bluuebunny/crossref_metadata_2025 huggingface dataset:
Mania Following Sleep Deprivation
Authors: Wright J. B. D.
Published: October 2008

A first episode of mania is described in a previously healthy man who was partially sleep deprived for four nights. The sleep deprivation preceded the psychosis. During the psychotic episode he believed that he was the Messiah. This case is discussed in the light of reports exploring the relationship between psychosis and sleep deprivation.
A Partial Form of Lycanthropy with Hair Delusion in a Manic-Depressive Patient
Authors: Verdoux Hélène , Bourgeois Marc
Published: October 2008

A 45-year-old man was admitted with a hair growth delusion and depressive symptoms. The delusion persisted for three years and disappeared after a manic episode. This odd delusion has some similarities with lycanthropy.
Long-Term, High-Dose Disulfiram in the Treatment of Alcohol Abuse
Authors: Brewer Colin
Published: October 2008

A patient who had experienced most of the standard methods of managing alcohol abuse found that during 11 years of treatment, the most consistently effective intervention has been the taking of disulfiram under family supervision. He has received 600 mg daily almost continuously for over six years without side-effects. Smaller doses do not have an adequate deterrent effect.

British Journal of Psychiatry (1993), 163, 687–689
Otago Women's Health Survey 30-Month Follow-Up
Authors: Romans S. E. , Walton V. A. , McNoe B. , Herbison G. P. , Mullen P. E.
Published: October 2008

The follow-up phase of a random community sample of New Zealand women contrasted the social, demographic, and clinical characteristics of those women whose initial psychiatric disorder had remitted with those who continued to describe significant psychiatric morbidity, two-and-a-half years later. Of 272 women studied at baseline and reinterviewed, 57 had originally been psychiatric cases. Twenty-five of those women (44%) were still cases at follow-up. Using figures that statistically reconstructed the original population from the stratified sample, the remission rate in the parent population was 61% over the two-and-a-half years (an average of 24% per annum). Women less likely to experience remission of their psychiatric disorder were of mid-age (45–64 years), with poor finances and with poor social relationships at the initial assessment. Although the age finding replicates a previous report from an Epidemiological Catchment Area study, it is not clear whether it is a universal relationship, true for all cultures. The alterations in social roles faced by women after child-rearing is a possible explanation, at least for New Zealand.
Self-esteem in Recovered Bipolar and Unipolar Out-patients
Authors: Pardoen D. , Bauwens F. , Tracy A. , Martin F. , Mendlewicz J.
Published: October 2008

The hypothesis of a low self-esteem in depressive patients was tested using the Rosenberg Self-Esteem Scale in 24 recovered unipolar and 27 recovered bipolar patients, compared with a normal control group of 26 subjects matched for age and sex. The hypothesis was confirmed only for unipolars; bipolar patients presented a self-esteem score not significantly different from normal scores. Self-esteem was not related to clinical characteristics of the affective disorder, suggesting that low self-esteem may be a basic component of a depression-prone personality. The investigation of the relationship between self-esteem and social adjustment confirmed the presence of social conformism in bipolar patients and rigidly set low self-esteem in unipolar patients. These results should stimulate the evaluation of different psychotherapeutic treatments in the long-term psychosocial management of affectively ill patients.
A Study of Psychiatric Morbidity in Patients with Huntington's Disease, Their Relatives, and Controls
Authors: Jensen Per , Sørensen Sven Asger , Fenger Kirsten , Bolwig Tom G.
Published: October 2008

Psychiatric morbidity among 74 non-affected first-degree relatives and 93 non-affected second-degree relatives of patients with Huntington's disease (HD) was compared with that of 37 patients with HD and with matched control groups. Due to specific age criteria, the first-degree relatives were at decreased risk and the second-degree relatives at negligible risk of being carriers of the gene for HD. Information on admissions to departments of psychiatry and diagnoses at discharge were obtained for all subjects from a nationwide central register. Psychiatric morbidity was no greater among relatives than among controls, whereas HD patients had significantly more admissions and psychiatric diagnoses than relatives. Growing up with a risk of developing HD does not itself increase the risk of developing psychiatric illness resulting in hospital admission. Severe psychiatric disorders in HD patients were thus most likely to be aetiologically related to the disease process, possibly through a genetic mechanism.
Jobst et al's “Detection in Life of Confirmed Alzheimer's Disease Using a Simple Measurement of Medial Temporal Lobe Atrophy by Computed Tomography”
Authors: Philpot Michael , Burns Alistair
Published: October 2008

