bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of pregnancy on bulimia nervosa
Authors: Morgan John Farnill , Lacey J. Hubert , Sedgwick Philip M.
Published: October 2008

Background

Bulimia nervosa affects women at a peak age of reproductive functioning, but few studies have examined the impact of pregnancy on bulimia.

Aim

To examine the impact of pregnancy on symptoms of bulimia nervosa and associated psychopathology.

Method

Women actively suffering from bulimia nervosa during pregnancy (n=94) were interviewed using the eating disorder examination (12th edn) and structured clinical interview for DSM–III–R, with additional structured questions. Behaviours were recorded at conception, each trimester and postnatally. Relative risks were calculated for prognostic factors.

Results

Bulimic symptoms improved throughout pregnancy. After delivery, 57% had worse symptoms than pre-pregnancy, but 34% were no longer bulimic. Relapse was predicted by behavioural severity and persistence, previous anorexia nervosa (‘Type II’ bulimia), gestational diabetes and ‘unplanned’ pregnancy. Unplanned pregnancies were the norm, usually resulting from mistaken beliefs about fertility. ‘Postnatal depression’ was suggested in one-third of the sample, and in two-thirds of those with ‘Type II’ bulimia, and was predicted by alcohol misuse, symptom severity and persistence.

Conclusions

Postnatal treatment intervention should focus on women ‘at risk’ of relapse, but all women with bulimia should be assessed for postnatal depression.
Satisfaction with in-patient psychiatric services
Authors: Greenwood Nan , Key Adrienne , Burns Tom , Bristow Mike , Sedgewick Philip
Published: October 2008

Background

There is growing concern about patient satisfaction with psychiatric in-patient provision. This paper measures satisfaction in psychiatric in-patients and its relationships with patient characteristics and ward experiences.

Aims

To: (a) measure overall in-patient satisfaction; (b) examine its relationship to in-patient experiences; and (c) examine its relationship to patient factors.

Method

Four hundred and thirty-three patients were interviewed. Satisfaction was assessed by a single question, the Client Satisfaction Questionnaire (CSQ) and by a semi-structured interview.

Results

Over three-quarters of the patients were satisfied, but two-thirds reported adverse events. Females, younger patients and those detained were more dissatisfied. No significant relationship was found for ethnic group. Results were similar in the mental hospital and district general hospital.

Conclusions

There remain problems with satisfaction scales. Qualitative approaches to examine patients' experiences in hospital and the causes of dissatisfaction are recommended.
Depression, cerebral atrophy, cognitive performance and incidence of dementia
Authors: Pálsson Sigurdur , Aevarsson Ólafur , Skoog Ingmar
Published: October 2008

Background

Hospital-based studies suggest that depression in old age relates to organic brain changes.

Aims

To determine whether these findings are confirmed in a population-based sample.

Method

A population sample of non-demented 85-year-olds (227 mentally healthy and 62 with DSM–III–R depression were given a neuropsychiatric examination and computerised tomographic scans of the brain, and followed for three years.

Results

On the Mini-Mental State Examination, those with a low educational level with major depression performed worse than the mentally healthy; this distinction was not evident among those who had received higher education. Measures of brain atrophy were similar in depressed and mentally healthy individuals. The three-year incidence of dementia was increased in those with early-onset major depression.

Conclusions

Higher education may protect against cognitive symptoms in depressed individuals. The association between depression and cerebral atrophy in the elderly is not very strong. The higher incidence of dementia in those with early-onset major depression may be due to a longer lifetime duration of depression, emphasising the importance of detecting and treating depression in the community.
Hypertension and cognitive decline
Authors: Stewart Robert
Published: October 2008

Significant associations have been reported between cognitive decline, dementia and measures of cardiovascular and cerebrovascular disease. Such findings raise important possibilities for prevention of dementia through reducing the burden of vascular pathology. However, given the long prodromal periods for both clinical vascular disease and dementia, the most fruitful way forward may lie in investigating the effects of risk factors for vascular disease, rather than clinical vascular disease itself. Hypertension has received considerable attention in this respect although it is only recently, thanks to findings from prospective population-based research, that the complex interrelationship between blood pressure levels and cognitive decline has begun to be clarified.
Review of community prevalence of depression in later life
Authors: Beekman A. T. F. , Copeland John , Prince M. J.
Published: October 2008

Background

Despite considerable interest, there is no consensus regarding the prevalence of depression in later life.

Aims

To assess the prevalence of late-life depression in the community.

Method

A systematic review of community-based studies of the prevalence of depression in later life (55+). Literature was analysed by level of caseness at which depression was defined and measured.

Results

Thirty-four studies eligible for inclusion were found. The reported prevalence rates vary enormously (0.4–35%). Arranged according to level of caseness, major depression is relatively rare among the elderly (weighted average prevalence 1.8%), minor depression is more common (weighted average prevalence 9.8%), while all depressive syndromes deemed clinically relevant yield an average prevalence of 13.5%. There is consistent evidence for higher prevalence rates for women and among older people living under adverse socio-economic circumstances.

