bluuebunny/crossref_metadata_2025 huggingface dataset:
Diminished recall and the cohort effect of major depression: a simulation study
Authors: Giuffra Luis A. , Risch Neil
Published: July 2009

Synopsis

Several large-scale epidemiological surveys have reported increasing lifetime rates of psychopathology among recently born cohorts. In the case of Major Depressive Disorder (MDD) younger cohorts tend to manifest higher lifetime prevalences of the condition than older cohorts, at any given age. In some studies, cohort differences are so large that the youngest cohort exceeds the lifetime prevalence of the oldest cohort well before passing through their total period of risk. The data on lifetime prevalences that support the existence of secular differences, however, has typically been collected in cross-sectional studies. Thus, individuals are interviewed at a single point in time and asked to recall all prior psychopathology. Due to poor recall, this design may greatly underestimate earlier experiences. In fact, cohort differences are not limited to MDD; similar results have been reported for a wide range of psychopathology, suggesting methodological problems at data collection. We have conducted a simulation study to examine the magnitude of annual rates of forgetting that could produce the secular trends reported for MDD. Small, but constant annual rates produce striking, ‘cohort effect-like’ curves. The rates needed to reconstruct the reported effect are compatible with published values for test–retest studies of lifetime recall of MDD.

This simulation study does not rule out the existence of a cohort effect in some psychiatric disorders, but stresses the possible limitations of using cross-sectional studies to investigate secular trends.
An association between anti-hippocampal antibody concentration and lymphocyte production of IL-2 in patients with schizophrenia
Authors: Yang Z. W. , Chengappa K. N. R. , Shurin G. , Brar J. S. , Rabin B. S. , Gubbi A. V. , Ganguli R.
Published: July 2009

Synopsis

Serum concentrations of anti-hippocampal antibodies andin vitroproduction of the lymphokine interleukin-2 (IL-2) in response to phytohaemagglutinin (PHA) stimulation were determined using an enzyme immunoassay in 49 schizophrenic patients and 41 healthy controls. Decrease in IL-2 production, a finding frequently associated with many autoimmune diseases, was associated with an elevation in anti-hippocampal antibody optical density (AHA-OD) in schizophrenic patients. Although some control subjects had elevated antibody levels, this elevation was not associated with decreased IL-2 production. Low IL-2 production is well known to be a state marker associated with active autoimmune disease. We suggest that production of hippocampal antibody is a trait marker of vulnerability to autoimmune diseases. Thus, our finding of low IL-2 production in patients with high concentrations of hippocampal antibody is compatible with the possibility that such patients have an ongoing autoimmune process.
The influence of life events on the subsequent course of psychotic illness: A prospective follow-up of the Camberwell Collaborative Psychosis Study
Authors: Van Os J. , Fahy T. A. , Bebbington P. , Jones P. , Wilkins S. , Sham P. , Russell A. , Gilvarry K. , Lewis S. , Toone B. , Murray R.
Published: July 2009

Synopsis

Fifty-nine psychotic patients with acute onset of illness, who had been interviewed about their experience of stressful life events before the episode, were followed up for an average of 42 months. Thirty patients (51%) had experienced a stressful life event in the 3 months immediately before onset (EV +), 29 had not (EV −).

In patients with an RDC diagnosis of affective disorder or unspecified functional psychosis, the presence of stressful life events was associated subsequently with milder symptom severity, less time spent in hospital, more treatment for depressive symptoms and less for psychotic symptoms. In schizophrenia, differences were less apparent, but patients with event associated episodes had less need of anti-psychotic maintenance medication over the follow-up period and tended to have spent more time in complete remission. EV + schizophrenic subjects also had higher morbid risk for schizophrenia in their first degree relatives, and tended to be female and to have less typical symptoms than EV − schizophrenic patients.
The differentiation of depression from dementia by temporal lobe magnetic resonance imaging
Authors: O'Brien J. T. , Desmond P. , Ames D. , Schweitzer I. , Tuckwell V. , Tress B.
Published: July 2009

Synopsis

Temporal lobe Magnetic Resonance Imaging (MRI) was performed in 43 patients with NINCDS/ADRDA Alzheimer's disease (AD) (33 probable, 7 possible, 3 definite) and 32 subjects with DSM-III-R Major Depression (DEP) matched for age, sex and level of education. Hippocampus (anterior and posterior, right and left), amygdala, entorhinal cortex, para-hippocampal gyrus and cerebral cortex were rated for atrophy on a 4-point scale. Good discrimination between groups could be achieved using a cut-off of 2 or more on anterior hippocampal atrophy rating (sensitivity 93%; specificity 84%; 89% cases correctly grouped overall). Even among a subgroup of 9 mild AD subjects and 10 cognitively impaired DEP subjects (matched on mini-mental state score), the same cut-off correctly grouped 84% (16/19) cases. Hippocampal atrophy increased with age in both AD and DEP subjects leading to a reduction in specificity (but not sensitivity) for those aged over 75. Within the AD group a significant correlation was observed between length of history and atrophy of the entorhinal cortex (r = 0·39, P = 0·009). We conclude that temporal lobe atrophy on MRI can provide good discrimination between AD and DEP subjects, including those DEP patients with cognitive impairment apparent on screening tests of cognitive function.
Pathways to psychiatric care in South-Verona, Italy
Authors: Balestrieri M. , Bon M. G. , Rodriguez-Sacristan A. , Tansella M.
Published: July 2009

