bluuebunny/crossref_metadata_2025 huggingface dataset:
Aggressive behaviour in patients with schizophrenia is associated with catechol-O-methyltransferase genotype
Authors: Jones G. , Zammit S. , Norton N. , Hamshere M. L. , Jones S. J. , Milham C. , Sanders R. D. , McCarthy G. M. , Jones L. A. , Cardno A. G. , Gray M. , Murphy K. C. , Owen M. J.
Published: August 2002

Background

Evidence exists for an association between aggression and schizophrenia. Although the aetiology of aggression is multifactorial, three studies have reported associations between polymorphisms of the catechol-O-methyltransferase (COMT) gene and aggression in schizophrenia.

Aims

To replicate these findings in a larger sample using the Overt Aggression Scale (OAS).

Method

A sample of 180 people with DSM–IV schizophrenia were rated for aggression using the OAS. Kruskal–Wallis and contingency table analyses were applied to the OAS results.

Results

The high-activity homozygotes showed significantly higher scores of aggression, whereas the heterozygotes showed significantly lower scores. The odds ratio for aggression for the high-activity homozygotes was 2.07 (95% Cl=1.03–4.15), whereas that for the heterozygotes was 0.54 (95% CI=0. 30–1.00).

Conclusions

The high-activity COMT homozygote confers a higher risk of recorded aggression in schizophrenia. Heterozygotes had a significantly lower risk, which may represent an example of heterosis/heterozygote advantage.
Antidopaminergic effects of dietary tyrosine depletion in healthy subjects and patients with manic illness
Authors: McTavish S. F. B. , McPherson M. H. , Harmer C. J. , Clark L. , Sharp T. , Goodwin G. M. , Cowen P. J.
Published: August 2002

Background

In rats, amino acid mixtures lacking tyrosine and its precursor phenylalanine decrease the release of dopamine produced by the psychostimulant drug amphetamine. Amphetamine has been proposed as a model for clinical mania.

Aims

To assess whether dietary tyrosine depletion attenuates the psychostimulant effects of methamphetamine in healthy volunteers and diminishes the severity of mania in acutely ill patients.

Method

Sixteen healthy volunteers received a tyrosine-free amino acid mixture and a control mixture in a double-blind crossover design 4 h before methamphetamine (0.15 mg/kg). Twenty in-patients meeting DSM–IV criteria for mania were allocated blindly and randomly to receive either the tyrosine-free mixture or the control mixture.

Results

The tyrosine-free mixture lowered both subjective and objective measures of the psychostimulant effects of methamphetamine. Ratings of mania were lower in the patients who received the tyrosine-free mixture.

Conclusions

Decreased tyrosine availability to the brain attenuates pathological increases in dopamine neurotransmission following methamphetamine administration and putatively in mania.
Mental health of migrant elders – the Islington study
Authors: Livingston G. , Leavey G. , Kitchen G. , Manela M. , Sembhi S. , Katona C.
Published: August 2002

Background

In the UK, 6% of those aged 65 years and over were born abroad, most of whom now live in inner-city areas. It has been suggested that ethnic elders are particularly vulnerable to mental illness.

Aims

To compare the prevalence of dementia and depression in older migrants with those born in the UK.

Method

A cross-sectional community study of 1085 people aged 65 years or older in an inner-London borough.

Results

Compared with those born in the UK, the prevalence of dementia was raised in African–Caribbeans (17.3%, relative risk=1.72, Cl=1.06–2.81) and lower for the Irish-born (3.6%, relative risk=0.36, Cl=0.17–0.87). All those of African–Caribbean country of birth were significantly younger (P=0.000) but no more likely to be taking antihypertensive drugs. They were no more likely to report having cardiovascular problems but had increased rates of diabetes (P < 0.0000). The overall prevalence of depression was 18.3% (95% Cl=16.1–20.7). The highest prevalence rate was found among those born in Greece and Turkey (27.2%, Cl=179–39.6). Migration per se does not appear to be a risk for depression and dementia in this population.

Conclusions

The excess of dementia may be of vascular aetiology. There is the potential for primary or secondary prevention.
Optimising antidepressant use in clinical practice: towards criteria for antidepressant selection
Authors: Mendlewicz Julien
Published: August 2002

Background

Current treatment for depression in primary care and other out-patient settings demonstrates a pattern that is incongruous with the magnitude of the burden of depression suggested by its associated disability.

Aims

To review important considerations in current depression treatment with a focus on antidepressant use.

Method

Factors influencing the under treatment of depression in real-world settings are examined.

Results

Patient and clinician behaviour as well as the incentives created by the health care system affect the likelihood of realising effective antidepressant therapy in practice.

Conclusions

Given the complexities of clinical practice, selection criteria for an antidepressant should include safety, efficacy and tolerability, as well as the ability of the antidepressant to deliver real-world efficacy while balancing health care costs in the long term.
Antidepressant selection and economic outcome: a review of methods and studies from clinical practice
Authors: Crown William H.
Published: August 2002

Background

Economic considerations increasingly play a role in the selection of antidepressant drugs and are often based on analyses from prospective and retrospective studies. However, the non-randomisation found in retrospective studies may result in significant selection bias.

