bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlations Between Akathisia and Residual Psychopathology: A By-product of Neuroleptic-Induced Dysphoria
Authors: Newcomer John W. , Miller L. Stephen , Faustman William O. , Wetzel Martin W. , Vogler George P. , Csernansky John G.
Published: October 2008

Patients developing neuroleptic-induced akathisia have been reported to show higher levels of psychopathology. We sought to replicate this finding and determine its symptom specificity. We confirmed a significant relationship between ratings of akathisia and total score on the Brief Psychiatric Rating Scale (BPRS) during both acute and maintenance neuroleptic treatment. Using stepwise regression models, BPRS anxious-depressive subscale scores were the strongest predictors of akathisia during both treatment conditions. Paranoid subscale scores predicted akathisia only during maintenance treatment. These results suggest that neuroleptic-induced dysphoria largely explains the relationship between akathisia and residual psychopathology during both acute and maintenance neuroleptic treatment.
Self-inflicted Intracranial Injury
Authors: Puri B. K. , El-Dosoky A. , Barrett J. S.
Published: October 2008

A man suffering from persecutory delusions attempted to commit suicide by holding the head of a three-inch masonry nail against a wall and head-butting its point until he had driven it fully into his forehead.
Which Patients with Non-affective Functional Psychosis are not Admitted at First Psychiatric Contact?
Authors: Castle David J. , Phelan Michael , Wessely Simon , Murray Robin M.
Published: October 2008

Background

We wished to explore the sociodemographic and clinical characteristics associated with admission to hospital in patients with a non-organic non-affective psychosis.

Method

Subjects were 484 first-contact patients with a non-affective functional psychosis from an inner-city catchment area over 20 years from the mid-1960s. Sociodemographic and clinical characteristics associated with admission to hospital were analysed.

Results

Around 20% of patients were not admitted, and the proportion did not change significantly over the years. Ethnicity, sex, and marital and employment status did not predict admission. Factors associated with admission included police involvement, and violence to self or others. A diagnosis of schizoaffective disorder, and persecutory delusions, auditory hallucinations, and bizarre behaviour were all more common in patients admitted to hospital.

Conclusions

The study indicates biases which might arise in research based exclusively on patients admitted to hospital.
Clinically Relevant Outcome Research in Individual PsychotherapyNew models guide the researcher and clinician
Authors: Howard Kenneth I. , Orlinsky David E. , Lueger Robert J.
Published: October 2008

How can we design relevant psychotherapy research? The answer must be shaped by the objectives and potential consumers of such research. For over 40 years, “does psychotherapy work?” (Eysenck, 1952) held the attention of psychotherapy researchers, and randomised clinical trial methodology seemed the most appropriate empirical option for answering this question. There are now well over 500 studies that attest to the efficacy of psychotherapy (see Smithet al, 1980; Shapiro & Shapiro, 1982; Lipsey & Wilson, 1993, for meta-analytic research summaries); it seems that psychotherapy is one of the best documented medical interventions in history. But the conclusion that psychotherapy “works” is akin to finding that antibiotics “work”. We are left with the daunting task of determining which of the wide variety of treatments (psychotherapies, antibiotics) are appropriate for which variety of illnesses (psychopathologies, infections). Morris Parloff (1982) warned us of this need for specificity in his classic article, “Bambi meets Godzilla”, but our preoccupation with documenting the efficacy of psychotherapy has only recently abated enough to mount empirical studies of such specificity.
The Nosological Status of Bereavement-Related Depressions
Authors: Karam Elie G.
Published: October 2008

Background

The validity of excluding bereavement-related depressive episodes which satisfy all the criteria of major depression is examined in this community study.

Method

A total of 658 subjects were interviewed in their homes using the Diagnostic Interview Schedule. The length of the episodes of depression, the dysfunction they caused, and the frequency of seeking and receiving treatment were assessed.

Results

The risk of recurrence did not differ whether the depressive episodes that satisfy the DSM–III–R criteria of major depression were or were not related to bereavement.

Conclusions

Excluding from the repertoire of depressions all those related to external stressors might need more research, but singling out those related to bereavement does not seem to be supported by our community-based data.
Attempted Suicide in Oxford and Utrecht
Authors: Grootenhuis Martha , Hawton Keith , Rooijen Liesbeth Van , Fagg Joan
Published: October 2008

Background

Attempted suicide rates are much higher in the UK than in the Netherlands. We have compared the characteristics of suicide attempters referred to general hospitals in Oxford and Utrecht.

Method

We compared the characteristics of referrals for attempted suicide to a general hospital in Oxford and one in Utrecht, for the years 1988 and 1989.

Results

Most of the attempters in Oxford were young whereas attempters in Utrecht were older; this age difference was particularly marked in females. Utrecht attempters appeared more often to have socio-economic problems and to suffer from psychiatric and personality disorders (except substance abuse), even when account was taken of the age differences of the two populations.