Synopsis

This paper compares the pathway to psychiatric care of patients contacting the South-Verona Community Psychiatric Service (CPS) with the pathways described in other countries, using the method of the WHO cross-cultural study of pathways in psychiatric care. One hundred and sixteen South-Verona residents starting new episodes of care were traced and included in the study. The first port of call for 92% of patients was a doctor. More than one-third arrived at the CPS directly, not filtered by other carers. One-third went first to the GP and then straight to the CPS. Both the median total interval since onset of symptoms and the median interval between onset of the problem and first seeking care was 8 weeks. Patients presenting first at the two major ports of call tend to have a quite similar latency period before seeking care. Problems presented are represented mostly by depression and anxiety. The diagnosis of affective disorders occurred in more than half of the sample, followed by neurotic and somatoform disorders and schizophrenia and related disorders. The intervals after seeing the first carer are short and quite homogeneous among all patients. More than three-quarters of the patients said that they received some form of treatment for their presenting problems prior to arrival at the CPS, mostly psychopharmacotherapy with sedatives/hypnotics. These results are discussed in the light of those obtained in the WHO cross-cultural study.
The effect of personality disorder on clinical outcome, social networks and adjustment: a controlled clinical trial of psychiatric emergencies
Authors: Tyrer P. , Merson S. , Onyett S. , Johnson T.
Published: July 2009

Synopsis

One hundred psychiatric emergencies presenting to an inner London teaching hospital had formal assessments of psychopathology, personality disorder (using both ICD-10 and the Personality Assessment Schedule), social networks and social functioning before being randomly assigned to a multidisciplinary community-based team (Early Intervention Service (N = 48) or conventional hospital-based psychiatric services (N = 52) and treated for a period of 12 weeks. The ICD-10 classification yielded a higher proportion (50%) of personality disordered patients than the Personality Assessment Schedule (34%) and those from ethnic minorities (mainly Afro-Caribbean) and upper social classes had a lower incidence of personality disorder. Social networks were smaller in personality disordered patients and there were fewer attachment figures. Improvement in social function, and to a lesser extent with depressive symptomatology, was better in patients with no personality disorder referred to the community service compared with the hospital service. No differences were found between the numbers and duration of social contacts in the two services and it is concluded that the better outcome in the community-treated patients was independent of changes in social networks.
Fractal analysis of the boundary between white matter and cerebral cortex in magnetic resonance images: a controlled study of schizophrenic and manic-depressive patients
Authors: Bullmore E. , Brammer M. , Harvey I. , Persaud R. , Murray R. , Ron M.
Published: July 2009

Synopsis

This paper reports development of a computerized (‘box-counting’) method for estimation of fractal dimension (FD) of the magnetic resonance image (MRI) boundary between cerebral cortex and white matter; and the application of this method to MRIs of 39 schizophrenics (SZs), 23 manic-depressives (MDs) and 31 controls (CONs). Mean FD across all diagnostic groups was 1·402; 95% confidence interval (CI) 1·399 to 1·406. Mean FD was greater in boundaries extracted from manic-depressive patients than in boundaries extracted from controls (difference between MD and CON mean FDs = 0·008; 95% CI −0·002 to +0·018); and less in schizophrenics than in controls (difference between SZ and CON mean FDs = −0·003; 95% CI −0·011 to +0·005). Mean FD was positively correlated with subcortical volume and anterior cerebral volume, and negatively correlated with sulcal cerebrospinal fluid volume. Significant differences in mean FD between diagnostic groups were demonstrated by analysis of covariance (ANCOVA; P < 0·01), with age and volumetric measures of brain size as covariates; and manic-depressive boundaries were shown to have significantly greater values for residual FD (after controlling for effects of brain size) than boundaries extracted from controls (t test; P < 0·05). It is proposed that FD is a useful measure of clinically relevant differences in the complexity of MRI boundaries.
Dysfunctional attitudes in depressed and recovered depressed patients and their first-degree relatives
Authors: Power M. J. , Duggan C. F. , Lee A. S. , Murray R. M.
Published: July 2009

Synopsis

A series of depressed probands and their first-degree relatives were categorized as follows: (a) currently depressed; (b) recovered depressed; and (c) never-ill relatives. Their scores on a subscaled version of the Dysfunctional Attitude Scale (the DAS-24) were compared. The DAS total scores mirrored previous findings in that the total scores for recovered individuals returned to normal or near-normal levels. However, the dependency subscale scores remained elevated for the recovered depressed group. It is proposed that these results support the conclusion that self-report measures of cognitive vulnerability should focus on specific rather than global effects, if progress is to be made in the search for true vulnerability factors.
Predictors of survival with Alzheimer's disease: a community-based study
Authors: Jagger Carol , Clarke Michael , Stone Andrew
Published: July 2009

