to make social contact with both staff and patients. It was social contact which was directly associated with improved attitudes rather than educationper se.Patients in the experimental area made contact and even friendships with neighbours whereas those in the control area did not.

Conclusions

The public education campaign did not lead to significant changes in neighbours' knowledge of mental illness. However, their attitudes improved and patients' social integration was enhanced.
A Controlled Trial of Dothiepin and Placebo in Treating Benzodiazepine Withdrawal Symptoms
Authors: Tyrer Peter , Ferguson Brian , Hallström Cosmo , Michie Marian , Tyrer Stephen , Cooper Stephen , Caplan Richard , Barczak Paul
Published: October 2008

Background

The possibility that treatment with tricyclic antidepressants, in the form of dothiepin, might attenuate benzodiazepine withdrawal symptoms was investigated in a double-blind trial.

Method

Eighty-seven non-depressed psychiatric out-patients with putative normal dose benzodiazepine dependence had their benzodiazepines reduced in stepwise amounts of 20% of the original dose for eight weeks. The patients were randomised to receive dothiepin (with dosage increasing to 150 mg/day) or placebo as an aid to withdrawal before benzodiazepine reduction and these drugs were taken for four further weeks before being stopped.

Results

Fewer patients entered and completed the study than expected and a Type II error was possible in the results. Although there was some evidence of withdrawal symptoms being less marked in those patients allocated to dothiepin this was independent of any antidepressant effect as depression scores were lower in the placebo group in the early phase of withdrawal (P<0.01). Of those completing the study, greater satisfaction (P=0.03) was recorded by those who had received dothiepin; no other differences reached statistical significance.

Conclusions

Dothiepin (and by implication other tricyclic antidepressants) might have some value in reducing benzodiazepine withdrawal symptoms but does not aid drug withdrawal.
Confirmatory Factor Analysis of the Fear Questionnaire with Social Phobia Patients
Authors: Cox Brian J. , Parker James D. A. , Swinson Richard P.
Published: October 2008

Background

The Fear Questionnaire is an internationally popular measure in anxiety disorder research, but its validity with social phobia patients has not been clearly demonstrated.

Method

A confirmatory factor analysis was conducted using the Fear Questionnaire responses of 122 social phobia patients.

Results

The results indicated that the proposed three-factor model of the scale (agoraphobia, social phobia, and Wood/injury dimensions) provided a good fit to the data.

Conclusions

These data provide strong support for the validity of the scale and for the multidimensional view of fears proposed by Arrindell.
The Use of Environmental Strategies and Psychotropic Medication in the Management of Delirium
Authors: Meagher David J. , O'Hanlon Donal , O'Mahony Edmond , Casey Patricia R.
Published: October 2008

Background

This paper examines the pattern and frequency of implementation of environmental strategies and the use of psychotropic medication in the management of patients with delirium in an acute hospital setting.

Method

The study involved 46 consecutive referrals to a consultation psychiatry service each of whom met ICD–10 criteria for delirium. Patients were subdivided into hyperactive, hypoactive and mixed subtypes of delirium and assessed regarding severity of delirium, the use of psychotropic medication prior to consultation and the implementation of environmental measures in their management.

Results

Mean age was 60.1 years. Thirty per cent of patients were of the hyperactive subtype, 24% hypoactive and 46% mixed. Psychotropic medication was given to 56.5% prior to consultation and this is significantly associated with severity of delirium and in particular, with hyperactive delirium subtype. Of eight environmental strategies only four were instituted in over 50% of the patients prior to consultation. The application of these strategies was associated with overall severity of delirium, agitation, mood lability and sleep-wake cycle disturbance. It was not significantly associated with severity of disorientation or with disturbed perception/thinking.

Conclusion

Simple environmental strategies such as limiting changes in staff, minimising noise levels and involving relatives in re-orientation are frequently overlooked in the management of patients with delirium. Our study suggests that the implementation of environmental strategies occurs primarily in response to behavioural challenges rather than to limit the core features of delirium.
Successful Treatment of Tardive Dystonia with Clozapine and Clonazepam
Authors: Shapleske J. , Mckay A. P. , Mckenna P. J.
Published: October 2008

Background

Tardive dystonia is an uncommon complication of neuroleptic treatment which is frequently disabling and poorly responsive to treatment.