Conclusions

Depression is common in later life. Methodological differences between studies preclude firm conclusions about cross-cultural and geographical variation. Improving the comparability of epidemiological research constitutes an important step forward.
Cross-cultural comparison of depressive symptoms in Europe does not support stereotypes of ageing
Authors: Copeland J. R. M. , Beekman A. T. F. , Dewey M. E. , Jordan A. , Lawlor B. A. , Linden M. , Lobo A. , Magnusson H. , Mann A. H. , Fichter M. , Prince M. J. , Saz P. , Turrina C. , Wilson K. C. M.
Published: October 2008

Background

Stereotypes of older people suggest that they are depressed.

Aims

To examine depression symptoms among people aged ⩾65 in the general population and to ask the following questions. Are there high proportions of depressive symptoms among otherwise well people? Do these levels reflect the prevalence of depression? Do key symptoms vary with age and do they confirm stereotypes?

Method

Nine centres contributed data from community-based random samples, using standardised methods (GMS–AGECAT package)

Results

Proportions of depressive symptoms varied between centres. Some often associated with ageing were rare. Many were more common in women. Low-prevalence centres tended to have fewer symptoms among ‘well’ people, but there were inconsistencies. Low levels of symptoms among the well population of a centre did not necessarily predict lower levels in the depressed.

Conclusions

Variations in the prevalence of depressive symptoms occurred between centres, not always related to levels of illness. There was no consistent relationship between proportions of symptoms in well persons and cases for all centres. Few symptoms were present in > 60% of the older population – stereotypes of old age were not upheld.
Depression symptoms in late life assessed using the EURO–D scale
Authors: Prince M. J. , Beekman A. T. F. , Deeg D. J. H. , Fuhrer R. , Kivela S.-L. , Lawlor B. A. , Lobo A. , Magnusson H. , Meller I. , Van Oyen H. , Reischies F. , Roelands M. , Skoog I. , Turrina C. , Copeland J. R. M.
Published: October 2008

Background

Data from surveys involving 21 724 subjects aged ⩾65 years were analysed using a harmonised depression symptom scale, the EURO–D.

Aims

To describe and compare the effects of age, gender and mental status on depressive symptoms across Europe.

Method

We tested for the effects of centre, age, gender and marital status on EURO–D score. Between-centre variance was partitioned according to centre characteristics: region, religion and survey instrument used.

Results

EURO–D scores tended to increase with age, women scored higher than men, and widowed and separated subjects scored higher than others. The EURO–D scale could be reduced into two factors: affective suffering, responsible for the gender difference, and motivation, accounting for the positive association with age.

Conclusions

Large between-centre differences in depression symptoms were not explained by demography or by the depression measure used in the survey. Consistent, small effects of age, gender and marital status were observed across Europe. Depression may be overdiagnosed in older persons because of an increase in lack of motivation that may be affectively neutral, and is possibly related to cognitive decline.
Health of the Nation Outcome Scales: A case study in general psychiatry
Authors: Sharma Vimal K. , Wilkinson Greg , Fear Simon
Published: October 2008

Background

Health of the Nation Outcome Scales (HoNOS) were incorporated in a data set recording the routine clinical activities of a mental health team in Liverpool.

Aims

To evaluate the use of HoNOS in general adult psychiatry.

Method

All consecutive patients who came in contact with the mental health team were administered HoNOS by the consultant psychiatrist. A cohort (n=204) of patients was identified over a period of 8 months. All patients (n=156) who had a repeat HoNOS after an interval of 6 months were included in the study.

Results

There was an overall reduction in HoNOS scores after an interval of 6 months, more so among patients with psychotic and affective disorders. Patients scoring on other disorders showed no change on HoNOS. The measured change in clinical state based on the Clinical Global Impression scale was broadly consistent with HoNOS scores.

Conclusions

It was feasible to administer HoNOS during routine assessments, but HoNOS data were of limited value in care-planning in day-today clinical practice. The widespread adoption of HoNOS for use in routine clinical practice would be premature.
Reduced cortical excitability in depression
Authors: Shajahan P. M. , Glabus M. F. , Gooding P. A. , Shah P. J. , Ebmeier K. P.
Published: October 2008

Background

In healthy controls, preactivation of muscles by exercise results in enhanced motor-evoked potential (MEP) responses to transcranial magnetic stimulation (TMS).

Aims

We tested the hypothesis that medicated, depressed patients would show reduced post-exercise MEP facilitation compared with controls.

Method

Ten patients with DSM-IV depression (two male, eight female) and ten controls (three male, seven female) participated. MEPs were elicited at rest, then after exercising the contralateral abductor pollicis brevis muscle, using TMS of the primary motor cortex.

Results

The mean MEP amplitude recorded after exercise (expressed as a percentage of baseline) was 210% in controls and 130% in patients. There was a significant difference in post-exercise MEP between patients and controls (P=0.03).

Conclusions

Post-exercise MEP facilitation was demonstrated in controls but not in patients. This supports the hypothesis that the modulation of cortical excitability may be impaired in depression.
Psychosocial adversity and child psychopathology
Authors: Rutter Michael L.
Published: October 2008

Background

Despite strong claims that genetic theory' should replace socialisation theory’, there are good grounds for taking seriously the notion that there are psychosocial influences on child psychopathology.

Aims

To re-evaluate this issue in the light of developments over the past half-century.

