bluuebunny/crossref_metadata_2025 huggingface dataset:
Determinants of general practitioner recognition of psychological problems in a multi-ethnic inner-city health district
Authors: Odell S. M. , Surtees P. G. , Wainwright N. W. J. , Commander M. J. , Sashidharan S. P.
Published: October 2008

Background

With few exceptions, evaluation of the capacity of general practitioners (GPs) to recognise psychiatric disorder in their patients has failed to consider the role of ethnic diversity in the consultation process and whether such knowledge can improve understanding of the degree to which psychiatric morbidity is recognised within GP settings.

Methods

This research was completed in five general practices representative of all those within an inner-city health district. Psychiatric morbidity in patients consecutively attending the practices was then assessed using the General Health Questionnaire; in addition, GPs were asked to complete a checklist of current problems identified during each consultation.

Results

Analysis suggested that Asian and Black patients were less likely than White patients to have psychological problems identified; that social problems and a psychiatric history facilitated recognition; and that current physical illness hindered recognition.

Conclusions

GP recognition of psychological problems varies according to patient ethnicity but can be substantially masked by both the physical and social circumstances of patients at consultation.
Psychiatric staff as attachment figures
Authors: Adshead Gwen
Published: October 2008

Background

Attachment theory argues that psychological development and functioning are affected by our earliest attachments to care-givers. Failed or pathological attachment in childhood may give rise to repetition of maladaptive attachment patterns in adulthood.

Method

Analysis of therapeutic relationships in the light of attachment theory.

Results

Relationships between patients and both psychiatric care-givers and institutions may resemble attachment relationships.

Conclusion

An attachment perspective may be useful for understanding common behavioural disturbances in general psychiatric settings, and support the use of clinical strategies which focus on containment of arousal and the management of anxiety states.
Placebo-controlled trial of moclobemide in social phobia
Authors: Schneier Franklin R. , Goetz Deborah , Campeas Raphael , Marshall Randall , Fallon Brian , Liebowitz Michael R.
Published: October 2008

Background

Moclobemide, a reversible inhibitor of monoamine oxidase A, previously has been reported to have efficacy in the treatment of social phobia.

Method

Seventy-seven non-responders to one week of single-blind placebo were randomly assigned to moclobemide or placebo for eight weeks of double-blind treatment. Outcome was assessed by independent evaluator, treating psychiatrist and self-ratings. After eight weeks, patients who were at least minimally improved continued treatment for a further eight weeks.

Results

Intention-to-treat sample response rates at week 8 were 7/40 (17.5%) for the moclobemide group and 5/37 (13.5%) for placebo (NS). Moclobemide was significantly superior to placebo on 2 of 10 primary outcome measures. Moclobemide was well tolerated.

Conclusions

Moclobemide may have efficacy in the treatment of social phobia, but absence of significant differences on most primary outcome measures and small effect sizes for all outcome measures suggest that the magnitude of its clinical effect is small.
Lateralised semantic and indirect semantic priming effects in people with schizophrenia
Authors: Weisbrod Matthias , Maier Sabine , Harig Sabine , Himmelsbach Ulrike , Spitzer Manfred
Published: October 2008

Background

In schizophrenia, disturbances in the development of physiological hemisphere asymmetry are assumed to play a pathogenetic role. The most striking difference between hemispheres is in language processing. The left hemisphere is superior in the use of syntactic or semantic information, whereas the right hemisphere uses contextual information more effectively.

Method

Using psycholinguistic experimental techniques, semantic associations were examined in 38 control subjects, 24 non-thought-disordered and 16 thought-disordered people with schizophrenia, for both hemispheres separately.

Results

Direct semantic priming did not differ between the hemispheres in any of the groups. Only thought-disordered people showed significant indirect semantic priming in the left hemisphere.

Conclusions

The results support: (a) a prominent role of the right hemisphere for remote associations; (b) enhanced spreading of semantic associations in thought-disordered subjects; and (c) disorganisation of the functional asymmetry of semantic processing in thought-disordered subjects.
Alcohol use disorders among the Yami aborigines in Taiwan
Authors: Liu Shen-Ing , Cheng Andrew T. A.
Published: October 2008

Background

Alcohol use disorders (AUDs) among the Yami aborigines in Taiwan were investigated and compared with four other Taiwanese aboriginal groups.

Method

A sample survey was conducted using a semi-structured clinical interview for AUDs among 252 subjects, aged 15 and above, from two Yami villages on Orchid Island.

