bluuebunny/crossref_metadata_2025 huggingface dataset:
Locus of control as an indicator of risk for suicidal behaviour among adolescents
Authors: Pearce C.M. , Martin G.
Published: August 2007

Using a sample of high school students, this pilot study investigated the relationship between locus of control and a range of suicidal behaviours, the proportion of high school students in an Australian sample who report having engaged in such behaviours and the proportion of suicide attempters who received medical attention following an attempt. Two hundred male and 205 female students aged between 13 and 19 years (mean = 15, SD = 1), attending one randomly chosen metropolitan state high school, completed a questionnaire that included demographic details, the Nowicki‐Strickland Locus of Control Scale for Children and questions concerning suicide. The findings indicated that a substantial proportion of individuals in the sample have suicidal ideation. A smaller proportion have engaged in a range of more serious and overt self‐destructive and suicidal behaviours. Further, a majority of attempters in the sample had not received medical attention following their attempt. There was also a clear association between locus of control and suicidal behaviour, with the individuals who had engaged in suicidal behaviours characterized by a more external locus of control orientation. This study adds further weight of evidence to the suggestion that the locus of control construct is useful in identifying adolescents at risk of engaging in suicidal behaviour.
The Prenatal Development Project
Authors: Reinisch J. M. , Mortensen E. L. , Sanders S. A.
Published: August 2007

The primary aim of the Prenatal Development Project (PDP) is to evaluate the developmental effects of prenatal exposure to steroid hormones and psychoactive drugs, particularly synthetic progestin, corticosteroids and barbiturates. Data collection has taken place at the Psykologisk Institut, now the Institute of Preventive Medicine, since 1981. The PDP database is unique for its breadth and depth as well as its combination of prospective longitudinal and cross‐sectional perspectives. This article describes the database, including subject selection, perinatal information, the comprehensive contemporary evaluation and archival information from Danish registers. The unique matching procedures designed specifically for these projects and data analytic strategies are explained. The value of the PDP database is discussed both in relation to specific project aims (evaluating effects of prenatal drug exposure) and in relation to developmental and psychological research in general.
The epidemiology of suicide and parasuicide
Authors: Diekstra R. F. W.
Published: August 2007

This article analyses secular trends in suicide and parasuicide and provides support for the hypothesis that a true increase in these phenomena has occurred since the early 1950s up to at least the early or mid‐1980s among the adolescent and young adult populations of Europe and North America, particularly young men. One of the potential causal mechanisms for this development, increasing secular trends in and lowering of age of onset for depressive disorders, is examined. Although it is difficult to assess whether the earlier age of onset observed for depressive disorders is reflected in an increase of suicide mortality at a lower age, there is indirect evidence to suggest that this might be the case. Studies show that lifetime parasuicide prevalence rates for the general population do not exceed and sometimes even remain below the rates for adolescents. Assuming that recall of past episodes remains constant throughout the life span, one possible explanation for this finding is an earlier age of the first‐ever parasuicidal act. Since parasuicide is an important precursor of suicide, a lowering of age for first‐ever parasuicides can be expected to lower the age for suicides and increase the overall lifetime risk.
Psychotherapy of the suicidal patient
Authors: Rosenberg N. K.
Published: August 2007

Three different psychological theories of depression, the psychoanalytic, the behavioural and the cognitive‐behavioural, and their psychothera‐peutic principles are presented. A common, central aim of these therapies is to prevent suicide. But whenever suicidal ideation becomes dominant, the therapeutic method should be changed to a directive, counselling and reassuring form.
Pharmacotherapy of the suicidal patient
Authors: Kragh‐Sørensen P.
Published: August 2007

The incidence of self‐poisoning and suicide accomplished with tricyclic antidepressants (TCA) is unacceptably high. TCA are undeniably highly toxic, and overdosage occurs frequently. This review presents data that more than suggest that the compounds are prescribed for patients for whom TCA treatment is not indicated. Therefore, the physicians must learn to face up to the benefit‐risk elements with these drugs. As TCA for many years to come probably remain the drug of choice in treatment of many depressed patients, the only way out of this dilemma is to focus on prevention. In any event, more cautious prescribing of TCA outside hospital is desirable.
The prevalence of depressive symptoms and predisposing factors in an elderly Chinese population
Authors: Woo J. , Ho S. C. , Lau J. , Yuen Y. K. , Chiu H. , Lee H. C. , Chi I.
Published: August 2007