Aims

To highlight the use of statistical methods in non-randomised studies and the application of those methods to economic analyses.

Method

The literature on the observational studies of economic outcomes with alternative antidepressants is reviewed and several statistical methodologies to control for biases that can occur in non-randomised study designs are described.

Results

In comparisons of antidepressant drugs, differences in acquisition costs are consistently found to be at least offset by other components of care when broad measures of health care resource utilisation are considered.

Conclusions

Economic evaluations of antidepressants should be based on broad measures of health care expenditure and can rely on data generated in real-world settings if appropriate statistical methods are used to control for the potential biases of non-randomisation.
Clinical importance of long-term antidepressant treatment
Authors: Hirschfeld Robert M. A.
Published: August 2002

Background

Depression, which only a few decades ago was considered to be a short-term illness requiring short-term treatment, is now recognised as a recurrent, sometimes chronic, long-term illness.

Aims

To highlight the clinical importance of long-term antidepressant therapy in the treatment of depression.

Method

The current literature was reviewed to examine the relationship between duration of antidepressant therapy and efficacy.

Results

Approximately one-third to a half of patients successfully stabilised in acute-phase treatment will relapse if medication is not sustained throughout the continuation period. Only 10–15% will relapse if medication is continued. For maintenance-phase therapy, approximately 60% of patients at risk will experience a recurrent episode of depression within I year if untreated, whereas those who continue in treatment will have a recurrence rate of between 10% and 30%.

Conclusions

Risk of relapse and recurrence of depression can be significantly reduced if adequate continuation and maintenance therapy durations are achieved.
Antidepressant use in clinical practice: efficacy v. effectiveness
Authors: Donoghue John , Hylan Timothy R.
Published: August 2002

Background

Although the efficacy of antidepressants has been demonstrated in randomised, controlled clinical trials, it is how an antidepressant is used in clinical practice that determines its clinical effectiveness, or real-world efficacy.

Aims

To explore the frequency with which antidepressants are used at adequate dose and duration to obtain remission of symptoms and prevent relapse in clinical practice and discuss potential implications for clinical outcomes.

Method

Studies of antidepressant prescribing were reviewed and comparisons made between antidepressant classes and individual compounds within those classes.

Results

Naturalistic studies show that patients who begin therapy on tricyclic antidepressants often receive sub-therapeutic doses for inadequate duration; conversely patients who begin therapy on selective serotonin reuptake inhibitors more often receive an adequate dose of therapy for a longer duration.

Conclusions

How antidepressants are used in clinical practice can determine the clinical outcomes that are achieved. Antidepressants that are more forgiving of sub-optimal prescribing and use patterns by providers and patients, respectively, may help to improve real-world efficacy.
New insights into the role of the GABAA–benzodiazepine receptor in psychiatric disorder
Authors: Nutt David J. , Malizia Andrea L.
Published: August 2002

Background

In the 40 years since the first benzodiazepine was brought into clinical use there has been a substantial growth in understanding the molecular basis of action of these drugs and the role of their receptors in disease states.

Aims

To present current knowledge about the role of the GABAA–benzodiazepine receptor in anxiety disorders, new insights into the molecular biology of the receptor complex and neuroimaging studies suggesting involvement of these receptors in disease states.

Method

An overview of published literature, including some recent data.

Results

The molecular biology of this receptor is detailed. Molecular genetic studies suggesting involvement of the GABAA–benzodiazepine receptor in animal behaviour and learning are outlined; possible parallels with human psychopathology are discussed.

Conclusions

Current insights into the role of the GABAA–benzodiazepine receptor in the action of benzodiazepines and as a factor in disease states, in both animals and humans, may lead to new, more sophisticated interventions at this receptor complex and potentially significant therapeutic gains.
Velo-cardio-facial syndrome: a model for understanding the genetics and pathogenesis of schizophrenia
Authors: Murphy K. C. , Owen M. J.
Published: August 2002

Background

Individuals with velocardio-facial syndrome (VCFS), a genetic disorder associated with microdeletions of chromosome 22q11, are reported to have high rates of psychiatric disorder, particularly schizophrenia.

Aims

To review the evidence for an association between VCFS and schizophrenia: to outline recent neuropsychological, neuroanatomical and genetic studies of individuals with VCFS; and to make recommendations for future work.

Method

A selective literature review was undertaken.

Results

Individuals with VCFS have high rates of psychotic disorders, particularly schizophrenia. In addition, specific neuropsychological and neuroanatomical abnormalities have been reported although it is unclear whether such abnormalities relate to the presence of psychiatric disorder in affected individuals.

Conclusions

Deletion of chromosome 22q11 represents one of the highest known risk factors for the development of schizophrenia. It is likely that haploinsufficiency (reduced gene dosage) of a neurodevelopmental gene or genes mapping to chromosome 22q11, leading to disturbed neuronal migration, underlies susceptibility to psychosis in VCFS.
Signs of asphyxia at birth and risk of schizophrenia
Authors: Dalman Christina , Thomas Hollie V. , David Antony S. , Gentz Johan , Lewis Glyn , Allebeck Peter
Published: August 2002

Background

Previous research has found an association between obstetric complications and schizophrenia, but in many studies the sample size was limited, and no assessment of specific exposures was possible.