Results

The prevalences of DSM–III–R and DSM–IV alcohol use disorders were 13.1% and 10.3% by one year, and 17.5% and 15.2% by lifetime, respectively with a male excess. The risk for AUDs in Yami men was significantly associated with a lower educational level, a non-married status, and the length of stay in mainland Taiwan. A protective effect of Christian belief was evident for lifetime risk for AUDs.

Conclusions

The lower prevalences of AUDs in Yami than in other aboriginal groups in Taiwan might be explained by social isolation of the former, and differences in drinking tradition, availability of alcohol, biological vulnerability, and the extent of acculturation between these groups.
Fluoxetine in breast-milk and developmental outcome of breast-fed infants
Authors: Yoshida K. , Smith B. , Craggs M. , Kumar R. Channi
Published: October 2008

Background

Selective serotonin reuptake inhibitors are currently the most widely prescribed antidepressant drugs. There are only four published studies of breast-feeding mothers and their infants in which the mothers were taking fluoxetine.

Method

Four mothers who took fluoxetine and their breast-fed infants were studied. Samples of plasma, breast-milk and urine were taken from the mothers and of plasma and urine from infants for assays of drug and metabolite concentrations. Bayley Scales of Infant Development were repeatedly used to assess cognitive and psychomotor development of the infants.

Results

Fluoxetine and norfluoxetine were detected in all samples of maternal plasma (range of total concentration 138–427 ng/ml) and in breast-milk (range 39–177 ng/ml). Amounts of both fluoxetine and norfluoxetine in infants' plasma and urine were below the lower limit of detection. All infants were observed to be developing normally and showed no abnormal findings on neurological examination.

Conclusions

Much larger databases are needed but these four cases do not provide any evidence to suggest that women who are maintained on therapeutic doses of fluoxetine should discontinue breast-feeding their infants if they wish to breast-feed.
Asperger syndrome and high-functioning autism
Authors: Gillberg Christopher
Published: October 2008

This paper reviews the history of Asperger syndrome (AS) and high-functioning autism (HFA), current diagnostic concepts and criteria, some controversial diagnostic issues, epidemiology, background factors, outcome, and intervention guidelines.
Questionable validity of ‘dissociative amnesia’ in trauma victims
Authors: Pope Harrison G. , Hudson James I. , Bodkin J. Alexander , Oliva Paul
Published: October 2008

Background

We reviewed evidence from prospective studies to test whether individuals can develop amnesia for traumatic experiences, a process variously termed ‘repression’, dissociative amnesia’ or ‘psychogenic amnesia’.

Method

Using specified criteria, we selected and analysed studies which prospectively assessed memory in victims of documented traumatic experiences.

Results

In studies in which people were asked directly about a past traumatic experience, they consistently reported memories. Non-reporting occurred only in studies where subjects were not asked directly about the experience. This latter design leaves open the well-documented possibility that subjects simply did not disclose events that they actually remembered. Some prospective studies were also limited by incomplete documentation of trauma and failure to rule out other more ordinary causes of amnesia.

Conclusions

Prospective data as yet fail to demonstrate that individuals can develop dissociative amnesia for traumatic events.
Thirteen-year follow-up of deliberate self-harm, using linked data
Authors: Hall David J. , O'Brien Fiona , Stark Cameron , Pelosi Antony , Smith Helen
Published: October 2008

Background

We describe a national cohort of individuals surviving an episode of deliberate self-harm (DSH). Subsequent admissions for DSH and mortality over the following 13 years were studied.

Method

In 1981, 8304 individuals were discharged from Scottish general hospitals with a diagnosis of attempted suicide (E950–959). They were followed-up to the end of 1994 using the Scottish Linked Data Set. Mortality was compared to the Scottish population using person-years analysis.

Results

2624 people (31.6%) were readmitted with further episodes of DSH. The median number of readmissions was I, range 1–137. The observed: expected ratio for all-cause mortality was 2.26 (95% CI 2.13–2.26). One hundred and sixty-eight people (2%) died from suicide, and 46 (0.6%) from undetermined causes. The observed: expected ratio for suicide plus undetermined deaths was 12.17 (95% CI 10.64-13.91). Accidental deaths in men and homicide deaths in men and women were elevated. The pattern of deaths from other causes suggested that alcohol misuse was a contributory factor.