In a survey of elderly Chinese aged 70 years and over living in Hong Kong selected by stratified random sampling, the prevalence of depression was determined using the 15‐item Geriatric Depression Scale using a cut‐off point of 8 (sensitivity 96.3% and specificity 87.5% for this population). Subjects with moderate to severe cognitive impairment (CAPE I/O score ≤ 7) were excluded. There were 877 men and 734 women. The adjusted overall prevalence for this population was 29.2% for men and 41.1% for women. The prevalence increased with age in men and was higher in women than in men. Univariate analysis identified many factors in the following areas that were associated with depression: socioeconomic characteristics, functional ability, physical health and social support. Stepwise logistic regression identified 16 factors predictive of depression: socioeconomic characteristics, such as borderline living expenses and dissatisfaction with living arrangement; poor social support, such as absence of an informal carer when ill, few relatives to turn to, and infrequent contact with neighbours and friends; functional disability, as indicated by a Barthel Index < 15, urinary incontinence and inability to do housework; and poor physical health – poor self perceived health, poor vision, difficulty with chewing, history of mental illness, frequent hospital admissions and increased level of symptoms such as poor memory, constipation and dizziness. Some of these factors may be amenable to intervention, and such measures may be important in reducing the high prevalence of depression in elderly people.
Morning light therapy for winter depression: predictors of response
Authors: Lam R. W.
Published: August 2007

Bright‐light therapy is widely regarded as an effective treatment for winter seasonal affective disorder (SAD). We attempted to identify predictors of light therapy response in 54 depressed, drug‐free outpatients diagnosed with SAD by DSM‐III‐R criteria. After a baseline week, patients were treated for 2 weeks with 2500‐lx cool‐white fluorescent light exposure from 0600 to 0800 daily. The results showed that light therapy significantly reduced depression scores. Several indices of atypical and typical symptoms correlated with response, but none was clearly superior to the pre‐treatment depression score. A multiple regression analysis identified 3 factors (hypersomnia, increased eating and younger age) that predicted light‐therapy response. These results suggest that specific symptoms of hypersomnia and hyperphagia are predictors of response to morning bright‐light therapy in SAD.
Sleep and suicidality in psychotic patients
Authors: Keshavan M. S. , Reynolds C. F. , Montrose D. , Miewald J. , Downs C. , Sabo E. M.
Published: August 2007

The purpose of the study was to determine whether polysomnographic rapid eye movement (REM) sleep parameters distinguish between psychotic patients with and without a history of suicidal behavior. We examined both hand‐scored and automated measures of rapid eye movement (REM) sleep in psychotic patients with and without a history of suicidal ideation or attempts. Patients with suicidal behavior had significantly increased REM activity and time both in the whole night data and in the first REM period. These findings suggest an association between REM sleep abnormalities and suicidal behavior, perhaps related to alteration in serotonergic function.
The reliability and validity of the Chinese Polarity Inventory
Authors: Zheng Y.P. , Lin K.M.
Published: August 2007

For the simultaneous measurement of manic and depressive symptoms, the Chinese Polarity Inventory (CPI), a 20‐item self‐report scale, was developed. A total of 329 depressive and 356 manic/hypomanic patients were recruited in this scale developmental study in China. All patients completed the CPI and either the Chinese version of the Hamilton Depression Rating Scale (for depressed subjects) or the Chinese version of the Bech‐Rafaelsen Mania Scale (for manic subjects). The CPI was found to have excellent reliability and satisfactory concurrent validity. Construct validity analysis was performed using principal component analysis, which yielded 4 clinically meaningful factors: activity, pleasurability, capability and irritability. The CPI was sensitive in differentiating different severities of depression and mania. However, its ability to differentiate mixed phase from other mood states and its sensitivity to changes during the treatment still need to be studied further.
A typological model of schizophrenia based on age at onset, sex and familial morbidity
Authors: Sham P.C. , MacLean C.J. , Kendler K.S.
Published: August 2007

We investigated the age at onset distributions of schizophrenia in men and women and the relationship of age at onset and sex to the familial rates of schizophrenia and manic‐depression in data from a Swedish family study of 270 schizophrenic probands. On the logarithmic scale, the age at onset distribution of schizophrenia in both male and female relatives was bimodal, suggesting that broadly defined schizophrenia may be a mixture of 2 (probably related) disorders. The risk of schizophrenia in relatives decreased as a function of the age at onset of the proband, irrespective of the sex of the proband or relative. In contrast, the risk of manic‐depression was significantly higher in relatives of female probands with an age at onset in the twenties than in relatives of female probands with earlier or later onset, or in relatives of male probands. This suggests a third disorder related to affective psychosis, with an intermediate age at onset and female preponderance.
Increased antipanic efficacy in combined treatment with clomipramine and dixyrazine
Authors: Feet P. O. , Götestam K. G.
Published: August 2007

A double‐blind 12 week trial was undertaken to compare the effects of clomipramine + dixyrazine with clomipramine + placebo in the treatment of panic disorder with or without agoraphobia. Of 45 patients included (21 dixyrazine, 24 placebo), 16 dropped out (6 dixyrazine, 10 placebo). The number of panic attacks and the scores on the panic disorder subscale of the Hamilton Anxiety Rating Scale were significantly reduced in response to both treatment regimens, but the reduction was significantly greater in the dixyrazine group. The patients’ daily functioning was significantly more improved with the dixyrazine combination. The serum concentration of desmethylclomipramine monotherapy was significantly higher and the side effects significantly lower in the combined treatment with dixyrazine than with clomipramine monotherapy. Clomipramine combined with dixyrazine seems superior to clomipramine in the treatment of panic disorder.
Medicine self‐poisoning and the sources of the drugs in Lund, Sweden
Authors: Alsén M. , Ekedahl A. , Löwenhielm P. , Niméus A. , Regnéll G. , Träskman‐Bendz L.
Published: August 2007

