bluuebunny/crossref_metadata_2025 huggingface dataset:
Violent children: a framework for assessment
Authors: Bailey Susan
Published: August 2002

Violence by and towards young people has become a major public health issue. Increased lethality, more random violence and fewer safe places largely account for the high levels of fear experienced by both children and adults. In the field of child protection and domestic violence, where traditionally the child is referred as the victim not the perpetrator, child psychiatrists are well versed, practised and skilled in the assessment of children and families. However, young people are increasingly being referred to child and adolescent mental health teams for assessment because of violent acts that they have carried out. This is reflected in heavy case-loads of children with conduct disorder who have multi-morbidity and complex need. In England and Wales, health (including mental health), social care and education services are mandated to assist youth offending teams.
Health informatics: information and communication
Authors: Lewis Alex
Published: August 2002

In health care, the word ‘communication’ covers a wide range of interactions, including interpersonal communication, communication technology, medical education, health policy and mass communication. It takes many forms, from a brief informal talk between colleagues to formalised written documents between professionals. The essence of this verbal and written communication is the sharing of information. To make our information exchange more useful and to give it more meaning, the information communicated needs an appropriate framework. For example, the meaning of the diagnosis ‘schizophrenia’ is greatly enhanced by knowledge of the individual patient within the context (the framework) of his or her past history and family background.
A cognitive–behavioural therapy assessment model for use in everyday clinical practice
Authors: Williams Chris , Garland Anne
Published: August 2002

Cognitive–behavioural therapy (CBT) is a shortterm, problem-focused psychosocial intervention. Evidence from randomised controlled trials and metaanalyses shows that it is an effective intervention for depression, panic disorder, generalised anxiety and obsessive–compulsive disorder (Department of Health, 2001). Increasing evidence indicates its usefulness in a growing range of other psychiatric disorders such as health anxiety/hypochondriasis, social phobia, schizophrenia and bipolar disorders. CBT is also of proven benefit to patients who attend psychiatric clinics (Paykel et al, 1999). The model is fully compatible with the use of medication, and studies examining depression have tended to confirm that CBT used together with antidepressant medication is more effective than either treatment alone (Blackburn et al, 1981) and that CBT treatment may lead to a reduction in future relapse (Evans et al, 1992). Generic CBT skills provide a readily accessible model for patient assessment and management and can usefully inform general clinical skills in everyday practice.
Compulsory treatment in the community: current legal powers
Authors: Davies Steffan
Published: August 2002

Reform of mental health legislation has been under consideration for several years in England and Wales (Department of Health, 2000a), where the Mental Health Act 1983 is in force, and in Scotland (Millan Committee Secretariat, 2001), which is governed by the Mental Health (Scotland) Act 1984. The Mental Health (Northern Ireland) Order 1986 is also under review, although the findings have yet to be published.
Glutamate and psychiatric disorders
Authors: Tsapakis Eva M. , Travis Michael J.
Published: August 2002

Most of the excitatory neurotransmission in the central nervous system (CNS) is mediated by the endogenous excitatory amino acids (EAAs) glutamate, aspartate and homocysteine. Most of the endogenous inhibitory neurotransmission is mediated by gamma-aminobutyric acid (GABA). EAAs modulate the firing of almost all neurons in the CNS, as excitatory neurotransmission can result in both neuronal inhibition and excitation. The glutamate system is the best characterised of the EAA systems (Box 1).
Use of medicines in nursing homes for older people
Authors: Furniss Lee
Published: August 2002

The National Health Service (NHS) spent £10 billion (40%) of its total budget on people aged 65 and over in 1998/1999. The profile of the health and social care of older people has been raised recently by the publication of the National Service Framework (NSF) for Older People (Department of Health, 2001). The NSF contains standards that older people can expect when they receive health and social care (Box 1). The document also discusses in detail medication management issues in older people. Its two aims in this area are to ensure that older people gain the maximum benefit from their medication in order to maintain or improve quality and duration of life, and do not suffer unnecessarily from illness caused by excessive, inappropriate or inadequate consumption of medicines.
Classification of psychiatric disorders in childhood and adolescence: building castles in the sand?
Authors: Scott Stephen
Published: August 2002

A classification system can benefit disturbed children enormously by bringing to bear a wealth of knowledge and experience. This can make all the difference between an inadequate consultation and a precise formulation of the nature and extent of a child's difficulties, their cause, the likely outcome and a realistic treatment plan. However, inappropriate application of a diagnostic label that has little validity could do more harm than good, and classification systems can be misused. This paper discusses, with examples, issues particular to childhood and adolescence that diagnostic systems need to address if they are to be useful. It considers different solutions applied by the two most widely used schemes, theInternational Classification of Diseases(ICD–10; World Heath Organization, 1992) and theDiagnostic and Statistical Manual of Mental Disorders(DSM–IV; American Psychiatric Association, 1994). Finally, the types of criteria used to validate categories are discussed.
Personal safety when visiting patients in the community
Authors: Galloway Jean
Published: August 2002