Conclusions

People admitted to general hospitals in Scotland after attempted suicide are at high risk of readmission for further episodes of DSH. Long-term follow-up of such large cohorts is impractical, but services should review the scope for intervention in alcohol misuse following DSH.
Postal self-exposure treatment of recurrent nightmares
Authors: Burgess Mary , Marks Isaac M. , Gill Michael
Published: October 2008

Background

Marry nightmare sufferers do not consult a health care professional. Though behaviour and cognitive therapy can help, they have not been tested as a self-treatment method at home using a manual.

Method

One hundred and seventy adults with primary nightmares were randomised to four weeks' self-exposure or self-relaxation at home using manuals posted to them, or to a waiting-list as a control group for four weeks. Individuals recorded nightmare frequency and intensity in four-week diaries.

Results

At one- and six-month follow-up, the self-rated nightmare frequency felt more significantly in exposure subjects than relaxation or waiting-list subjects. The self-exposure group had the most drop-outs but remained superior in an over-cautious intent-to-treat analysis. The individuals' partners confirmed the superiority of self-exposure to self-relaxation at one- and six-month follow-up.

Conclusions

Recurrent nightmare sufferers improved more with self-exposure manuals than with self-relaxation manuals or by being on a waiting-list. Self-exposure may be needed for longer than four weeks in order to reduce nightmare intensity as well as frequency. Despite a high drop-out rate, some sufferers of other conditions may benefit from self-treatment manuals.
Validity of childhood disintegrative psychosis
Authors: Mouridsen Svend Erik , Rich Bente , Isager Torben
Published: October 2008

Background

Empirical evidence for the validity of the diagnostic label ‘disintegrative psychosis' is sparse. The issue of whether it is a separate form of infantile autism is unresolved.

Method

To investigate the validity of disintegrative psychosis as defined in ICD–9, the natural history of 13 cases were compared with 39 matched cases of infantile autism on various outcome variables. Average follow-up time was 22 (11–33) years.

Results

Statistically significant differences were found between the two groups in terms of number of admissions to non-psychiatric departments, occurrence of comorbid epilepsy social style, and score on the Global Assessment of Functioning scale. In most other areas assessed there was a tendency, although statistically insignificant, towards a better outcome in the infantile autism comparison group.

Conclusions

Our findings provide some support for maintaining a diagnostic category of disintegrative psychosis as distinct from infantile autism.
Adults with Williams syndrome
Authors: Davies Mark , Howlin Patricia , Udwin Orlee
Published: October 2008

Background

In recent years there has been an upsurge of interest in the study of distinctive patterns of behavioural and psychological characteristics associated with specific, biologically determined, intellectually disabling conditions. This study investigates whether such a profile can be identified in adults with Williams syndrome.

Method

Parents and other care-givers were interviewed about the social, emotional and behavioural characteristics of 70 adults with Williams syndrome, aged 19 years to 39 years 9 months.

Results

The adults were reported to have high rates of behavioural and emotional difficulties, particularly in terms of poor social relationships, over-friendliness and social disinhibition, preoccupations and obsessions, and high levels of anxiety and distractibility.

Conclusions

The findings provide preliminary support for the existence of a specific pattern of behavioural and personality characteristics and associated difficulties in adults with Williams syndrome, which persist from childhood and often require intervention from mental health professionals. Implications for clinical practice are considered.
Premorbid adjustment and personality in people with schizophrenia†
Authors: Malmberg A. , Lewis G. , David A. , Allebeck P.
Published: October 2008

Background

Schizoid personality and poor social adjustment have been thought of as common antecedents of schizophrenia but the existing literature is inconclusive. We have carried out a large cohort study with improved methodology.

Method

The premorbid personality and adjustment of 50 054 Swedish men were assessed on entry into the army at the age of 18. Individuals who developed schizophrenia or another psychosis after 15-year follow-up were identified. Odds ratios for variables independently associated with the later development of schizophrenia were calculated, adjusting for potential confounders.

Results

Four variables reflecting early problems with interpersonal relationships were strongly associated with later schizophrenia and, to a lesser extent, non-schizophrenic psychoses, but also occurred commonly in the cohort as a whole. These associations with schizophrenia persisted after early-onset cases were excluded, though their predictive value was low (3.0%, 95% CI 1.5–4.5).