Synopsis

Factors associated with reduced survival were investigated in elderly people diagnosed as having Alzheimer's disease (AD) and in those free of dementia at diagnosis. The study population comprised 155 people free of dementia and 222 with AD; all were aged 75 years and over and were part of a two-stage prevalence study of dementia during 1988 in Melton Mowbray, Leicestershire. An increased risk of death was found for those with a history of heavy alcohol use, lower cognitive function, a history of heart failure and those in institutional care, these factors acting in the same manner for persons free of dementia and those with AD. For the non-demented group a greater risk of death was found with increasing age and for those with a history of cancer. A greater risk of death was found for males with AD compared to females with the risk increasing over time. The longer survival of women over men may explain the sex differences found in the prevalence of AD without accompanying differences in incidence.
Addendum
Authors: Bebbington P. , Kuipers L.
Published: July 2009

In our article ‘The predictive utility of expressed emotion in schizophrenia: an aggregate analysis’ (Bebbington, P. & Kuipers, L., Vol. 24, pp. 707–718), we omitted to acknowledge the help given to us by Dr Rob Howard in making initial contact with the authors of the various studies. We are happy to have the opportunity to do so now.
Psychiatric comorbidity in patients with eating disorders
Authors: Braun D. L. , Sunday S. R. , Halmi K. A.
Published: July 2009

Synopsis

The Structured Clinical Interview for DSM-III-R (SCID and SCID II) was administered to 105 eating disorder in-patients in order to examine rates of comorbid psychiatric disorders and the chronological sequence in which these disorders developed. Eighty-six patients, 81·9% of the sample, had Axis I diagnoses in addition to their eating disorder. Depression, anxiety and substance dependence were the most common comorbid diagnoses. Anorexic restrictors were significantly more likely than bulimics (all subtypes) to develop their eating disorder before other Axis I comorbid conditions.

Personality disorders were common among the subjects; 69% met criteria for at least one personality disorder diagnosis. Of the 72 patients with personality disorders, 93% also had Axis I comorbidity. Patients with at least one personality disorder were significantly more likely to have an affective disorder or substance dependence than those with no personality disorder.
The nucleus accumbens–possible site of antipsychotic action of neuroleptic drugs?
Authors: Crow T. J. , Deakin J. F. W. , Longden A.
Published: July 2009

synopsis

The hypothesis that neuroleptic drugs exert their therapeutic effects by blocking dopaminergic transmission has been investigated by examining the effects of 3 neuroleptic drugs on dopamine turnover in 2 dopaminergically innervated regions of brain – the neostriatum and nucleus accumbens. The drugs chlorpromazine, thioridazine and fluphenazine, known to be therapeutically active in the treatment of schizophrenia, but to have differing incidences of extrapyramidal side effects, were administered to rats in dose ratios approximating to those effective in man. All 3 drugs induced a similar rise in the content of the dopamine metabolite homovanillic acid (HVA) in the nucleus accumbens, whilst the changes in HVA observed in the neostriatum were in the rank order in which these drugs produce extrapyramidal side effects. While the concentrations of dopamine metabolites in the frontal cortex were too low to assess the possibility that neuroleptic drugs have actions at this level, our results are consistent with the hypothesis that these drugs exert their therapeutic effects by dopamine receptor blockade in the nucleus accumbens.
Anterior pituitary hormone secretion in chronic schizophrenia – an approach to neurohumoral mechanisms
Authors: Johnstone Eve C. , Crow T. J. , Mashiter K.
Published: July 2009

Synopsis

Prolactin, FSH, LH and TSH were determined in repeated samples of serum from 16 unmedicated male patients with chronic schizophrenia. Changes in the mental states between the 2 occasions were related to changes in hormone levels. Significant inverse correlations were established between prolactin and incoherence of speech, between prolactin and total positive symptoms and between FSH and poverty of speech. A significant positive correlation was established between FSH and delusions. These findings are discussed in the context of evidence concerning the role of monoamines in the control of anterior pituitary function, and of the dopamine and other monoamine hypotheses of schizophrenia. Although prolactin secretion was not as low, as would be predicted on the basis of the dopamine overactivity hypothesis of schizophrenia, the relationship between symptom change and change in prolactin secretion was consistent with the hypothesis that increasing symptom severity is associated with increasing dopamine release from the tubero-infundibular system.
Predicting success in psychiatric training for foreign medical graduates: II. Patterns in course
Authors: Weiss James M. A. , Davis David
Published: July 2009

synopsis

Faculty ratings of 22 foreign medical graduates (‘FMGs’), all of whom entered psychiatric residency training at the University of Missouri–Columbia from 1966 through 1973, were compared with those of a similar group of North American medical graduates (‘AMGs’). An on-going evaluation programme provided data for a variety of parameters ranging from ‘theoretical knowledge’ to ‘clinical skills’. Results indicated that in most areas of performance the median FMG started at a level substantially lower than that of the median AMG and very slowly caught up. When achievement criteria were utilized it became apparent that, at least by the third year of training, ‘superior’ FMGs could equal or surpass the median performance of ‘superior’ AMGs, whereas ‘marginal’ residents, whether foreign or native-born, seldom attained even competence in most major spheres of functioning. Implications of these findings and those in related studies are discussed.
The validity of the diagnosis of mild dementia
Authors: Rosenman Stephen
Published: July 2009