Violence towards psychiatrists has been recognised as an occupational hazard for many years. With the development of community care it is increasingly likely to be encountered outside the hospital. To maximise personal safety in the community, psychiatrists need to be working in trusts in which an infrastructure to establish and maintain safety standards is in place.
Essential fatty acids: theoretical aspects and treatment implications for schizophrenia and depression
Authors: Peet Malcolm
Published: August 2002

Almost all current research into developing new pharmacological treatment for depression and schizophrenia is focused directly on modulating neurotransmitter receptors in the brain. This approach was stimulated by the chance discovery of the prototype psychotropic drugs such as chlorpromazine and imipramine and the subsequent development of hypotheses based on the presumed mode of action of these drugs. Even clozapine was first introduced as yet another dopamine receptor blocker, and it was only after it was recognised that clozapine shows improved efficacy that hypotheses were developed as to its possible mode of action. Subsequent research based on the receptor approach has led to improved side-effect profiles for modern psychotropic agents, but has not resulted in any improvement of efficacy over and above that of the drugs discovered by good fortune rather than by hypotheses.
Outcome research in family therapy
Authors: Asen Eia
Published: August 2002

The family and therapy

The term family therapy can be misleading. ‘Family’ is open to many interpretations, if not attacks, because it is frequently read as implying a two-parent, heterosexual couple with two children, with the woman primarily the ‘homemaker’ and the man the ‘breadwinner’, with occasional backup from the grandparents. Such a picture would seem to marginalise or exclude other family forms, such as childless couples, single parents with children, gay or lesbian couples and unattached elderly persons. However, the reality is that family therapists treat many different forms of committed relationships and friendships. As to the term therapy, it tends to imply the presence of illness or dysfunction, located in the family rather than one of its individual members, and may thus be quite unacceptable to families who often believe that it is the patient and not them whom requires help. Being at the receiving end of family therapy can have strong connotations of blame. Practitioners therefore increasingly use the term systemic therapy, which is also more informative because some of the work often involves the wider system. The systemic approach is essentially a contextual approach – seeing and treating people in context.
Mental health of refugees and asylum-seekers
Authors: Tribe Rachel
Published: August 2002

Refugees are not a recent phenomenon. Since the time of the Roman Empire there have been many examples of people fleeing persecution and seeking refuge and protection in other countries. Refugees flee war, internal unrest and persecution by their own governments because of their ethnic origin or their political, religious or social activities. Estimates of the number of refugees and displaced people worldwide range from about 23 million to about 50 million, this latter figure including those who are not officially registered. It is perhaps pertinent to realise that this number is larger than the entire population of Australia and almost the same as the number of refugees resulting from the Second World War. Refugees represent a variety of cultures, races and nations from all over the world. Summerfield (2000) claims that nearly 1% of the people in the world are refugees or displaced persons resulting from about 40 current violent conflicts.
Commentary
Authors: Summerfield Derek
Published: August 2002

What prior assumptions might a psychiatrist bring into the room when the patient is an asylum-seeker? First, as a member of the public he or she is likely to have a view on asylum-seeking as a sociological phenomenon – up to 5 million have sought asylum in Western Europe in the past decade – and on how ‘deserving’ the average case is. After all, two adversarially opposed constructions of asylum-seeking have predominated. Governments, and the conservative social sectors, have stressed the prevalence of ‘bogus' applications by people who are essentially economic migrants, portraying them as wily, determined and tough rather than as having suffered. On the other side are the agencies and interests who support asylum-seekers, and the liberal and radical social sectors. They portray asylum-seekers as people who had no choice but to run from their countries, innocent of any thought but to escape further persecution and the risk of death. This portrayal invokes the image of suffering and vulnerability rather than resilience and agency. The reality is the muddied, uneven terrain that lies between these two entrenched positions. Many asylum-seekers do not have stories that easily fit the definition of a political refugee in the 1951 United Nations Convention. Even those with the clearest-cut cases – such as those with a credible history of torture – usually cannot prove it; few are vulnerable in any medically attestable sense and, however much they have suffered, they continue to make choices and actively engage with their situations. All asylum-seekers are looking for a better life for themselves and their children.
Spiritual care and psychiatric treatment: an introduction
Authors: Culliford Larry
Published: August 2002