Method

A wide-ranging review of topics related to this issue, 1948–1998.

Results and conclusions

The findings are used to consider the challenges still to be met as we enter the next century. It is argued that it is necessary to put aside the absurd brain–mind dualisms of the past.
Fever and acute brief psychosis in urban and rural settings in north India
Authors: Collins Pamela Y. , Varma Vijoy K. , Wig Narendra N. , Mojtabal Ramin , Day Richard , Susser Ezra
Published: October 2008

Background

This case-control study used data from Chandigarh, North India to investigate the association between antecedent fever and acute brief psychosis.

Aims

To assess whether antecedent fever may be a biological correlate of acute brief psychosis, and contribute to the nosology of acute brief psychosis.

Method

The study was based in an incidence cohort from two catchment areas, an urban and a rural site, that were part of the World Hearth Organization Determinants of Outcome study. The cases (n=17) met criteria for acute brief psychosis; controls (n=40) were patients with other acute and subacute psychoses. The Life Events Schedule was used to determine the presence of antecedent fever.

Results

The crude odds ratio for fever as a risk factor for acute brief psychosis was 6.2 (P=0.004). The odds ratio in a logistic regression analysis – adjusted for site, gender and CATEGO classification – was 11.2 (P=0.003).

Conclusions

Antecedent fever may be a biological correlate of acute brief psychosis. This finding supports the validity of this entity, and has implications for its aetiology and diagnosis.
Aetiological risk factors for personality disorders
Authors: Coid Jeremy
Published: October 2008

Background

Elucidation of aetiological processes leading to development of Axis II disorders is important in category validation and could lead to new treatments.

Aims

To establish aetiological associations between Axis II disorders and specific risk factors.

Method

Male and female subjects (n=260) in maximum security hospitals and prisons were interviewed to determine DSM-III Axis II and lifetime Axis I diagnoses. Aetiological risk factors were obtained at interview and from case files. Independent statistical associations were established by logistic regression.

Results

Axis II categories were divided into four groups: (a) disorders of character development, secondary to an adverse early environment: antisocial, self-defeating and paranoid; (b) disorders of temperament, secondary to constitutional aetiology: avoidant, dependent, schizoid and schizotypal; (c) a ‘mixed’ disorder of constitutional and environmental aetiology: borderline; and (d) aetiological associations not established: narcissistic, histrionic, compulsive and passive-aggressive.

Conclusions

The study validates several Axis II categories but challenges the inclusion of others within Axis II of DSM-IV, in particular schizoid, schizotypal, avoidant and borderline personality disorders. The findings have implications for future treatment interventions.
People at risk of schizophrenia
Authors: Hodges Ann , Byrne Majella , Grant Elizabeth , Johnstone Eve
Published: October 2008

Background

The Edinburgh High-Risk Study is designed to explore the underlying pathogenesis of schizophrenia.

Aims

To establish the sample characteristics of the first 100 subjects in this study of young adults at risk of schizophrenia for genetic reasons, and to compare them with appropriate controls.

Method

Details of the recruitment of the first 100 high-risk subjects aged 16–25 years into a prospective Scotland-wide study are given. Subjects and 30 age- and gender-matched normal controls were interviewed using the PSE, SADS-L and SIS and an unstructured psychiatric interview.

Results

Some significant differences emerged between the high-risk group and the control group, namely in previous psychiatric history (31 v. 6.3%), forensic contacts (19 v. 3.1%) and delinquent behaviour (20 v. 3.1%). There were also differences in some parameters from the SIS: childhood social isolation, interpersonal sensitivity, social isolation, suicidal ideation, restricted affect, oddness and disordered speech.

Conclusions

These differences may represent increased risk of developing schizophrenia although their true significance will not be revealed until the cohort has been followed through the at-risk years.
North Staffordshire Community Beds Study: Longitudinal evaluation of psychiatric in-patient units attached to community mental health centres
Authors: Haycox Alan , Unsworth Louise , Allen Keith , Hodgson Richard E. , Lewis Martyn , Boardman Anthony P.
Published: October 2008

Background

Innovative approaches to the provision of psychiatric care must justify their ability to improve the quality of life within the resource constraints imposed on psychiatry.

Aims

To examine the average costs per patient of the experimental and control group services.

Method

An individual patient costing methodology that identified, measured and valued all public and private resources.

Results

The experimental group was more likely to remain in contact with services over a 12-month period, had fewer acute readmissions and spent less time in acute in-patient units. There were significantly different levels and patterns of resource consumption between the groups and between the two separate catchment areas.

Conclusion

The cost analysis should be assessed in the context of the previous outcome analysis. It is likely, but not inevitable, that such units will increase the overall costs of care provision; this largely depends on the effectiveness with which such units are integrated into existing care provision.
Alcohol and the brain
Authors: Nutt David
Published: October 2008

Background

Alcohol misuse, as well as being a major form of psychiatric morbidity, is also commonly associated with other psychiatric disorders. A greater understanding of the brain mechanisms underlying the adverse effects of alcohol is now possible, thanks to significant research advances made over the past decade.

Aims

To elucidate for psychiatrists the growing knowledge of the importance of specific neurotransmitter interactions in the effects of alcohol.

