bluuebunny/crossref_metadata_2025 huggingface dataset:
Antidepressant-treated Patients in Ambulatory Care
Authors: Bingefors Kerstin , Isacson Dag , Von Knorring Lars , Smedby Björn , Ekselius Lisa , Kupper Lawrence L.
Published: October 2008

Background

Despite the problems involved in treating depression and concomitant medical disease, there are virtually no longitudinal studies on drug utilisation among depressed patients.

Method

Use of prescription drugs among all first-time users of antidepressants in a defined population five years before and six years after the index (first) treatment was compared to a referent group without antidepressant treatment. The generalised estimating equations (GEE) method was used for analysis.

Results

The antidepressant-treated group used considerably more non-psychotropic drugs during the whole study period than the referent group. They also used more psychotropic drugs, a use which increased in connection with the initiation of antidepressant treatment and stayed high for a further five years.

Conclusions

The high use of prescription drugs indicated widespread somatic and psychiatric health problems during the whole study period. Antidepressant-treated patients are at risk for drug interactions and adverse effects, and would benefit from a closer collaboration between psychiatry and medicine.
General Practitioners and Young Suicides
Authors: Appleby Louis , Amos Tim , Doyle Una , Tomenson Barbara , Woodman Miriam
Published: October 2008

Background

The suicide rate in young men, but not young women, is rising. One possible route to suicide prevention is through general practice but recent evidence suggests that young suicides are not likely to attend GP surgeries prior to death.

Method

We carried out a retrospective examination of general practice contacts by a 2-year sample of suicides under 35 years of age in the 12 health districts of Greater Manchester. In the 61 young suicides who were known to attend a GP in the three months before death, we recorded (a) the number of consultations each week in the three months before suicide; (b) sex differences in rates of and reasons for consultation; (c) frequency of recorded risk assessment at the last GP visit before suicide.

Results

The number of GP visits increased significantly before death. A monthly increase was more evident in males, but the increase in the week before death was more marked in females. There was no sex difference in the rate of GP visits before suicide; both sexes were most likely to attend for psychological reasons. Significant suicide risk had been noted at none of the final GP visits.

Conclusions

There remains a potential role for GPs in preventing suicides by young people of both sexes. The recent increase in suicide by young males does not appear to be related to a lower rate of GP attendance before death. Future training of GPs in this area should focus on risk assessment.
Somatisation in Primary Care in Spain
Authors: García-Campayo Javier , Campos Ricardo , Marcos Guillermo , Peréz-Echeverría Ma Jesus , Lobo Antonio ,   the GMPPZ
Published: October 2008

Background

This study is the first attempt to document the differences between somatisers (STs) and psychologisers (PGs) in Spanish primary care patients.

Method

A sample of 1559 consecutive patients attending eight randomly selected health centres in Zaragoza, were examined in a two-phase screening using Spanish versions of GHQ–28, CAGE questionnaire, substance abuse, MMSE and SPPI. STs and PGs were diagnosed according to operationalised Bridges & Goldbergs criteria.

Results

ST was found to be three times more prevalent than PG, but the ratio ST: PG was highest (10.5) in the DSM–IV category dysthymia. Generalised anxiety disorder was the most frequent diagnosis in STs and major depressive episode the most frequent in PGs. No significant differences between the two groups have been found in demographic characteristics. Total GHQ scores were significantly higher in PGs, but global SPPI scores were not. Most psychopathological scores were higher in PGs, but both somatic symptoms and suspiciousness were higher in STs. The psychopathological findings are consistent with hypotheses related to blame avoidance and defensiveness in STs.

Conclusions

ST is three times more prevalent than PG, but the ratio ST: PG depends heavily on diagnostic categories. While most psychopathological scores are higher in PGs, both patient groups are similarly disturbed. Previously assumed socio-demographic differences between STs and PGs have not been found in this study.
Screening for Psychiatric Morbidity in Subjects Presenting with Chronic Fatigue Syndrome
Authors: Farmer Anne , Chubb Helen , Jones Irene , Hillier Janis , Smith Andy , Borysiewicz Leszek
Published: October 2008

Background

There is a need for a valid self-rating questionnaire to screen for psychiatric morbidity in patients with chronic fatigue syndrome (CFS). This study had the aim of assessing the utility and validity of two commonly used measures.

Method

Scores obtained on the General Health Questionnaire (GHQ) and the Beck Depression Inventory (BDI) were compared with various diagnostic and severity ratings obtained via a validating clinical interview, the Schedules for the Clinical Assessment of Neuropsychiatry (SCAN) in 95 consecutively referred subjects at a medical out-patient clinic who fulfilled standard criteria for CFS, and 48 healthy controls. Outcome measures were validating coefficients and receiver operating characteristics (ROC) for different thresholds and scoring on GHQ and BDI and index of definition (ID) as measured by SCAN; and Pearson and point by serial correlation coefficients for different diagnostic groups derived via SCAN and defined according to ICD–10 and DSM–III–R.

Results

GHQ and BDI perform poorly as screeners of psychiatric morbidity in CFS subjects when compared with various SCAN derived ratings although results for controls are comparable with other studies.