The purpose of this study was to investigate the prevalence of toxic agents in attempted and completed suicides. The purpose was also to explore the sources of the drugs taken by suicide attempters. Verbal information on drug intake was collected from 280 suicide attempters during 1987–1990 in the Lund‐Orup catchment area. Information on the sources of the drugs was collected from 143 of these attempters. The study also includes toxicological screening from 73 fatal poisonings in southern Sweden during 1989. According to verbal information, the most common drugs used by suicide attempters were benzodiazepines (51%), analgesics (29%) and antidepressants (20%). In suicide attempters, diazepam and levomepromazine were reported more than expected from prescription data. Toxicological screenings of fatal poisonings showed that benzodiazepines were most common (55%), followed by analgesics (38%), mainly propoxyphene (29%) and antidepressants (30%), mainly amitriptyline (22%). Amitriptyline and diazepam were more commonly detected in completed suicides than expected from prescription data. The most common sources of drugs to attempted suicides were physicians, and especially psychiatrists. We therefore conclude that continuous information to physicians on drug overdose is important, and it is also important to introduce alternative strategies to prevent suicidal behaviour.
Benzodiazepines in the treatment of catatonic syndrome
Authors: Ungvari G. S. , Leung C. M. , Wong M. K. , Lau J.
Published: August 2007

During a 5‐month period, 18 (8%) of 212 patients admitted to a psychiatric unit affiliated to a teaching hospital were found to have a catatonic syndrome associated with various nonorganic mental disorders. Signs and symptoms of motor retardation predominated the clinical presentations. In the course of a prospective, open study, all 18 patients were challenged by a small dose of oral lorazepam or intramuscular diazepam. Catatonic signs and symptoms in 2 patients showed an immediate, complete, and sustained response to the medication. The remaining 16 patients were maintained on 1 of the 2 benzodiazepines for the next 48 h when their motor status was re‐evaluated. Significant clinical improvement was detected in all but 2 patients. However, 9 patients needed electroconvulsive treatment to achieve further improvement. Short‐term benzodiazepine administration proved to be a safe and effective treatment of the catatonic syndrome.
A long‐term follow‐up study of cerebrospinal fluid somatostatin in delirium
Authors: Koponen H. J. , Leinonen E. , Lepola U. , Riekkinen P. J.
Published: August 2007

Cerebrospinal fluid somatostatin‐like immunoreactivity (CSF SLI) was determined for elderly delirious patients during the acute stage and after 1‐ and 4‐year follow‐up periods, and the SLI levels were compared with age‐equivalent controls. As a whole group, and also when the group was subdivided according to the severity of cognitive decline at the acute stage, type of delirium or the central nervous system disease, delirious patients showed significant reduction of SLI as compared with the controls. In the follow‐up, we observed a further reduction of CSF SLI together with significant correlations in the second, third and fourth samples between SLI levels and Mini‐Mental State Examination scores. Our results suggest a role for somatostatinergic dysfunction in the genesis of some symptoms of delirium, and this dysfunction may be linked to the long‐term prognosis of delirious patients.
Conduct disorder patients 20 years later: a personal follow‐up study
Authors: Storm‐Mathisen A. , Vaglum P.
Published: August 2007

As a part of a larger study, 75 consecutive patients with conduct disorder (48% men, median age 15, range: 6–19 years) were followed up after 18–21 years (mean: 19) with a clinical interview using DSM‐III criteria. At follow‐up, 47% had no Axis I disorder, 24% an anxiety disorder, 25% a substance abuse disorder and only one a psychotic disorder. Thirty‐three percent fulfilled the criteria of an antisocial personality disorder. An additional anxiety disorder at the time of the primary examination was a strong predictor of a poor outcome, as was also criminal offences. The study shows the severe prognosis of conduct disorder and the importance of this disorder as an antecedent to substance abuse. However, since nearly half of these patients developed into a healthy state during the 20‐year follow‐up period, work should be continued to develop better treatment for these patients.
Seroprevalence of human immunodeficiency virus infection among Chinese psychiatric patients in Taiwan
Authors: Chen C. H.
Published: August 2007

Psychiatric patients were reported to have high risks of contracting HIV infection due to unstable mental symptoms and comorbidity of drug abuse. The author surveyed the seroprevalence of human immunodeficiency virus (HIV) infection among Chinese psychiatric patients hospitalized in 2 psychiatric hospitals in the Taipei City area, Taiwan. No positive case was identified among 834 psychiatric patients in 1 year's survey. The low seropositive rate of HIV infection among Chinese psychiatric patients may be explained by: the low prevalence of HIV infection in Taiwan and low HIV‐related risk behaviors, especially rare comorbidity of drug abuse among Chinese psychiatric patients.
Obsessive‐compulsive disorder: admission patterns and diagnostic stability
Authors: Thomsen P. H. , Jensen J.
Published: August 2007