Method

A survey of the literature, extracting current knowledge of interest to psychiatrists.

Results

There is good evidence that the acute effects of alcohol are mediated through interactions with amino acid neurotransmitters plus parallel changes in amines such as noradrenaline, dopamine and serotonin. Neuroadaptive responses at amino acid receptors probably underlie significant components of the withdrawal syndrome and probably also contribute to neuronal death found in chronic alcoholism.

Conclusions

An understanding of the pharmacology of alcohol use may lead to greater ability to treat psychiatric consequences of alcoholism, and may also prevent some of the secondary psychiatric comorbidity and later brain damage.
Compulsory treatment in anorexia nervosa
Authors: Ramsay Rosalind , Ward Anne , Treasure Janet , Russell Gerald F. M.
Published: October 2008

Background

Anorexia nervosa is a mental disorder with a high long-term mortality. Patients are ambivalent about treatment and often avoid it. Of necessity, compulsory treatment sometimes must be considered. A report from the Mental Health Act Commission has helped to reduce previous confusion.

Aims

To identify the premorbid and clinical features that predisposed to compulsory admissions, the short-term benefits of the treatment and the long-term mortality rates (derived from the National Register)

Method

Eighty-one compulsory patients were compared with 81 voluntary patients.

Results

Predisposing factors to a compulsory admission were a history of childhood sexual or physical abuse or previous self-harm. Detained patients had more previous admissions. Detained patients gained as much weight during admission as voluntary patients, but took longer. More deaths among compulsory than voluntary patients (10/79 v. 2/78) were found 5.7 years (mean) after admission.

Conclusions

Compulsory treatment is effective in the short term. The higher long-term mortality in the detained patients is due to selection factors associated with an intractable illness.
Using consensus OPCRIT diagnoses
Authors: Azevedo M. H. , Soares M. J. , Coelho I. , Dourado A. , Valente J. , Macedo A. , Pato M. , Pato C.
Published: October 2008

Background

The Operational Criteria Checklist (OPCRIT) generates diagnoses according to 12 operational diagnostic systems (e. g. DSM–III, DSM–III–R, Research Diagnostic Criteria, ICD–10)

Aims

To examine the agreement between diagnoses generated by the OPCRIT, as completed by the interviewer, with a best-estimate lifetime procedure using the OPCRIT.

Method

Subjects came from large mufti-generational bipolar or schizophrenia pedigrees (n=100), and from a sample of unrelated subjects with schizophrenia (n=40). We analysed the diagnostic agreement between OPCRIT diagnoses generated by the interviewer and our best-estimate OPCRIT diagnoses, according to DSM–III–R and ICD–10, using Cohen kappa statistics.

Results

Excellent agreement was found between interviewer OPCRIT diagnoses and OPCRIT diagnoses made by the best-estimate lifetime consensus procedure for DSM–III–R (κ=0.83) and ICD-10 (κ=0.81)

Conclusions

Results suggest that this procedure for diagnostic assessment is an efficient alternative to classic best-estimate diagnosis procedures.
Evaluation of the opioid addiction test in an out-patient drug dependency unit
Authors: Ghodse A. H. , Greaves J. L. , Lynch D.
Published: October 2008

Background

The opioid addiction test is based on the measurement of pupil dilatation in opioid-dependent people in response to conjunctivally applied naloxone hydrochloride. A positive response (pupil dilatation) indicates that the subject is dependent on opioids.

Aims

To evaluate the test in an out-patient setting and to identify factors affecting its outcome.

Method

Pupil size was measured using binocular pupillometry in 100 new patients attending an out-patient clinic for assessment and treatment of opioid use. Measurement was repeated 40 minutes after the unilateral instillation of naloxone drops into the conjunctival sac.

Results

We performed 127 tests, of which 103 (81.1%) were positive. Males, and those not on methadone at the time of the test, were more likely to have a negative test result.

Conclusions

The opioid addiction test proved to be a very useful tool for the rapid diagnosis of opioid dependence in the out-patient clinic. Specialist pupillometric equipment increases the number of patients correctly identified as opioid-dependent on the first visit, but is not essential.
Risk factors for suicide independent of DSM–III–R Axis I disorder
Authors: Foster Tom , Gillespie Kate , McLelland Roy , Patterson Chris
Published: October 2008

Background

The vast majority of suicides suffer from at least one mental disorder at the time of death.

Aims

To identify risk factors for suicide, particularly those independent of current DSM–III–R Axis I disorder(s)

Method

A case–control psychological autopsy study comparing suicides with matched community controls.