Aims

To assess the role of different complications, and in particular to distinguish between disordered foetal development and hypoxia at birth.

Method

From the Stockholm County In-Patient Register and community registers, we identified 524 cases of schizophrenia and 1043 controls, matched for age, gender, hospital and parish of birth. Data on obstetric complications were obtained from birth records.

Results

There was a strong association between signs of asphyxia at birth and schizophrenia (OR 4.4; 95% C11.9–10.3) after adjustment for other obstetric complications, maternal history of psychotic illness and social class.

Conclusions

Signs of asphyxia at birth are associated with an increased risk of schizophrenia in adults.
Obstetric complications and risk of schizophrenia
Authors: Thomas Hollie V. , Dalman Christina , David Anthony S. , Gentz Johan , Lewis Glyn , Allebeck Peter
Published: August 2002

Background

Obstetric complications have been studied frequently as possible risk factors for schizophrenia.

Aims

To test the hypotheses that individual obstetric complications are most strongly associated with an increased risk of schizophrenia in males, in patients with an early age at first diagnosis and in subjects with a maternal history of psychosis.

Method

Cases of schizophrenia diagnosed between January 1971 and June 1994 were identified in the Stockholm County In-Patient Register. Controls were matched on age, gender, hospital of birth and parish of birth. Obstetric data were recorded blind to case–control status for 524 cases and 1043 controls.

Results

This study did not find any large or consistent effect of gender, age at diagnosis or maternal history of psychosis on the risk of schizophrenia associated with individual complications.

Conclusions

Future studies should examine these effects using a much larger sample that includes patients with schizophrenia and control subjects whose genetic risk of schizophrenia has been assessed accurately.
Shortfall in mental health service utilisation
Authors: Andrews Gavin , Issakidis Cathy , Carter Greg
Published: August 2002

Background

Treatment coverage for mental disorders is poor in most developed countries.

Aims

To explore some reasons for the poor treatment coverage for mental disorders in developed countries.

Method

Data were taken from Australian national surveys and from the World Health Report.

Results

Only one-third of people with a mental disorder consulted. Probability of consulting varied by diagnosis: 90% for schizophrenia, which is accounted for by external factors; 60% for depression; and 15% for substance use and personality disorders. The probability of consulting varied by gender, age, marital status and disability, from 73% among women aged 25–54 years, disabled and once married to 9% among males without these risk factors. Those who did not consult but were disabled or comorbid said that they “preferred to manage themselves”. Data from five countries showed no evidence that overall health expenditure, out-of-pocket cost or responsiveness of the health system affected the overall consulting rates.

Conclusions

Societal, attitudinal and diagnostic variables account for the variation. Funding does not. Public education about the recognition and treatment of mental disorders and the provision of effective treatment by providers might remedy the shortfall.
On becoming depressed or anxious in late life: similar vulnerability factors but different effects of stressful life events
Authors: De Beurs Edwin , Beekman Aartjan , Geerlings Sandra , Deeg Dorly , Van Dyck Richard , Van Tilburg Willem
Published: August 2002

Background

Little research has been done on the uniqueness of risk profiles for depression and anxiety in late life.

Aims

Delineating risk factors for the decline of mental health in older persons, comparing risk profiles for developing symptoms of pure depression, pure anxiety and both anxiety and depression in a prospective design.

Method

Self-Report data on depression and anxiety were collected from community-dwelling older respondents (⩾55 years) on two occasions, 3 years apart. Data from emotionally healthy respondents (n=1810) were used to investigate the effects of long-standing vulnerability factors and stressful life events.

Results

After 3 years 9% of the subjects had scored beyond the thresholds for symptoms. Vulnerability for depression and anxiety was quite similar, but life events differed: onset of depression was predicted by death of a partner or other relatives; onset of anxiety was best predicted by having a partner who developed a major illness. No support for moderator effects between vulnerability factors and stress was found; the effects were purely additive.

Conclusions

Depression and anxiety have many risk factors in common, but specific risk factors also were found, especially in subjects developing both depression and anxiety.
Nicotine, alcohol and drug dependence and psychiatric comorbidity
Authors: Farrell Michael , Howes Samantha , Bebbington Paul , Brugha Traolach , Jenkins Rachel , Lewis Glyn , Marsden John , Taylor Colin , Meltzer Howard
Published: August 2002

Background

There is a well-recognised relationship between substance use disorders and other psychiatric disorders. This relationship has been well documented in a range of population-based studies.

Aims

This study aims to report on consumption patterns of and dependence on nicotine, alcohol and non-prescribed drugs and to report on the levels of psychiatric morbidity in these groups.

Method

A national household study of psychiatric morbidity was conducted in England and Wales. Psychiatric assessment was based on the Clinical Interview Schedule – Revised (CIS–R). Measures of nicotine, alcohol and drug use and dependence were obtained. This paper compares the levels of psychiatric morbidity in the non-dependent and the nicotine-, alcohol— and drug-dependent cases.