The Patron of the Royal College of Psychiatrists has pointed out the irony involved in recording patients' religion, without seeking to discover that all this means to them in terms of understanding and coping with their illness (HRH The Prince of Wales, 1991). One College past-President (Sims, 1994) firmly recommends evaluating the religious and spiritual experiences of our patients in assessing aetiology, diagnosis, prognosis and planning treatment. Across the water, an American Journal of Psychiatry editorial (Andreasen, 1996) has it that, ‘We must practice and preach the fact that psychiatrists are physicians to the soul as well as the body.’
Commentary
Authors: Brazier David
Published: August 2002

Culliford (2002, this issue) has given us a valuable tour of what is involved in an appraisal of a patient's spirituality and its relevance to the assessment of mental state and prognosis. My task here is to provide some commentary from the perspective of a Buddhist. What immediately confronts me, therefore, is whether the teachings and practices of Buddhism do, in fact, find a place upon the map here set out. This is not a straightforward question, and this alone illustrates the fact that this is a subject within which one has to be willing to encompass, or at least allow for, differences of basic paradigm. However, what strikes me particularly is the fact that the Buddhist paradigm actually may be less at odds with the medical model than many might imagine.
Commentary
Authors: Sajid Abduljalil
Published: August 2002

I read Culliford's article (2002, this issue) with keen interest. I am pleased to comment on some of the aspects from the traditional view of my Islamic faith. Let me begin with the terminology. In Islam, the term spirituality is inseparable from the awareness of the One, of Allah (God), and a life lived according to His Will. This principle of Oneness (Al-tawheed –unity) must be taken into consideration in any study of Islamic spirituality. In the Qur'an, God has manifested that which is within the soul of man. He has ‘breathed into man’ His own spirit. The word that Muslims use for spirituality is ruhaniyyah. Ruh, which means spirit, is mentioned in the Qur'an; ‘The Spirit is from the command of my Lord’ (Chapter 17, verse 85).
Exercise therapy and mental health in clinical populations: is exercise therapy a worthwhile intervention?
Authors: Daley Amanda J.
Published: August 2002

There is widespread support for a positive and lasting relationship between participation in regular exercise and various indices of mental health, and several consensus documents and reviews (e.g. Biddleet al, 2000; Craft & Landers, 1998) have been published in this field. The evidence for psychological benefits, although impressive for mentally healthy individuals, is even stronger for psychiatric populations (Martinsen & Stephens, 1994). For example, a number of studies have demonstrated a positive relationship between exercise and mental health in people with alcohol misuse problems (Donaghyet al, 1991), people with schizophrenia (Chamove, 1986; Faulkner & Sparkes, 1999) and those with clinical depression (Mutrie, 1988; Martinsen, 1993; 1994; Martinsenet al, 1989a, b).
The interface between old age psychiatry and the law
Authors: Murray Brian , Jacoby Robin
Published: August 2002

This article aims to provide a practical overview concentrating on civil legal aspects of psychiatric care for the elderly. We limit ourselves to English law (which also has jurisdiction in Wales; Scottish and Northern Irish law may be similar, but not identical). Civil law can, in turn, be divided into statute law (legislation provided by Parliament) and common law (the UK, unlike some European countries, has a strong tradition of law based on previous rulings by judges).
Commentary
Authors: Gunn Michael
Published: August 2002

Murray & Jacoby (2002, this issue) emphasise the functional nature of capacity and draw attention to the dangers of adopting any other approach. The status approach (where determining whether someone is capable is dependent on diagnosis) makes assumptions about individual capacities and abilities that may be, and often will be, untrue. The outcome approach fails to realise that no one is expected always to make decisions with which others would agree. It is the process of decision-making that matters, and this must be determined in the case of an individual and in relation to a particular decision at a particular time.
Community rehabilitation orders with additional requirements of psychiatric treatment
Authors: Clark Tom , Kenney-Herbert Jeremy , Humphreys Martin S.
Published: August 2002

It is not uncommon for people with mental illness to be convicted of a criminal offence. The relationship between the two is not necessarily simple. It may be diffuse and subtle, perhaps relating to the disinhibiting effect of severe mental illness or associated factors such as poor social integration, unemployment, lack of close and intimate relationships or substance misuse.
Commentary
Authors: Bartlett Annie
Published: August 2002

It is entirely possible that most readers will have been ignorant of community rehabilitation orders with or without requirements of psychiatric treatment until reading the article by Clark et al (2002, this issue). It is valuable as an educational article and is applicable to the work of both general adult and forensic psychiatrists.
Confidentiality and security of clinical information in mental health practice
Authors: McClelland Roy , Thomas Victoria
Published: August 2002