Conclusions

Neither the GHQ nor BDI alone can be recommended as screeners for psychiatric morbidity in CFS subjects.
Prenatal Exposure to the 1957 Influenza Epidemic and Adult Schizophrenia: A Follow-Up Study
Authors: Cannon M. , Cotter D. , Coffey V. P. , Sham P. C. , Takei N. , Larkin C. , Murray R. M. , O'callaghan E.
Published: October 2008

Background

We investigated the hypothesis that prenatal exposure to the 1957 A2 influenza increases the risk of schizophrenia in adulthood.

Method

We traced a cohort of individuals known to have been exposed to the 1957 influenza epidemic during gestation and an unexposed cohort matched for period of gestation and hospital of birth. Follow-up information on psychiatric illness in subjects was sought from two sources: maternal interview and psychiatric hospital admission data.

Results

Follow-up information was obtained on 54% of the sample: 238 subjects from the influenza-exposed group and 287 subjects from the unexposed group. There was no increased risk of schizophrenia among the exposed cohort compared to the unexposed cohort (relative risk 1.1; 95% CI 0.41–2.95), although there was an increase in depressive illness (relative risk 1.59; 95% CI 1.15–2.19).

Conclusions

The association between prenatal influenza and an increased risk of schizophrenia in adulthood has thus far been found only in population-based data and is not supported by the present observational study which has information about exposure and outcome in individuals.
Obsessive–Compulsive Disorder, Tattooing and Bizarre Sexual Practices
Authors: Caplan Richard , Komaromi Judith , Rhodes Mike
Published: October 2008

Background

A case is presented describing an association between obsessive–compulsive disorder, tattooing and unusual sexual practices.

Method

A single case report.

Conclusions

Tattooing and unusual sexual practices are compulsive behaviours associated with the subject's obsessive–compulsive disorder. Such associations have not previously been described in the literature.
Are SSRIs a Cost-Effective Alternative to Tricyclics?
Authors: Hotopf Matthew , Lewis Glyn , Normand Charles
Published: October 2008

Background

Selective serotonin reuptake inhibitors (SSRIs) are more expensive than tricyclics. Reports have suggested that SSRIs are cost-effective because they are better tolerated and safer in overdose.

Method

A systematic review of all randomised controlled trials (RCTs), meta-analyses, and cost-effectiveness studies comparing SSRIs and tricyclic antidepressants (TCAs).

Results

None of the RCTs provided an economic analysis and there were methodological problems in the majority which would preclude this approach. Meta-analyses suggest that clinical efficacy is equivalent but slightly fewer patients prescribed SSRIs drop out of RCTs. Cost-effectiveness studies have been based on crude ‘modelling’ approaches and over-estimate the difference in attrition rates and the cost of treatment failure. It appears impossible to evaluate the economic aspects of suicide because of its rarity.

Conclusions

There is no evidence to suggest that SSRIs are more cost-effective than TCAs. The debate will only be concluded when a prospective cost-effectiveness study is done in the setting of a large primary care based RCT.
The Camden Schizophrenia Surveys
Authors: Harvey Carol A.
Published: October 2008

Background

The development of appropriate community care requires knowledge of the characteristics of the severely mentally ill.

Method

All patients with a broad diagnosis of schizophrenia (n=528) were identified via key informants within an inner London health district; Feighner and DSM–III–R criteria for schizophrenia were applied. Clinical and social status, psychopathology (Manchester Scale) and problem behaviours (Social Behaviour Schedule) were assessed in a 4:5 representative sample.

Results

Fifty-seven per cent had experienced at least one compulsory admission. Forty-five per cent (excluding long-stay in-patients) had marked positive psychotic symptoms; social isolation and lack of daytime activity was more common than among comparable populations elsewhere. One hundred and eleven (25%) of the non-hospitalised patients were not in contact with specialist services.

Conclusions

Difficulties in establishing and maintaining a therapeutic alliance between patients and professionals present a challenge to services in inner London. Many social and occupational needs were not being met by existing community provision.
The Camden Schizophrenia Surveys
Authors: Harvey Carol A. , Pantelis Christos , Taylor Jason , Mccabe Patrick J. , Lefevre Karen , Campbell Patrick G. , Hirsch Steven R.
Published: October 2008

Background

Investigation of the geographical distribution of schizophrenia and its relationship to socio-demographic factors is useful for planning services.

Method

Individuals with schizophrenia (n=980) were identified by key informants within an inner London borough and point prevalence calculated for broad, Feighner and DSM–III–R schizophrenia. The distribution of cases was tested for significant variation using the Poisson process model. Regression models using the Jarman-8 score and its component variables were tested for their ability to predict the prevalence of schizophrenia.

Results

A high point prevalence of schizophrenia (5.3 per 1000 resident population) was demonstrated. Case distribution showed a marked and significant variation associated with socio-demographic factors. The prediction of prevalence was more accurate for broad than for narrower definitions of schizophrenia; unemployment rate performed best.

Conclusions

Unemployment rates and Jarman-8 scores may provide crude estimates for resource allocation in planning mental health services, highlighting the need for additional services in deprived inner city areas.
Does Familiality Predispose to both Emergence and Persistence of Psychosis?
Authors: Verdoux Hélène , Van Os Jim , Sham Pak C. , Jones Peter B. , Gilvarry Karyna , Murray Robin
Published: October 2008

Background

It has been suggested that in schizophrenia an association exists between family history of schizophrenia and poor outcome on the one hand, and family history of affective disorders and good outcome on the other.