SYNOPSIS

Five operational methods for clinical diagnosis of mild dementia were compared to find out their diagnostic concordance when applied to a single group of seventy-five subjects. The clinical validity of the diagnoses was assessed in terms of their capacity to predict continued cognitive deterioration over three years after diagnosis and their capacity to reject the diagnostic influence of ‘non-dementia’ factors (that is, the cognitive consequences of depression, poor intellect, limited education and non-neurological physical illness). By all criteria of clinical validity the diagnostic methods for mild dementia performed poorly. Kappas measuring agreement between methods averaged only 0·15 and up to 57% of diagnostic deviance was explained by ‘non-dementia’ factors. Prediction of continued deterioration was poor, with a false positive rate which was too high for the diagnoses to be clinically usable. By no criterion of validity did the diagnostic methods exceed the performance of a clinician's judgement of the presence of pathological cognitive impairment or diagnosis by a cutpoint on the Mini-Mental State Examination.
Structural brain imaging abnormalities associated with schizophrenia and partial trisomy of chromosome 5
Authors: Honer William G. , Bassett Anne S. , MacEwan G. William , Hurwitz Trevor , Li David K. B. , Hilal Sadek , Prohovnik Isak
Published: July 2009

SYNOPSIS

Chromosomal abnormalities occurring in association with mental illness provide a unique opportunity to study the interaction of genetic abnormalities and the brain in mental illness. Four individuals from a family in which schizophrenia was found to cosegregate with a partial trisomy of chromosome 5 were studied with computed tomography and magnetic resonance imaging. Temporal lobe atrophy was found in the two trisomic males and in the asymptomatic balanced translocation female. In addition, a large cavum septum pellucidum and a cavum vergae were found in the older trisomic individual. Scans from the normal male were free of abnormalities. These results suggest that molecular studies of the translocation breakpoints in this chromosomal abnormality may be of interest, and encourage further studies of brain structure in other chromosomal abnormalities associated with psychosis.
The effect of temporal lobe surgery on electrodermal activity: implications for an organic hypothesis in the aetiology of schizophrenia
Authors: Toone B. K. , Cooke E. , Lader M. H.
Published: July 2009

Synopsis

It has recently been suggested that the bilateral asymmetry of electrodermal activity (EDA) reported in schizophrenia may be related to unilateral temporal lobe dysfunction. To test this hypothesis, 3 aspects of EDA – skin conductance level (SCL), number of spontaneous fluctuations (SF), and skin conductance response (SCR) – were measured bilaterally in 10 patients who had undergone unilateral temporal lobectomy. No differences could be detected between the operated and non-operated sides within the patient group, nor between the patient and control groups. The implications of these findings are discussed.
Application to the alcohol dependence syndrome of a method of determining the sequential development of symptoms
Authors: Chick Jonathan , Duffy John C.
Published: July 2009

Synopsis

Temporal ordering of core items in the alcohol dependence syndrome was investigated in 38 men admitted to an alcoholism treatment unit. An analysis of rank sums yielded a modal sequence which resembled classical descriptions of alcoholism, though ‘loss of control’ appeared very early.
Informing the consultant psychiatrist – the problems of communication
Authors: Kemp I. W.
Published: July 2009

Synopsis

There is considerable difficulty in providing clinicians with statistics relating to their work which are both relevant in content and suitable in style. As a contribution towards the solution of the problem for psychiatrists, a new type of statistical feedback, the Hospital/National Comparison Tables, has been produced in Scotland. In these tables the work of individual hospitals is compared with the work of all other hospitals of the same type. These are critically examined, together with examples of analyses showing the uses to which the data can be put.
Murder under hypnosis
Authors: Harris Ruth
Published: July 2009

Synopsis

This article discusses the trial of a woman accused of murder in 1890 whose defence rested on the claim that she acted unconsciously under the hypnotic influence of her older lover. This relatively banal case brought together two rival schools of French psychiatry – that of J.-M. Charcot in Paris and that of Hippolyte Bernheim in Nancy – and provided a wide-ranging examination of views on the nature of unconscious mental activity as well as the social, political and professional implications that their theories on hypnotism and hysteria contained. Discussions on women's sexuality, family relations, crowd behaviour and political radicalism all played a part in the debate and are examined through the case study that the trial of Gabrielle Bompard permits. Moreover, the trial shed incidental light on the campaign by physicians against amateur healers and hypnotists whom they blamed for unleashing a wave of mass hysteria through their theatrical representations. The episode was one important element in the struggle for the passage of the law of 30 November 1892, which outlawed amateur practitioners and established the medical monopoly over healing in France.
Psychiatric aspects of contempt of court among women
Authors: d'Orbán P. T.
Published: July 2009

Synopsis

The case histories of 72 women admitted to prison for contempt of court in 1979–83 were reviewed. The sample included 45% of all women imprisoned for contempt in England and Wales over the 5-year period. The contemnors were significantly older than other sentenced prisoners, one third were foreign born and 37–5% were suffering from psychiatric disorder. Two thirds of the mentally disordered group had a paranoid disorder, litigiousness was a prominent feature of their illness, and 52% committed contempt in the context of a matrimonial dispute or a dispute with neighbours. Recent legislation may help to prevent the imprisonment of mentally ill contemnors.
Psychiatric symptoms in self-poisoning patients
Authors: Newson-Smith J. G. B. , Hirsch S. R.
Published: July 2009