Method

The case is reported of a 28-year-old patient with schizophrenia who developed severe, generalised tardive dystonia after five years of neuroleptic treatment. Stopping neuroleptic medication and treatment with tetrabenazine, an anticholinergic and a benzodiazepine were ineffective. Treatment with clozapine and then the novel combination of clozapine plus clonazepam was instituted.

Results

Treatment with clozapine alone brought about limited improvement. Addition of clonazepam resulted in virtually complete disappearance of all abnormal movements. This remission has been sustained for nearly two years.

Conclusions

This report adds to two other cases suggesting that the combination of clozapine and clonazepam may be an effective treatment for tardive dystonia.
Obstetric Complications and Schizophrenia: A Case Control Study Based on Standardised Obstetric Records
Authors: Kendell R. E. , Juszczak E. , Cole S. K.
Published: October 2008

Background

There have been many reports of a higher incidence of ‘obstetric complications’ in the histories of schizophrenics than of controls, but because of the methodological shortcomings of most of these comparisons the relationship remains controversial.

Method

Comprehensive records covering all psychiatric hospital admissions and all hospital deliveries in Scotland since 1971 made it possible to identify the obstetric records of people born in 1971–74 who were subsequently admitted to hospital with a diagnosis of schizophrenia, and then to compare their standardised obstetric records with those of closely matched controls.

Results

One hundred and fifteen schizophrenic/control pairs were compared. The former showed a highly significant (P < 0.001) excess of complications of both pregnancy and delivery. In particular, there was a significant excess of pre-eclampsia (10 v. 2) and of infants detained in hospital for neonatal care (18 v. 6).

Conclusion

The raised incidence of obstetric complications often reported in people with schizophrenia is genuine and probably contributes to the aetiology of the condition.
Four Behavioural Syndromes of Schizophrenia
Authors: Harvey Carol A. , Curson David A. , Panteus Christos , Taylor Jason , Barnes Thomas R. E.
Published: October 2008

Background

A complementary approach to defining symptomatic subtypes of schizophrenia is to identify characteristic patterns of ‘problem behaviours’ associated with the capacity of patients to function in the community.

Method

In a large epidemiological survey, patients fulfilling Feighner criteria for schizophrenia were identified by key informants and assessed using the MRC Social Behaviour Schedule (SBS) and the Manchester Scale. An exploratory factor analysis was used to extract behavioural syndromes from the SBS data in order to compare the syndrome profiles in community, acute and long-stay subgroups and to examine their associations with symptoms and social functioning.

Results

Four behavioural syndromes were identified: Thought disturbance, ‘Social withdrawal’, ‘Depressed behaviour’ and ‘Anti-social behaviour’, which distinguished between the patient subgroups and had significant differential relationships to symptoms and social functioning variables.

Conclusions

The evaluation of disability in schizophrenia and effectiveness of treatment interventions is incomplete without an assessment of problem behaviours.
Links Between Expressed Emotion and Burden of Care in Relatives of Patients with Schizophrenia
Authors: Scazufca Marcia , Kuipers Elizabeth
Published: October 2008

Background

Findings that the EE level of a relative may change over time support the idea that EE may represent the circumstances of the relationship between patient and caregiver. The present study examines to what extent EE levels in relatives are related to relatives' burden of care and their perceptions of patients' deficits in social role performance.

Method

Fifty patients recently admitted to hospital with DSM–III–R diagnoses of schizophrenia or schizophreniform disorder were assessed for positive and negative symptoms. Fifty relatives who were living or were in close contact with these patients were interviewed for the assessment of EE and burden of care, and to provide information about patients' social role performance and social and behaviour problems.

Results

High-EE relatives had considerably higher mean scores for burden of care than low-EE relatives (12.5v.6.8, respectively,P=0.002), and perceived more deficits in patients' social functioning than low-EE relatives (means: 16.2v.6.9, respectively,P=0.004). The employment status of relatives was the only socio-demographic characteristic of relatives and patients associated with EE levels, those who were working being less likely to be high EE. Patients' psychopathology was not associated with EE levels and burden of care.

Conclusions

This study shows that EE and the burden of care are related. EE and burden both measure aspects of the relationship between relatives and patients. These findings suggest that EE and burden of care are more dependent on relatives' appraisal of the patient condition than on patients' actual deficits.
The Effectiveness of Cognitive Therapy in the Treatment of Non-Psychotic Morbid Jealousy
Authors: Dolan Mairead , Bishay Nagy
Published: October 2008

Background

Although a cognitive–behavioural formulation of morbid jealousy has been described there is little empirical research into the practical usefulness of this model. This study evaluated the effectiveness of treating non-psychotic morbid jealousy using a cognitive approach.