Method

We tested for associations between four-year outcome and familial loading for psychotic disorders in a mixed sample of 150 consecutively admitted patients with functional psychosis (schizophrenia, psychotic affective disorders, other psychotic disorders) of recent onset. For each proband, a familial loading score for (i) broadly defined psychotic disorder, (ii) schizophrenia, and (iii) affective disorder was calculated using information on relatives obtained through the Family History Research Diagnostic Criteria method and direct interviews of relatives with the Schedule for Affective Disorders and Schizophrenia.

Results

In our sample of psychotic patients, familial loading for psychotic disorder predicted persistent negative symptoms over the follow-up period (OR 1.5; 95% CI 1–2.2), especially in schizophrenia, and was also associated with more time hospitalised (P > 0.05), and more social disability at follow-up (P < 0.05). Greater familial loading for schizophrenia predicted a greater likelihood of non-recovery (OR 2.2; 95% CI 1.1–4.4) and a greater likelihood to have had persistent negative symptoms over the follow-up period (OR 1.7; 95% CI 0.9–3.1). No association was found between outcome and familial loading for affective disorder.

Conclusions

We conclude that familial loading may be a continuous risk factor for some dimensions of clinical outcome in the functional psychoses. This suggests that there is a continuum of genetic liability not only to the emergence of psychotic illness, but also the subsequent chronicity of the disorder.
Patients' Views Towards Care Received from Psychiatrists
Authors: Barker Dave A. , Shergill Sukhwinder S. , Higginson Irene , Orrell Martin W.
Published: October 2008

Background

Measurement of the quality of psychiatric care including assessment of patients' views have become increasingly important as expectations of the standard of care rises.

Method

Attitudes and satisfaction of acute psychiatric in-patients were investigated using a questionnaire looking at satisfaction, patients' views on personal and professional qualities of psychiatrists, empowerment and insight.

Results

The response rate was 79.2% (137 out of 173). Patients with a diagnosis of a non-affective psychotic illness, particularly those lacking insight were significantly less satisfied with their care. Respondents were more satisfied with the personal rather than the professional qualities of the doctors, and less satisfied with their empowerment and doctors' availability.

Conclusions

In-patients' attitudes towards their psychiatric care involves a complex relationship between clinical and sociocultural characteristics. Satisfaction studies can serve as an important monitor and reminder of patient dissent.
Incidence of Mental Disorders in the Finnish UKKI Study
Authors: Lehtinen Ville , Veijola Juha , Lindholm Tomi , Moring Juha , Puukka Pauli , Väisänen Erkki
Published: October 2008

Background

The aim was to give estimates of the incidence of different mental disorders from a Finnish prospective epidemiological follow-up study, the UKKI Study.

Method

The original probability sample consisted of 1000 persons, aged 15–64 years. The baseline survey took place in 1969–71, and follow-up surveys were conducted 5 and 16 years after the baseline survey. The research methods included a personal psychiatric interview and data collection from different registers. The diagnostic system was based on the ICD–8 classification.

Results

The estimated annual incidence of all mental disorders was close to 15 per 1000 both between baseline and the 5-year follow-up as well as between the 5-year and the 16-year follow-up. During the entire 16-year follow-up period the annual incidence of all disorders was 14 per 1000 in men and 17 per 1000 in women. The annual incidence of neurotic disorders was 10 per 1000 in men and 14 per 1000 in women, and that of psychotic disorders 2 per 1000.

Conclusions

In the literature, there are huge differences in the results concerning incidence of mental disorders. The results of the present study were rather close to those of the Swedish Lundby Study, but nowhere near the results of the American ECA Study.
Patterns of Positive and Negative Symptoms in First Episode Schizophrenia
Authors: Vázquez-Barquero José Luis , Lastra Ismael , Nuñez Ma Jesús Cuesta , Castanedo Sara Herrera , Dunn Graham
Published: October 2008

Background

The aim is to examine, in first episodes of schizophrenia the appropriateness of the simple two-dimensional model of schizophrenia (‘negative’ and ‘positive’ dimensions) and more complex variants.

Method

All patients with a first episode of schizophrenia who, over a two-year period, made contact with any of the public mental health services of the autonomous region of Cantabria in northern Spain were investigated. The psychiatric evaluation included, among other instruments, the Present State Examination (PSE–9), and the scales for the assessment of the ‘positive’ and ‘negative’ symptoms of schizophrenia (SAPS and SANS respectively). The dimensionality of the SAPS/SANS item scores and sub-scales was examined through the use of principal component analysis.

Results

The principal component solution that best fits the data obtained with the initial SANS/SAPS sub-scales reflects the existence of three different (‘negative’ ‘positive’, ‘disorganisation’) factors. The strategy adopted of repeating the analysis after extracting the principal components of the original sub-scales, revealed that although the nature and item composition of the initial ‘negative’ and ‘disorganisation’ factors were in general confirmed, the ‘positive’ dimension presented a more complex structure with at least two ‘positive’ (‘Non-Paranoid’ and ‘Paranoid’) independent factors.