Results

Twelve per cent of the non-dependent population were assessed as having any psychiatric disorder compared with 22% of the nicotine-dependent, 30% of the alcohol-dependent and 45% of the drug-dependent population.

Conclusions

There is a clear relationship between dependence on nicotine, alcohol and drugs and other psychiatric morbidity.
Cause-specific mortality in psychiatric patients after deinstitutionalisation
Authors: Hansen Vidje , Jacobsen Bjarne K. , Arnesen Egil
Published: August 2002

Background

Since the late 1970s, the psychiatric service system in Norway has been changed gradually according to the principles of deinstitutionalisation.

Aims

To document the mortality of psychiatric patients in a deinstitutionalised service system.

Methods

The case register of a psychiatric hospital covering the period 1980–1992 was linked to the Central Register of Deaths. Age-adjusted death rates and standardised mortality ratios (SMRs) were computed.

Results

Patients with organic psychiatric disorders had significantly higher mortality regardless of cause of death. SMRs ranged from 0.9 for death by cancer in women to 36.3 for suicide in men. For unnatural death, SMRs were highest in the first year after discharge. Compared to the periods 1950–1962 and 1963–1974, there has been an increase in SMRs for cardiovascular death and suicide in both genders.

Conclusions

Deinstitutionalisation seems to have had as its cost a relative rise both in cardiovascular death and unnatural deaths for both genders, but most pronounced in men.
Features of childhood sexual abuse and the development of psychiatric and substance use disorders
Authors: Bulik Cynthia M. , Prescott Carol A. , Kendler Kenneth S.
Published: August 2002

Background

Childhood sexual abuse (CSA) is associated with an increased risk of subsequent psychiatric disorders.

Aims

To explore the risk associated with features of CSA and examine whether specific associations exist between particular profiles of CSA and the development of specific syndromes.

Method

In a population-based sample of adult female twins, we used logistic regression to explore the association between features of CSA (reported by the twin and her co-twin) and lifetime major depression, generalised anxiety disorder, bulimia nervosa, panic disorder and alcohol and drug dependence.

Results

In univariate and stepwise multiple regressions, patterns of predictors differed, although not significantly, across diagnoses. Greater risk was associated with attempted or completed intercourse, the use of force or threats, abuse by a relative, and a negative response by someone who was told about the abuse. Similar patterns were observed with co-twin reports.

Conclusions

Specific features of CSA differentially increase risk of later psychopathology; however, there do not appear to be unique predictive relationships between features of CSA and the emergence of specific psychiatric disorders.
Birth weight and the risk of depressive disorder in late life
Authors: Thompson Christopher , Syddall Holly , Rodin Ian , Osmond Clive , Barker David J. P.
Published: August 2002

Background

Low birth weight is a risk factor for coronary heart disease, diabetes, stroke and hypertension. Depression is highly associated with these conditions.

Aims

To examine the association between birth weight and depression in late life.

Method

A total of 882 singleton term births in the 1920s had contemporary records of birth weight and weight at 1 year. At 68 years all completed the Geriatric Depression Scale and 867 completed the Geriatric Mental State Examination. A logistic regression was used to analyse the associations between depression, birth weight and weight at 1 year while adjusting for known risk factors.

Results

Current social class, social class at birth, recent bereavement, social isolation and physical illness increased the risk of depression. After adjusting for these and weight at 1 year, the odds ratios for depression among men, but not women, rose incrementally with decreasing birth weight (1.0, 12.8; for continuous variable,P< 0.007).

Conclusions

Foetal undernutrition predisposes men to depression in late adult life. If replicated, these results would suggest a neurodevelopmental aetiology of depression, possibly mediated by programming of the hypothalamic–pituitary–adrenal axis.
Reducing demands on clinicians by offering computer-aided self-help for phobia/panic
Authors: Kenwright Mark , Liness Sheena , Marks Isaac
Published: August 2002

Background

Many patients with phobia/panic find it hard to access effective treatment.

Aims

To test the feasibility of computer-guided exposure therapy for phobia/panic.

Method

Self-referrals were screened for 20 min and, if suitable, had six sessions of computer-guided self-help (from a system called Fear Fighter). Pre— and post-treatment ratings of 54 patients were compared with those of 31 similar out-patients with phobia/panic who received the same treatment guided by a clinician.

Results

At pre-treatment, computer-guided cases were slightly less severe than clinician-guided patients. In a post-treatment intent-to-treat analysis, both groups improved comparably but computer-guided patients spent 86% less time with a clinician than did purely clinician-guided patients, who had no access to the computer system.