Method

Cognitive–behavioural and emotional measures of jealousy were calibrated by comparison with 40 non-jealous normal controls. These instruments were used as measures of change to assess the effectiveness of cognitive therapy in altering cognitive errors in 30 morbidly jealous out-patient referrals, divided into delayed and immediate treatment subgroups to assess the stability of the condition. Both groups completed all measures immediately before and after treatment, and at follow-up.

Results

The instruments demonstrated significant differences between jealous and non-jealous subjects on cognitive–behavioural and emotional aspects of jealousy. The delayed treatment group showed no significant alteration in scores on any of the instruments after 12 weeks on the waiting list, confirming the stability of the condition. In the majority of cases cognitive therapy aimed at the modification of dysfunctional cognitive processes resulted in a significant improvement on all jealousy measures, immediately after treatment and at follow-up. The improvement reported by patients was supported by the partner's ratings.

Conclusion

The results support the postulation of the cognitive model that modification of cognitive schema by a schema-focused treatment package results in a significant reduction in disturbance in all aspects of the jealousy syndrome.
Demographic and Obstetric Risk Factors for Postnatal Psychiatric Morbidity
Authors: Warner Rachel , Appleby Louis , Whitton Anna , Faragher Brian
Published: October 2008

Background

Postnatal depression follows 10% of live births but there is little consensus on the risk factors associated with its development. Previous smaller studies have been unable to quantify the impact of independent risk factors as relative and attributable risks.

Method

The Edinburgh Postnatal Depression Scale (EPDS) was used to screen a systematic sample of 2375 women, six to eight weeks after delivery. Information on socio-demographic and obstetric variables was collected at the screening interview. The risk factors associated with high EPDS scores (>12) were determined and entered stepwise into a regression model.

Results

Four independent variables were found to be associated with an EPDS score above this threshold. These were an unplanned pregnancy (OR 1.44); not breast-feeding (OR 1.52), and unemployment in either the mother, i.e. no job to return to following maternity leave (OR 1.56), or the head of household (OR 1.50). These four variables appeared to explain the risk associated with other risk factors.

Conclusions

Although a direct aetiological role for these risk factors is not certain, they may indicate strategies for the prevention of affective morbidity in postnatal women. These may include reducing unwanted pregnancy and employment for women after childbirth.
Drug and Alcohol Problems among Individuals with Severe Mental Illnesses in South London
Authors: Menezes Paulo R. , Johnson Sonia , Thornicroft Graham , Marshall Jane , Prosser David , Bebbington Paul , Kuipers Elizabeth
Published: October 2008

Background

High rates of comorbid alcohol and drug disorders have previously been found among individuals with severe mental illnesses such as schizophrenia and bipolar affective disorders. Clinical and social outcomes have been reported to be worse in this group and service costs greater than in individuals with severe mental illness only. These ‘dual diagnosis’ patients have mainly been investigated in the USA, and there has been very little research in Europe, where patterns of substance abuse may be different.

Method

All patients with psychotic illnesses who had any contact with the mental health services in a geographically defined sector in South London over a specified period were studied. Individuals with problems related to alcohol or drugs were identified using standardised interviews with subjects and their keyworkers. Data on psychiatric service use during the previous 2 years were also obtained.

Results

One hundred and seventy-one subjects with psychotic illnesses were interviewed (response rate: 78.4%). The one-year prevalence rate for any substance problem was 36.3% (95% CI=29.1–43.5), for alcohol problems it was 31.6% (95% CI=24.6–38.5), and for drug problems 15.8% (95% CI=10.3–21.3). Young male subjects were at higher risk of having substance problems. Patients with substance problems had spent almost twice as many days in hospital as those without such problems over the previous two years (difference=26.3 days, 95% CI=3.8–48.7).

Conclusions

The prevalence of substance problems among people suffering from severe mental disorders is high, and seems to be associated with greater use of in-patient services. This is a significant clinical problem, with cost implications. Further investigation is needed for adequate service provision.
Relationship Between Insight, Educational Background and Cognition in Schizophrenia
Authors: Macpherson Rob , Jerrom Bill , Hughes Anthony
Published: October 2008

Background

There is a paucity of research into the relationship between insight and variables including cognitive function, educational background and symptomatology in schizophrenia.