Conclusion

The psychopathological structure of the early stages of schizophrenia, as evaluated by the SANS/SAPS, is characterised by the presence of four dimensions: two ‘positive’, one ‘negative’ and one ‘disorganisation‘.
Severe Personality Disorder
Authors: Norton Kingsley , Hinshelwood R. D.
Published: October 2008

Background

Severe personality disorder (SPD) is an imprecise but useful term referring to some notoriously difficult to treat psychiatric patients. Their long-term psychiatric treatment is often unsuccessful, in spite of hospitalisation. The specialist expertise of in-patient psychotherapy units (IPUs) can successfully meet some of SPD patients' needs.

Method

Relevant literature on the subject is summarised and integrated with the authors' specialist clinical experience.

Results

Many clinical problems with SPD patients are interpersonal and prevent any effective therapeutic alliance, which is necessary for successful treatment. With in-patients, inconsistencies in treatment delivery and issues surrounding compulsory treatment reinforce patients' mistrust of professionals, compromising accurate diagnosis and an assessment of the need for specialist IPU referral.

Conclusions

General psychiatric teams are well-placed to plan long-term treatment for SPD patients which may include IPU treatment. Timely referral of selected SPD patients to an IPU maximises a successful outcome, especially if there is appropriate post-discharge collaboration with general psychiatric teams to consolidate gains made.
Economic Analysis of Treating Depression with Nefazodonev.Imipramine
Authors: Montgomery S. A. , Brown Ruth E. , Clark Michael
Published: October 2008

Background

It is estimated that treating diagnosed depression costs £420 million annually in England and Wales. This economic study analyses treatment of major depression with nefazodonev.imipramine.

Method

The study updates a previously published model using data obtained from the continuation phase of a double-blind one-year placebo-controlled comparison of nefazodone with imipramine.

Results

Annual costs for nefazodone are lower than those for imipramine, £218 compared to £254; the cost per successfully treated patient is also lower for nefazodone than for imipramine, £242v.£323. Varying the resources included in the treatment patterns still results in lower costs for nefazodone treatment.

Conclusions

Based on clinical trial data for patients completing six to eight weeks of depression treatment and followed for at least one year, the model shows that the annual costs of nefazodone are lower than those for the less expensive imipramine.
The Mortality Experience of Individuals on the Salford Psychiatric Case Register
Authors: Baxter D. N.
Published: October 2008

Background

Several studies, mainly non-UK based, have reported higher than expected mortality for individuals with mental illness. This investigation in Salford (England) was undertaken to determine local experiences.

Method

An historical cohort design was employed with record linkage to determine status at study end: maximum follow-up was 18 years. All 6952 individuals with schizophrenia, neuroses, affective or personality disorders, enrolled on the psychiatric case register between 1 January 1968 and 31 December 1975 were recruited: there were 199 exclusions. Death was the study end-point.

Results

Observed mortality was 65% higher than expected and elevated throughout the whole of follow-up. Mortality was highest in younger ages, females and subjects born locally. Circulatory disorders, injury and poisoning each caused approximately one-third of the excess deaths.

Conclusions

Documenting mortality risk has important applications for prioritisation, resource allocation, developing control programmes, evaluating service effectiveness, disease forecasting and future research.
Hyperkinetic or Attention Deficit Disorder
Authors: Sandberg Seija
Published: October 2008

Background

In the face of rapidly expanding empirical knowledge about this common childhood condition, there is a need for an up-to-date synthesis, especially for the use of practising clinicians.

Method

The main epidemiological, experimental and clinical studies over the past decade are selectively reviewed.

Results

Hyperkinetic/attention deficit hyperactivity disorder is common, with young school-age males most frequently affected. The prevalence figures vary depending on the criteria used. Overlap with conduct disorder is high. The causes are likely to stem from a combination of biological, often genetically determined neurochemical disturbances, and environmental disadvantages, with the biological risk tending to be highest in severely hyperactive girls. Good clinical management combines pharmacological, psychological and educational approaches in a sustained manner. Even then, the outcome is often equivocal and the long-term psychosocial adaptation unpredictable.

Conclusions

Clinically significant hyperactivity is rooted in biological, often genetically transmitted vulnerabilities, upon which environmental disadvantages transact. It may be viewed as a disorder of self-regulation with its roots partly in strained early caregiver–child interactions and disrupted primary attachments.
Comparisons Among the Yale–Brown Obsessive–Compulsive Scale, Compulsion Checklist, and Other Measures of Obsessive–Compulsive Disorder
Authors: Nakagawa A. , Marks I. M. , Takei N. , de Araujo L A. , Ito L M.
Published: October 2008

Background

The Yale–Brown Obsessive–Compulsive Scale (YBOCS) and Compulsion Checklist (CC) were compared with one another and with five other measures to assess their place in measuring the outcome of obsessive–compulsive disorder (OCD).

Method

Data came from a randomised trial of 46 patients with OCD who completed eight weeks of treatment by exposure and response prevention. Using a structured modelling analysis, the YBOCS and the CC were compared with a latent factor derived from five other variables (Target Rituals, Target Obsession, Clinical Global Impression, Avoidance, Disability) of baseline severity and change after treatment, and also directly with those variables.