Conclusions

There is some evidence for different thresholds for attempted suicide in the UK and the Netherlands, although other social explanations for the difference in attempted suicide rates are feasible and require further study.
Comparison of the Efficacy, Safety and Withdrawal of Alpidem and Alprazolam in Anxious Patients
Authors: Frattola Lodovico , Garreau Martine , Piolti Roberto , Bassi Sirio , Albizzati Maria G. , Borghi Cristina , Morselli Paolo L.
Published: October 2008

Background

We investigated whether a new non-benzodiazepine anti-anxiety drug, alpidem, produces weaker withdrawal symptoms than alprazolam.

Method

Under a double-blind procedure, 122 patients suffering from general anxiety disorders were randomly allocated to either alpidem (50 mg, three times a day) or alprazolam (0.5 mg, three times a day) for six weeks, followed by a two-week placebo withdrawal phase. The diagnosis of withdrawal syndrome (WS) was made, in blind conditions, on the basis of the Withdrawal Symptom Check List (WSCL), after one or two weeks of discontinuation of active treatment.

Results

The WS occurred significantly less frequently in the alpidem group (n = 10, 18%) than in the alprazolam group (n = 26, 48%). Typical withdrawal symptoms on the WSCL were also significantly less severe (P = 0.044) in the alpidem group compared with the alprazolam group.

Conclusions

Alpidem may be a valid alternative to current benzodiazepine anxiolytic therapy because it produces fewer and weaker withdrawal symptoms than alprazolam and is better tolerated.
A National Audit of New Long-Stay Psychiatric Patients
Authors: Lelliott Paul , Wing John , Clifford Paul
Published: October 2008

Background.

This first report of a national audit of new long-stay (NLS) psychiatric patients conducted in 1992 describes the survey method and characteristics of the cohort.

Method.

Psychiatrists from 59 UK mental health services returned data on 905 patients, aged 18–64 on admission, who had been in hospital for between six months and three years.

Results.

Two particular sub-groups were observed. Younger NLS patients (aged 18–34) were predominantly single men with schizophrenia; 43% of these had a history of serious violence, dangerous behaviour or admission to a Special Hospital and over one-third were formally detained. Older NLS patients (aged 55–67) were predominantly married or previously married women, more often with a diagnosis of affective disorder or dementia and with poor personal and social functioning; over half were at moderate or severe risk of non-deliberate self-harm.

Conclusions.

Despite the continued policy of bed closures and focus on care in the community, some patients admitted recently to psychiatric units in the UK still have protracted hospital stays.
Home-Based Versus Out-Patient/In-Patient Care for People with Serious Mental Illness
Authors: Audini B. , Marks I. M. , Lawrence R. E. , Connolly J. , Watts V.
Published: October 2008

Background.

The effect of a randomised controlled withdrawal of home-based care was studied for half of a sample of seriously mentally ill (SMI) patients from an inner London catchment area, compared with the effects of continuing home-based care.

Method.

Patients, aged 18–64, had entered the trial at month 0 when facing emergency admission for SMI. After at least 20 months home-based care (Phase I), patients were randomised at month 30 into Phase II (months 30–45) to have either further home-based care (DLPII, n = 33) or be transferred to out-/in-patient care (DLP-control, n = 33). They were assessed at 30, 34, and 45 months. Phase I control patients (n = 10) were assessed again at month 45. Measures used were number and duration of in-patient admissions, independent ratings of clinical and social function, and patients' and relatives' satisfaction.

Results.

The slim clinical and social gains from home-based v. out-/in-patient care during Phase I were largely lost in Phase II. Duration of crisis admissions increased from Phase I to Phase II in both DLPII and DLP-control patients. During Phase II, patients' and relatives' satisfaction remained greater for home-based than out-/in-patient care patients. At 45 months, compared with the Phase I controls, DLPII patients and relatives were more satisfied with care. Such satisfaction was independent of clinical/social gains.

Conclusions.

The loss of Phase I gains were perhaps due to attenuation of home-based care quality and to benefits of Phase I home-based care lingering into Phase II in DLP-controls. The Phase II home-based care team suffered from low morale.
The Outcome of Training Community Psychiatric Nurses to Deliver Psychosocial Intervention
Authors: Brooker Charles , Falloon Ian , Butterworth Antony , Goldberg David , Graham-Hole Victor , Hillier Valerie
Published: October 2008

Background.

A prospective quasi-experimental design was used to evaluate the effect of training CPNs to undertake psychosocial intervention with families caring for a relative with schizophrenia.

Method.

Patients meeting predetermined criteria were allocated to either an initial waiting-list control group or a delayed intervention group. The CPNs were trained to offer family interventions to a total target group of 48. Treatment was eventually accepted by 85%, of whom 81 % (n = 34) were followed-up for 12 months. Families received a weekly mean session of 47 minutes (compared with 33 minutes in the controls). The main outcome measures are frequency and severity of symptoms (KGV), social functioning (SFS) and days in hospital. Carers' minor psychiatric morbidity (GHQ) and knowledge (KASI) are also reported.

Results.

In the patient group both the positive and negative symptoms of schizophrenia improved significantly (P ≤ 0.001 and P ≤ 0.01 respectively) to 12-month follow-up, as did a global measure of social functioning (P ≤ 0.001). Tentative evidence was also collected that family intervention reduced in-patient episodes. Benefits for relatives included a decrease in minor psychiatric morbidity (P ≤ 0.05) and an increase in knowledge about neuroleptic drugs (P ≤ 0.001).