Conclusions

Some aspects of premorbid personality and adjustment may act as risk factors for schizophrenia. The results appear to be most consistent with a multi-factorial aetiology for schizophrenia and offer tentative support for a psychological disturbance mediating genetic and environmental effects on the causal pathway to the illness.
Prenatal exposure to maternal stress and subsequent schizophrenia
Authors: Van Os Jim , Selten Jean-Paul
Published: October 2008

Background

It has been suggested that prenatal exposure to maternal stress increases the risk of subsequently developing schizophrenia.

Method

The five-day invasion and defeat of The Netherlands by the German army in May 1940 constituted a severe, well-circumscribed national stressful event. Individuals exposed and non-exposed to this stressor in the first, second and third trimester of pregnancy were followed up for lifetime schizophrenia outcome through the National Psychiatric Case Register.

Register

Cumulative incidence of schizophrenia was higher in the exposed cohort (risk ratio (RR): 1.15, 95% CI: 1.03–1.28), especially in those exposed in the first trimester (RR: 1.28, 95% CI: 1.07–1.53). Significant interaction with gender was apparent in second trimester exposed cohorts (RR men: 1.35, 95% CI: 1.05–1.74; RR women: 0.83, 95% CI: 0.61–1.12).

Conclusion

Maternal stress during pregnancy may contribute to the development of vulnerability to schizophrenia. The apparent longer window of exposure in male foetuses may be related to the slower pace of male early cerebral development.
African–Caribbean men remanded to Brixton Prison
Authors: Bhui Kamaldeep , Brown Phillip , Hardie Tim , Watson J. P. , Parrott Janet
Published: October 2008

Background

African–Caribbean men are over-represented in psychiatric and forensic services and in the prison population. A failure of community services to engage mentally ill African–Caribbean men and their presentation through the criminal justice system culminates in a repeated pattern of forensic service and criminal justice system contact.

Method

We carried out a cross-sectional survey during a one-year period of a sample of potentially mentally ill men remanded to HMP Brixton in south London. Men were interviewed to establish their place of birth, first language, socio-demographic profile, ethnicity, psychiatric diagnosis, levels of alcohol and substance misuse, criminality, violence involved in their index offence, past psychiatric and forensic contacts and outcome of court appearance.

Results

Two hundred and seventy-seven men were interviewed. In comparison with White men, African–Caribbean men were more often diagnosed as having schizophrenia and were more often sent to hospital under a mental health act order. African–Caribbean men were remanded in custody despite more stable housing conditions and more favourable indices of lifetime criminality, substance misuse and violence.

Conclusions

Community services, including diversion schemes, should be especially sensitive to African–Caribbean men with schizophrenia who ‘fall out of care’, who are not diverted back into care and are therefore unnecessarily remanded.
Self-injury and violence in people with severe learning disabilities
Authors: Read Stephen
Published: October 2008

Background

Psychiatry in severe and profound learning disability is essentially behavioural psychiatry. Some clinical and research observations of disorders of behaviour in this group are summarised in this study.

Method

After inspection of the literature, I postulated a clinical syndrome of violence and self-injury in the severely learning disabled. A check-list of behavioural symptoms was developed and used in a community survey.

Results

Behaviour, assessed by the check-list, supported the existence of organic behaviour disorder, as did small-scale psychophysiological testing.

Conclusions

Self-injury is strongly associated with violence, and with severe and profound learning disability. Pathophysiology of violence and self-injury may include high levels of psychophysiological arousal demonstrated by unstable EEGs. Reduction of arousal by antipsychotic medication is associated with clinical improvement in violent and self-injurious behaviours.
Serious criminal offending and mental disorder
Authors: Wallace Cameron , Mullen Paul E. , Burgess Philip , Palmer Simon , Ruschena David , Browne Chris
Published: October 2008

Background

A relationship exists between mental disorder and offending behaviours but the nature and extent of the association remains in doubt.

Method

Those convicted in the higher courts of Victoria between 1993 and 1995 had their pyschiatric history explored by case linkage to a register listing virtually all contacts with the public psychiatric services.

Results

Prior psychiatric contact was found in 25% of offenders, but the personality disorder and substance misuse accounted for much of this relationship. Schizophrenia and affective disorders were also over-represented, particularly those with coexisting substance misuse.