Results

Both the YBOCS and the CC were accurate and sensitive measures of OCD. The YBOCS related slightly more than did the CC to the latent factor and to Disability directly. The YBOCS related slightly more to Disability than it did to other measures. Inter-assessor and self v. assessor reliability was high.

Conclusions

The 10-item YBOCS plus the 4-item Disability scale are a simple and efficient way to measure important aspects of OCD in clinical practice.
Estimating Local-Area Needs for Psychiatric Care: A Case Study
Authors: Lesage Alain D. , Clerc Doris , Uribé Isabelle , Cournoyer Jocelyne , Fabian José , Tourjman Valérie , Van Haaster Ian , Chang Chi-Hsing
Published: October 2008

Background

Different approaches to estimating local catchment-area needs for psychiatric services are illustrated and compared.

Method

Data from an epidemiological morbidity survey of a random sample of 496 adults were available, as were actual service utilisation rates. Four types of utilisation were modelled (i.e. overall out-patient, in-patient, emergency clinic) using social indicators available from Statistics Canada census-tract data. Finally, a case–control study compared out-patients from a deprived and an affluent catchment area, matched case by case for primary diagnosis, age, sex and residential status (n=52).

Results

Modelling proved highly predictive of utilisation, the overall-use model accounting for 73% of the variance. The case–control study indicated a higher rate of Axis II traits, substance abuse and needs for social care in the deprived catchment area.

Conclusions

Resource allocation based on the social indicators modelling method was more consistent with sensible distribution of human resources. None of the methods, however, appear to reflect adequately the severity of caseloads evidenced in the case–control study.
Artificial Neural Network to Assist Psychiatric Diagnosis
Authors: Zou Yizhuang , Shen Yucun , Shu Liang , Wang Yufeng , Feng Feng , Xu Keqin , Qu Ying , Song Yanming , Zhong Yixin , Wang Minghui , Liu Weiquan
Published: October 2008

Background

Artificial Neural Network (ANN), as a potential powerful classifier, was explored to assist psychiatric diagnosis of the Composite International Diagnostic Interview (CIDI).

Method

Both Back-Propagation (BP) and Kohonen networks were developed to fit psychiatric diagnosis and programmed (using 60 cases) to classify neurosis, schizophrenia and normal people. The programmed networks were cross-tested using another 222 cases. All subjects were randomly selected from two mental hospitals in Beijing.

Results

Compared to ICD-10 diagnosis by psychiatrists, the overall kappa of BP network was 0.94 and that of Kohonen was 0.88 (both P < 0.01). In classifying patients who were difficult to diagnose, the kappa of BP was 0.69 (P < 0.01). ANN-assisted CIDI was compared with expert system assisted CIDI (kappa=0.72–0.76); ANN was more powerful than a traditional expert system.

Conclusion

ANN might be used to improve psychiatric diagnosis.
Head Circumference as a Measure of Cognitive Reserve
Authors: Graves A. B. , Mortimer J. A. , Larson E. B. , Wenzlow A. , Bowen J. D. , McCormick W. C.
Published: October 2008

Background

Recent studies suggest that larger brain size may offer some protection against the clinical manifestations of Alzheimer's disease. However, this association has not been investigated in population-based studies.

Method

The relationship between head circumference, a measure of premorbid brain size, and score on the Cognitive Abilities Screening Instrument (CASI) was studied in a population of 1985 Japanese–Americans aged 65+ living in King County, Washington, USA.

Results

After adjusting for age, sex and education, head circumference was positively associated with CASI score (b=3.8, 95% CI: 2.2, 5.4;P=0.0000), but not with diagnosis of probable AD (odds ratio=0.87, 95% CI: 0.33, 1.87). When the data were stratified by AD status, no association was seen among controls (b=1.6, 95% CI: – 1.7, 5.1;P=0.4), whereas a strong effect was present among cases (b=35.3, 95% CI: 12.2, 58.4:P=0.006).

Conclusions

These results suggest that persons with AD with smaller head circumference either had the disease longer or progressed more rapidly than those with larger head circumference. Improvement in environmental factors in prenatal and early life that partially determine completed brain/head size may have consequences for the late-life expression of Alzheimer's disease in vulnerable individuals.
The Nottingham Study of Neurotic Disorder: Influence of Cognitive Therapists on Outcome
Authors: Kingdon David , Tyrer Peter , Seivewright Nicholas , Ferguson Brian , Murphy Siobhan
Published: October 2008

Background

In previously published papers from the Nottingham Study of Neurotic Disorder a short treatment package of cognitive–behaviour therapy was no more effective than placebo drug treatment after 10 weeks' assessment in a cohort of 210 patients with neurotic disorders. This paper examines the outcome over two years of the patients treated by cognitive–behaviour therapy separated into two therapist groups, those who were competent in administering treatment and those of uncertain competence.

Method

The therapists (mainly community psychiatric nurses) of 70 patients with an original DSM–III diagnosis of either dysthymic, panic or generalised anxiety disorder were separated into two groups on the basis of their perceived competence by their supervisor (DK). Ratings of psychopathology were made at regular intervals over two years by assessors blind to knowledge of treatment or therapist.

Results

The patients treated by competent therapists (n=30) generally showed greater improvement than those allocated to therapists of uncertain competence (n=40), mainly with respect to depressive symptoms, and the difference persisted over two years, long after the cognitive–behaviour therapy had been completed.