Conclusions.

The study offers some evidence that CPNs can be taught to improve the outcome for families who care for a relative with schizophrenia.
Family-Based Intervention for Schizophrenic Patients in China
Authors: Xiong Wei , Phillips M. R. , Hu Xiong , Wang Ruiwen , Dai Qinqing , Kleinman J. , Kleinman A.
Published: October 2008

Background.

We developed and evaluated a comprehensive, ongoing intervention for families of schizophrenic patients appropriate for China's complex family relationships and unique social environment.

Method.

Sixty-three DSM–III–R schizophrenic patients living with family members were enrolled when admitted to hospital and randomly assigned to receive standard care or a family-based intervention that included monthly 45-minute counselling sessions focused on the management of social and occupational problems, medication management, family education, family group meetings, and crisis intervention.

Results.

At 6, 12, and 18-month follow-ups by blind evaluators, the proportion of subjects rehospitalised was lower, the duration of rehospitalisation was shorter, and the duration of employment was longer in the experimental group than in the control group; these differences were statistically significant at the 12 and 18-month follow-ups and were not explained by differences in drug compliance. Family intervention was associated with significantly lower levels of family burden.

Conclusions.

This intervention is less costly than standard treatment, is suitable for urban families of schizophrenic patients in China and feasible given the constraints of the Chinese mental health system.
Cognitive Therapy, Analytic Psychotherapy and Anxiety Management Training for Generalised Anxiety Disorder
Authors: Durham Robert C. , Murphy Tom , Allan Thérèse , Richard Karen , Treliving Linda R. , Fenton George W.
Published: October 2008

Background

We test the hypotheses that (a) cognitive therapy is of comparable efficacy to psychodynamic psychotherapy, (b) 8–10 sessions of therapy is as effective as 16–20 sessions, and (c) brief therapist training is as effective as intensive training.

Method

Of 178 out-patients referred to a clinical trial of psychological treatment for generalised anxiety, 110 patients met DSM–III–R criteria for generalised anxiety disorder and were randomly assigned to three different forms of psychotherapy. The main comparison was between cognitive therapy and analytic psychotherapy, delivered by experienced therapists at weekly or fortnightly intervals over six months. A third treatment, anxiety management training, was delivered at fortnightly intervals by registrars in psychiatry after a brief period of training. Eighty patients completed treatment and were assessed before treatment, after treatment, and at six-month follow-up.

Results

Cognitive therapy was significantly more effective than analytic psychotherapy, with about 50% of patients considerably better at follow-up. Analytic psychotherapy gave significant improvement but to a lesser degree than cognitive therapy. There was no significant effect for level of contact. Patients receiving anxiety management training showed similar improvements to cognitive therapy after treatment, with rather lower proportions showing clinically significant change.

Conclusions

Cognitive therapy is likely to be more effective than psychodynamic psychotherapy with chronically anxious patients. Significant improvements in symptoms can be achieved by trainee psychiatrists after only brief instruction in behaviourally based anxiety management. However, the superiority of cognitive therapy at follow-up suggests that the greater investment of resources required for this approach is likely to pay off in terms of more sustained improvement. There is no evidence that 16–20 sessions of treatment is more effective, on average, than 8–10 sessions.
The Nithsdale Schizophrenia Surveys
Authors: Mccreadie R. G. , Connolly M. A. , Williamson D. J. , Athawes R. W. B. , Tilak-Singh D.
Published: October 2008

Background

The aim was to examine in a population of schizophrenic patients the clinical correlates of ‘neurodevelopmental’ schizophrenia and their relationship to putative aetiological factors.

Method

Premorbid social adjustment, premorbid schizoid and schizotypal personality traits, and the obstetric history of 40 schizophrenic patients and their 102 sibs were assessed through interviews with their mothers. Patients' premorbid level of intelligence was assessed by the National Adult Reading Test and current symptoms by the Positive and Negative Syndrome Scale and the Subjective Deficit Syndrome Scale.

Results

Patients had more schizoid and schizotypal traits than their sibs. They showed a deterioration in social adjustment between childhood and adolescence; sibs' social adjustment improved. There were statistically significant associations between current negative schizophrenic symptoms, premorbid deterioration in social adjustment, and schizoid and schizotypal personality traits, and between an early age of onset of illness and the same premorbid assessments. There was no evidence that patients with a family history of severe mental illness leading to hospitalisation, or a history of definite obstetric complications, had poorer premorbid functioning or more severe current symptoms.

Conclusions

We have confirmed clinical correlates of ‘neurodevelopmental’ schizophrenia but found no association between these and obstetric complications or a family history of severe mental disorder.
Oculogyric Spasm in Asian Psychiatric In-patients on Maintenance Medication
Authors: Tan Chay-Hoon , Chiang Peck-Chiam , Ng Li-Ling , Chee Kuan-Tzee
Published: October 2008

Background

The objective was to investigate the occurrence and characteristics of oculogyric spasm (OGS) in an Asian country.