‘Security holds the key’ was the title of a newspaper article concerned with e-commerce (D. Sumner-Smith, The Sunday Times, 6 February, 2000, p. 3.13). However, it applies just as readily to the health sector. The need to safeguard the confidentiality of information that patients share with clinicians is as fundamental as the principle of consent. This issue has come to the fore in the context of the rapid developments and applications of information and communication technologies within society in general and within the health sector in particular. There are also changing societal expectations regarding access to information, confidentiality and disclosure. The emerging scenarios present significant challenges in relation to the traditional methods used to deal with the privacy and confidentiality of personal information (Anderson, 1995). In addition to the impact of new technologies, consideration also needs to be given to the impact of changes in health care organisation and practice, for example multidisciplinary and multi-agency working. Mental health services are in many respects at the vanguard of these changes, where the ideals of community care, shared care and seamless care depend fundamentally on good communication and information sharing. Failures in communicating information, particularly across sectoral boundaries, have led to significant problems in patient care, as revealed in several recent enquiries into homicides (Northamptonshire Health Authority & Northamptonshire Social Services, 1999)
Managing depression in physical illness
Authors: MacHale Siobhan
Published: August 2002

Depressive disorders are more common in patients with physical illness than in those without, with up to one-third of medical in-patients reporting mild to moderate symptoms of depression (Rodin & Voshart, 1986). Some medical conditions have a stronger association with psychiatric illness than others, for example the prevalence rates of depressive illness in patients with diabetes, cardiac or neurological disease is about 25%, but not much more than the general population in those with hypertension. Medical in-patients are more likely to have depression than are out-patients. There are a number of potential factors that may contribute to this increased risk of depression in people with physical illness, as outlined in Box 1.
Commentary
Authors: Dickens Chris
Published: August 2002

As the arsenal of antidepressant drugs increases with time so, concurrently, does the list of caveats that must be considered when using these agents in patients with other physical illnesses and using other medications. MacHale's (2002, this issue) overview of the management of depression in physical illness serves as a crucial update for clinicians providing psychiatric services for patients with comorbid physical illnesses. Appropriate emphasis is placed on the usefulness of non-pharmacological treatments in such patients, although the reality of modern practice is that drug treatment is most often considered first-line owing to limited psychological service resources.
Using the Five Areas cognitive–behavioural therapy model with psychiatric patients
Authors: Wright Ben , Williams Chris , Garland Anne
Published: August 2002

In the first article in this series (Williams & Garland, 2002) we encouraged readers to try out elements of the Five Areas model of cognitive–behavioural therapy (CBT) with some patients. Before we further discuss the model it might be of value to reflect on your experiences. If you did try, was it successful? Did it teach you anything about your clinical skills and the patients' problems? Can you build on this experience and use the Five Areas model more widely in your practice? If you did not try this out, why not? Were you prevented by internal factors (too busy, could not see the patient, thought you could not do it) or problems beyond your control (the patient failed to turn up)? How can you overcome these obstacles?
Implications for psychiatric services of chronic civilian strife: young refugees in the UK
Authors: Hodes Matthew
Published: August 2002

Over the past century war and organised violence have led to the displacement of large populations and threatened or resulted in genocide of many ethnic or cultural groups. Although many people are internally displaced within their own country, some flee and seek asylum in other countries. The United Nations High Commission on Refugees (UNHCR) defines a refugee as someone who:

‘Owing to well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country; or who, not having a nationality and being outside that country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it’ (UNHCR, 1951: Article 1A(2)).
Commentary
Authors: Booton Paul
Published: August 2002

‘Knowledge management’ is not a term which makes the pulse race. It smacks of a combination of dull facts and bureaucracy. It could almost be something from a European Commission (EC) directive on the training of taxicab drivers. Neither Bellinger et al's (1999) definition of knowledge (‘the collation of information for a particular purpose, intended to be useful’) nor Sensky's (2002, this issue) own definition of knowledge management make it sound much more exciting.
Genetics advances and learning disability
Authors: Muir Walter J.
Published: August 2002

Background

Medicine is rapidly becoming molecular medicine, and little escapes the grasp of modern genetics. Most disorders associated with learning disability have at least a genetic component influencing their expression; in many disorders, disturbances of genetic mechanisms play a pivotal role.

Aims

Dynamic mutations, imprinting mechanisms and gene-dosage effects are explained with reference to genetic disorders that lead to learning disability.

Method

A review of recent important studies in the genetics of learning disability.

Results

A host of new genetic connections to conditions associated with learning disability have been made.

Conclusions

A basic understanding of these genetic connections is important for all learning disability psychiatrists if they are to follow the rapid changes – already beginning to influence our practice – that hold immense promise for the future.
Autism – an evolving concept
Authors: Berney T. P.
Published: August 2002

Background

The rapid increase in research endeavour has not kept pace with the advent of well-publicised theories and treatments for autism.

Aims

To explore some of the newer developments in biological research into autism.

Method

A review of recent publications and presentations.