Conclusions

Cognitive–behaviour therapy given by competent therapists over a 10 week period is of lasting benefit in neurotic disorder.
The Neural Correlates of Inner Speech and Auditory Verbal Imagery in Schizophrenia: Relationship to Auditory Verbal Hallucinations
Authors: McGuire P. K. , Silbersweig D. A. , Wright I. , Murray R. M. , Frackowiak R. S. J. , Frith C. D.
Published: October 2008

Background

Auditory verbal hallucinations are thought to arise from the disordered monitoring of inner speech (thinking in words). We tested the hypothesis that a predisposition to verbal auditory hallucinations would be associated with an abnormal pattern of brain activation during tasks which involved the generation and monitoring of inner speech.

Method

The neural correlates of tasks which engaged inner speech and auditory verbal imagery were examined using positron emission tomography in (a) schizophrenic patients with a strong predisposition to auditory verbal hallucinations (hallucinators), (b) schizophrenic patients with no history of hallucinations (nonhallucinators), and (c) normal controls.

Results

There were few between-group differences in activation during the inner speech task. However, when imagining sentences spoken in another person's voice, which entails the monitoring of inner speech, hallucinators showed reduced activation in the left middle temporal gyrus and the rostral supplementary motor area, regions which were strongly activated by both normal subjects and nonhallucinators (P<0.001). Conversely, when nonhallucinators imagined speech, they differed from both hallucinators and controls in showing reduced activation in the right parietal operculum.

Conclusions

A predisposition to verbal hallucinations in schizophrenia is associated with a failure to activate areas implicated in the normal monitoring of inner speech, whereas the absence of a history of hallucinations may be linked to reduced activation in an area concerned with verbal prosody.
A Controlled Trial of Cognitive–Behavioural Treatment of Hypochondriasis
Authors: Warwick Hilary M. C. , Clark David M. , Cobb Andrew M. , Salkovskis Paul M.
Published: October 2008

Background

Hypochondriasis is a distressing disorder for which there is no adequate established treatment. This study evaluates the effect of cognitive–behavioural treatment of hypochondriasis, compared with a waiting list control.

Method

Thirty-two patients were randomly assigned to either cognitive–behavioural therapy or a no treatment waiting list control. Cognitive–behavioural treatment consisted of 16 individual treatment sessions over a four-month period. The waiting list control lasted for four months and was followed by 16 sessions of cognitive–behavioural treatment. Assessments were made before allocation and after treatment or waiting list control. Patients who had cognitive–behavioural treatment were reassessed three months after completion of treatment.

Results

Paired comparisons on post-treatment/wait scores indicated that the cognitive–behavioural group showed significantly greater improvements than the waiting list on all but one patient rating, all therapist ratings and all assessor ratings. After three months the benefits of therapy were maintained.

Conclusions

Cognitive–behavioural treatment is an effective therapy for hypochondriasis. Implications of the study are discussed.
Body Dysmorphic Disorder
Authors: Veale David , Boocock Ann , Gournay Kevin , Dryden Windy , Shah Fozia , Willson Robert , Walburn Jessica
Published: October 2008

Background

Body dysmorphic disorder (BDD) consists of a preoccupation with an ‘imagined’ defect in appearance which causes significant distress or impairment in functioning. There has been little previous research into BDD. This study replicates a survey from the USA in a UK population and evaluates specific measures of BDD.

Method

Cross-sectional interview survey of 50 patients who satisfied DSM–IV criteria for BDD as their primary disorder.

Results

The average age at onset was late adolescence and a large proportion of patients were either single or divorced. Three-quarters of the sample were female. There was a high degree of comorbidity with the most common additional Axis I diagnosis being either a mood disorder (26%), social phobia (16%) or obsessive–compulsive disorder (6%). Twenty-four per cent had made a suicide attempt in the past. Personality disorders were present in 72% of patients, the most common being paranoid, avoidant and obsessive–compulsive.

Conclusions

BDD patients had a high associated comorbidity and previous suicide attempts. BDD is a chronic handicapping disorder and patients are not being adequately identified or treated by health professionals.
Cumulative Incidence and Prevalence of Childhood Autism in Children in Japan
Authors: Honda Hideo , Shimizu Yasuo , Misumi Kimiko , Niimi Miyuki , Ohashi Yasuo
Published: October 2008

Background

An epidemiological survey of childhood autism as defined in ICD–10 Research Criteria was conducted in the northern part of Yokohama, Japan.

Method

The routine health checkup for 18-month-old children served as the initial mass-screening, and all facilities which provide child care services function to detect all cases with childhood autism and refer them to the Yokohama Rehabilitation Centre. Cumulative incidence of childhood autism up to 5 years of age among the birth cohort of 1988, and prevalence on 1 January 1994, among residents born in 1988 were estimated.

Results

Cumulative incidence and prevalence were 16.2 per 10 000 and 21.1 per 10 000, respectively. Children with high-functioning autism who had IQs of 70 and over constituted approximately half of all the children with childhood autism.

Conclusion

It was confirmed through better detection of high-functioning cases that childhood autism in Japan is more common than formerly estimated.
Factitious Illness by Proxy
Authors: Bools Christopher
Published: October 2008

Background

Since 1977 a literature has grown describing examples of factitious illness by proxy (FIP).