Method

All 2035 Asian (88% Chinese, 7% Malays and 5% Indonesians) psychiatric in-patients in the state psychiatric hospital in Singapore were surveyed for occurrence of oculogyric spasm (OGS) over a two-month period.

Results

Thirty-four patients (1.7%) developed OGS (53% male and 47% female). All the 34 patients had been on maintenance antipsychotic drugs for more than five months. Eighteen patients had recurrent attacks. The mean chlorpromazine equivalent daily dose for those patients with recurrent OGS was 511 mg. This was significantly higher (P < 0.05) than the 277 mg daily dose received by those without recurrent OGS. Most (68%) of the attacks occurred between 1400–2000 h suggesting that OGS may have a diurnal variation.

Conclusions

GS presenting as tardive dystonia may be due to a relative increase in cholinergic activity.
Neuroleptic Medication for Dystonia
Authors: Young C. S. , Stewart J. B. , Fenton G. W.
Published: October 2008

Background

The presence of dysphoric symptoms associated with neuroleptic medication is commonly reported.

Method

Neuroleptic treatment of a segmental dystonia resulted in a disabling depressive illness, which when treated with antidepressants led to the return of the involuntary movements.

Results

The use of several different antidepressants and neuroleptics confirmed the association between drugs and symptoms. Genetic studies excluded “poor metaboliser status” as a reason for the patient's sensitivity to these drugs.

Conclusions

The case illustrates a delicate imbalance between dose of neuroleptic medication and depressive symptoms. We should be aware of the possibility of mood changes in patients treated with neuroleptics for a variety of conditions.
Postal Self-Exposure Treatment of Recurrent Nightmares
Authors: Burgess Mary , Marks Isaac M. , Gill Michael
Published: October 2008

Background

Case reports suggest that recurrent nightmares are alleviated by behavioural treatment. We have administered such treatment to a client by post.

Method

The frequency of nightmares was recorded by the client before and during treatment, and at one and six months follow-up. Nightmare problem and target scales, and treatment expectation were recorded at the end of each period. Treatment was by rehearsal relief, self-administered using written instructions.

Results

A reduction in nightmare frequency from 5.5 per week in the baseline period to an average of one per week resulted after treatment.

Conclusions

The client's chronic nightmares were lastingly relieved after self-administered exposure treatment. A controlled trial is underway.
The Prevalence of Autistic Disorder among Children with a Learning Disability
Authors: Deb Shoumitro , Prasad K. B. G.
Published: October 2008

Background

It has been suggested recently that the prevalence of autistic disorder may be rising. No prevalence study specifically among learning disabled children exists and so this study was prompted.

Method. 767 children with a learning disability who attended 16 different special schools in the Grampian region of north-east Scotland were studied for a diagnosis of autistic disorder according to the DSM–III–R criteria. The study was conducted in three stages. In the first screening stage, a questionnaire was completed for each child by their teachers. In the second stage, teachers completed another questionnaire based on DSM–III–R criteria for autistic disorder. A final diagnosis was made on the basis of examination and information gathered from the questionnaires.

Results

Questionnaires were completed for 634 (82.7%) children. 14.3% of children with a learning disability fulfilled the diagnostic criteria for autistic disorder. There was a male: female ratio of 3:1. This gave a 9 per 10 000 minimum prevalence of autistic disorder among all school-age children in the Grampian region. There was a higher prevalence of autistic disorder in the cities compared with rural areas. The prevalence did not change with age but increased with decreasing IQ.
Clinical Features and Diagnostic Criteria of Depression in Down's Syndrome
Authors: Cooper Sally-Ann , Collacott Richard A.
Published: October 2008

Background

Depression occurs commonly in people with Down's syndrome, although there is little published about this association. This study explores the limitations of Diagnostic Criteria for Research, based on ICD-10 (DCR) and DSM–III–R depressive criteria.

Method

Case note examination identified 42 adults with Down's syndrome who have sustained 56 depressive episodes. The clinical features are reported.

Results

All episodes were diagnosed as depression. DSM–III–R criteria for major depressive episode were met by 50% of the episodes. DCR for depressive episode of at least mild severity were fulfilled by 68%.

Conclusions

These criteria were unduly restrictive for this group. Commonly occurring symptoms are not included in the criteria, while certain criteria items never occurred. Criteria should be modified to facilitate future research.
Clinical and Psychosocial Origins of Chronic Depressive Episodes
Authors: Brown George W. , Moran Patricia
Published: October 2008

Background

We consider how far it is possible to predict a chronic course of a depressive disorder from psychosocial and clinical material available at the point of onset.

Method

A population survey found 404 working-class mothers living in an inner-city area of London. The majority were interviewed three times over a 3-year period.

Results

Chronicity (more than 12 months' duration) was strongly related to both childhood adversity (parental indifference, family violence or any sexual abuse) and current adult interpersonal difficulties. The lack of positive events during the course of the episode was also independently related to chronicity, but to a lesser degree. Clinical characteristics were relatively unimportant compared with psychosocial factors.