All first‐time admissions from 1970 to 1986 with obsessive‐compulsive neurosis (OCD) (ICD‐8 diagnosis number 300.39) or obsessive‐compulsive personality disorder (OCPD) (ICD‐8 diagnosis number 301.49) were analyzed based on an extract from the nationwide Psychiatric Case Register in Denmark. All patients with secondary diagnoses other than neurotic disorders or personality disorders (including “neuroses characterogenes”) were excluded from the study. A total of 284 patients were first‐time admitted with a main diagnosis of OCD during the period. The sex ratio was 0.67 (males/females). A total of 126 were first‐time admitted with a diagnosis of OCPD, with a sex ratio of 1.18 (males/females). Seventy‐seven percent of the readmitted patients with a first‐time diagnosis of OCD kept a diagnosis within the “emotional spectrum” at the last admission. About half kept OCD as a main diagnosis, whereas only 15% shifted to a severe psychiatric diagnosis such as schizophrenia or manic‐depressive psychosis. Of the readmitted patients with OCPD. 13% later developed a diagnosis of manic‐depressive psychosis.
Correlation of regional cerebral blood flow equivalents measured by single photon emission computerized tomography with P300 latency and eye movement abnormality in schizophrenia
Authors: Blackwood D. H. R. , Ebmeier K. P. , Muir W. J. , Sharp C. W. , Glabus M. , Walker M. , Souza V. , Dunan J. R. , Goodwin G. M.
Published: August 2007

Single photon emission tomography with the intravenous blood flow marker 99mTc‐exametazime was carried out in 14 acutely ill drug‐free schizophrenic patients from whom P300 event‐related potential, smooth eye pursuit eye tracking and verbal fluency were measured within a few days of scanning. Smooth pursuit eye movement abnormality correlated significantly with abnormal tracer uptake in superior pre‐frontal cortex on the right and left and inferior pre‐frontal cortex on the left. Abnormal eye movement was also associated with higher tracer uptake in left anterior cingulate and left posterior cingulate. P300 latency was significantly correlated with higher tracer uptake in left superior pre‐frontal and left parietal regions. Verbal fluency performance was negatively correlated with tracer uptake in left frontal region. Eye tracking abnormality in schizophrenia is associated with bilateral frontal lobe disturbance and P300 latency increase with left‐sided frontal and temporoparietal dysfunction. There was, however, a significant inverse relation between eye tracking abnormalities and abnormal perfusion in the left anterior cingulate region.
Psychopathology in Huntington's disease patients
Authors: Shiwach R.
Published: August 2007

A retrospective study of 30 Huntington's disease families (110 patients: 75 alive and 35 dead) known to a regional genetic centre, using multiple sources of information, showed the minimum lifetime prevalence of depression to be 39% in the prodrome and the diagnosed disease phase of the illness. The frequency of symptomatic schizophrenia was found to be about 9% and significant personality changes were found in 72% of the sample, some of them leading to gross behavioural anomalies. The findings reinforce the point that depression and schizophrenia, unaccompanied or preceded by organic personality changes and/or very early neural symptoms, are unlikely to lead to the eventual manifestation of the disease.
Does defense style vary with severity of mental disorder?
Authors: Sammallahti P. , Aalberg V. , Pentinsaari J.‐P.
Published: August 2007

Bond's Defense Style Questionnaire was administered to control subjects from the general population (n= 50) and to psychiatric outpatients with neurosis (n= 42), high‐level personality disorder (n= 37) and low‐level personality disorder (n= 22). Factor analysis yielded 4 defense styles ranging on a continuum from immature to mature; the reliabilities of the subscales as measured with Cronbach's alpha were adequate. Three of the styles – the mature, neurotic and immature – were similar to the styles in Bond's original study, but the fourth style consisted of items reflecting inhibition instead of omnipotence as in the original study. The level of defense maturity varied with severity of disorder. The construct and criterion validity of the measure are discussed.
Mode of inheritance in families of patients with lithium‐responsive affective disorders
Authors: Alda M. , Grof P. , Grof E. , Zvolsky P. , Walsh M.
Published: August 2007

A better understanding of the role of genetic factors in affective disorders is likely to result from investigating more homogeneous populations. To achieve this goal, we have systematically studied patients who are excellent responders to long‐term lithium treatment and their relatives. In the families of 71 such probands, we have analyzed the mode of inheritance by comparing the observed morbidity risks with the risks expected under different genetic models. The results demonstrate major‐gene effects in the transmission of primary affective disorders; the polygenic model with sex‐specific thresholds could be rejected. Discrimination between the autosomal and X‐chromosome models was not possible, but the autosomal recessive model predicts more realistic, gender‐specific frequencies of affective disorders in the general population. These results suggest that autosomal recessive inheritance deserves serious consideration in molecular genetic investigations.
Axis V—Global Assessment of Functioning Scale
Authors: Bodlund O. , Kullgren G. , Ekselius L. , Lindström E. , von Knorring L.
Published: August 2007