Method

The literature in English was searched using MEDLINE and supplemented by a manual search. Extracted data focused on terminology of a spectrum of behaviours, clinical features and psychopathology of perpetrators.

Results

There has been difficulty with the use of terminology and classification of psychiatric disorders.

Conclusions

The spectrum of FIP is wide. Suggestions are made for the use of terminology and classification when FIP is identified.
The TAPS Project. 36: The Most Difficult to Place Long-Stay Psychiatric In-patients
Authors: Trieman Noam , Leff Julian
Published: October 2008

Background

The clinical and social outcomes were evaluated of “difficult to place” (DTP) patients discharged from hospital to alternative facilities.

Method

In the course of a reprovision programme for a psychiatric hospital, 72 long-stay patients were considered to be too problematic to live within the usual range of community placements. Their clinical and social state was assessed shortly before the hospital closed. Severe, persistent behavioural problems were recorded for each subject at baseline. One year after being relocated, patients were reassessed.

Results

Clinical and social measures were stable over time. The profile of severe behavioural problems changed over time, with one-third of the total problems subsiding and a similar number of new problems emerging. There was a significant reduction in physical aggression. One of the settings provided an environment as free of restrictions as the usual community homes.

Conclusions

The most difficult patients to reprovide for can be contained in a relatively non-restrictive care environment. There is some indication that aggressive behaviour can improve, raising the possibility that some DTP patients can move on to the usual community homes.
Single Photon Emission Computerised Tomography in Chronic Alcoholism
Authors: Kuruoglu Asli Çepik , Arikan Zehra , Vural Gülin , Karataş Metin , Araç Mehmet , Işik Erdal
Published: October 2008

Background

We examined the functional and structural cerebral changes in chronic alcoholics, analysing their association with personality features and alcohol drinking habits.

Method

Forty patients with alcohol dependency, including 15 with antisocial personality disorder (ASP) as defined in DSM–III–R and 10 age and sex matched healthy controls were studied after termination of withdrawal symptoms, using high resolution single photon emission tomography (SPECT), cranial computerised tomography (CT) and brainstem auditory evoked potentials (BAEP).

Results

We found significant reductions in regional cerebral blood flow (rCBF) measurements of alcoholic patients. Low flow in frontal regions encountered in 67.5% of the patients was associated with the duration of alcohol consumption, while no such relation existed with the amount of daily intake. Patients with ASP exhibited more marked frontal hypoperfusion. Significant brain atrophy detected by CT was present in 40% of the patients and did not correlate with frontal hypoperfusion.

Conclusions

Patients with ASP are more sensitive to toxic effects of alcohol. Alternatively chronic alcoholism leads to frontal lobe dysfunction recognised as ASP in the clinical setting.
Sexual Abuse in People with Alcohol Problems
Authors: Moncrieff Joanna , Drummond D. Colin , Candy Bridget , Checinski Ken , Farmer Roger
Published: October 2008

Background

There is evidence that people with a history of sexual abuse may have an increased risk of developing alcohol and drug problems.

Method

A self-completion sexual abuse questionnaire was designed and administered to a sample of attenders at three London alcohol services. Drinking behaviour was assessed using the Severity of Alcohol Dependence Questionnaire and the Alcohol Problems Questionnaire, and additional data were derived from case notes.

Results

Fifty-four per cent of women and 24% of men identified themselves as victims of sexual abuse or assault. For the majority this had started before the age of 16 and involved non-relatives. Subjects with a history of sexual abuse were younger, reached drinking milestones earlier, were more likely to have a family history of alcohol misuse and had more alcohol-related problems than non-abused subjects. Sexual abuse, age and alcohol dependence predicted level of problems in a regression analysis.

Conclusions

The high rates of sexual abuse and its association with indications of increased morbidity suggest it is an important issue for the management of alcohol problems. More use could be made of self-completion questionnaires for the investigation of sexual abuse.
Long-Term Stability of Diagnosis and Symptom Dimensions in a Systematic Sample of Patients with Onset of Schizophrenia in Childhood and Early Adolescence. I: Nosology, Sex and Age of Onset
Authors: Maziade Michel , Gingras Nathalie , Rodrigue Caroune , Bouchard Stéphane , Cardinal Andrée , Gauthier Benoît , Tremblay Guy , Côté Serge , Fournier Christiane , Boutin Pierrette , Hamel Martin , Roy Marc-André , Martinez Maria , Mérette Chantal
Published: October 2008

Background

Little is known about the long-term outcome of schizophrenia that has its onset during childhood and early adolescence (early-onset schizophrenia, or EO-SZ). Whether or not EO-SZ is an aetiologically separate form of schizophrenia (SZ) is unresolved.

Method

The study was a 14.8-year follow-up, using methods such as systematic sampling, evaluation of possible non-respondent bias, consensus best-estimate diagnoses (DSM–III–R) made independently in childhood and adulthood, measures of positive and negative dimensions, of non-psychotic behaviour disturbances (NPBD) and of developmental problems before the appearance of SZ.