Results

Independent risk factors for suicide included: Axis II (personality) disorder (particularly antisocial, avoidant and dependent); at least one of 12 life events (from the List of Threatening Experiences) during the previous 52 or 4 weeks (in particular, a ‘serious problem with close friend, neighbour or relative’); current unemployment; previous history of deliberate self-harm; and contact with a GP within 26 weeks. Relative to individuals with no current mental disorder, the estimated risk of suicide in those with Axis I–Axis II comorbidity (OR 346.0) was significantly greater than that in those with Axis I disorder(s) only (OR 52.4)

Conclusions

Suicide risk assessment may be enhanced by enquiry about the aforementioned independent risk factors, and attention to Axis I–Axis II comorbidity.
Classification in psychiatry: ICD–10 v. DSM–IV
Authors: First Michael B. , Pincus Harold Alan
Published: October 2008

The editorial by Andrews et al (1999) usefully calls attention to issues of compatibility between diagnostic classification systems but we believe that the editorial greatly overstates the compatibility problem as well as its implications. The article begins with the suggestion that the DSM–IV authors' position is to downplay the differences between DSM–IV and ICD–10. After stating that the American Psychiatric Association “felt sufficiently confident to publish a DSM–IV International Version in which the DSM–IV criteria are listed against the ICD–10 codes”, the authors go on to report concordances between the classifications for the main mental disorders as ranging from a low of 33% (for substance harmful use or abuse) to 87% (for dysthymia), with an overall concordance of only 68%. The authors conclude that if this “unnecessary dissonance between the classification systems continues, patients, researchers and clinicians will be all the poorer”. Although we acknowledge that there are a number of differences between the two systems, the authors fail to assess fully the sources, significance and solutions for this compatibility problem.
Use of electroconvulsive therapy in young people
Authors: Duffett Richard , Hill Peter , Lelliott Paul
Published: October 2008

Background

Electroconvulsive therapy (ECT) is a controversial treatment for psychiatric disorders, particularly when it is administered to young people.

Aims

To assess how frequently ECT is administered to people under the age of 18 years in the UK, and why it is given.

Method

Electroconvulsive therapy clinics, private hospitals, adolescent units and UK members of the Royal College of Psychiatrists were surveyed to ask if they were aware of ECT being administered during 1996 to a young person under the age of 18 years. Consultants identified as having prescribed ECT were sent a follow-up questionnaire.

Results

Twelve young people were identified as having received ECT; three were aged 15 years or younger and eight were female. Nine patients were rated as improved following ECT. The indications for its use were similar to those for adults.

Conclusions

Electroconvulsive therapy is rarely administered to young people in the UK.
Follow-up study of depression in the elderly
Authors: Halloran Eleanor , Prentice Neil , Murray Catherine L. , O'Carroll Ronan E. , Glabus Michael F. , Goodwin Guy M. , Ebmeier Klaus P.
Published: October 2008

Background

Imaging studies in depression of the elderly are often small and highly selective.

Aims

To investigate a large group of elderly depressed patients in order to assess changes in clinical, imaging and neuropsychological variables at follow-up.

Method

Patients (n=175, age range 65–91 years) with clinical depression were identified from consecutive local referrals. Clinical interviews, neuropsychological tests and SPECT scans were carried out at referral and at two-year follow-up.

Results

Of 84 re-examined patients, 46.5% were well, 9.5% were ill, 33% partially recovered and 11% had developed dementia. Duration of illness before index assessment was the only factor to predict outcome. Thirty-nine patients could be scannedandfollowed up. There were no differences between patients with good or poor depressive outcome on SPECT. Ten clinically improved patients could be re-examined with SPECT. There were relative increases in right cingulate gyrus and right cerebellum at follow-up.

Conclusions

The patient group was comparable with other studies showing high levels of residual depressive symptoms. Activity changes in limbic cortex are implicated in depression of old age.
Suicide and unemployment in young people
Authors: Gunnell David , Lopatatzidis Tom , Dorling Daniel , Wehner Helen , Southall Humphrey , Frankel Stephen
Published: October 2008

Background

The influence of the macro-economic climate on suicide is unclear. During the recent recession, rates have increased in young males but declined in females.

Aims

To investigate associations between unemployment and suicide in 15 – to 44-year-old men and women over a period spanning two major economic recessions (1921–1995). To minimise confounding by changes in method availability, analyses are restricted to suicides using methods other than poisons and gases.

Method

Time-series analysis using routine mortality and unemployment data.

Results

There were significant associations between unemployment and suicide in both males and females. Associations were generally stronger at younger ages.

Conclusions

Secular trends in youth suicide may be influenced by unemployment or other factors associated with changes in the macroeconomic climate. These factors appear to affect women to the same extent as men. Although it is not possible to draw firm aetiological conclusions from time-trend data, our findings are in keeping with those of person-based studies.
Suicide among drug addicts in the UK
Authors: Oyefeso Adenekan , Ghodse Hamid , Clancy Carmel , Corkefy John M.
Published: October 2008

Background

The extent of suicide among addicts in the UK has not been sufficiently examined.

Aims

To examine suicide trends among registered addicts in the UK over a 25-year period.

Method

We quantified suicide using International Classification of Diseases (ICD) external death codes E950–959, calculated annual age-standardised suicide rates, standardised mortality ratios (SMRs) and described trends in methods of suicide and drug overdose suicides in five successive cohorts of registered addicts.

Results

Male and female suicide rates are 69.0 and 44.8 per 100 000 person-years, respectively. There was a consistent decline in suicide rate throughout the 25-year period. Among males, the SMR for suicide declined from 17.2 in 1968–1972 to 4.4 in 1988–1992 (SMR ratio=3.9, 95% CI=2.5–6.1); among females it declined from 52.6 to 11.3 in the same period (SMR ratio=4.7, 95% CI=1.9–10.8). Drug overdose was the most common method of suicide, accounting for 45% of cases. Significant increase in antidepressant (percentage difference=23.5%, 95% CI=15.2–31.8) and methadone (percentage difference=1.0%, 95% CI=0.5, 21.5) overdose in 1988–1992 compared with 1968–1972 was reported.