Method

Sixty-four patients with DSM–III–R diagnosis schizophrenia were assessed with the Schedule for Assessment of Insight, Mini Mental State cognitive test, a new measure of knowledge about treatment (the Understanding of Medication Questionnaire), and educational background and compliance assessments.

Results

Insight scores correlated significantly with a range of variables. In a multiple regression analysis only knowledge about treatment and number of years in education explained a significant proportion of insight.

Conclusion

Educational background and the intellectual ability required to learn complex concepts, such as models of mental illness, appear to be more important than previously considered. Research is limited by the lack of a generally accepted definition of insight.
An Epidemiological Study of Dementia in a Rural Community in Kerala, India
Authors: Shaji S. , Promodu K. , Abraham Tony , Roy K. Jacob , Verghese Abraham
Published: October 2008

Background

This community-based epidemiologic study of dementia in a rural population in India investigated the prevalence of various dementing disorders in the community, psychosocial correlates of the morbidity, and assessment of the risk factors associated with dementia.

Method

A door to door survey was conducted to identify elderly people aged 60 and above. A total of 2067 elderly persons were then screened with a vernacular adaptation of the MMSE. All those who scored 23 and below had a detailed neuropsychological evaluation by CAMDEX–Section B, and the care-givers of the people with confirmed cognitive impairment were interviewed using CAMDEX–Section H to confirm the history of deterioration or impairment in social or personal functioning. In the third phase the subjects with confirmed cognitive impairment were evaluated at home as to whether they satisfied the DSM–III–R criteria for dementia. Subcategorisation of dementia was done based on ICD–10 diagnostic criteria. Five per cent of those whose screening was negative were randomly selected and evaluated during each stage.

Results

Sixty-six cases of dementia were identified from 2067 persons aged 60 and above, a prevalence rate of 31.9 per thousand After correction this rate was 33.9 per thousand. Fifty-eight per cent of the dementia cases were diagnosed as vascular dementia and 41% satisfied the criteria for ICD–10 dementia in Alzheimer's disease. There were more women in the Alzheimer's disease group; smoking and hypertension were associated with vascular dementia while a family history of dementia was more likely in the Alzheimer's group.

Conclusion

Dementia is an important cause of morbidity in the geriatric population in this community, where families take responsibility for the care of relatives with dementia.
Explaining Suicide: The Views of Survivors of Serious Suicide Attempts
Authors: O'Donnell Ian , Farmer Richard , Catalán José
Published: October 2008

Background

There is a dearth of information on the motivational aspects of serious suicide attempts, in particular those which involve violent methods. Clarification of the reasons which lie behind such acts may suggest appropriate preventive strategies.

Method

Interviews were carried out with 20 individuals who had attempted suicide by jumping in front of a railway train. Demographic and psychiatric data were collected for each case and the Suicidal Intent Scale was administered.

Results

In most cases the act had been impulsive and was characterised by an extremely high level of suicidal intent. The majority were receiving psychiatric treatment at the time of their suicide attempt. In some cases, survival and the aftermath of the attempt appeared to have a beneficial effect on mental state.

Conclusions

While high levels of psychiatric morbidity and high suicidal intent were common, impulsivity and improved mental state indicate that there are similarities between high and low suicide intent survivors.
Comparative Incidence of Depression in Women and Men, During Pregnancy and after Childbirth
Authors: Areias M. E. G. , Kumar R. , Barros H. , Figueiredo E.
Published: October 2008

Background

Comparing women's and men's emotional reactions to childbirth can clarify the impact on mental health of childbirth as a life event.

Method

Fifty-four first-time mothers attending obstetric services in Oporto, Portugal, and 42 of their husbands or partners participated in a longitudinal study of their mental health. All subjects were given a semi-structured clinical interview (SADS) at 6 months antenatally and at 12 months postnatally and sub-samples were interviewed at 3 months postnatally. At all these times all the mothers and fathers also completed a translated version of a self-rating scale for depression, the Edinburgh Postnatal Depression Scale (EPDS).