Results

The concept is shifting from the narrow perception of aloof autism, described by Kanner, to a wider one that includes a spectrum extending to a broader, subclinical phenotype. The genetic basis has been established; now we need to discover the location and interaction of the relevant sites. There is considerable interest in the bowel as a pathogenetic agent, particularly in the effects of exogenous opioids and multiple viral infection (the latter posing a public health problem). Also of concern is the role of (potentially treatable) epilepsy, analogous to the Laudau-Kleffner syndrome.

Conclusions

In the absence of a cure, the implementation of ideas will continue to outstrip factual evidence. Clinicians are challenged by the availability of information (and misinformation), particularly on the internet.
Ageing and learning disability
Authors: Holland A. J.
Published: August 2002

Background

Ageing is a continuation of the developmental process and is influenced by genetic and other biological factors as well as personal and social circumstances.

Aims

To identify some key biological, psychological and social issues relevant to how ageing might particularly effect people with learning disabilities.

Method

This selected review considers the extent to which there are similarities and differences relative to people without learning disabilities.

Results

There is a convergence, in later life, between people with a learning disability and those without, owing to the reduced life expectancy of people with more severe disabilities. People with Down's syndrome have particular risks of age-related problems relatively early in life.

Conclusions

The improved life expectancy of people with learning disabilities is well established. There is a lack of a concerted response to ensure that the best possible health and social care is provided for people with learning disabilities in later life.
Psychotherapy, learning disabilities and trauma: new perspectives
Authors: Hollins Sheila , Sinason Valerie
Published: August 2002

Background

Psychological therapies are rarely used in people with learning disabilities. Learning disability is often given as an exclusion criterion. There is insufficient published research to conduct a systematic review. Few outcome studies of psychoanalytic or cognitive psychotherapy have been reported.

Aims

To describe recent advances in understanding and practice within the learning disability field which have not received wider recognition within mainstream psychotherapy and psychiatry.

Method

The availability of different psychotherapeutic approaches is discussed. We explore developmental issues including the contribution of attachment theory to our understanding, and the effects of trauma on the lives of people with learning disabilities.

Results

Theoretical and clinical perspectives suggest that many therapeutic opportunities exist.

Conclusions

Practitioners are encouraged to extend their therapeutic repertoire, and to report measurable outcomes.
Record-linkage study of epidemiology and factors contributing to hospital care uptake
Authors: Morgan Christopher L. , Ahmed Zahir , Kerr Michael P.
Published: August 2002

Background

We know little about how people with a learning disability access secondary health care.

Aims

To describe the epidemiology of learning disability, the influence of deprivation on prevalence and the pattern of secondary care uptake, including the effect of institutionalisation.

Method

A record-linkage study of secondary care contacts of 434 000 people between 1991 and 1997. A population with learning disability was identified; their secondary care contact was calculated and compared with the general population's.

Results

The distribution of people with a learning disability (n = 1595) correlated significantly with deprivation. The presence of a learning disability hospital significantly affected care uptake. Place of residence also affected acute admission to the learning disability hospital. Former institution residents generated 212 admissions per 1000 patients; community patients generated 18 per 1000. The admission rate with any psychiatric diagnosis to any setting was 26.3 per 1000 people with a learning disability; 16.5% of such patients had a dual diagnosis.

Conclusions

Health provision for people with a learning disability is affected by institutional provision.
Reducing antipsychotic medication in people with a learning disability
Authors: Ahmed Zahir , Fraser William , Kerr Michael P. , Kiernan Chris , Emerson Eric , Robertson Janet , Felce David , Allen David , Baxter Helen , Thomas James
Published: August 2002

Background

The use of antipsychotic drugs in people with learning disabilities is currently receiving intensified scrutiny and attempts are being made to reduce it.

Aims

A randomised controlled trial was designed to investigate factors influencing antipsychotic drug reduction among people with learning disabilities prescribed such medication for behavioural problems.

Method

Thirty-six participants randomly allocated to the experimental group underwent four, monthly 25% drug reduction stages. There were no planned drug changes for the control group (n = 20).

Results

Twelve participants (33%) completed full withdrawal; afurther seven (19%) achieved and maintained at least a 50% reduction. Drug reduction was associated with increased dyskinesia and higher activity engagement but not increased maladaptive behaviour. Some setting characteristics were associated with drug reinstatement.

Conclusions

A substantial proportion of people with learning disability prescribed antipsychotic medications for behavioural purposes rather than for treating psychotic illness can have their drugs reduced or withdrawn.
Open peer review: A randomised controlled trial
Authors: Walsh Elizabeth , Rooney Maeve , Appleby Louis , Wilkinson Greg
Published: August 2002

Background

Most scientific journals practise anonymous peer review. There is no evidence, however, that this is any better than an open system.

Aims

To evaluate the feasibility of an open peer review system.