Conclusions

The increased offending in schizophrenia and affective illness is modest and may often be mediated by coexisting substance misuse. The risk of a serious crime being committed by someone with a major mental illness is small and does not justify subjecting them, as a group, to either increased institutional containment or greater coercion.
Randomised, double-blind, placebo-controlled treatment trial of fluoxetine and graded exercise for chronic fatigue syndrome†
Authors: Wearden Alison J. , Morriss Richard K. , Mullis Ricky , Strickland P. L. , Pearson David J. , Appleby Louis , Campbell Iain T. , Morris Julie A.
Published: October 2008

Background

The Joint Working Group of the Royal Colleges of Physicians, Psychiatrists and General Practitioners (1996) recommended graded exercise and antidepressants for patients with chronic fatigue syndrome. We assessed efficacy and acceptability of these treatments.

Method

Six-month prospective randomised placebo and therapist contact time controlled trial with allocation to one of four treatment cells: exercise and 20 mg fluoxetine, exercise and placebo drug, appointments only and 20 mg fluoxetine, appointments and placebo drug. Drug treatment was double blind and patients were blind to assignment to exercise or appointments.

Results

Ninety-six (71%) of 136 patients completed the trial. Patients were more likely to drop out of exercise than non-exercise treatment (P=0.05). In an intention to treat analysis, exercise resulted in fewer patients with case level fatigue than appointments only at 26 weeks (12 (18%) v. 4 (6%) respectively P=0.025) and improvement in functional work capacity at 12(P=0.005) and 26 weeks (P=0.03). Fluoxetine had a significant effect on depression at week 12 only (P=0.04). Exercise significantly improved health perception (P=0.012) and fatigue (P=0.028) at 28 weeks.

Conclusions

Graded exercise produced improvements in functional work capacity and fatigue, while fluoxetine improved depression only.
Population-based study of the prevalence and presentation of dementia in adults with Down's syndrome
Authors: Holland Anthony J. , Hon Johnny , Huppert Felicia A. , Stevens Fran , Watson Peter
Published: October 2008

Background

The reported prevalence rates of dementia in people with Down's syndrome have varied considerably across studies. The aim of this study was to investigate the extent of clinical change with age using an established diagnostic instrument in an unbiased, population-based sample of older people with Down's syndrome.

Method

Changes in memory, personality, general mental functioning and daily living skills were assessed using a modified version of the informant interview of the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX).

Results

Age-specific prevalence rates of dementia varied according to the diagnostic criteria used. Using CAMDEX criteria for Alzheimer's disease, prevalence rates increased from 3.4 to 10.3 to 40% in the 30–39, 40–49 and 50–59 age group, respectively.

Conclusions

Overall, the age-related pattern of presentation and dementia diagnoses differs from that seen in the general elderly population. However, age-specific prevalence rates of Alzheimer's disease were similar but 30–40 years earlier in life.
Midline brain anomalies and schizophrenia in people with CATCH 22 syndrome
Authors: Vataja R. , Elomaa Eero
Published: October 2008

Background

Since people with chromosome 22q11 deletion (CATCH 22 syndrome) have unexpectedly high incidence of major psychosis it has been suggested that 22q area might be involved in the pathogenesis of schizophrenia and bipolar disorders.

Method

A single case report.

Results

A 32-year-old male patient with CATCH 22 syndrome and schizophrenia had extensive midline anomalies of the brain in the regions relevant to psychotic disorders.

Conclusions

22q11-dependent abnormalities in the midline structures of the brain may cause dysfunction in the limbic system and interfere with the interhemispheric information exchange thus predisposing people with CATCH 22 syndrome to psychotic disorders.
Post-partum psychoses
Authors: Terp Inger Merete , Mortensen Preben Bo
Published: October 2008

Background

Previous studies have suggested that the risk for psychosis, especially affective psychosis, is highly increased during the first 30 days after delivery. The aim of our study was to replicate these findings.

Method

LinkingThe Danish Medical Birth Register and The Danish Psychiatric Central Register from 1 January 1973 to 31 December 1993 revealed 1253 admissions diagnosed as psychosis within 91 days after delivery. The admission rate after delivery was compared with the admission rate among non-puerperal women in the general Danish female population.

Results

The relative risk of all admissions was only slightly increased, RR=I.09 (95% C11.03–1.16). The admission rate concerning first admissions was highly increased, RR=3.21 (95% CI 2.96–3.49) whereas the admission rate concerning readmissions was reduced, RR=0.66 (95% CI 0.61–0.72).