Conclusions

The childhood risk factors were particularly important (judged by a path analysis), and a challenge for future research will be to establish the intervening processes involved with this distal link.
Clinical and Psychosocial Origins of Chronic Depressive Episodes
Authors: Brown George W. , Moran P. , Harris T. O. , Hepworth C. , Robinson R.
Published: October 2008

Background

We consider how well the psychosocial and clinical factors found to predict a chronic course for depressive episodes in the community, held for female psychiatric patients.

Method

A consecutive series of depressed patients, aged 18 to 60, treated as in-patients, out-patients or day-patients at psychiatric departments of two London hospitals, were interviewed initially and at follow-up two years later.

Results

Indices of childhood adversity and current interpersonal difficulties predicted episodes taking a chronic course (of more than 12 months' duration). Half of the episodes associated with one or the other factor were chronic, compared with 22% of those with neither. The patients were at higher risk than the community series (75% v. 34%) and this explains their much greater rate of chronicity. There was also some evidence that social support reduced risk. Clinical features and the presence of a personality disorder were unrelated to chronicity.

Conclusions

Similar psychosocial factors are important for predicting chronicity in both community and patient series.
Age at Onset, Sex, and Familial Psychiatric Morbidity in Schizophrenia
Authors: Sham Pak Chung , Jones Peter , Russell Ailsa , Gilvarry Karyna , Bebbington Paul , Lewis Shôn , Toone Brian , Murray Robin
Published: October 2008

Background

Although a genetic component in schizophrenia is well established, it is likely that the contribution of genetic factors is not constant for all cases. Several recent studies have found that the relatives of female or early onset schizophrenic patients have an increased risk of schizophrenia, compared to relatives of male or late onset cases. These hypotheses are tested in the current study.

Method

A family study design was employed; the probands were 195 patients with functional psychosis admitted to three south London hospitals, diagnosed using Research Diagnostic Criteria (RDC), and assessed using the Present State Examination (PSE). Information on their relatives was obtained by personal interview of the mother of the proband, and from medical records. Psychiatric diagnoses were made using Family History – Research Diagnostic Criteria (FH-RDC), blind to proband information.

Results

There was a tendency for homotypia in the form of psychosis within families. The lifetime risk of schizophrenia in the first degree relatives of schizophrenic probands, and the risk of bipolar disorder in the first degree relatives of bipolar probands, were 5–10 times higher than reported population risks. Relatives of female and early onset (<22 years) schizophrenic probands had higher risk of schizophrenia than relatives of male and late onset schizophrenic probands. However, this effect was compensated in part by an excess of non-schizophrenic psychoses in the relatives of male probands.

Conclusions

These results suggest a high familial, possibly genetic, loading in female and early onset schizophrenia, but do not resolve the question of heterogeneity within schizophrenia.
Quantitative Magnetic Resonance Imaging Volumetry Distinguishes Delusional Disorder from Late-Onset Schizophrenia
Authors: Howard Robert J. , Almeida Osvaldo , Levy Raymond , Graves Phillipa , Graves Martin
Published: October 2008

Background

Late paraphrenia is recognised as a heterogeneous disorder. This is reflected by the division of such patients into schizophrenia and delusional disorder in ICD-10. Earlier imaging studies have suggested that major structural abnormalities may be associated with the onset of psychosis in later life.

Method

Fifty late paraphrenics and 35 age-matched healthy controls underwent structural magnetic resonance imaging of the whole brain in the coronal plane. Measurements were made of intracranial and brain volumes and the volumes of the intracerebral and extracerebral cerebrospinal fluid spaces.

Results

No differences in intracranial, brain or extracerebral cerebrospinal fluid volumes between patients and controls were found. Late paraphrenic patients had greater lateral and third ventricle volumes than controls and the left lateral ventricle was larger than the right. When the patients were divided into appropriate ICD-10 diagnoses: paranoid schizophrenia (n= 31) and delusional disorder (n= 16), lateral ventricle volumes in the delusional disorder patients were much greater than those of the schizophrenics and almost twice those of controls.

Conclusions

Structural brain differences underly diagnostic heterogeneity within late paraphrenia. The brains of late onset schizophrenics are only subtly different from those of healthy elderly individuals.
Proton Magnetic Resonance Spectroscopy (1H MRS) of the Hippocampal Formation in Schizophrenia: A Pilot Study
Authors: Nasrallah Henry A. , Skinner Thomas E. , Schmalbrock Petra , Robitaille Pierre-Marle
Published: October 2008

Background

Recent post-mortem and magnetic resonance imaging (MRI) studies strongly suggest a decrease in the volume of the hippocampus and other limbic temporal structures in schizophrenia. Therefore, we hypothesised that N-acetyl aspartate (NAA) which is found mainly in neurons and which can be measured by proton magnetic resonance spectroscopy (1H MRS) would be decreased in the limbic temporal region in schizophrenia.

Method

Consenting subjects fulfilling DSM-III-R criteria for schizophrenia (n = 11) and matched healthy volunteers (n = 11) who were recruited in a tertiary university referral centre, participated in a 1H MRS brain study. Proton MRS spectra were obtained from a 12 cm3 voxel (2 × 2 × 3 cm) in the right and left hippocampus/amygdala region. A researcher blind to the source of the spectra, measured the NAA intensity in all subjects, which were then statistically compared across the two groups.