‘The medial temporal lobe of the brain is important for normal cognitive function, notably for memory, and is the region with the most extensive pathological change in Alzheimer's disease (AD). We wanted to find out if atrophy of the medial temporal lobe could be detected in life in patients in whom a diagnosis of AD was subsequently established histopathologically. The minimum width of the medial temporal lobe, measured by temporal-lobe-oriented computed tomography (CT) about one year before death, in 44 patients with a histopathological diagnosis of AD (cases) was nearly half (0.56 of the median) that in 75 controls of the same age with no clinical evidence of dementia (95% confidence interval 0.51–0.61). There was little overlap between the distributions of measurements in cases and controls. A cut-off (< 0.79 MoM) selected to yield a 5% false-positive rate gave an expected detection rate of 92%. A cut-off selected to yield a false-positive rate of 1 % (< 0.70 MoM) yielded a 79% detection rate. 20 of the 44 patients with histopathologically diagnosed AD had been scanned more than once before death, and the test (cut-off < 0.79 MoM) was positive in all 20 more than a year before and in 9/10 more than 2 years before death. In 10 subjects with dementia but with histopathology excluding AD, the mean minimum width of the medial temporal lobe was significantly greater than that in the cases with AD, but was not significantly different from that in controls. Medial temporal lobe CT is a non-invasive, rapid, simple and effective test for AD which could have immediate application firstly in improving the accuracy of prevalence and incidence studies and, secondly, for the identification of groups of high-risk patients in the evaluation of novel treatments for AD. In the future, it could be applied as a screening test.”
Clozapine in the Treatment of Psychotic Refractory Depression
Authors: Dassa Daniel , Kaladjian Arthur , Azorin Jean M. , Giudicelli Sebastien
Published: October 2008

A 40-year-old woman suffering from major depression with psychotic features was unresponsive to conventional therapy. After the administration of a wide range of drug treatments and ECT, she received clozapine. Depressive symptoms improved and psychotic features disappeared. It is suggested that clozapine could be efficient in psychotic refractory depression.
Automatism and Post-traumatic Stress Disorder
Authors: Bisson Jonathan I.
Published: October 2008

A soldier with post-traumatic stress disorder (PTSD) who committed a criminal act during a dissociative episode is described. This report and other published cases indicate that criminal acts can occur during dissociative episodes among people who suffer from PTSD. However, the evidence suggests that such incidents are rare and may be overemphasised. There often seems to be little relationship between the crimes committed by war veterans and their war experiences.
Creatine Kinase Elevations with Clozapine
Authors: Keshavan Matcheri S. , Stecker John , Kambhampati R. Krishna
Published: October 2008

We describe a patient with marked elevations of creatine kinase following institution of clozapine treatment. The enzyme levels promptly subsided with discontinuation of clozapine. The clinical features did not meet any of the published criteria for neuroleptic malignant syndrome.
Neuroleptic Malignant Syndrome - A Cautionary Tale and a Surprising Outcome
Authors: Cape Gavin
Published: October 2008

Vigilance is required in order to detect the cardinal signs of neuroleptic malignant syndrome (NMS), especially after prolonged exposure to neuroleptics. In this case, NMS was diagnosed in a 29-year-old man, who had been on fluphenazine decanoate for over one year, coinciding with a cessation of his neuroleptic medication. Vigorous treatment, including assisted ventilation, was necessary, extending over three months. On recovery, his mental state and social functioning had undergone a sustained improvement sufficient for his release from hospital.
Central D2Receptors and Negative Symptoms of Schizophrenia
Authors: Martinot J. L. , Paillère-Martinot M. L. , Loc'h C. , Lecrubier Y. , Dao-Castellana M. H. , Aubin F. , Allilaire J. F. , Mazoyer B. , Mazière B. , Syrota A.
Published: October 2008