Conclusions

Computer-guided self-exposure therapy appeared feasible and effective for self-referrals and saved much clinician time. A controlled study is now needed.
Mortality statistics in psychiatry
Authors: Sims Andrew
Published: August 2002

Often the medical epidemiologist can gain valuable information, with therapeutic implications, from the study of mortality statistics – and it causes neither pain to the patient, nor the emotional trauma of a post-mortem to the relatives. In psychiatric epidemiology, death is one of the few really hard items of data we have, and mortality statistics have been used both in research and service planning. The earliest study was conducted 160 years ago (Farr, 1841). Early studies of the mortality associated with mental illness were conducted with patients in mental hospitals and showed greatly increased premature mortality, especially from tuberculosis and gastrointestinal infections (Shepherd, 1957). As the quality of care improved in mental hospitals during the 20th century, the excess mortality among psychiatric in-patients began to diminish, with fewer deaths from pneumonia, tuberculosis and malnutrition (Norris, 1959).
Adjustment disorders: Fault line in the psychiatric glossary
Authors: Casey Patricia , Dowrick Christopher , Wilkinson Greg
Published: August 2002

Adjustment disorder entered the DSM–II nomenclature in 1968 and was recognized in ICD–9 in 1978. Before then the term ‘transient situational disturbance’ was applied to such conditions. The addition of adjustment disorder to the ICD classification was in response to the confusion generated by the older concepts of reactive and endogenous depression. Both DSM–IV (American Psychiatric Association, 1994) and ICD–10 (World Health Organization, 1992) retain the category of adjustment disorder, which has utility as a clinical concept. However, it has been eclipsed by the focus on mood disorder among research and policy-makers. A consequence of this is the danger of exaggerating the need for expensive and sometimes unpredictable mental health interventions in those whose problems are likely to resolve spontaneously.
Cycle of child sexual abuse: Links between being a victim and becoming a perpetrator
Authors: Glasser M. , Kolvin I. , Campbell D. , Glasser A. , Leitch I. , Farrelly S.
Published: August 2002

Background

There is widespread belief in a ‘cycle’ of child sexual abuse, but little empirical evidence for this belief.

Aims

To identify perpetrators of such abuse who had been victims of paedophilia and/or incest, in order to: ascertain whether subjects who had been victims become perpetrators of such abuse; compare characteristics of those who had and had not been victims; and review psychodynamic ideas thought to underlie the behaviour of perpetrators.

Method

Retrospective clinical case note review of 843 subjects attending a specialist forensic psychotherapy centre.

Results

Among 747 males the risk of being a perpetrator was positively correlated with reported sexual abuse victim experiences. The overall rate of having been a victim was 35% for perpetrators and 11 % for non-perpetrators. Of the 96 females, 43% had been victims but only one was a perpetrator. A high percentage of male subjects abused in childhood by a female relative became perpetrators. Having been a victim was a strong predictor of becoming a perpetrator, as was an index of parental loss in childhood.

Conclusions

The data support the notion of a victim-to-victimiser cycle in a minority of male perpetrators but not among the female victims studied. Sexual abuse by a female in childhood may be a risk factor for a cycle of abuse in males.
Invited commentaries on: Cycle of child sexual abuse: Links between being a victim and becoming a perpetrator
Authors: Cannon Mary
Published: August 2002

It is a natural human instinct to seek explanations for the seemingly senseless cruelties that humans inflict on one another, particularly on the young and innocent. However, the recent outcry about paedophiles in the UK demonstrates that there is little public desire to understand or explain such behaviour at present. People who abuse children are viewed as beyond comprehension or redemption – they are ‘wicked, evil and perverted’ and should be ‘locked away’ forever. In the current climate, the paper by Glasser et al is a brave attempt to study the perpetrators of child sexual abuse and look for causal explanations for such behaviour. Many of us would shy away from such a topic or find it difficult to be dispassionate about these perpetrators. The authors propose that they have discovered “links between being a victim and becoming a perpetrator”. Indeed, a casual reading of this paper or a glance at the abstract might seem to indicate that children who are sexually abused are, in turn, likely to become sexual abusers of children in adulthood – what the authors refer to as “the cycle of child sexual abuse”. But blaming the victim is a risky business and this so-called ‘link’ may lead to further stigmatisation and distress for individuals who have been abused in childhood. Therefore, before reaching this conclusion, we should examine carefully the problems associated with establishing causality from the data presented in this paper.
Breaking the Cycle: Challenge and Opportunities
Authors: Bailey Susan
Published: August 2002

Tapping into such a rich database the paper by Glasser et al raises important but complex issues challenging the direct causal link between involvement in sexual activity with an older person and subsequently becoming an adult who perpetrates child sexual abuse.
Mental disorders and cause-specific mortality
Authors: Joukamaa Matti , HeliöVaara Markku , Knekt Paul , Aromaa Arpo , Raitasalo Raimo , Lehtinen Ville
Published: August 2002

Background

The impact of clinically diagnosed mental disorders on mortality in the general population has not been established.

Aims

To examine mental disorders for their prediction of cause-specific mortality.

Method

Mental disorders were determined using the 36-item version of the General Health Questionnaire and the Present State Examination in a nationally representative sample of 8000 adult Finns.

Results

During the 17-year follow-up period 1597 deaths occurred. The presence of a mental disorder detected at baseline was associated with an elevated mortality rate. The relative risk in men was 1.6 (95% confidence interval 1.3–1.8) and in women, 1.4 (95% Cl 1.2–1.6). In men and women with schizophrenia the relative risks of death during the follow-up period were 3.3 (95% Cl 2.3–4.9) and 2.3 (95% Cl 1.3–3.8) respectively, compared with the rest of the sample. In both men and women with schizophrenia the risk of dying of respiratory disease was increased, but the risk of dying of cardiovascular disease was increased only in men with neurotic depression.