Synopsis

Self-poisoning patients admitted to hospital were studied for persistence of psychiatric symptoms over a 3-month period and evaluated at 3 points in time with the General Health Questionnaire and the Present State Examination. Symptoms were identified which had a high or low prevalence at 3-month follow-up. GHQ and PSE scores correlated at 0·8. The implications of the study are discussed, particularly the earlier need for out-patient help in those who had a moderate or high number of symptoms at initial interview.
The contextual threat of life events: the concept and its reliability
Authors: Tennant Christopher , Smith Alan , Bebbington Paul , Hurry Jane
Published: July 2009

Synopsis

The reliability of Brown's contextual measure of threat is assessed and found to be highly satisfactory. Previously inexperienced raters achieve highly reliable ratings after only brief training. The implications for the concept of the threat of life events are discussed.
Movement disorders and psychological tests of frontal lobe function in schizophrenic patients
Authors: Brown K. W. , White T. , Palmer D.
Published: July 2009

SYNOPSIS

Neuropsychological tests of frontal lobe functions were undertaken in 46 chronic schizophrenic patients who were also rated for movement disorders. Tardive dyskinesia was found to have significant associations with most of these psychological tests. The possible mechanisms are discussed within the context of known neostriatal psychological functions.
Remission and relapse in major depression: a two-year prospective follow-up study
Authors: Ramana R. , Paykel E. S. , Cooper Z. , Hayhurst H. , Saxty M. , Surtees P. G.
Published: July 2009

Synopsis

This paper reports the course with respect to remission and relapse of a cohort of predominantly in-patient RDC major depressive subjects, who were followed at 3-monthly intervals to remission and for up to 15 months thereafter. Remission was comparatively rapid with 70% of subjects remitting within 6 months. Only 6% failed to do so by 15 months. However, 40% relapsed over the subsequent 15 months, with all the relapses occurring in the first 10 months. Greater severity of the depression and longer duration of the illness predicted a longer time to remission. Greater initial severity of depression also predicted relapse. Subjects with a worse outcome had not received less adequate treatment than the remainder. Our results confirm the comparatively poor outcome subsequent to remission that has been reported in recent literature, in spite of the availability of modern methods of treatment. The clustering of relapses in the first 10 months gives some support to the distinction between relapse and later recurrence.
The structure of common psychiatric symptoms: how many dimensions of neurosis?
Authors: Ormel J. , Oldehinkel A. J. , Goldberg D. P. , Hodiamont P. P. G. , Wilmink F. W. , Bridges K.
Published: July 2009

SYNOPSIS

Synopsis In order to replicate and elaborate the two-dimensional model of depression and anxiety underlying the structure of common psychiatric symptoms proposed by Goldberg et al. (1987), we carried out latent trait analyses on PSE symptom data of the original Manchester study and two recent Dutch studies. We used the same analytical strategy as Goldberg et al. to facilitate comparison with the earlier work. It was found that a more comprehensive set of common psychiatric symptoms caused an extra, third dimension to emerge, so that the earlier anxiety dimension became split between a specific anxiety axis characterized by situational and phobic anxiety and avoidance, and a non-specific anxiety axis characterized by free-floating anxiety, various symptoms relating to tension, irritability and restlessness. It is argued that three dimensions are sufficient to account for the covariance between common psychiatric symptoms. A fairly consistent correlation between the non-specific anxiety and the depression dimension was found across sites, as well as independence of the specific anxiety dimension from the other two dimensions. Furthermore, the depression dimension was robust with similar symptom profiles across samples, but there appeared to be local differences in the structure of anxiety symptoms.
Social, psychological and physical correlates of eating problems. A study of the general adolescent population in Norway
Authors: Wichstrøm Lars
Published: July 2009

SYNOPSIS

The characteristics and concurrent predictors of eating problems were identified. Ninety-seven per cent of a representative sample of Norwegian adolescents (N = 11315) completed a questionnaire containing a 12-item version of the Eating Attitudes Test (EAT) and measures of a large number of physiological, psychological and social factors previously suggested to be of aetiological importance. Social class, drug use and indicators of ‘the model child’ (high grades, high occupational aspirations and much homework) were not related to eating problems. Logistic regression analyses identified perceived obesity as the strongest associated factor, followed by gender, depression, excessive exercise and unstable self-perceptions. In addition, adopting idols with perfect bodies, body dissatisfaction, low self-worth, feminine sex-role orientation, lack of parental care, early pubertal timing, age and number of alcohol intoxications all added to the probability of eating problems. About 6% perceived themselves as obese in spite of subnormal BMI. Such misperceptions increased the risk of high scores on EAT.
The neuropsychology of schizophrenia: relations with clinical and neurobiological dimensions
Authors: Elliott Rebecca , Sahakian Barbara J.
Published: July 2009