Conclusions

The findings confirm that addicts are still at higher risk of suicide than the general population and that prescribed drugs, notably antidepressants and methadone, influence this heightened risk.
Outcome of admission to a medium secure psychiatric unit
Authors: Maden A. , Friendship C. , McClintock T. , Rutter S.
Published: October 2008

Background

A follow-up of patients discharged from medium secure psychiatric units is used to compare outcome in patients of different ethnic origin.

Aims

To test the hypothesis that there are systematic differences in clinical outcome between ethnic groups.

Method

A descriptive, longitudinal cohort study of discharges from a medium secure unit is used to compare the 125 patients of White/European ethnic origin and the 104 patients of Black/African–Caribbean origin.

Results

Patients of African – Caribbean origin were admitted at three times the rate of White patients, had a higher prevalence of psychosis and a lower prevalence of personality disorder. There was no difference in outcome as measured by location at follow-up, readmission or re-offending.

Conclusions

The higher rate of admission of African–Caribbean patients is consistent with a higher level of demand. There is a need for studies of the pathways by which patients from ethnic minorities reach medium-security accommodation, with a view to early intervention.
Lithium-associated clinical hypothyroidism
Authors: Johnston Ann M. , Eagles John M.
Published: October 2008

Background

Rates of, and risk factors for, lithium-associated clinical hypothyroidism are uncertain.

Aims

To determine prevalence of and risk factors for clinical hypothyroidism in patients treated with lithium carbonate.

Method

Retrospective case-note review of 718 patients who had undergone serum lithium estimation during a 15-month period. Patients on thyroxine had a more detailed review.

Results

The prevalence of clinical hypothyroidism during lithium treatment was 10.4%. The main risk factor was female gender (women 14% v. men 4.5%). Women were at highest risk during the first two years of lithium treatment, and women starting lithium aged 40–59 years had the greatest prevalence (> 20%). No equivalent risk factors emerged in men, although, like women, their prevalence of hypothyroidism was substantially higher than community rates.

Conclusions

The high rates of clinical hypothyroidism identified may call for a review of the drug information given to women, particularly to those starting lithium in middle age. Consideration should be given to screening for thyroid antibodies before treatment in high-risk cases. Monitoring of thyroid function should take into account gender, age and stage of lithium treatment.
Bereavement and grief in adults with learning disabilities
Authors: Bonell-Pascual Enrique , Huline-Dickens Sarah , Hollins Sheila , Esterhuyzen Alexander , Sedgwick Philip , Abdelnoor Adam , Hubert Jane
Published: October 2008

Background

This paper reports on the follow-up of a cohort of parentally bereaved adults with learning disabilities.

Aims

To investigate whether significant psychopathology, present up to 2.1 years after the death, had resolved five years later.

Method

Of an original sample of 50 adults with learning disabilities, 41 were reassessed. The Aberrant Behaviour Checklist and the Psychopathology Instrument for Mentally Retarded Adults were re-administered to carers.

Results

At follow-up, there was a small increase in the measures of aberrant behaviour. Measures of psychopathology showed improvement, and in particular there was a reduction in anxiety.

Conclusions

The response to bereavement by adults with learning disabilities is similar in type, though not in expression, to that of the general population. Learning disability is a significant predictor of mental health problems following bereavement. Participants adapted more easily when basic emotional needs had been constructively met by carers.
Genetic and environmental risk factors in the aetiology of illicit drug initiation and subsequent misuse in women
Authors: Kendler Kenneth S. , Karkowski Laura M. , Corey Linda A. , Prescott Carol A. , Neale Michael C.
Published: October 2008

Background

Subsequent to initial exposure to the use of a psychoactive substance, psychoactive substance use disorder (PSUD) may or may not develop.

Aims

To investigate the relationship between the risk factors for initiation and the subsequent misuse of psychoactive substances.

Method

The lifetime history of illicit substance use and misuse was obtained by telephone interview with 1934 members of female–female twin pairs. We apply a novel model, which estimates the role of genetic and environmental risk factors that influence initiation and those specific to misuse, to three classes of illicit psychoactive substances.

Results

The individual-specific environment and family environment influenced the probability of initiation, but only individual-specific environment had an impact on the probability of subsequent misuse. Genetic factors which influence the risk of initiation and of misuse were identified.

Conclusions

Aetiological factors that influence drug initiation and subsequent misuse are correlated but not identical. Family environment is an important determinant of risk for drug experimentation. Two classes of genetic risk factors act on the liability to PSUD: those that influence the probability of initiation and those that influence the risk of misuse.
Transcallosal inhibition and motor conduction studies in patients with schizophrenia using transcranial magnetic stimulation
Authors: Boroojerdi B. , Töpper R. , Foltys H. , Meincke U.
Published: October 2008

Background

Transcranial magnetic stimulation of the motor cortex may not only elicit excitatory responses in hand muscles contralateral to the stimulated hemisphere, but may also suppress tonic voluntary electromyogram activity in muscles ipsilateral to the stimulation. This inhibition is mediated between the motor cortices via the corpus callosum.