Conclusions

Childbirth is a strong risk factor for first admission with psychosis, but the risk may be less increased than previously assumed.
Electroretinogram in withdrawn cocaine-dependent subjects
Authors: Smelson David A. , Roy Monique , Roy Alec , Santana Sandra
Published: October 2008

Background

We have previously reported that people who are cocaine-dependent have reduced blue cone b-wave electroretinogram (ERG) responses. In this preliminary study, we examined the relationship between blue cone ERG amplitudes and craving response to cocaine cues.

Method

A new series of 14 recently withdrawn subjects who were cocaine-dependent completed a cocaine craving questionnaire at baseline, and again following exposure to laboratory cues; an ERG was also performed.

Results

Cocaine-dependent subjects with a blunted ERG blue cone response (<0.5 μV) showed significantly greater increases in craving following cue-exposure than subjects without the blunted ERG blue cone response.

Conclusions

Subjects with a blunted ERG response may represent a subgroup more vulnerable to cocaine craving and relapse.
The National Health Service celebrates its 50th birthday
Authors: Kendell Robert E.
Published: October 2008

The National Health Service (NHS) was born on 5 July 1948, after a prolonged and difficult labour, and in 1949 it cost the Treasury all of $433 million, or 3.5% of Britain's gross domestic product. In 1997/98 it cost the Treasury $44203 million, 5.6% of gross domestic product, and on 5 July this year it celebrates its 50th anniversary with parades, speeches, television programmes, symposia, much nostalgia and a service of thanksgiving in Westminster Abbey.
Excess mortality of mental disorder
Authors: Harris Clare , Barraclough Brian
Published: October 2008

Background

We describe the increased risk of premature death from natural and from unnatural causes for the common mental disorders.

Method

With a Medline search (1966–1995) we found 152 English language reports on the mortality of mental disorder which met our inclusion criteria. From these reports, covering 27 mental disorder categories and eight treatment categories, we calculated standardised mortality ratios (SMRs) and 95% confidence intervals (CIs) for all causes of death, all natural causes and all unnatural causes; and for most, SMRs for suicide, other violent causes and specific natural causes.

Results

Highest risks of premature death, from both natural and unnatural causes, are for substance abuse and eating disorders. Risk of death from unnatural causes is especially high for the functional disorders, particularly schizophrenia and major depression. Deaths from natural causes are markedly increased for organic mental disorders, mental retardation and epilepsy.

Conclusion

All mental disorders have an increased risk of premature death.
London-East Anglia randomised controlled trial of cognitive-behavioural therapy for psychosis
Authors: Kuipers Elizabeth , Fowler David , Garety Phiuppa , Chisholm Daniel , Freeman Daniel , Dunn Graham , Bebbington Paul , Hadley Clare
Published: October 2008

Background

A randomised controlled trial of cognitive — behavioural therapy (CBT) for people with medication-resistant psychosis showed improvements in overall symptomatology after nine months of treatment; good outcome was strongly predicted by a measure of cognitive flexibility concerning delusions. The present paper presents a follow-up evaluation 18 months after baseline.

Method

Forty-seven (78% of original n=60) participants were available for follow-up at 18 months, and were reassessed on all the original outcome measures (see Part I). An economic evaluation was also completed.

Results

Those in the CBT treatment group showed a significant and continuing improvement in Brief Psychiatric Rating Scale scores, whereas the control group did not change from baseline. Delusional distress and the frequency of hallucinations were also significantly reduced in the CBT group. The costs of CB Tappear to have been offset by reductions in service utilisation and associated costs during follow-up.

Conclusions

Improvement in overall symptoms was maintained in the CBT group 18 months after baseline and nine months after intensive therapy was completed. CBT may be a specific and cost-effective intervention in medication-resistant psychosis.
Inequalities in mental health
Authors: Henderson Claire , Thornicroft Graham , Glover Gyles
Published: October 2008

The Government emphasis on tackling health inequalities and the availability of recent data on mental health inequalities from the Office of Population Censuses and Survey's (OPCS) National Psychiatric Morbidity Survey (NPMS) (Meitzer et al, 1995) suggest that it is time to review the evidence on inequalities in mental health. We aim to summarise the relevant research on rates of psychiatric morbidity within the general population, and define specific populations at high risk of mental disorder. The theories put forward to account for these inequalities are considered, noting the limitations of the data they are based on and highlighting their implications for the data required to facilitate further research. Inequalities in access, provision and appropriateness of services are also discussed. We make policy recommendations for reducing these inequalities at national, regional and district levels.
Peer review and editorial decision-making
Authors: Howard Louise , Wilkinson Greg
Published: October 2008

Introduction

This paper describes and analyses the editor's decision-making process at the British Journal of Psychiatry (BJP), and investigates the association between reviewers' assessments and editorial decisions.