The present study examines a self‐report version of the Global Assessment of Functioning Scale according to Axis V (GAF self‐report). The sample (n= 73) was a psychiatric outpatient population from a catchment area clinic. Patients with psychotic and organic mental disorders were not included. The diagnostic distribution on Axis I was similar to the findings from previous studies. Axis II disorders were identified among 47%, of whom a majority also had a concomitant Axis I disorder. The mean GAF expert score was 66.5 (range: 48–86). High complexity and severity of disorders and a high number of fulfilled Axis II criteria were significantly associated with low GAF scores. Independent expert ratings on GAF were correlated with the GAF self‐report overall at r= 0.62, varying from 0.45 to 0.91 between different diagnostic groups. In general, the patients scored themselves lower (mean: ‐ 4.4 units) than expert ratings. Patients with depressive symptoms from an adjustment disorder or mood disorder were most prone to underestimation. Women also tended to score themselves lower than experts did. Conclusively, the GAF self‐report turned out to be a valid and reliable unidimensional instrument measuring psychological, social and occupational functioning. The GAF is easy to handle, and with a self‐report version as a complement, Axis V could be more frequently used in future clinical practice and research.
High levels of free testosterone in women with bulimia nervosa
Authors: Sundblad C. , Bergman L. , Eriksson E.
Published: August 2007

Women with normal‐weight bulimia nervosa (n= 11) displayed significantly higher serum levels of free testosterone than age‐matched controls (6.0 ± 0.7 vs 3.9 ± 0.8 pmol/l; P= 0.03). The possible importance of androgens, in women, for the pathophysiology of conditions characterized by an impairment in impulse control is being discussed.
Major Depressive Disorder
Authors: Spaner D. , Bland R.C. , Newman S.C.
Published: August 2007

A random sample of 3258 adult household residents of Edmonton, Alberta, Canada, were interviewed by trained lay interviewers, using the Diagnostic Interview Schedule (DIS), which generated DSM‐III diagnosis data. This paper reports results for major depressive disorder (MDD). MDD was found to affect women more than men by a ratio of nearly 2 to 1. The lifetime prevalence rate for both sexes combined was 8.6%. The period prevalence rates for both sexes combined were 3.2% and 4.6%, for six month and one year, respectively. The presence of a recurrent Major Depressive Disorder was associated with an increased risk of substance abuse, panic disorder and dysthymia, whereas a single major depressive episode was not associated with increased comorbidity.
Physical activity and depression: clinical experience
Authors: Martinsen E. W.
Published: August 2007

Two quasiexperimental and 10 experimental exercise intervention studies have been performed in depressed subjects. Some of the studies have methodological shortcomings, but in all studies the results point in the same direction: aerobic exercise is more effective than no treatment, but not significantly different from other forms of therapy, including various forms of psychotherapy. Aerobic and anaerobic forms of exercise are equally effective. The results are restricted to patients with mild to moderate forms of unipolar depression. Patients appreciate exercise and consider it a useful form of therapy. Physical exercise may be an alternative or adjunct to traditional forms of treatment in mild to moderate forms of unipolar depression.
Alcohol and depression: a clinical perspective
Authors: Schuckit M. A.
Published: August 2007

Sadness, even when intense enough to interfere with functioning, can be seen in a variety of conditions. Affective syndromes developing in the course of treatment with antihypertensive medications, sadness that accompanies various forms of cancer, and periods of sadness observed during the clinical course of schizophrenia might all have different contributory causes, prognoses, and optimal treatments. In that light, intoxication with brain depressants, especially alcohol, can cause clinically relevant changes in mood, with prolonged intoxication likely to induce depressive symptoms that resemble those seen in major depressive disorder. However, as is true of all complex clinical pictures developing in the course of a pre‐existing physiological or psychiatric condition, the depressive symptomatology associated with heavy consumption of alcohol might not have the same causes as independent major depressive disorder, and the symptoms often disappear with abstinence. This paper reports studies documenting the phenomenon of depression in alcoholism, presents an approach for distinguishing between alcohol‐related depressions and independent major depressive disorders, and explores the clinical and research implications of the relationship between alcohol and depression.
The concept of borderline conditions: a critical comment on validity issues
Authors: Parnas J.
Published: August 2007

It is pointed out that many published empirical studies on the issue of borderline conditions suffer from methodological shortcomings due to the prevailing empiricist simplification of research. Attention is drawn to the fact that the current psychiatric research in classification issues is dominated by an exaggerated quest for reliability at the expense of concern with validity issues. Concepts of operational criteria, polythetic‐prototypic systems, and epistemic peculiarities of psychiatric, clinical typification are briefly exposed. It is suggested that future scientific progress in the area of personality research must take into account these general methodological considerations: repotentiate clinical‐phenomenological observation, include prototypical approaches, extend studied samples with subjects drawn from the general population and import insights from personality trait research in normal psychology. Some of the claims of Gunderson and Torgersen (this volume) are discussed.
The temperamental borders of affective disorders
Authors: Akiskal H. S.
Published: August 2007