Method

Reviewers for the British Journal of Psychiatry were asked whether they would agree to have their name revealed to the authors whose papers they review; 408 manuscripts assigned to reviewers who agreed were randomised to signed or unsigned groups. We measured review quality, tone, recommendation for publication and time taken to complete each review.

Results

A total of 245 reviewers (76%) agreed to sign. Signed reviews were of higher quality, were more courteous and took longer to complete than unsigned reviews. Reviewers who signed were more likely to recommend publication.

Conclusions

This study supports the feasibility of an open peer review system and identifies such a system's potential drawbacks.
Functional anatomy of verbal fluency in people with schizophrenia and those at genetic risk
Authors: Spence Sean A. , Liddle Peter F. , Stefan Martin D. , Hellewell Jonathan S. E. , Sharma Tonmoy , Friston Karl J. , Hirsch Steven R. , Frith Christopher D. , Murray Robin M. , Deakin J. F. William , Grasby Paul M.
Published: August 2002

Background

PET studies of verbal fluency in schizophrenia report a failure of ‘deactivation’ of left superior temporal gyrus (STG) in the presence of activation of left dorsolateral prefrontal cortex (DLPFC), which deficit has been attributed to underlying ‘functional disconnectivity’.

Aim

To test whether these findings provide trait-markers for schizophrenia.

Method

We used H215O PET to examine verbal fluency in 10 obligate carriers of the predisposition to schizophrenia, 10 stable patients and 10 normal controls.

Results

We found no evidence of a failure of left STG deactivation in carriers or patients. Instead, patients failed to deactivate the precuneus relative to other groups. We found no differences in functional connectivity between left DLPFC and left STG but patients exhibited significant disconnectivity between left DLPFC and anterior cingulate cortex.

Conclusions

Failure of left STG ‘deactivation’ and left fronto-temporal disconnectivity are not consistent findings in schizophrenia; neither are they trait-markers for genetic risk. Prefrontal functional disconnectivity here may characterise the schizophrenic phenotype.
Invited commentary on: Functional anatomy of verbal fluency in people with schizophrenia and those at genetic risk
Authors: Crow T. J.
Published: August 2002

Spence et al (2000, this issue) describe an original and incisive approach to the genetics of psychosis – an attempt to define brain connectivity in patients and family members closest to the genetic risk (‘obligate carriers’) by comparison with those remote from familial risk. Their findings are potentially important but I suggest an alternative interpretation: that words are simply less lateralised in those genetically predisposed to suffer from schizophrenic symptoms. This conclusion has, I believe, implications for understanding the organisation of the human brain.
Changes in suicide in England and Wales, 1960–1997
Authors: McClure G. M. G.
Published: August 2002

Background

Methods of suicide and suicide rates in England and Wales have fluctuated considerably since the 1960s.

Aims

To review the changes that have occurred in suicide rates in England and Wales between 1960 and 1997.

Method

Suicide rates, derived from total annual suicides and the estimated annual resident population, were obtained from the Office for National Statistics.

Results

Suicide rates decreased in both genders between the early 1960s and the mid-1970s. The rate for males then increased between 1975 and 1990, while the rate for females continued to fall. Between 1990 and 1997, the rate decreased for males and females in all age groups, particularly for those using motor vehicle exhaust gas; the latter finding is associated with increasing use of catalytic converters.

Conclusions

Following the increase in suicide among males until 1990 there was a decrease for both genders between 1990 and 1997, consistent with the ‘Health of the Nation’ target.
Season of birth in schizophrenia: no latitude at the equator
Authors: Parker Gordon , Mahendran Rathi , Koh Eng Seng , Machin David
Published: August 2002

Background

If the established winter excess in births of people who subsequently develop schizophrenia is an effect of ‘seasonality’, this would be testable by examining the pattern of births in an equatorial region with no formal seasons.

Aims

To investigate whether there is any variation in month of birth among patients from equatorial Singapore with a diagnosis of schizophrenia.

Method

All 9655 patients discharged from Singapore's national psychiatric hospital with a diagnosis of schizophrenia were included (year of birth range 1930–1984). We analysed aggregated data, as well as the data of subsamples grouped according to birth-year periods, in order to examine secular trends. One patient subsample (those born 1960–84) allowed exact matching againstthe general population data set and close testing of any seasonal influence.

Results

Monthly variation in births was evident for both patients and controls; the patterns were very similar, apart from the patient sample showing a trough in March–April.

Conclusions

In an equatorial region, where ‘seasons’ are absent, no seasonal excess in births of those later developing schizophrenia was evident.
Impaired regulation of brain serotonin function during dieting in women recovered from depression
Authors: Smith K. A. , Williams C. , Cowen P. J.
Published: August 2002

Background

Amino acid mixtures that lower brain availability of the serotonin (5-HT) precursor tryptophan produce acute depressive relapse in women with a history of major depression. Dieting also lowers brain tryptophan availability, but its effects on brain 5-HT function in recovered depressed women have not been studied.