Conclusions

Schizophrenia and depression are associated with an elevated risk of natural and unnatural deaths.
Extrastriatal and striatal D2 dopamine receptor blockade with haloperidol or new antipsychotic drugs in patients with schizophrenia
Authors: Xiberas X. , Martinot J. L. , Mallet L. , Artiges E. , Loc'h C. , Mazière B. , Paillère-Martinot M. L.
Published: August 2002

Background

Both traditional and atypical antipsychotics have been hypothesised to be effective in schizophrenia through limbic and cortical D2 dopamine receptor blockade.

Aims

To investigate this hypothesis with the D2/D3-selective positron emission tomography (PET) probe [76Br]-FLB457.

Method

PETscans were performed on 6 controls and 18 patients with schizophreniatreated with haloperidol or with risperidone, clozapine, amisulpride or olanzapine.

Results

The D2 dopamine receptor blockade was high in the temporal cortex with both haloperidol and atypical antipsychotics. The atypicals, however, induced a significantly lower D2 binding index than haloperidol in the thalamus and in the striatum.

Conclusions

Results suggest that cortical D2 dopamine receptors are a common target of traditional and atypical antipsychotics for therapeutic action. Higher in vivo binding to the D2 receptors in the cortex than in the basal ganglia is suggested as an indicator of favourable profile for a putative antipsychotic compound.
Comorbid non-alcohol substance misuse among people with schizophrenia
Authors: Duke Peter J. , Pantelis Christos , McPhillips Michael A. , Barnes Thomas R. E.
Published: August 2002

Background

Few epidemiological studies have assessed the extent and nature of comorbid non-alcohol substance misuse in people with schizophrenia in the community in the UK.

Aims

To study the extent and nature of comorbid non-alcohol substance misuse in people with schizophrenia in central London.

Method

Subjects were identified in an epidemiological census survey of South Westminster. Standardised assessment of each subject included demographic data, ratings of mental state and movement disorder and questioning about drug and alcohol misuse.

Results

Individuals with schizophrenia or related psychoses were identified (n=352) and 57 (16%) reported a lifetime history of non-alcohol substance misuse. Age and gender were the main variables relevant to the extent and pattern of misuse. Self-reported non-alcohol substance misuse showed no significant relationship with a range of outcome measures.

Conclusions

The high proportion of subjects reporting non-alcohol substance misuse is comparable with figures from the USA. The reports of lifetime misuse most commonly referred to cannabis, psychostimulants, LSD, opiates and anticholinergics. Misuse was concentrated in those younger than 36 years and was reported more often by males.
Efficacy of usual antidepressant dosing regimens of fluoxetine in panic disorder
Authors: Michelson D. , Allgulander C. , Dantendorfer K. , Knezevic A. , Maierhofer D. , Micev V. , Paunovic V. R. , Timotijevic I. , Sarkar N. , Skoglund L. , Pemberton S. C.
Published: August 2002

Background

Although serotonin reuptake inhibitors are effective in panic disorder, questions concerning whether doses associated with antidepressant efficacy are also effective for panic disorder remain.

Aims

To assess the efficacy of the usual antidepressant dose of fluoxetine in treating full panic attacks.

Method

Patients with panic disorder were randomised to placebo or to fluoxetine initiated at 10 mg daily for I week and then increased to 20 mg daily. The trial lasted 12 weeks, but after 6 weeks patients who had failed to achieve a satisfactory response were eligible for dose escalation to a maximum of 60 mg of fluoxetine daily.

Results

Fluoxetine was associated with a statistically significantly greater proportion of panic-free patients compared with placebo after 6 weeks and at end-point.

Conclusions

Fluoxetine at a dose of 20 mg daily is safe and efficacious in reducing symptoms of panic disorder. Patients who fail to obtain a satisfactory response at 20 mg daily may benefit from further dose increases.
Spontaneous lapses in dosing during chronic treatment with selective serotonin reuptake inhibitors
Authors: Meijer Welmoed E. E. , Bouvy Marcel L. , Heerdink Eibert R. , Urquhart John , Leufkens Hubert G. M.
Published: August 2002

Background

In previous research, lapses in dosing of paroxetine or sertraline were associated with significantly more discontinuation symptoms and deterioration of depressive symptomatology compared with fluoxetine.

Aims

To evaluate dosing lapses in patients chronically treated with selective serotonin reuptake inhibitors (SSRIs) in uncontrolled circumstances.

Method

In a prospective observational study we evaluated compliance data in chronic users of SSRIs using electronic drug exposure monitors.

Results

During a 3-month follow-up we found that 50/69 (72.5%) patients missed at least one dosing day and 20/69 (29.0%) missed two or more consecutive days.