Method

Four hundred consecutive manuscripts submitted over a six-month period to the BJP were examined prospectively for assessors' comments and editorial decisions on acceptance or rejection. Interrater reliability of assessments was calculated and a logistic regression analysis investigated the effect of the rank allocated by assessors and the comprehensiveness of the assessments on the editor's decision.

Results

The editor sent 248/400 (62%) manuscripts to assessors for peer review. Kappa for reliability of assessors' rankings was 0.1 indicating poor interrater reliability. Assessors agreed best on whether to reject a paper. A ranking of five (indicating rejection) had the greatest association with editor's rejection (P < 0.001, odds ratio 0.079), and the mean ranking of assessments was also significantly associated with editorial acceptance or rejection (P=0.004, odds ratio 0.24)

Conclusion

Assessors and editors tend to agree on what is clearly not acceptable for publication but there is less agreement on what is suitable.
Suicidal behaviours in vulnerable adolescents
Authors: Fombonne Eric
Published: October 2008

Background

Suicide rates have increased over the past three decades, especially in young men. Depression, conduct disorder, crime and substance misuse have also increased. This study tested hypotheses on the possible links between the secular increase in the rates of these behaviours.

Method

A data set on 6091 subjects aged 8–18 years (58.4% boys) referred to psychiatric services over & 21-year period (1970–1990) was used. & detailed analysis of & random sample of 80 case notes was conducted.

Results

Suicidal behaviours increased significantly among pubertal male adolescents only (n=1313). In this sub-sample, substance misuse accounted for the increase over time. The rates of both suicidal behaviours and of substance misuse almost doubled between 1979 and 1990 in this patient group. The case note analysis showed that solvent and alcohol misuse had also increased over the study period. Moreover, among the subjects misusing substances, alcohol was the only substance with & strong and positive association with suicidal behaviours. Substance misuse pre-dated suicidal behaviours in most patients.

Conclusions

A link has been found between the increase over time of suicidal behaviours in adolescent boys and & contemporaneous increase in substance misuse. The strength and direction of the association suggests that alcohol misuse is the causal factor.
Economic burden of drug dependency
Authors: Healey Andrew , Knapp Martin , Astin Jack , Gossop Michael , Marsden John , Stewart Duncan , Lehmann Petra , Godfrey Christine
Published: October 2008

Background

The use of illegal drugs is seen as & major social problem. The social costs can be high.

Methods

Self-report data from interviews at intake to the National Treatment Outcome Research Study (NTORS) for 1075 drug users and cost data from various sources were used to estimate criminal behaviour and health and addiction service costs for & 12-month period. Multivariate statistical analysis was used to analyse cost variations.

Results

Total costs for one year for the drug users amounted to over $12 million, the majority attributable to self-reported criminal behaviour. Social costs were positively related to & variety of factors including instability in living circumstances, amount of heroin used and whether or not drugs were taken intravenously.

Conclusions

The study clearly demonstrates the economic and social burden associated with heavy drug users and highlights the need for further investigations into the costs and benefits of policies that can reduce these social costs.
Suicide and other causes of mortality after post-partum psychiatric admission
Authors: Appleby Louis , Mortensen Preben B. , Faragher E. Brian
Published: October 2008

Background

The risk of suicide in postnatal women is low and those suicides that occur appear to be associated with severe psychiatric illness. No previous study has specifically studied the risk of suicide following post-partum psychiatric disorder.

Method

We calculated standardised mortality ratios (SMRs) for suicide, unnatural deaths and deaths from natural causes for women admitted to psychiatric hospital in the first year after childbirth, using computerised cross-linkages between the Danish Psychiatric Case Register and the Danish registers of birth and causes of death for 1973–1993.

Results

During the study period 1567 women were admitted to psychiatric hospital of whom 107 (6.8%) died. The SMRs (compared with 100) were 1719 (95% CI 1284–2254) for suicide, 1329 (95% CI 1038–1676) for all unnatural causes and 238 (95% CI 167–329) for natural causes. Suicides and deaths from all unnatural causes were most likely to occur in the first year after childbirth, the SMR for suicide within one year being 7216 (95% CI 3945–12 108).