Aim

To test the hypothesis that women with a history of major depression would show impaired regulation of brain 5-HT function during a period of dieting-induced tryptophan depletion.

Method

Women with and without a history of major depression were placed on a daily 1000 kcal (approximately 4200 kJ) diet for three weeks. Before the diet and in the final week we measured fasting plasma tryptophan levels and the prolactin response to an intravenous tryptophan challenge.

Results

Dieting lowered plasma tryptophan levels equivalently in women with and without a history of depression. In women without a history of depression, dieting also increased the prolactin response to tryptophan. This increase did not occur in women with a history of depression.

Conclusions

Women with a history of depression showed impaired regulation of brain 5-HT function in response to dieting.
Mortality and causes of death in a total national sample of patients with affective disorders admitted for the first time between 1973 and 1993
Authors: Høyer Eyd Hansen , Mortensen Preben Bo , Olesen Anne V.
Published: August 2002

Background

The high mortality from suicide in patients admitted to hospital with an affective disorder is well documented, although specific causes of mortality and changes in mortality are less well studied.

Aims

To describe the pattern of mortality in patients with affective disorder and to study changes in suicide riskduring the study period.

Method

All patients (n=54 103) admitted for the first time to a psychiatric hospital in Denmarkduring the period 1973–1993 because of affective disorder were included in this study. The mortality rate was compared with that of the general population.

Results

Mortality from natural and unnatural causes was elevated in all subgroups of affective disorder. The risk of suicide among patients ill for one year or less after first admission increased during the period 1973–1993.

Conclusions

More attention should be paid to the risk of suicide and to physical illness in patients with affective disorders.
Tokophobia: An unreasoning dread of childbirth
Authors: Hofberg Kristina , Brockington Ian
Published: August 2002

Background

Some women dread and avoid childbirth despite desperately wanting a baby. This is called tokophobia.

Aims

To classify tokophobia for the first time in the medical literature.

Method

Twenty-six women noted to have an unreasoning dread of childbirth were interviewed by the same psychiatrist, who was not the treating doctor. A qualitative analysis of these psychiatric interviews was performed.

Results

Phobic avoidance of pregnancy may date from adolescence (primary tokophobia), be secondary to atraumatic delivery (secondary tokophobia) or be a symptom of prenatal depression (tokophobia as a symptom of depression). Pregnant women with tokophobia who were refused their choice of delivery method suffered higher rates of psychological morbidity than those who achieved their desired delivery method.

Conclusions

Tokophobia is a specific and harrowing condition that needs acknowledging. Close liaison between the obstetrician and the psychiatrist in order to assess the balance between surgical and psychiatric morbidity is imperative with tokophobia.
Jerusalem syndrome
Authors: Bar-El Yair , Durst Rimona , Katz Gregory , Zislin Josef , Strauss Ziva , Knobler Haim Y.
Published: August 2002

Background

Jerusalem's psychiatrists expect to encounter, as the millennium approaches, an ever-increasing number of tourists who, upon arriving in Jerusalem, may suffer psychotic decompensation.

Aims

To describe the Jerusalem syndrome as a unique acute psychotic state.

Method

This analysis is based on accumulated clinical experience and phenomenological data consisting of cultural and religious perspectives.

Results

Three main categories of the syndrome are identified and described, with special focus on the category pertaining to spontaneous manifestations, unconfounded by previous psychotic history or psychopathology.

Conclusions

The discrete form of the Jerusalem syndrome is related to religious excitement induced by proximity to the holy places of Jerusalem, and is indicated by seven characteristic sequential stages.
Focus on psychiatry in Australia
Authors: Henderson Scott
Published: August 2002

Humankind has been present on the Australian continent for at least 40 000, some say 60 000 years, remarkably adapted to the environment and having a cultural tradition appreciated by few Caucasians. White people have been here for only 200 years; and psychiatry for about half of that. We know nothing about the mental health of pre-contact indigenous peoples; but we now know a little about the ways in which mental disorders are explained and treated by traditional methods. In two centuries, the Aboriginal and Torres Strait Islands communities, which are very diverse, have been steadily reduced to become only 1.5% of the population. From settlement in 1788 until the 1950s, most non-aboriginal Australians were of Anglo-Saxon or Celtic origin. Since the Second World War, the pattern of immigration has greatly enriched Australian life, first through large numbers of people from the Mediterranean littoral, Western Europe and the Balkans, and more recently from south-east Asia. Ethnic diversity is now evident in most peoples' daily lives – whom you see in the street, whom you work alongside, who your friends are, what you eat and who you have as patients. So the present Australian population of 18 million has undergone a marked change in demography and lifestyle within only two generations. Like the people, psychiatry is also changing rapidly. Where are the changes taking place? What is it like to be a psychiatrist here at present? Where has there been success and where has there been failure? Where is there lots of action?
Doctors on tribunals
Authors: Richardson Genevra , Machin David
Published: August 2002

Background

Mental health review tribunals are required to apply legal criteria within a clinical context. This can create tensions within both law and psychiatry.