Conclusions

About 30% of patients treated with short-acting SSRIs had dosing lapses of 2 or more days, which, as described in prior studies, is long enough to result in clinically relevant deterioration of mental status.
Long-term affective disorder in people with mild learning disability
Authors: Richards Marcus , Maughan Barbara , Hardy Rebecca , Hall Ian , Strydom Andre , Wadsworth Michael
Published: August 2002

Background

Increased risk of affective disorder in learning disability has been reported, although the extent to which this is due to adverse social and material circumstances is uncertain and there have been potential limitations in the measurement of affective disorder.

Aims

To determine risk of affective disorder in those classified with mild learning disability in the British 1946 birth cohort and to investigate whether this risk was accounted for by disadvantage in childhood and adulthood.

Method

Learning disability was defined as the equivalent of an IQ ≤ 69 at age 15 years. The Present State Examination at age 36 years and the Psychiatric Symptom Frequency Scale at age 43 years provided psychiatric outcome measures.

Results

Learning disability was associated with a fourfold increase in risk of affective disorder, not accounted for by social and material disadvantage or by medical disorder.

Conclusions

Learning disability is strongly associated with risk of affective disorder, persisting well into midlife.
Outcome in consecutive emergency department attenders following a road traffic accident
Authors: Mayou Richard , Bryant Bridget
Published: August 2002

Background

Little is known about the consequences of road traffic accidents.

Aims

To determine psychological and social outcome at 3 months and I year following a road traffic accident.

Method

A cohort study of a 1-year sample of consecutive attenders (n=1148) aged 17–69 years at the accident and emergency department of a teaching district general hospital (excluding major head injury). Data were extracted from medical notes and from self-report at baseline, 3 months and 1 year.

Results

Most (61%) injuries were physically minor. At 1 year 45% reported major physical problems and 32% reported psychiatric consequences. Non-injury variables were the principal predictors of outcome.

Conclusions

Outcome across a range of variables is considerably worse than would be expected from the nature of the physical injuries. There is a need for changes in clinical care and socio-legal policy to prevent, identify and treat distressing and disabling chronic problems.
Hidden psychiatric morbidity in elderly prisoners
Authors: Fazel Seena , Hope Tony , O'Donnell Ian , Jacoby Robin
Published: August 2002

Background

The number of elderly prisoners has increased significantly in Western countries over the past decade. Little is known about the psychiatric morbidity of this population.

Aims

To determine the prevalence of psychiatric morbidity in elderly sentenced prisoners.

Method

A stratified sample of 203 male sentenced prisoners aged over 59 years, from 15 prisons in England and Wales, representing one in five men in this age group, was interviewed using semi-structured standardised instruments for psychiatric illness and personality disorder.

Results

More than half of the elderly prisoners had a psychiatric diagnosis. The most common diagnoses were personality disorder and depressive illness.

Conclusions

The prevalence of depressive illness was five times greater than that found in other studies of younger adult prisoners and elderly people in the community. Underdetected, undertreated depressive illness in elderly prisoners is an increasing public health problem.
Hospital Anxiety and Depression (HAD) scale: Factor structure, item analyses and internal consistency in a large population
Authors: Mykletun Arnstein , Stordal Eystein , Dahl Alv A.
Published: August 2002

Background

The Hospital Anxiety and Depression (HAD) rating scale is a commonly used questionnaire. Former studies have given inconsistent results as to the psychometric properties of the HAD scale.

Aims

To examine the psychometric properties of the HAD scale in a large population.

Method

All inhabitants aged 20–89 years (n=92 100) were invited to take part in The Nord-Tr⊘ndelag Health Study, Norway. A total of 65 648 subjects participated, and only completed HAD scale forms (n=51 930) formed the basis for the psychometric examinations.

Results

Principal component analysis extracted two factors in the HAD scale that accounted for 57% of the variance. The anxiety and depression sub-scales shared 30% of the variance. Both sub-scales were found to be internally consistent, with values of Cronbach's coefficient (a) being 0.80 and 0.76, respectively.

Conclusions

Based on data from a large population, the basic psychometric properties of the HAD scale as a self-rating instrument should be considered as quite good in terms of factor structure, intercorrelation, homogeneity and internal consistency.
Straight talking: An investigation of the attitudes and practice of psychoanalysts and psychotherapists in relation to gays and lesbians
Authors: Bartlett Annie , King Michael , Phillips Peter
Published: August 2002

Background

Early psychodynamic writing on same-gender sexual preference contributed to its pathologisation and an interest in treatment directed at changing sexual orientation.

Aims

To establish the therapeutic approaches taken by contemporary psychotherapists and psychoanalysts to gay and lesbian clients/patients.

Method

A random sample of individuals listed as working with adults in the British Confederation of Psychotherapists' register were sent postal questionnaires.

Results

Data are available from 274 (69%) of 395 questionnaires. Only one of 218 respondents said that he/she was homosexual. One-third said that gay and lesbian patients did have a right to a gay or lesbian therapist. A total of 179 (82% of 218) respondents described work with gay and lesbian clients/patients, and in the majority of cases sexual orientation was an important aspect of the work.