Results

There was high stability of EO-SZ (n=40) diagnoses (mean onset at 14.0 years) until adulthood (mean age at follow-up 28.8 years) but a lower stability of positive and negative schizophrenic dimensions. There was a poor outcome of EO-SZ, a strong over-representation of males but few gender differences, and no effect of age of onset on clinical features and outcome.

Conclusions

EO-SZ taken as a whole shows no qualitative differences to adult-onset SZ. However, a distinction through the onset of preschizophrenic developmental problems or NPBD might be a way to investigate heterogeneity within EO-SZ.
Seven Year Prognosis in Depression
Authors: O'Leary Denis A. , Lee Alan S.
Published: October 2008

Background

The longer term prognosis of depressed patients treated with ECT is relatively unknown. We describe seven-year mortality and readmission risks for the Nottingham ECT series.

Method

Cases were defined and subtyped using the Present State Examination (PSE). Follow-up was naturalistic. Death and readmission were ascertained using the Nottingham case register.

Results

The risk of death was doubled (SMR=1.99, 95% CI = 1.34–2.84, P < 0.001). The seven-year cumulative probability of remaining without readmission was 0.27 (95% CI 0.19–0.35), being 0.79 (0.71–0.87) at 16 weeks (relapse) and 0.34 (0.24–0.44) thereafter (recurrence readmissions). Multiple regression analysis showed that delusions predicted relapse, while endogenous subtype, absence of psychomotor retardation, and previous history predicted recurrence readmissions.

Conclusion

Index ECT treatment predicted high longer-term mortality and readmission risks. PSE/CATEGO-based subtyping identified patients most vulnerable to relapse and recurrence.
Cognitive Function and Duration of Rooflessness in Entrants to a Hostel for Homeless Men
Authors: Bremner Alexander J. , Duke Peter J. , Nelson Hazel E. , Pantelis Christos , Barnes Thomas R. E.
Published: October 2008

Background

Four previous studies of homeless adults have yielded conflicting results regarding the presence of cognitive impairment.

Method

A consecutive series of 80 roofless entrants to a hostel for homeless men were sampled and 62 (76%) completed a range of assessments, including measures of mental state, cognitive functions and substance use.

Results

Estimated premorbid IQ (mean=96), current IQ (mean=84) and cognitive speed were significantly lower than the norm. There was a significant IQ drop in all diagnostic groups. IQ drop, but not current IQ, correlated with duration of rooflessness. Those with schizophrenia or alcohol problems were roofless for longest. Alcohol misuse did not correlate with IQ drop, excepting alcohol withdrawal symptoms in those with schizophrenia.

Conclusion

The hypothesis that low IQ is a risk factor for rooflessness is supported. However, length of rooflessness was more closely related to IQ drop than to current IQ, suggesting that some third factor may be affecting both rooflessness and intellectual functioning. Roofless men with schizophrenia or alcohol problems may be especially at risk of long-term rooflessness.
Impulsivity or Comorbidity in Bulimia Nervosa
Authors: Welch Sarah L. , Fairburn Christopher G.
Published: October 2008

Background

Studies showing high rates of alcohol and drug misuse and deliberate self-harm in bulimia nervosa have led some authors to call for a distinct diagnostic subgroup, sometimes termed “multi-impulsive bulimia”. However, these studies have been uncontrolled and of clinic samples and may be subject to sampling bias.

Method

One hundred and two women with DSM–III–R bulimia nervosa were compared with 204 normal controls and 102 controls with other psychiatric disorders, all recruited from the same community sample. Interview measures were used for diagnosis and for the assessment of alcohol and drug misuse and deliberate self-harm.

Results

Bulimia nervosa cases did not differ from either of the control groups in terms of current alcohol consumption. Bulimia nervosa cases used more illicit drugs than either control group, but loss of control over drug use was very uncommon. Bulimia nervosa cases had a higher rate of deliberate self-harm than the controls. Only six (6%) bulimia nervosa cases had two or more of these behaviours concurrently.

Conclusion

Sampling bias is present in clinic-based studies of comorbidity in bulimia nervosa. Those with comorbid substance misuse and deliberate self-harm are probably heterogeneous in character, and their classification as a subgroup would therefore be premature.
Hypnagogic and Hypnopompic Hallucinations: Pathological Phenomena?
Authors: Ohayon Maurice M. , Priest Robert G. , Caulet Malijaï , Guilleminault Christian
Published: October 2008

Background

Hypnagogic and hypnopompic hallucinations are common in narcolepsy. However, the prevalence of these phenomena in the general population is uncertain.

Method

A representative community sample of 4972 people in the UK, aged 15–100, was interviewed by telephone (79.6% of those contacted). Interviews were performed by lay interviewers using a computerised system that guided the interviewer through the interview process.

Results

Thirty-seven per cent of the sample reported experiencing hypnagogic hallucinations and 12.5% reported hypnopompic hallucinations. Both types of hallucinations were significantly more common among subjects with symptoms of insomnia, excessive daytime sleepiness or mental disorders. According to this study, the prevalence of narcolepsy in the UK is 0.04%.

Conclusions

Hypnagogic and hypnopompic hallucinations were much more common than expected, with a prevalence that far exceeds that which can be explained by the association with narcolepsy. Hypnopompic hallucinations may be a better indicator of narcolepsy than hypnagogic hallucinations in subjects reporting excessive daytime sleepiness.