Results

More women than men had past histories of depression but their rates of depression did not differ significantly during pregnancy. In the first 3 months postnatally, nearly a quarter of the women ‘at risk’ were found to have become depressed (major, minor and intermittent) in contrast with less than 5% of the men. In the next nine months men were more prone to become depressed than previously and their conditions tended to follow an earlier onset of depression in their spouses.

Conclusion

Comparisons of EPDS and SADS ratings showed that the translated EPDS was a valid instrument for women but it was less satisfactory when applied to men.
Correlates of Postnatal Depression in Mothers and Fathers
Authors: Areias M. E. G. , Kumar R. , Barros H. , Figueiredo E.
Published: October 2008

Background

We compare and contrast some correlates of paternal and maternal depression after the live birth of a first child, as part of a longitudinal study.

Method

Fifty-four first-time mothers attending obstetric services in Oporto, Portugal, and 42 of their husbands or partners participated in a longitudinal study of their mental health. All subjects were given a semi-structured clinical interview (SADS) at six months antenatally and at 12 months postnatally and sub-samples were interviewed at three months postnatally. At all these times all the mothers and fathers also completed a translated version of a self-rating scale for depression, the Edinburgh Postnatal Depression Scale (EPDS) and a series of other questionnaires and interviews to measure different psychosocial variables. Profiles of risk factors associated with depression in the first postnatal year were analysed by means of logistic regressions.

Results

In the mothers, aside from a history of depression, the only other powerful predictor of postnatal depression was the mean objective negative impact score of life events. ‘Postnatal’ depression in fathers was associated with a history of depression in themselves and with the presence of depression in their wives or partners during pregnancy and soon after delivery.

Conclusion

Prevention and early treatment of depression in fathers may benefit not only themselves but also their spouses and their children.
Alcohol and Drugs in Suicides
Authors: Ohberg Annakatri , Vuori Erkki , Ojanperä Ilkka , Lonnqvist Jouko
Published: October 2008

Background

Alcohol and drugs use were assessed in a nationwide one year suicide study in Finland.

Method

Alcohol and drugs use were analysed in 1348 suicides, 96.5% of all suicides in the study year. Relative suicide risks for drugs were defined by relating the number of suicides committed by use of various drugs to drug availability.

Results

Alcohol was detected twice as often in men as in women; the opposite was the case with drugs. The drugs most commonly used for suicide were neuroleptics and antidepressants, which were, in 74.3% and 77.4% of the cases, respectively, the victim's own prescribed drugs. Antidepressants were found in 19.0% of women and only 4.8% of men. Relative suicide risk for antidepressants varied substantially between different compounds.

Conclusions

Undertreatment of depression is a challenge for suicide prevention. Those who commit suicide by antidepressants use their own drugs. Relative suicide risk for a drug should be considered when choosing treatment for depressive patients.
The Galway Study of Panic Disorder IV
Authors: O'Rourke D. , Fahy T. J. , Prescott P.
Published: October 2008

Background

A long-term outcome study of DSM–III–R panic disorder included the Present State Examination (PSE) at baseline and follow up five to six years later.

Method

PSE test–retest and individual within-patient change scores on various PSE syndromes were assessed for consistency with either a categorical view of panic disorder as a stable clinical entity or panic disorder as one facet only of a ‘general neurotic syndrome’.

Results

PSE profile at baseline was virtually identical with that at follow up. Few patients had ‘changed’ in PSE syndrome diagnosis after five to six years.

Conclusion

These data, although not conclusive, are supportive of the concept of DSM–III–R panic disorder as a stable clinical entity and are correspondingly difficult to reconcile with the view that panic disorder is but one facet only of a general neurotic syndrome.
The Mental Health Residential Care Study: Classification of Facilities and Description of Residents
Authors: Lelliott Paul , Audini Bernard , Knapp Martin , Chisholm Daniel
Published: October 2008

Background

The NHS is no longer a virtual monopoly provider of mental health residential care. This makes it difficult to assess the volume, range and adequacy of local provision.

Method

Local data collectors used standard instruments to collect detailed information about 368 facilities (with 1951 residents) providing mental health residential care in eight districts. Because local definitions were inconsistent, facilities were reclassified on the basis of facility size and extent of day and night cover. The eight categories of accommodation are compared on levels of staffing, staff qualifications and the characteristics of their residents.