It is now beyond question that the symptoms observed in schizophrenia include a range of cognitive neuropsychological deficits that may be more enduring than psychotic symptoms (Cassenset al.1990; Goldberget al.1993) Goldberget al.(1993) found that a group of patients treated with clozapine whose psychotic symptoms improved significantly over a 15 month study period showed no improvement in cognitive impairments. He argued that the enduring cognitive deficits are responsible for failure of patients to rehabilitate socially even when psychotic symptoms are in remission. Clearly an understanding of neuropsychological deficits is Important from a clinical as well as a theoretical viewpoint. There is, however, still much debate about the nature of these deficits and how they related to the psychotic symptoms of schizophrenia and also to the neurobiological substrate of this disorder.
Perspective production in a savant autistic draughtsman
Authors: Mottron L. , Belleville S.
Published: July 2009

SYNOPSIS

This study examines perspective construction in an autistic patient (E.C.) with quasi-normal intelligence who exhibits exceptional ability when performing three-dimensional drawings of inanimate objects. Examination of E.C.'s spontaneous graphic productions showed that although his drawings approximate the ‘linear perspective’ system, the subject does not use vanishing points in his productions. Nevertheless, a formal computational analysis of E.C.'s accuracy in an experimental task showed that he was able to draw objects rotated in three-dimensional space more accurately than over-trained controls. This accuracy was not modified by suppressing graphic cues that permitted the construction of a vanishing point. E.C. was also able to detect a perspective incongruency between an object and a landscape at a level superior to that of control subjects. Since E.C. does not construct vanishing points in his drawings, it is proposed that his production of a precise realistic perspective is reached without the use of explicit or implicit perspective rules. ‘Special abilities’ in perspective are examined in relation to existing theoretical models of the cognitive deficit in autism and are compared to other special abilities in autism.
A comprehensive public mental health programme in Guinea-Bissau: a useful model for African, Asian and Latin-American countries
Authors: De Jong Joop T. V. M.
Published: July 2009

Synopsis

From 1983–1994 a community mental health programme was set up in Guinea-Bissau. The first part of the programme concentrated on epidemiological aspects: rural and urban study areas were selected on socio-economic level and participation in the liberation war. A two-stage design was used to screen 351 adult consecutive general health care attenders and 100 children in a rural and an urban area for mental disorder. Psychiatric disorders have a morbidity of 12% among adults seen in Primary Health Care. Disorders were mainly neuroses (74%), but more psychoses were found than in other countries. No statistically significant difference in morbidity was found between rural-urban areas or between previous war and non-war zones. The diagnostic sensitivity of the Primary Health Care workers was 31%, their diagnostic specificity 88%. Thirteen per cent of the children showed neuropsychiatric disturbances. There were no sociocultural impediments to this public mental health approach. During the following intervention programme 850 Primary Health Care workers were trained and supervised nationwide. The diagnostic sensitivity of major mental disorders and epilepsy increased from 31% to an average of 85%. Before the training, their knowledge of the treatment of these disorders was nil whereas after training 82% of the patients received appropriate treatment. Moreover, this model programme shows a profitable cost/benefit ratio and a high sustainability over the last 10 years.
Serotonin activity in anorexia nervosa after long-term weight restoration: response to D-fenfluramine challenge
Authors: O'Dwyer A-M. , Lucey J. V. , Russell G. F. M.
Published: July 2009

Synopsis

Abnormalities in central serotonin function have been implicated in the pathogenesis of anorexia nervosa. It is difficult, however, to separate neuroendocrine abnormalities induced by weight loss and malnutrition from those related primarily to the disorder itself. To minimize these influences, this study assessed long-term weight restored anorexics. A correlation between persistent eating-related psychopathology, co-morbid illness and serotonin dysfunction was sought. Nine female weight-restored out-patients who had previously fulfilled DSM-III-R criteria for anorexia nervosa and nine healthy controls participated. Following baseline estimation, prolactin and cortisol responses to 30 mg p.o. ofD-fenfluramine were measured over a 5 h period. Eating related psychopathology was assessed using the Eating Disorders Inventory and Eating Attitudes Test. Depressive and obsessional symptoms were measured using the Beck Depressive and Maudsley Obsessive–Compulsive Inventories respectively. The Tridimensional Personality Questionnaire assessed impulsivity. The weight-restored anorexic group exhibited persistent eating-related psychopathology and significant co-morbid symptomatology. There was no difference between long-term weight restored anorexics and controls in their endocrine response toD-fenfluramine. Long-term weight-recovered anorexic subjects continued to exhibit behavioural and attitudinal disturbances characteristic of anorexia nervosa. The results suggest that abnormalities in 5HT activity do not contribute significantly to trait status in anorexia nervosa.
A prospective clinical study of stereotactic subcaudate tractotomy
Authors: Poynton A. M. , Kartsounis L. D. , Bridges P. K.
Published: July 2009

SYNOPSIS

This study describes a cohort of 23 patients undergoing stereotactic subcaudate tractotomy. Research Diagnostic Criteria indicated that 70% suffered major depressive disorder; the remainder mostly had a bipolar affective disorder. There were serial assessments pre-operatively and at 2 weeks and 6 months post-operatively using the Hamilton Rating Scale for depression, the Present State Examination (PSE), Newcastle Scale, the Beck Depression Inventory, and the Taylor Manifest Anxiety Scale. Neuropsychological assessment included tests thought to be sensitive to frontal lobe dysfunction, as well as tests of general intelligence, attention, memory, language and visuo-spatial function.