Conclusions

Gays and lesbians seeking psychoanalysis or psychotherapy in the National Health Service or outside it for personal and/or training purposes will be unlikely to find a gay or lesbian therapist if they want one. The British Confederation of Psychotherapists' practitioners take on gay and lesbian clients/patients, although many do not see these social identities as relevant to the therapeutic process. Evidence from this study indicates that such clients/patients may encounter overt or covert bias, including the pathologisation of homosexuality per se.
Death of neurasthenia and its psychological reincarnation
Authors: Taylor Ruth E.
Published: August 2002

Background

The diagnosis of neurasthenia appeared in 1869 and rapidly became fashionable and highly prevalent. It disappeared almost completely, producing ongoing debates about what happened to the disease, which have not so far been informed by empirical data.

Aims

To use empirical historical hospital data from one specific hospital to explore several controversies about neurasthenia, including what happened to the disorder.

Method

The annual reports of Queen Square Hospital were examined from 1870 to 1947. The prevalence of neurasthenia diagnoses as a proportion of total discharges was recorded. The possible diagnostic categories into which neurasthenia could have been reclassified were identified. Textbooks and writing by neurologists working at the hospital during this period were examined.

Results

Neurasthenia accounted for 6–11% of total discharges from the late 1890s to 1930, when it virtually disappeared. Men accounted for 33–50% of cases.

Conclusions

Neurasthenia affected both the upper and working classes and both men and women. Neurologists, not psychiatrists, continued to see the disorder well into the 20th century. Neurasthenia did not disappear, but was reclassified into psychological diagnoses.
User-led research and evidence-based medicine
Authors: Faulkner Alison , Thomas Phil
Published: August 2002

Evidence-based medicine (EBM) and clinical governance play a central role in raising the quality of medical care. People want clinical decisions to be based on the best evidence and EBM places scientific knowledge in the service of clinical decision-making. Yet a quite different agenda is engaging patients as partners in health research, to make the medical profession more accountable. Here, we examine the epistemological basis of EBM, and the ethical concerns raised by this. In particular, we examine the value of user-led research in psychiatry in improving the concept of ‘evidence’ in evidence-based psychiatry.
Improving the delivery and organisation of mental health services: Beyond the conventional randomised controlled trial
Authors: Gilbody Simon , Whitty Paula
Published: August 2002

Background

There is an ethical imperative to evaluate service and policy initiatives, such as those highlighted in the recent National Service Framework, just as there is to evaluate individual treatments.

Aims

To outline the best methods available for evaluating the delivery and organisation of mental health services.

Method

We present a narrative methodological overview, using salient examples from mental health services research.

Results

Cluster randomised studies involve the random allocation of groups of clinicians, clinical teams or hospitals rather than individual patients, and produce the least biased evaluation of mental health policy, organisation or service delivery. Where randomisation is impossible or impractical (often when services or policies are already implemented), then quasi-experimental designs can be used. Such designs have both strengths and many potential flaws.

Conclusions

The gold standard remains the randomised trial, but with due consideration to the unit of randomisation. Use of quasi-experimental designs can be justified in certain circumstances but should be attempted and interpreted with caution.
The Maudsley long-term follow-up of child and adolescent depression
Authors: Knapp Martin , McCrone Paul , Fombonne Eric , Beecham Jennifer , Wostear Gail
Published: August 2002

Background

Depression in childhood or adolescence often has morbidity implications continuing into adulthood, generating needs for specialist services and support.

Aims

To estimate the patterns of service use and costs in adulthood of former patients.

Method

Service use and other cost-related data were collected from former patients. Comparisons were made between those people with and without comorbid conduct disorder in childhood and with data for the general population.

Results

Data on 91 people with depression (only) and 49 with comorbid conduct disorder revealed high adulthood service utilisation rates and costs. Inpatient care and criminal justice services were used more frequently by the comorbid group and total costs were significantly higher. There were also indications of higher service use by the comorbid group than the general adult population.

Conclusions

The high and enduring long-term costs associated with childhood depression and conduct disorder give further reason for early and effective intervention.
State and trait abnormalities in serotonin function in major depression
Authors: Bhagwagar Zubin , Whale Richard , Cowen Philip J.
Published: August 2002

Background

Neuroendocrine studies of brain serotonin (5-HT) function in depression generally show evidence of impaired 5-HT function but it is disputed whether or not this impairment resolves with clinical recovery.

Aims

To use the endocrine response to the selective 5-HTreuptake inhibitor, citalopram, to study brain 5-HT function in acute and recovered depressed subjects relative to healthy controls.

Method

We used a double-blind, placebo-controlled design to measure the prolactin and cortisol responses to citalopram (10 mg intravenously) in patients with major depression, in unmedicated subjects recovered from depression and in healthy controls.

Results

The prolactin responses to citalopram were blunted similarly in both acutely depressed and recovered subjects. The cortisol responses were blunted in the acutely depressed patients but not in the recovered subjects.

Conclusions

Our data support the proposal that some aspects of impaired 5-HT neurotransmission may be trait markers of vulnerability to depression. The recovery of the cortisol response to citalopram may indicate resolution of hypothalamic – pituitary-adrenal axis dysfunction.