Results

There was a nearly threefold variation between districts in the total number of residential places available per unit of population, and even greater variation in the number of places with 24-hour waking cover. Most residents have long-term, severe mental illness and severe impairment. Long-stay wards accommodate people who pose greater risk of violence than do the two types of non-hospital facility with 24-hour waking cover (P<0.001). The former also employ a much greater proportion of staff with formal care qualifications and, in particular, nursing qualifications than the latter (49% v. 15%, P < 0.001).

Conclusions

It is suggested that one consequence of the diversification in provision of mental health residential accommodation has been a relative reduction in the proportion of provision available to the most severely disabled. This might apply particularly to those who pose a risk of acting violently.
Life Events and Primary Affective Disorders
Authors: Pardoen D. , Bauwens F. , Dramaix M. , Tracy A. , Genevrois C. , Staner L. , Mendlewicz J.
Published: October 2008

Background

Unipolar and bipolar patients with a chronic illness pattern were investigated to determine whether they experienced a higher number of life events prior to the onset of recurrent affective episodes.

Method

The study participants consisted of 27 recovered bipolar patients, 24 recovered unipolar patients and 26 healthy control subjects. Life events and psychiatric status were assessed by bimonthly interviews over the period of one year using the Inventory for Recent Life Events and the Research Diagnostic Criteria.

Results

In both unipolar and bipolar patients, analyses revealed no significant differences in the number of life events experienced, irrespective of whether the patients had presented with a depressive episode of at least minor intensity during the study (all P > 0.1). Specifically, an increase in marital problems was observed in bipolar patients prior to the onset of recurrent hypomanic and manic episodes (P=0.06).

Conclusion

The causal association between life events and the onset of depression, shown to be relevant in non-chronically depressed subjects, does not apply in chronic affective disorders. In addition, our results suggest that marital events have an impact on the onset of recurrent hypomanic and manic episodes.
Deliberate Self-Poisoning and Self-Injury in Children and Adolescents Under 16 Years of Age in Oxford, 1976–1993
Authors: Hawton Keith , Fagg Joan , Simkin Sue
Published: October 2008

Background

Deliberate self-harm (DSH) is common in adolescents in the United Kingdom and suicide has greatly increased in frequency in older male adolescents. There is, however, very little information about DSH in older children and young adolescents.

Method

Analysis of data collected by the Oxford Monitoring System for Attempted Suicide between 1976 and 1993 for all cases of DSH in under 16-year-olds referred to the general hospital in Oxford.

Results

Seven hundred and fifty-five individuals were involved in 854 episodes of DSH. There were very few cases under 12 years of age but after that the behaviour increased greatly in frequency with each year of age, especially in girls. Eighty-five per cent were girls, the sex ratio being 5.7 girls to each boy. Most cases involved self-poisoning. During the final six years of the study period paracetamol was involved in 54.7% of overdoses, compared with 19.5% in 1976–1981. A minority of individuals had had previous psychiatric treatment. The most frequent problems were relationship difficulties with parents, followed by difficulties with friends, school and social isolation. Among those who reported previous episodes of DSH, in the majority of cases these had not come to medical attention. Repetition of self-harm occurred in 9.4% of cases within a year of an episode and 19.3% during the overall study period. There was some indication that repetition was most common in youngsters discharged from the Accident and Emergency Department without a psychiatric assessment.

Conclusions

DSH in under 16-year-olds is not uncommon and there is evidence that it occurs far more frequently in the community than is reflected in general hospital figures. The problem of paracetamol self-poisoning in this age group needs to be addressed. A psychiatric assessment should be performed in all cases coming to the general hospital.
Age at Onset in Schizophrenia and Risk of Illness in Relatives
Authors: Kendler Kenneth S. , Karkowski-Shuman Laura , Walsh Dermot
Published: October 2008

Background

For many common medical and neuropsychiatric disorders, early age at onset reflects high familial liability to illness. However, for schizophrenia, most studies do not find such a relationship.

Method

Using Cox proportional hazard models, we investigate this question in the epidemiologically-based Roscommon family study.

Results

No relationship was found between age at onset in schizophrenic probands and the hazard rate for schizophrenia in their relatives. Similar results were obtained when the definition of illness was expanded to include schizoaffective disorder and other non-affective psychoses.