Results

NAA intensities were significantly reduced in the right hippocampus/amygdala region of schizophrenic patients (P = 0.038). The difference of the left side did not reach significance at the 95% confidence level.

Conclusions

The findings of decreased NAA in this study suggest that there may be a decrement in neuronal number or tissue volume of the right hippocampal/amygdala region in schizophrenia. Biochemical alterations in the metabolism of NAA in schizophrenia may be an alternative explanation. The findings are consistent with other types of post-mortem and in vivo evidence for hypoplasia of the limbic temporal structures in schizophrenia, postulated to be of neurodevelopmental pathogenesis.
War Trauma in a Civilian Population
Authors: Somasundaram D. J. , Sivayokan S.
Published: October 2008

Background

An epidemiological survey was made of war trauma and its consequences in the general population.

Method

One member aged over 15 years from each of 101 randomly selected families in a Primary Health Area in Sri Lanka were interviewed using the Stress Impact Questionnaire.

Results

Nearly one-half had experienced between five and nine war stresses, and one-quarter experienced over 10 (mean 6.66). Only 6% had not experienced any. Sixty-four per cent had developed psychosocial sequelae, including somatisation (41 %), post-traumatic stress disorder (27%), anxiety disorder (26%), major depression (25%), hostility (19%), relationship problems (13%), alcohol and drug misuse (15%) and functional disability (18%).

Conclusion

The trauma experienced correlated strongly with psychosocial and somatic symptoms.
Affective Disorders Among Elderly General Practice Patients
Authors: Turrina C. , Caruso R. , Este R. , Lucchi F. , Fazzari G. , Dewey M. E. , Ermentini A.
Published: October 2008

Background

We investigated the prevalence of depression among 255 elderly general practice patients and the practitioners' performance in identifying depression.

Method

Elderly patients attending 14 general practices entered a screening phase with GHQ-12 and MMSE. Those positive were then interviewed with GMS and HAS.

Results

DSM-III-R major depression affected 22.4%, dysthymic disorder 6.3%, not otherwise specified (n.o.s.) depression 7.1 %. General practitioners performed fairly well: identification index 88.4%, accuracy 0.49, bias 1.85.

Conclusions

Depression was markedly high. A selective progression of depressed elderly from the community to general practitioners is implied.
Mental Health Problems of the Edinburgh ‘Roofless’
Authors: Newton J. R. , Geddes J. R. , Bailey S. , Freeman C. P. , McAleavy A. , Young G. C.
Published: October 2008

Background

The roofless have not been previously surveyed in detail looking specifically at their psychiatric status.

Method

All roofless people in a discrete area were interviewed in their ‘skippers’ using a semi-structured interview. Other roofless people helped in case finding and diagnostic validity was confirmed using a computerised case register.

Results

Sixty-five people were interviewed. High rates of substance abuse (n = 48, 75%), and very low rates of psychotic illness (n = 2, 3%) were found. High rates of serious physical morbidity, of imprisonment and of being the victim of a crime were found.

Conclusion

The roofless have multiple severe medical, social, and psychiatric problems. These all must be addressed when considering the provision of services.
Lethal Catatonia and Neuroleptic Malignant Syndrome
Authors: Osman Abdelkarim A. , Khurasani Mohamed H.
Published: October 2008

Background

Lethal catatonia and neuroleptic malignant syndrome (NMS) have been suggested to have a common neurochemical cause. We hypothesise that both conditions may be due to a sudden and massive blockade of dopamine neurotransmitters.

Method

NMS was diagnosed in psychotic in-patients treated with neuroleptics if four features were present: diffuse severe rigidity, altered level of consciousness, hyperpyrexia and autonomic instability.

Results

Over three years, five NMS cases were diagnosed. Two presented with catatonic features and were diagnosed as acute reactive psychosis. Their neuroleptic doses were small, arguing for a particular sensitivity in these two cases.

Conclusion

The sensitivity of two patients with catatonic features who developed NMS with small doses of neuroleptics supports a common neurochemical basis for the two conditions.
Cross-cultural Psychiatry
Authors: Dein Simon
Published: October 2008

“Insanity is then a part of the price we pay for civilisation. The causes of the one increase with the developments and results of the other” (Jarvis, 1851).

Emil Kraepelin, while visiting southeast Asia at the turn of the century, noted the absence of depression among various Asian populations. He believed that mental disorders were organic diseases for which specific pathogens would ultimately be found. Despite the cultural variations in mental disorders he observed during his world trip in 1904, he considered mental disorder to be universal: “mental illness in Java showed broadly the same clinical picture as we see in our country … The overall similarity far outweighed the deviant features.”
Recognition of Mental State Terms
Authors: Baron-Cohen Simon , Ring Howard , Moriarty John , Schmitz Bettina , Costa Durval , Ell Peter
Published: October 2008

Background

The mind's ability to think about the mind has attracted substantial research interest in cognitive science in recent decades, as ‘theory of mind’. No research has attempted to identify the brain basis of this ability, probably because it involves several separate processes. As a first step, we investigated one component process – the ability to recognise mental state terms.