Post-operatively, depression rating scale scores decreased significantly but most patients continued to exhibit a number of PSE syndromes. Depression rating scale scores were correlated with 1 year global outcome: there was no significant correlation except for the 6 month assessment when lower Hamilton scores were found to be associated with better global outcome. Correlations between the neuropsychological tests and the Hamilton and Beck depression scales at 2 weeks post-operatively suggested that an improvement in psychiatric condition was associated with greater efficiency on some tests of attention and verbal recall, as well as faster performance on a sorting task. By contrast, the changes at 6 months suggested an association between improvement in psychiatric condition and less efficient performance on certain neuropsychological tests including verbal recognition memory, attention and two tests of frontal lobe dysfunction.
The relationship between suggestibility and anxiety among suspects detained at police stations
Authors: Gudjonsson G. H. , Rutter S. C. , Clare I. C. H.
Published: July 2009

SYNOPSIS

The present study investigated the relationship between anxiety, as measured by the State-Trait Inventory (Spielberger, 1983) and interrogative suggestibility, as measured by the Gudjonsson Suggestibility Scale (GSS 2, Gudjonsson, 1987). One hundred and sixty-one suspects detained at two English police stations for questioning were assessed prior to being interviewed by the police. Unexpectedly, trait anxiety correlated more consistently with suggestibility than did state anxiety. The correlations were consistently higher among the Caucasian than the Afro-Caribbean subjects and the Afro-Caribbean subjects were significantly more suggestible than the Caucasian subjects even after their GSS 2 memory and IQ scores had been controlled for. The main practical implications of the findings are that interrogative suggestibility cannot be easily evaluated from the person's self-reported anxiety and the situation in which people are assessed may influence the relationship between these psychological variables.
A two-stage epidemiological study of abnormal eating attitudes and their prospective risk factors in Polish schoolgirls
Authors: Włodarczyk-Bisaga Katarzyna , Dolan Bridget
Published: July 2009

Synopsis

In this longitudinal two-stage screening study of abnormal eating attitudes and behaviours in Polish schoolgirls self-report questionnaires (EAT-26) were completed by 747 schoolgirls aged between 14 and 16 years. On the basis of their EAT-26 scores 167 girls were selected for a clinical interview conducted blind to questionnaire scores. No clinical cases of DSM-III-R anorexia or bulimia nervosa were identified, however, there was a point prevalence of 2·34% for subclinical eating disorder and of 28·6% for dieting. Natural history was investigated, repeating the screening and interviews after 10 months. Both the group mean EAT-26 score and the proportion of subclinical cases remained the same at follow-up however, individual girls showed substantial fluctuations over time. On re-screening 11·5% of the sample had moved EAT category (based on scoring below or above the clinical cut-off point). Follow-up interviews showed that 58% (7) of the original subclinical cases were no longer cases while seven girls were ‘new’ subclinical cases. This second stage of the study also aimed to investigate the risk factors for the development of eating disorders. Several family factors distinguished the dieters from non-dieters at the initial stage. Subjects who began dieting between the initial and follow-up interviews had higher Body Mass Index, felt more overweight and had greater discrepancy between their current and ideal weights than the non-dieters. However, analysis of regression revealed no specific risk factors for development of a subclinical syndrome.
Are blunted dexamethasone-induced growth hormone responses unique to depression?
Authors: Thakore Jogin H. , Dinan Timothy G.
Published: July 2009

Synopsis

In health, acute administration of glucocorticoids, such as dexamethasone (DEX), leads to growth hormone (GH) secretion. Depression is characterized by blunted DEX/GH responses. In order to determine the specificity of this test for depression we administered 4 mg of oral DEX, to patients with a DSM-III-R diagnosis of depression, schizophrenia, mania and alcohol dependency syndrome. Samples for GH estimation were taken at − 15 min, 0 min, +60 min, +180 min, +240 min and +300 min. GH responses were attenuated to a similar degree in depression and mania. Less marked attenuation was seen in schizophrenia while those with alcohol dependency syndrome had GH responses indistinguishable from normal volunteers. Overall, we conclude that subnormal DEX/GH secretion is not specific to depression.
Psychological distress among recent immigrants from the former Soviet Union to Israel, I. Correlates of level of distress
Authors: Zilber N. , Lerner Y.
Published: July 2009

Synopsis

In most migrations some selection takes place either by the absorbing country and/or the individuals who emigrate. Israel has an open-door policy for immigrants and the recent large wave of immigrants from the former Soviet Union was made up of entire families rather than individuals. This provided an opportunity to examine the issue of migration and psychological distress more directly. A nationwide sample of 600 immigrants who arrived during the preceding year were interviewed in December 1990. Their psychological distress was measured by the PERI Demoralization questionnaire. For both genders, the mean demoralization score of the immigrant sample was found to be significantly higher than that reported for the Israeli-born population (after controlling for education). The factors that were found to be correlated with the level of distress were mostly individual characteristics of the immigrants (e.g. profession, religiousness, former residence in the Chernobyl region, previous contact with the health profession because of psychological problems). Increased distress was also significantly related to perceived lack of social support in Israel, which may in fact be partly determined by personality traits.
Aberrant interhemispheric alpha coherence on electroencephalography in schizophrenic patients during activation tasks
Authors: Morrison-Stewart S. L. , Velikonja D. , Corning W. C. , Williamson P.
Published: July 2009