Depending on the population studied, anywhere from half to two‐thirds of DSM‐III borderline disorders seem to represent subaffective expressions, principally on the border of bipolar disorder. “Borderland” may actually be a better characterization of this large temperamentally unstable terrain with a population prevalence of 4–6% (as compared with 1% for classical bipolar disorder). The temperaments include the dysthymic, irritable, and cyclothymic types which, respectively, coexist with “double depressive”, mixed bipolar, and bipolar II disorders; others conform to an anxious‐sensitive temperament in continuum with hysteroid dysphoric and atypical depressive disorders. Borderline “stable instability” in these patients appears secondary to affective temperamental dysregulation, which has exacerbated into a protracted emotional storm during a difficult maturational phase in the biigraphy of a given patient.
The borderline syndromes of depression, mania and schophrenia: the coaxial or temperamental approach
Authors: Bech P.
Published: August 2007

When analyzing the diagnostic position of “neurosis”, Akiskal found it clinically meaningless because it lacks sufficient phenomenological characterization. In contrast, Tyrer found it meaningful because it explains the heterogeneity of neurotic symptoms. The diagnostic position of “borderline” has been treated analogically by Akiskal and Tyrer. Thus, Tyrer uses the term borderline in a very broad and general sense, while Akiskal again has found it without sufficient phenomenological characterization. Hence, the DSM‐III concept of borderline personality disorder includes the temperament borders of affective disorders (melancholic, choleric and sanguine). A closer look at the Tyrer concept of neurosis places it within the melancholic temperament. The choleric temperament covers cyclothymia and the sanguine temperament the subclinical manifestations of mania. The term borderline personality disorders should, then, be restricted to cover the phlegmatic temperament or mild degrees of the schizophrenic suectrum disorders, which is in accordance with ICD‐10.
Neuroleptics and the neuroleptic‐induced deficit syndrome
Authors: Lewander T.
Published: August 2007

The first central pharmacodynamic action of chlorpromazine to be described was sedation without narcosis. The antipsychotic action and extrapyramidal symptoms were observed later. Sedation can be separated into nonspecific sedation (drowsiness, somnolence) and specific sedation (psychomotor inhibition and psychic indifference). Both types are parts of the clinical profiles of classical neuroleptics. The sedative properties of neuroleptics may contribute to the overall efficacy in the treatment of psychotic patients, depending on the clinical situation. In most patients, however, sedation is only needed for a short period, or not at all. The drug induced sedation may adversely affect the patients' well‐being and functional capabilities. The term neuroleptic‐induced deficit syndrome (NIDS) has been coined to focus attention on the adverse mental effects of neuroleptics. NIDS still needs to be properly defined and to be differentiated from the deficit syndrome of schizophrenia and postpsychotic depression. Assessment methods are needed to establish the incidence and prevalence of NIDS, to evaluate the importance of NIDS in the overall treatment outcome in psychoses and to facilitate development of better antipsychotic agents.
The tolerabilitv and efficacv of the atypical neuroleptic remoxipride cokpared with clozapine and haloperidol in acute schizophrenia
Authors: Klieser E. , Strauss W. H. , Lemmer W.
Published: August 2007

Remoxipride and clozapine are new neuroleptics that are thought to be superior to the substances in use by their efficacy and tolerance. At the University Clinic of Psychiatry in Dusseldorf a double‐blind study with 54 patients diagnosed as schizophrenic in accordance with DSM‐III was conducted to record the influence of the neuroleptics remoxipride, clozapine and haloperidol on schizophrenic psychosis. The schizophrenic symptoms were rated by the AMDP‐system (Arbeitsgemeinschaft fur Methodik und Dokumentation in der Psychiatrie), Brief Psychiatric Rating Scale and the Clinical Global Impression on days 0, 7, 14, 21 and 28 of treatment to evaluate the degree of change in psychopathology. The tolerance of the neuroleptic treatment was checked by the doctor's overall impression and the somatic findings of the AMDP‐system. All 3 neuroleptics reduced the schizophrenic symptoms to a similar degree but showed differentiation as to their side effects.
How high is the relapse rate in schizophrenia?
Authors: Johnstone E. C. , Geddes J.
Published: August 2007

Although maintenance neuroleptic treatment reduces the risk of relapse in schizophrenia, that risk remains substantial. Maintenance neuroleptics following first schizophrenic episodes are valuable in reducing the relapse rate but may be associated with occupational disadvantage. In first episodes the early introduction of neuroleptic treatment may be important in later reduction of relapse rate. Response to placebo during a psychotic episode does not predict sustained wellbeing without neuroleptics. Long‐term follow‐up indicates that some schizophrenic patients will remain relapse‐free and that there are patients who remain well without neuroleptics, but it is not possible to select those for whom prophylactic neuroleptics will not reduce the risk of relapse.
Compliance, quality assurance and standards for relapse prevention in schizophrenia
Authors: Kissling W.
Published: August 2007

The treatment and, above all, the prophylaxis of schizophrenic psychoses has made great progress in the last 40 years due to the introduction of the neuroleptics and the use of psychosocial treatment strategies. Unfortunately, the potentialities inherent in neuroleptic relapse prevention are far from being fully utilized. As a consequence, the relapse rate for this severe mental illness is still 3 times higher than it ought to be. In view of the severe consequences of this disease for each individual patient and his family, but also in view of the immense costs incurred by each relapse, we must not rest content with this situation. By use of compliance improving measures and quality assurance it would probably be possible within a few years to increase the efficiency of neuroleptic relapse prevention so far as to reduce the high relapse rates of schizophrenic patients at least by half. It is time we began trying.
Cognitive therapy with schizophrenic patients
Authors: Perris C. , Skagerlind L.
Published: August 2007