Method

In Experiment 1, we tested a group of children with autism (known to have theory of mind deficits) and a control group of children with mental handicap, for their ability to recognise mental state terms in a word list. This was to test if the mental state recognition task was related to traditional theory of mind tests. In Experiment 2, we investigated if in the normal brain, recognition of mental state terms might be localised. The procedure employed single photon emission computerised tomography (SPECT) in normal adult volunteers. We tested the prediction (based on available neurological and animal lesion studies) that there would be increased activation in the orbito-frontal cortex during this task, relative to a control condition, and relative to an adjacent frontal area (frontal-polar cortex).

Results

In Experiment 1, the group with autism performed significantly worse than the group without autism. In Experiment 2, there was increased cerebral blood flow during the mental state recognition task in the right orbito-frontal cortex relative to the left frontal-polar region.

Conclusions

This simple mental state recognition task appears to relate to theory of mind, in that both are impaired in autism. The SPECT results implicate the orbito-frontal cortex as the basis of this ability.
Henry Maudsley on Swedenborg's Messianic Psychosis
Authors: Johnson John
Published: October 2008

Background

Creativity, religiosity and madness have long been thought to be aetiologically interrelated.

Method

Henry Maudsley's little known pathography of the 17th century Swedish philosopher and polymath, Emanuel Swedenborg, was examined.

Results

Swedenborg developed a messianic psychosis in middle life, considered by Maudsley to be a monomania, possibly due to epilepsy. Many of Swedenborg's contemporaries thought of him, however, as a religious eccentric. Under criticism from Swedenborg's followers, Maudsley avoided further reference to Swedenborg, and the pathography was lost from view.

Conclusions

Renewed interest is deserved in the contentious issues of the nature of religiosity and its relationship to psychotic experience.

British Journal of Psychiatry (1994), 165, 690–691
Extrapyramidal Symptoms with Selective Serotonin Reuptake Inhibitors
Authors: Arya Dinesh K.
Published: October 2008

Background

Several case reports in the literature suggest that selective serotonin reuptake inhibitors can produce extrapyramidal symptoms.

Method

Computerised literature searches were used to identify reports on extrapyramidal symptoms and serotonin reuptake inhibitors. Subsequently, manual searches were made for articles in which there was any indication of the mechanisms responsible for these extrapyramidal symptoms.

Results

Only a few reports could be identified in which serotonin reuptake inhibitors were implicated in extrapyramidal symptoms in some patients.

Conclusions

Evidence is discussed from preclinical and clinical studies suggesting the interaction between serotoninergic and dopaminergic neurotransmitter system, as a possible mechanism for production of extrapyramidal symptoms.
Outcome of Deliberate Self-Poisoning
Authors: Owens David , Dennis Michael , Read Susan , Davis Norah
Published: October 2008

Background

One of the most important outcomes following an episode of non-fatal deliberate self-poisoning is its repetition.

Method

In a prospective follow-up study the subjects were 992 people responsible for 1096 consecutive episodes of deliberate self-poisoning recorded at a teaching hospital accident and emergency department. Risk factors examined were socio–demographic variables, psychiatric and self-harm history, aspects of the self-poisoning episode, and appearance and behaviour at accident and emergency; the frequency of each was compared between those patients who repeated within one year (n= 116) and those who did not (n = 876).

Results

Those who repeated were more likely to have ingested more than one drug, to report a previous episode of self-poisoning, to be aged 25–54, and to have experienced previous psychiatric care or psychiatric admission. They were less likely to be in paid employment, or to have expressed a threat to another person or written a note. The best predictor – previous psychiatric contact – only had a positive predictive value of 21 % (95% confidence interval 16–25%).

Conclusions

Risk factors for repetition of self-poisoning should be kept up-to-date despite modest predictive power. More attention might be paid to clinical rather than socio–demographic aspects of self-harm.
Autoscopic Phenomena
Authors: Dening T. R. , Berrios G. E.
Published: October 2008

Background

Autoscopy is defined here as a visual experience where the subject sees an image of him/herself in external space, viewed from within his/her own physical body. This paper reviews the literature both historically and conceptually, and includes a quantitative study of accumulated cases.

Method

Cases published since 1935 and meeting the above definition for autoscopy (n = 53) were included, together with three personally-observed patients. A clinical protocol was completed for each case, including information about the autoscopic image. Cases were compared using non-parametric statistics on dichotomised variables.

Results

There were 38 men and 18 women, with a mean age of 39.5 years (range 13–78). Of the subjects, 33 (59%) had a neurological illness, most frequently epilepsy (18 cases). Right and left sided lesions were equally represented. Psychiatric disorder was often present (33 cases, 59%), most commonly delirium, depression or psychosis. The features of the images seen were diverse, but speaking images were associated with younger age, male sex, psychotic illness, longer duration of image, and hypnagogic/hypnopompic experiences.