Aims

To investigate motor excitability and interhemispheric (transcallosal) connections in patients with schizophrenia.

Method

Transcallosal inhibition and motor conduction parameters were investigated in ten patients with schizophrenia and in ten age- and gender-matched healthy subjects.

Results

Transcallosal conduction time (TCT) and duration of the inhibition were significantly longer in patients with schizophrenia (mean (s.d.)): TCT, 12.4 (2.9) ms in normal subjects and 15.3 (2.6) ms in patients (P=0.03); mean duration, 34.1 (4.9) ms in normal subjects and 51.9 (16.8) ms in patients (P=0.01).

Conclusions

Magnetic motor conduction parameters are unaltered in schizophrenia, but transcallosal inhibition is significantly delayed and prolonged. This may indicate abnormal function of the corpus callosum in these patients.
Predictors of quality of life in people with severe mental illness
Authors: Fahy Thomas , Kent Andy , Tattan Theresa , Van Horn Elizabeth , White Ian
Published: October 2008

Background

It is not clear which model of case management is most likely to improve quality of life in people with severe mental illness.

Aims

To use baseline data derived from the UK700 Case Management Trial to assess the relative importance of clinical, social and unmet needs variables as predictors of subjective quality of life in patients with severe mental illness.

Method

Patients (n=708) were assessed on quality of life (Lancashire Quality of Life Profile), needs (Camber well Assessment of Need), psychopathology and social functioning. Variables that were amenable to change through case management were investigated as predictors of quality of life.

Results

Social variables accounted for 7% of the variance for subjective quality of life, compared with 19% for clinical variables, and 20% for unmet needs. The strongest predictors of subjective quality of life were unmet basic, social and functioning needs, depression and positive psychotic symptoms.

Conclusions

Subjective quality of life in severely mentally ill patients is predicted by clinical variables and unmet needs. The results identify priority areas for the attention of case managers who seek to improve quality of life in these patients.
Seasonal affective disorder among primary care attenders and a community sample in Aberdeen
Authors: Eagles John M. , Wileman Samantha M. , Cameron Isobel M. , Howie Fiona L. , Lawton Kenneth , Gray Douglas A. , Andrew Jane E. , Naji Simon A.
Published: October 2008

Background

There are no large published studies of the prevalence of seasonal affective disorder (SAD) among UK populations.

Aim

To determine the prevalence of SAD among patients attending a general practitioner (GP).

Method

Patients aged 16–64 consulting their GPs in Aberdeen during January were screened with the Seasonal Pattern Assessment Questionnaire (SPAQ). SPAQs were also mailed to 600 matched patients, who had not consulted their GP during January. Surgery attenders who fulfilled SPAQ criteria for SAD were invited for interview to determine whether they met criteria for SAD in DSM–IVand the Structured Interview Guide for the Hamilton Rating Scale for Depression–Seasonal Affective Disorder Version (SIGH–SAD).

Results

Of 6161 surgery attenders, 4557 (74%) completed a SPAQ; 442 (9.7%) were SPAQ cases of SAD. Rate of caseness on the SPAQ did not differ between surgery attenders and non-attenders. Of 223 interviewed SPAQ cases of SAD, 91 (41%) also fulfilled DSM–IVand SIGH–SAD criteria.

Conclusions

There is a high prevalence of SAD among patients attending their GPs in January in Aberdeen; this is likely to reflect a similar rate in the community.
Evaluation of ICD-10 PHC mental health guidelines in detecting and managing depression within primary care
Authors: Upton Mark W. M. , Evans Maggie , Goldberg David P. , Sharp Deborah J.
Published: October 2008

Background

The prevalence of mental disorders in the community is high, yet many remain unrecognised, misdiagnosed or poorly managed within primary care. Hence, guidelines for diagnosing and managing mental disorders in primary care, ICD–10 PHC, have been developed.

Aims

To introduce the guidelines into primary care and to assess whether they improve recognition, accuracy of diagnosis and treatment standards.

Method

GPs recorded information on all patients presenting with mental disorders before and after guidelines were introduced. A10% sample of patients underwent interviews to establish a formal diagnosis. Recognition of mental disorders was assessed by screening of patients attending their GP.

Results

The guidelines had no impact on the overall detection of mental disorders, the accuracy of diagnosis or the prescription of antidepressants. There was a significant increase in the number of patients diagnosed with depression or unexplained somatic symptoms. The GPs also made increased use of psychological interventions.

Conclusions

The success of the guidelines in bringing about change is by no means certain. Some areas appeared more susceptible to change than others.
Annual variation in birth rate of people who subsequently develop schizophrenia
Authors: Adams W. , Kendell R. E.
Published: October 2008

Background

Previous attempts to decide whether there is significant year-to-year variation in the birth rate of people who subsequently develop schizophrenia have given conflicting results, probably because of differences in the statistical methods employed.

Aims

To determine whether there is significant year-to-year variation in the birth rate.

Method

Variation in the birth rate for the period 1921–1960 was studied in three separate national data sets – English, Danish and Scottish – using cubic splines to smooth the distribution curve before calculating residuals from a Poisson distribution.