Synopsis

Thirty schizophrenic patients (20 medicated, 10 off medication) were compared with 30 normal controls subjects matched for age, sex, handedness and intelligence. During the performance of a frontal activation task, normal subjects showed increased interhemispheric coherence between anterior brain regions. Schizophrenic patients did not show the same amount of bilateral anterior activation. During the performance of right hemisphere cognitive activation tasks, normal subjects and medicated schizophrenic patients showed significantly reduced bilateral interhemispheric coherence patterns, while the drug-free schizophrenic patients showed a trend towards this same pattern. It is suggested that these findings provide additional evidence for an aberrant functional organization of the brain in schizophrenia.
Abnormalities of self-representation and persecutory delusions: a test of a cognitive model of paranoia
Authors: Bentall Richard P. , Kaney Sue
Published: July 2009

Synopsis

Patients suffering from persecutory delusions exhibit information processing and social reasoning biases that have been hypothesized to have a self-protective function. In a test of this hypothesis, patients suffering from persecutory delusions who were also depressed and non-depressed deluded subjects were compared with depressed and normal controls on two indirect assessments of self-schemata: the Dysfunctional Attitudes Scale (DAS) and incidental recall of negative and positive trait words that had previously been judged to be self-descriptive or not self-descriptive. Both the depressed subjects and the deluded subjects, whether or not they were depressed, scored highly on the DAS. Like normals, both depressed and non-depressed deluded subjects endorsed more positive than negative trait words as true of themselves whereas the depressed subjects endorsed as many negative as positive trait works. Like the depressed subjects, both groups of deluded subjects recalled as many of the negative words they had endorsed as positive words, whereas the normals remembered more positive words. No such bias was observed in subjects' recall of unendorsed words. The DAS results are interpreted as clearly consistent with a defensive model of persecutory delusions whereas the incidental recall data were equivocally so.
Mood disorders in long-term survivors of stroke: associations with brain lesion location and volume
Authors: Sharpe M. , Hawton K. , House A. , Molyneux A. , Sandercock P. , Bamford J. , Warlow C.
Published: July 2009

Synopsis

Sixty surviving patients from a community-based stroke register who had CT scan evidence of a single brain lesion and neurological signs appropriate to it were interviewed three to five years following their first-ever stroke. Mood disorder (anxiety and depression), physical disability, and intellectual impairment were assessed using standardized measures. The position and volume of the brain lesion was determined from CT scans performed soon after the stroke. The prevalence of depressive disorder was lower in this sample than that reported in previous studies (DSM-IIIR major depression 8 3 %; all DSM-IIIR depressive disorders 183%). Reports by other workers for an association of depressive disorder either with left-sided brain lesions, or with anteriorly placed lesions in the left cerebral hemisphere, were not supported. Neither was there evidence of a correlation between symptom score and proximity of the lesion to the anterior pole of the left cerebral hemisphere. Psychiatric symptom scores were however greater with larger volume brain lesions. Anxiety disorders, especially agoraphobia, were relatively common (20 % if diagnosed in the presence of depressive disorder), but were not related to lesion location or volume.
Recognition, management and outcome of psychological disorders in primary care: a naturalistic follow-up study
Authors: Ormel J. , Brink W. Van Den , Koeter M. W. J. , Giel R. , Meer K. Van Der , Willige G. Van De , Wilmink F. W.
Published: July 2009

Synopsis

This article addresses the issues of recognition and labelling of psychological disorders (PDs) by general practitioners (GPs), and he association of recognition with management and outcome. Nearly 2000 attenders of 25 GPs were screened with the GHQ and a stratified sample of 296 patients was examined twice, using the Present State Examination (PSE) and Groningen Social Disability Schedule (GSDS).

Prevalence rates of PDs according to the GHQ, GP and PSE were 46%, 26% and 15% respectively. For the 1450 ‘new’ patients, i.e. patients who had no PD diagnosed by their GP in the 12 months prior to the enrolment visit, these rates were 38%, 14%, and 10%. GPs missed half of the PSE cases and typically assigned non-specific diagnoses to recognized cases. Depressions were more readily recognized than anxiety disorders, and the detection rates for severe disorders were higher than those for less severe disorders.

Recognition was strongly associated with management and outcome. Recognized as compared to non-recognized cases were more likely to receive mental health interventions from their GP and had better outcomes in terms of both psychopathology and social functioning. Initial severity, psychological reasons for encounter, recency of onset, diagnostic category, and psychiatric comorbidity were related to both better recognition and outcome. However, these variables could not account for the association of recognition with management and outcome, but some did modify the association. A causal model of the relationships is presented and possible reasons for non-recognition and for the beneficial effects of recognition are discussed.