Conclusions

Autoscopy may arise from a convergence of several variables, including gender, personality factors, neurological and/or psychiatric disease, exhaustion and dissociation, whose interaction may override the normal inhibition of temporal lobe activity. A cognitive neuropsychological hypothesis is proposed, together with avenues for future research.
Social and Community Psychiatry
Authors: Forster Donald P.
Published: October 2008

Since the last update on this subject in the British Journal of Psychiatry (Forster, 1988), and the 1986 publication of the reading list from the Section for Social, Community and Rehabilitation Psychiatry, profound changes have been taking place in Britain, and therefore to the context in which the subject has to be considered. Some of these changes were a continuation of a philosophy encouraged in the early 1980s, namely the promotion of individualism and the provision for self, accompanied by the diminution or denial of a societal or welfare approach. In addition, many members of society have been subject to increasing uncertainty in their lives because of the rapid spread of short-term work contracts and part-time work into both the public and private sectors.
A Neural Model of Memory Impairment in Diffuse Cerebral Atrophy
Authors: Ruppin Eytan , Reggia James A.
Published: October 2008

Background

Computer-supported neural network models have been subjected to diffuse, progressive deletion of synapses/neurons, to show that modelling cerebral neuropathological changes can predict the pattern of memory degradation in diffuse degenerative processes such as Alzheimer's disease. However, it has been suggested that neural models cannot account for more detailed aspects of memory impairment, such as the relative sparing of remote versus recent memories.

Method

The latter claim is examined from a computational perspective, using a neural associative memory model.

Results

The neural network model not only demonstrates progressive memory deterioration as diffuse network damage occurs, but also exhibits differential sparing of remote versus recent memories.

Conclusions

Our results show that neural models can account for a large variety of experimental phenomena characterising memory degradation in Alzheimer's patients. Specific testable predictions are generated concerning the relation between the neuroanatomical findings and the clinical manifestations of Alzheimer's disease.
The Prevalence and Costs of Psychiatric Disorders and Learning Disabilities
Authors: Smith Kirsteen , Shah Ajit , Wright Ken , Lewis Glyn
Published: October 2008

Background

The economic burden of psychiatric disorders and learning disability is assessed in order to aid decisions on priorities for research funding.

Method

A wide variety of data sources both on prevalence and on the usage and costs of relevant services were used to measure the economic burden of each condition.

Results

Despite methodological problems and problems with the data, an attempt is made to estimate the relative economic burden imposed by each condition. No attempt is made to sum up the costs for each condition across the agencies and individuals involved.

Conclusions

Our findings show that learning disability, schizophrenia and neurotic conditions (including depression) are major burdens on the National Health Service; senile dementia and depression in older people impact largely on local authority social services. Senile dementia, schizophrenia and learning disability are also heavy charges on the social security system. It is also notable that the large numbers with less severely disabling neurotic disorders generate a burden that, according to our figures, is comparable to schizophrenia and other psychotic disorders.
Psychiatric Illness in Patients with Persistent Somatisation
Authors: Fink Per
Published: October 2008

Background

This study explores the incidence and nature of mental illness among persistent somatisers, and analyses their use of mental health services.

Method

Individuals with at least ten admissions to non-psychiatric departments during an 8-year period were studied. Persistent somatisers (n = 56) were compared with other frequent users (n = 57) of non-psychiatric services.

Results

Of the persistent somatisers, 82% had been examined by a psychiatrist at least once (median, 3 times). Sixteen per cent were mentally retarded, 48% were dependent on alcohol or drugs, and 48% had DSM–III–R personality disorder. The most prevalent ICD–10 diagnoses were anxiety states (54%), depressions (30%), phobias (18%) and psychoses (20%).

Conclusions

Persistent somatisation is associated with severe mental illness and a broad spectrum of heterogeneous psychiatric diagnoses and syndromes. Persistent somatisers impose a serious burden on the mental health care system.
Decision Analysis in Psychiatry
Authors: Hatcher Simon
Published: October 2008

Background

Decision analysis is an explicit, quantitative approach to examining difficult decisions about course of action. Its applicability to psychiatry is considered.

Method

An example of how decision analysis could be used in psychiatry is given, criticism of the technique is discussed, and previous attempts to apply it to mental illness problems (from a Medline search from 1966 onwards) are reviewed.

Conclusion

The future for decision analysis in psychiatry lies in teaching, audit and research, rather than clinical work.
Effects of Biperiden and Amantadine on Memory in Medicated Chronic Schizophrenic Patients
Authors: Silver H. , Geraisy N.
Published: October 2008

Background

The effects on memory of an anticholinergic (biperiden) and a dopaminergic (amantadine) anti-Parkinsonian agent were compared.

Method

Twenty-six chronically medicated schizophrenic (DSM–III–R) in-patients received amantadine (200 mg/day) or biperiden (4 mg/day) for two weeks in a double-blind cross-over design.

Results

Biperiden treatment was associated with significantly lower scores on Benton Visual Retention Test (P< 0.003) and the visual subscale of Wechsler Memory Scale (WMS) (P≤ 0.02), with a trend to poorer scores on WMS total (P= 0.086) and the digit span (P= 0.07) and logical memory (P= 0.06) subscales.

Conclusions

In usual clinical doses, biperiden interferes with memory, particularly visual, more than amantadine.