Conclusions

For schizophrenia, a ‘common-sense’ model for age of onset (i.e. those with highest familial liability to illness succumb first while those with lower liability survive longer before falling ill) does not seem to apply. Our results are more consistent with a model in which variation in age at onset of schizophrenia is due to random developmental effects or to environmental experiences unique to the individual.
Prevalence and Cluster Typology of Maladaptive Behaviours in a Geographically Defined Population of Adults with Learning Disabilities
Authors: Smith Susan , Branford David , Collacott Richard A. , Cooper Sally-Ann , McGrother Catherine
Published: October 2008

Background

Maladaptive behaviours are frequently present in individuals with learning disabilities; however, their prevalence varies between studies and the aetiology, classification and most appropriate management of such behaviours remain unclear. The aims of the study were twofold: firstly to determine the prevalence of maladaptive behaviours, and secondly to develop a classification typology.

Method

A population of 2202 adults with learning disabilities was surveyed to determine the prevalence of maladaptive behaviours. These were subjected on the basis of 13 behavioural characteristics to cluster analysis. The clusters were further examined in respect of secondary variables.

Results

Over 60% of individuals demonstrated the presence of at least one maladaptive behaviour and in 40% this problem was of either severe degree or frequent occurrence. Men were more likely to demonstrate physical aggression, property destruction, tantrums and verbal abuse than women. Although some severe maladaptive behaviours diminished with age, many persisted through all age groups. Six behavioural clusters were devised which demonstrated face validity and which differed in respect of demographic and developmental variables, and the prevalence of maladaptive habits and autistic symptoms.

Conclusions

These findings demonstrate a high prevalence of maladaptive behaviours and ‘objectionable habits’ among people with learning disabilities. A classification of behavioural symptoms may be possible on the basis of symptom clusters.
Physical and Psychiatric Comorbidity in General Practice
Authors: Kisely S. R. , Goldberg D. P.
Published: October 2008

Background

The aim of this study was to determine the association between physical and psychiatric morbidity among general practice patients and to explore the influence of possible intervening variables.

Method

Physical and psychiatric morbidity in 1620 consecutive patients attending their general practitioner (GP) was assessed using a two-stage design. Ninety-four per cent of the patients (n=1523) were successfully screened using the General Health Questionnaire (GHQ–12); 428 of the 602 patients (71%) eligible for the second stage were interviewed using the Composite International Diagnostic Instrument adapted for use in primary health care (CIDI–PHC), the Brief Disability Questionnaire (BDQ) and the Groningen Social Disability Schedule (GSDS) to assess psychiatric, physical and social status. Assessments of physical and psychiatric morbidity were also obtained from the patients' GPs.

Results

There was a significant association between physical and psychiatric morbidity, although patients with four symptoms or less of physical illness were no more likely to be psychiatric cases than those with none. The association was accounted for by patients at the severe end of the physical continuum with five or more medically explained somatic symptoms: these were twice as likely to be psychiatric cases as those with no such symptoms. Female gender, social disability and physical disability were all significantly more likely to be associated with psychiatric disorder, whether measured by GP or research interview; and these relationships remained after the data were corrected for age differences.

Conclusions

Patients in general practice with moderate to severe physical morbidity are at increased risk of developing psychiatric illness, and when medical illness is present, psychiatric symptoms are more severe. As physical and psychiatric comorbidity is relatively common in general practice, the specific needs of these patients should receive greater attention.
The Benzodiazepine Dependence Questionnaire: Development, Reliability and Validity
Authors: Baillie Andrew J. , Mattick Richard P.
Published: October 2008

Background

A short self-report questionnaire was developed to assess dependence on benzodiazepines (BZDs), the Benzodiazepine Dependence Questionnaire (BDEPQ). The BDEPQ is the first scale to assess dependence on BZDs comprehensively, as all existing scales focus exclusively on withdrawal symptoms.

Method

To evaluate its internal consistency and construct validity, 302 regular BZD users were recruited from media advertisements and assessed on a number of measures. The BDEPQ was compared with measures of depression, anxiety, sleep quality, BZD withdrawal symptoms and neuroticism to assess its construct validity. A 3–4 month follow-up was conducted to assess the ability of the BDEPQ to predict changes in BZD consumption and future BZD withdrawal.

Results

The BDEPQ was found to have high internal consistency and to be relatively stable over the follow-up period. Three subscales were identified, each with good internal consistency and temporal stability. The BDEPQ was able to predict the severity of withdrawal symptoms.

Conclusion

The BDEPQ was found to be a reliable and valid self-report instrument for the assessment of BZD dependence in samples approximating the general population of people using BZDs.