Aims

To examine the role of the medical member of the tribunal as a possible mediator between the two disciplines.

Method

Observation of tribunal hearings and panel deliberations and interviews with tribunal members were used to describe the role of the medical member.

Results

The dual roles imposed on the medical member as witness and decisionmaker and as doctor and legal actor create formal demands and ethical conflicts that are hard, in practice, either to meet or to resolve.

Conclusions

The structure for providing tribunals with access to expert psychiatric input and advice requires reconsideration.
Role of risk assessment in reducing homicides by people with mental illness
Authors: Munro Eileen , Rumgay Judith
Published: August 2002

Background

Improved risk assessment has been stressed as the way to reduce homicides by people with mental illness. The feasibility of predicting rare events needs examining.

Aims

To examine the findings of public inquiries into homicides by people with mental illness to see if they support the claim that better risk assessment would have averted the tragedy.

Method

Analysis was made of the findings of the public inquiries between 1988 and 1997 in relation to the predictability and preventability of the homicides.

Results

Of the homicides considered by the inquiry panels, 27.5% were judged to have been predictable, 65% preventable and 60% of the patients had a long-term history containing violence or substantial risk factors for violence.

Conclusions

Improved risk assessment has only a limited role in reducing homicides. More deaths could be prevented by improved mental health care irrespective of the risk of violence. If services become biased towards those assessed as high risk, then ethical concerns arise about the care of both violent and non-violent patients.
Adolescent psychiatric in-patients
Authors: Kjelsberg Ellen
Published: August 2002

Background

Research has demonstrated increased mortality rates in adolescent psychiatric in-patients.

Aims

To investigate this excess mortality by calculating standardised mortality ratios (SMRs) relative to cause of death, diagnosis, cohort and age.

Method

A nationwide Norwegian sample of 1095 former adolescent psychiatric in-patients were followed up 15–33 years after first hospitalisation by record linkage to the National Death Cause Registry.

Results

The SMR was significantly increased for almost all causes of death investigated. In males, all psychiatric diagnoses had significantly increased SMRs, whereas in females, organic mental disorder, anxiety disorder and affective disorder had non-significantly increased SMRs. The SMR was significantly elevated for all age-spans and cohorts investigated.

Conclusions

A broad prevention strategy is needed to combat the increased mortality rates found in adolescent psychiatric in-patients.
Assessing young people who deliberately harm themselves
Authors: Hurry Jane , Storey Pamela
Published: August 2002

Background

Many young people who harm themselves have chronic mental health or social problems or are at risk of future self-harm or even suicide. The accident and emergency (A&E) clinic is an important gateway to treatment.

Aims

To describe the psychosocial assessment of 12- to 24-year-old patients attending A&E clinics following deliberate self-harm (DSH) and to identify features of service management and provision which maximise specialist assessment.

Method

A postal questionnaire was sent to a sample of one in three A&E departments in England. In a representative sample of 18 of these hospitals, staff were interviewed and 50 case notes per hospital were examined.

Results

Psychosocial assessment by non-specialist doctors in A&E departments tended to be of variable quality, focused on short-term risk. Around 43% of patients aged 12–24 were assessed by a specialist; specialist assessment was associated with high admission rates and the presence of on-site psychiatric departments and DSH teams.

Conclusions

Young DSH patients at risk often go unidentified; as a result their psychological problems may not be treated. Hospitals are frequently unaware of the proportion of patients discharged without adequate assessment.
Parental high concern and adolescent-onset anorexia nervosa
Authors: Shoebridge Philip , Gowers Simon G.
Published: August 2002

Background

Robust evidence that anorexia nervosa is preceded rather than accompanied by high-concern (overprotective) parenting is limited.

Aims

To look for evidence of parental high concern occurring before any onset of disorder.

Method

Forty consecutive referrals of adolescent girls with DSM – III – R anorexia nervosa were compared with matched controls using obstetric records and maternal interviews.

Results

Index mothers reported higher rates of: near-exclusive child care (P=0.02), infant sleep difficulties (P=0.018), severe distress at first regular separation (P=0.048), high maternal trait anxiety levels (P=0.008) and later age for first sleeping away from home (P=0.009). More index families had experienced a severe obstetric loss prior to their daughter's birth (P=0.066).

Conclusions

This study lends evidence to the clinical contention that high-concern parenting in infancy is associated with the later development of anorexia nervosa. This may derive, in part, from aspects of unresolved grief.