Results

Over-dispersion was found in all three data sets, particularly in the Danish and Scottish data. However, the correlation between the sets of standardised residuals derived from the three data sets was only statistically significant for Denmarkv.England.

Conclusions

There was statistically significant year-to-year variation in the birth rate of people who subsequently developed schizophrenia in three countries in north-west Europe in the years 1921–1960. This is potentially a clue to the nature of the environmental determinants of schizophrenia, but better data will be needed before useful explanatory hypotheses can be generated and tested.
Patients with personality disorder admitted to secure forensic psychiatry services
Authors: Coid Jeremy , Kahtan Nadji , Gault Simon , Jarman Brian
Published: October 2008

Background

Treatment of patients with personality disorder remains controversial and severe mental illness is prioritised in secure forensic psychiatry services.

Aims

To compare patients with personality disorder and mental illness according to demography, referral, criminality, previous institutionalisation and diagnostic comorbidity.

Method

A record survey of 511 patients with personality disorder and 2575 with mental illness admitted to secure forensic psychiatry services between 1 January 1988 and 31 December 1994 from half of England and Wales.

Results

Personality disorder admissions declined over time; more were female, White, younger and extensively criminal (specifically, sexual and arson offences). Personality disorder was highly comorbid; antisocial, borderline, paranoid and dependent personality disorder were most prevalent.

Conclusions

Patients with personality disorder were highly selected and previously known to psychiatric services. Referrer, diagnostic comorbidity and behavioural presentation determined their pathways into care. Future research must determine whether their continuing admission represents effective use of scarce resources and whether new services are required.
Diagnostic stability of first-episode psychosis
Authors: Amin Shazad , Singh Swaran P. , Brewin John , Jones Peter B. , Medley Ian , Harrison Glyn
Published: October 2008

Background

The temporal stability of a diagnosis is one measure of its predictive validity.

Aims

To measure diagnostic stability in first-episode psychosis using ICD–10 and DSM–III–R.

Method

Between 1992 and 1994 we ascertained a cohort of persons with first-episode psychosis (n=168), assigning to each a consensus diagnosis. At three-year follow-up, longitudinal consensus diagnoses, blind to onset diagnoses, were made. Stability was measured by the positive predictive values (PPVs) of onset diagnoses. For onset schizophrenia, we also calculated sensitivity, specificity and concordance (κ).

Results

First-episode ICD–10 and DSM–III–R schizophrenia had a PPV of over 80% at three years. Over one-third of cases with ICD–10 F20 schizophrenia at three years had non-schizophrenia diagnoses at onset. Manic psychoses showed the highest PPV (91%). For onset schizophrenia, both systems had high specificity (ICD–10: 89; DSM–III–R: 93%), but low sensitivity (ICD–10: 64%; DSM–III–R: 51%) and moderate concordance (ICD–10: 0.54; DSM–III–R: 0.46).

Conclusions

Bipolar disorders and schizophrenia showed the highest stability. DSM–III–R schizophrenia did not have greater stability than ICD–10 schizophrenia.
More severe mental illness is more concentrated in deprived areas
Authors: Glover Gyles R. , Leese Morven , McCrone Paul
Published: October 2008

Background

The greater frequency of mental illness in deprived and inner-city populations is well recognised; allocation of funds in the UK health service makes some allowance for this. However, it is not clear whether the differences are similar for all levels of mental health care need.

Aims

To study the range in prevalence of mental health problems and care at primary care, general secondary care and forensic care levels.

Method

We used mainly descriptive statistics to study evidence available from existing sources – some based on indicators of likely need, some on observed prevalance of treatment.

Results

Among English health authority areas, the most morbid have about twice the prevalence of primary care level mental illness of the least morbid. For secondary care the ratio is between 2.5 and 4 to 1, while for services for mentally disordered offenders it is in excess of 20:1.

Conclusions

Where needs indices are used for resource allocation, responsible authorities should ensure that they produce ranges reflecting the full compass of services funded. For forensic services the range of morbidity levels may be so great that funding needs to rest at a larger population level than that of health authorities.
Heritability of social cognitive skills in children and adolescents
Authors: Scourfield Jane , Martin Neilson , Lewis Glyn , McGuffin Peter
Published: October 2008

Background

Social cognitive skills are those which enable understanding of social situations; they are relevant to a variety of psychiatric disorders including autism, schizophrenia and externalising behaviour problems in children.

Aims

To examine the heritability of social cognitive skills.

Method

Using a population-based sample of twins aged 5–17, the genetic and environmental influences on social cognitive skills were examined.

Results

Male scores were higher than female scores (P < 0.001), indicating poorer social cognition among males. A heritability of 0.68 (95% CI 0.43–0.78) was found, with shared environmental influences accounting for only 0.05 of the variance (95% CI 0.00–0.28). This could be removed from the model without worsening the fit. There were no significant differences in genetic effects between the genders, but age-related changes were found, with younger twins showing greater genetic influence on social cognition.

Conclusions

Social cognition appears to be under considerable genetic influence in the population and shows significant male–female differences. No gender differences in genetic influences on the variance of scores were found, but the effects of age were significant.