Cognitive therapy has emerged as a feasible and valuable complement to the treatment of patients suffering from a schizophrenic disorder. It can be carried out at various levels and with different goals in mind and its use is not in conflict with concomitant and strictly individualized medication. In the article some of the approaches most commonly used are pointed out and some of the results of various approaches are highlighted.
Methods for evaluation of the direct and indirect costs of long‐term schizophrenia
Authors: Capri S.
Published: August 2007

Two approaches can be used to estimate the cost of schizophrenia. Prevalence‐based cost provides an estimate of the direct and indirect economic burden incurred in a period of time as a result of the prevalence of schizophrenia during the same base period, most often a year. Incidence‐based cost represents the lifetime cost resulting from the illness. Different examples of studies applying the 2 methods are illustrated, by stressing the advantages and the pitfalls of both. The incidence‐based approach is the most appropriate for the purpose of making decisions about which treatment to implement. Cost analysis of lifetime schizophrenia requires reliable data on service use and treatments and particular methodological instruments. In particular. since schizophrenia is in many cases a chronic disease. pharmacoeconomic evaluation should also be applied using an incidence‐based approach rather than a short period of treatment.
Pharmacological therapy of dysthymia
Authors: Lapierre Y. D.
Published: August 2007

For a number of years, dysthymia was considered to be non‐responsive to antidepressant treatment. During the last decade, early studies with tricyclic antidepressants (TCAs) demonstrated the superiority of the TCAs over placebo. The side effect profile of the TCAs and the moderate degree of symptomatology resulted in reduced compliance and thus to the clinical impression of lack of efficacy. The newest generation of antidepressants, the SRRIs and the RIMAs. with their more acceptable side effect profiles, allowed for the adequate evaluation of pharmacotherapy in dysthymia. The initial open studies with SSRIs indicate a clear efficacy of this group of antidepressants. Likewise, a 5HT2 antagonist, ritanserin, has been shown to be superior to placebo. More recently, a large placebo‐controlled study of moclobemide. a RIMA, clearly demonstrated the superiority of this drug over placebo. Based on this evidence, it is now appropriate to consider antidepressants as a clearly effective method of treating dysthymia.
Recent advances in the pharmacotherapy of schxzophrenia
Authors: Meltzer Herbert Y. , Lee Myung A. , Ranjan Rakesh
Published: August 2007

The major advance in the psychopharmacology of schizophrenia has been the rediscovery of clozapine and the development of other novel antipsychotic drugs, all of which are superior to typical neuroleptic drugs with regard to extrapyramidal symptoms. Clozapine, the best studied of these agents, is also superior in efficacy with regard to psychopathology and cognitive function and has been shown not to cause tardive dyskinesia. A variety of other novel agents, e.g., risperidone, olanazpine, amperozide, seroquel, sertindole, zaprisidone and melperone, must be further studied to establish their efficacy relative to clozapine or the typical neuroleptics, or both. It is likely that these novel agents will displace the typical neuroleptic drugs as the primary treatment of schizophrenia.
Stress reduction in the social environment of schizophrenic patients
Authors: Leff Julian
Published: August 2007

Patients with schizophrenia are sensitive to short term social stressors in the form of life events, and the long term stress of living with high Expressed Emotion (EE) relatives. A number of family interventions have been evaluated in controlled trials. A comparison of successful and unsuccessful interventions indicates the optimal type of intervention for patients in high EE environments.
Symptoms of depression, suicidal behaviour and use of substances in Greece: a nationwide general population survey
Authors: Madianos M.G. , Gefou‐Madianou D. , Stefanis C.N.
Published: August 2007

This study aimed at investigating the relationship between the use of unprescribed licit and illicit drugs and problematic drinking with reported depressive symptoms and suicidal behaviour in a nationwide general population sample of 4291 respondents aged 12 to 64. Depressive symptoms were detected by the use of the Center for Epidemiological Studies Depression Scale (CES‐D). A higher proportion of respondents who have reported illicit drug use in their lifetime were found to be depressed with a > 16 score in the CES‐D in all age groups and both sexes, than of the other categories of substance use. A multiple range test revealed 3 groups of substance users. The more frequent illicit drug users together with the problematic drinkers exhibited the higher average depressive symptoms scores. The 12‐month prevalence of suicidal ideation and suicide attempts was found to be in accordance with the severity and frequency of substance consumption.
The Psychosis Project: outcome and cost‐effectiveness of a psychoeducational treatment programme for schizophrenic adolescents
Authors: Rund B.R. , Moe L. , Sollien T. , Fjell A. , Borchgrevink T. , Hallert M. , Næss P.o.
Published: August 2007