Conclusions

Although postnatal women as a whole appear to have a low rate of suicide, severe post-partum psychiatric disorder is associated with a high rate of deaths from natural and unnatural causes, particularly suicide. The risk is especially high in the first postnatal year, when the suicide risk is increased 70-fold. Close clinical superivision at this time is indicated.
Two psychological treatments for hypochondriasis
Authors: Clark David M. , Salkovskis Paul M. , Hackmann Ann , Wells Adrian , Fennell Melanie , Ludgate John , Ahmad Sameena , Richards H. Candida , Gelder Michael
Published: October 2008

Background

Hypochondriasis is generally considered difficult to manage. This study aimed to assess the effectiveness of cognitive therapy and to compare it with an equally credible, alternative treatment.

Method

Forty-eight patients with hypochondriasis were initially randomly assigned to either cognitive therapy, behavioural stress management or a no treatment waiting list control group. At the end of the waiting period, patients in the control group were randomly assigned to one of the two treatments. Assessments were at pre-, mid- and post-treatment or waiting list and at three-, six- and 12-month post-treatment follow-up.

Results

Comparisons with the waiting list group showed both treatments were effective. Comparisons between the treatments showed that cognitive therapy was more effective than behavioural stress management on measures of hypochondriasis, but not general mood disturbance at mid-treatment and at post-treatment. One year after treatment patients who had received either treatment remained significantly better than before treatment, and on almost all measures the two therapies did not differ from each other.

Conclusions

Cognitive therapy is a specific treatment for hypochondriasis. Behavioural stress management is also effective but its specificity remains to be demonstrated.
5-HT2A receptor blockade in patients with schizophrenia treated with risperidone or clozapine
Authors: Travis Michael J. , Busatto Geraldo F. , Pilowsky Lyn S. , Mulligan Rachel , Acton Paul D. , Gacinovic Sveto , Mertens John , Terrière Dirk , Costa Durval C. , Ell Peter J. , Kerwin Robert W.
Published: October 2008

Background

5-HT2A receptor antagonism may be crucial to the action of atypical antipsychotics. Previous work has related 5-HT2A receptor blockade to clinical efficacy and protection from extrapyramidal side-effects.

Method

We developed a SPET imaging protocol for assessing 5-HT2A receptor binding using the selective ligand 1231-5-1-R91150. Six healthy volunteers, five clozapine- and five risperidone-treated subjects with DSM–IV schizophrenia were studied. Multi-slice SPET was performed on each subject.

Results

Cortex: cerebellum ratios were significantly lower in both clozapine-and risperidone-treated subjects compared with the healthy volunteers in all cortical regions. There was no difference in occupancy between the two drug-treated groups. No correlation was found between the percentage change in the Global Assessment Scale (GAS) and 5-HT2A receptor binding indices in the drug-treated groups.

Conclusions

Clozapine and risperidone potently block 5-HT2A receptors in vivo. The lack of relationship between receptor binding indices and change in GAS suggests that 5-HT2A receptor blockade may be unrelated to clinical improvement. Future studies will substantiate this finding by studying 5-HT2A receptor binding in large groups of patients treated with both typical and novel atypical antipsychotics.
Culturally sensitive validation of screening questionnaires for depression in older African– Caribbean people living in south London
Authors: Abas Melanie A. , Phillips Courtney , Carter Janet , Walter Joanna , Banerjee Sube , Levy Raymond
Published: October 2008

Background

We tested the validity of two screens for depression in older African–Caribbean adults, the 15-item Geriatric Depression Scale (GDS) and a new Caribbean Culture-Specific Screen for emotional distress (CCSS). Two independent criteria were used for validity: (a) a psychiatric diagnosis derived from GMS–AGECAT, and (b) a culturally sensitive assessment of mental disorder, derived from a tool developed with local African–Caribbean religious healers.

Method

One hundred and sixty-four consecutive African–Caribbean primary care users, aged 60 years or older, were screened with the GDS and the CCSS. Diagnostic interviews were carried out on 80% of high scorers and 20% of low scorers.

Results

The number of cases detected by the two separate diagnostic approaches was similar. However, the agreement between who was and who was not a case was only modest. At a cutoff of $5, the GDS was an adequate case detector for psychiatric depression, and, at a cut-off of $4, for ‘depressed/lost spirit’, as defined by culture-specific criteria. It performed as well as the new CCSS.

Conclusions

At a cut-off of $4 the 15-item GDS can be recommended as a case detector for significant forms of depression in older African–Caribbean people living in south London.