The outcome of a psychoeducational treatment programme for very early‐onset schizophrenics was compared with a standard reference treatment. The study sample consisted of 12 patients in each group. Clinical outcome was assessed by relapses during the 2‐year treatment period and changes in psychosocial functioning as measured by the Global Assessment Scale. A cost‐effectiveness analysis was also carried out. The results indicated that the most effective programme measured by relapse was also the cheapest: the psychoeducational programme. Patients with poor premorbid psychosocial functioning benefit most from this treatment. Decisive with respect to how effective the programme can be is the cooperativeness of patients' parents and their ability to change their emotional attitudes toward the patient.
Clinical efficacy of reversible and selective inhibitors of monoamine oxidase A in major depression
Authors: Paykel E. S.
Published: August 2007

This article reviews efficacy studies of the reversible selective inhibitor of monoamine oxidase A (MAO‐A) nioclobemide, which has now received extensive evaluation. Placebo‐controlled trials have shown it clearly to be effective. In comparisons with tricyclic and similar antidepressants and with serotonin reuptake inhibitors, it has been found of equal efficacy to these standard drugs. Because of previous suggestions that older MAO inhibitors are particularly effective in depressions characterized as alypical, the effects in subtypes are of particular interest. The evidence indicates that moclobemide is effective in typical severe depression with melancholia rather than being limited to less lypical subtypes.
Reversible and selective inhibitors of monoamine oxidase A in mental and other disorders
Authors: Priest R. G. , Gimbrett R. , Roberts M. , Steinert J.
Published: August 2007

The clinically tested reversiblc inhibitors of monoamine oxidase A (RIMAs) include brofaromine, moclobemide and toloxatone. Moclobemide has shown unequivocal antidepressant activity against serious deprcssivc illness in 4 placebo‐controlled double‐blind trials. It has been compared with amitriptyline, imipramine, clomipramine, desipramine, maprotiline, fluoxetine, fluvoxamine, tranylcypromine. toloxatone, mianserin and amineptine in the treatment of depressive disorders. Meta‐analysis showed convincing evidence of moclobemide efficacy, comparable with the most potent antidepressants available. The efficacy of moclobemide has been demonstrated in psychotic and non‐psychotic depression, in depression with and without melancholia, in endogenous depression (both unipolar and bipolar), in retarded depression and in agitated depression. The efficacy of moelobemide, allied to the unusually benign side effect profile, has led to exploration of its use in other disorders. Two small studies have given encouraging results in the treatment of attention‐deficit hyperactivity disorder. Large placebo‐controlled studies have shown the activity of moclobemide in the depression that accompanies dementia (such as senile dementia of Alzheimer type). The results also suggested that, in this patient population, cognitive ability improved in parallel. Social phobia has also been shown to improve on treatment with either moclobemide or brofaromine. Clinical trials are in progress on the effect of moclobemide in chronic fatigue syndrome. Moreover, there are encouraging results with the use of brofaromine and moclobemide in panic disorder. Other disorders in which treatment with RIMA is of interest include agoraphobia, bulimia, borderline personality disorder, post‐traumatic stress disorder, compulsive hair pulling (trichotillomania), dysmorphophobia, kleptomania as well as various anxiety syndromes.
Patients dropping out of treatment in Italy
Authors: Morlino M. , Martucci G. , Musella V. , Bolzan M. , de Girolamo G.
Published: August 2007

The aim of this study was to explore the extent and the specific features of drop‐out for patients having a first contact with an university psychiatric outpatient clinic in Italy over the course of 1 year and to determine which variables were associated with early termination of treatment. Of the 158 patients selected for this study, there was an overall 3‐month drop‐out rate following the first visit of 63 %. Of the 59 patients who had returned once after the initial contact, 28 interrupted subsequently the treatment, although the therapist's plan included further visits. The overall drop‐out rate at 3 months was thus 82%. The only 2 variables associated with drop‐out rates were the patients’ perception of the severity of their disorder and the psychiatric history: continuing patients were more frequently in agreement with the clinician's judgment as compared with those who dropped out and were more likely to have already been in psychiatric treatment.
Neuropsychological deficit in newly diagnosed patients with schizophrenia or schizophreniform disorder
Authors: Rubin P. , Holm A. , Møller‐Madsen S. , Videbech P. , Hertel C. , Povlsen U. J. , Hemmingsen R.
Published: August 2007

Forty‐six patients with schizophrenia or schizophreniform disorder admitted to hospital for the first time were compared with 21 healthy volunteers on neuropsychological tests reflecting prefrontal and left respectively right hemisphere function. The patients with schizophrenia or schizophreniform disorder had a poorer performance on neuropsychological tests (such as Wisconsin Card Sorting) compared with healthy volunteers. Both left and right hemisphere seemed to be involved. Especially poor performance was found on somewhat complicated tests requiring ability of analysis, abstraction and memory, thus indicating dysfunction of prefrontal and temporohippocampal regions. Signs of sulcal enlargement and size of lateral ventricles on computed tomographic scan correlated with poor test performance on some tests both in patients and in healthy volunteers. No correlations were found between performance on neuropsychological test and negative symptoms.