Mostin vivostudies of striatal D2receptor (SD2R) density with positron emission tomography in schizophrenia have attempted to relate this variable to the diagnosis of the illness. In the present study, a relationship between SD2R and clinical dimensions of this psychosis was searched for in a highly selected group of young negative schizophrenics (8 drug-naïve and 2 drug-free). The SD2R density index measuredin vivousing76Br-bromolisuride and PET correlated negatively (r= 0.80,P< 0.01) with a psychomotor dimension of schizophrenia involving blunted affect and alogia. The mean SD2R index of the patients did not differ from that of age-matched control subjects. Therefore, this behavioural dimension accounts for the variance of the SD2R, suggesting that the striatal dopamine system modulates symptoms such as flattened affect and alogia.
Jealousy: A Community Study
Authors: Mullen Paul E. , Martin J.
Published: October 2008

This study represents the first attempt to study sexual jealousy in a random community sample. Jealousy was reported by all subjects. Men, when jealous, were particularly concerned about the potential loss of the partner, whereas women were more concerned with the effects of infidelity on the quality of the relationship. Behaviours such as searching the partner's belongings or inspecting their clothes for signs of sexual activity correlated with unusually intense jealousy. Men tended to cope with jealousy by using denial and avoidance, whereas women were more likely to express their distress and to try to make themselves more attractive to their erring partner. Greater jealousy concerns were expressed by young men who had either married early or were now living without a partner. Heavy drinkers and those reporting more psychiatric symptoms were also more prone to jealousy. A clear correlation emerged between lowered self-esteem and increased jealousy, which was particularly marked in women, for whom robust self-esteem was virtually incompatible with high jealousy concerns. The study supported the prosaic notion that those who are satisfied with their romantic attachments are less prone to jealous suspicions. This study offers a starting point for the clinician seeking information about the experience of jealousy in the community.
The Chartres Study: I. Prevalence of Psychiatric Disorders Among French School-Aged Children
Authors: Fombonne Eric
Published: October 2008

A survey of child psychiatric disorders was conducted in a community sample of 2441 French school-aged children selected from 18 public and private schools; children attending special classes were oversampled. A two-stage survey design was used to identify disorders. Measures were the Child Behavior Checklist and the Rutter teacher scale for screening. The Isle of Wight parental interview was used in the second phase for 217 home interviews, along with the Children Global Assessment Scale as an index of impaired functioning. Response rates were excellent, and non-respondents in the screening phase were shown to have higher levels of psychopathology as gauged by their teacher scale scores. Several weights were used in the analysis to adjust for differential probabilities of selection and participation in each survey phase. The overall prevalence rate among 8–11-year-olds was estimated to be 12.4% (5.9% for more severe disorders), with roughly equal rates of disruptive and emotional disorders (6.5% and 5.9%). Prevalence was higher in boys (15.0%) than in girls (9.5%), owing to a threefold increase in their frequency of conduct disturbances. Rates of disturbance were twice as high among children with special educational needs, while no difference was found between private and public schools. The frequency of behavioural problems appeared to be similar in the urban and semi-rural subsamples.
Movement Disorder in Never and Minimally Treated Nigerian Schizophrenic Patients
Authors: McCreadie Robin G. , Ohaeri Jude U.
Published: October 2008

Two hundred and forty-two Nigerian schizophrenic patients (63% male, 37% female), whose mean age was 42 years and length of illness 12 years, were examined for movement disorders using the Abnormal Involuntary Movements Scale, the Simpson and Angus Parkinsonism Scale and the Barnes Akathisia Scale. Twelve patients had never received antipsychotic medication; and none of these had dyskinesia. Dyskinesia was found in 5 of 49 patients (10%) who had taken medication throughout the course of their illness for a total of up to 3 months, 13 of 74 (18%) who had taken medication for 4–12 months, 14 of 41 (34%) for 1–5 years, and 29 of 66 (45%) who had taken medication for more than 5 years. Of 77 patients who were receiving antipsychotic medication at the time of examination, 9 (12%) had Parkinsonism and 12 (15%) akathisia. Examination of the patients' mental state by the Positive and Negative Syndrome Scale showed an association between dyskinesia and positive, but not negative, schizophrenic symptoms. Nigerian patients showed a low level of negative symptoms.
Evidence Against a Genetic Relationship between Tourette's Syndrome and Anxiety, Depression, Panic and Phobic Disorders
Authors: Pauls David L. , Leckman James F. , Cohen Donald J.
Published: October 2008

Analyses were undertaken to examine whether a wide range of psychiatric disorders, including anxiety, affective, substance abuse and psychotic disorders, represent variant manifestations of Tourette's syndrome (TS). Previous studies have suggested that chronic tics (CT) and obsessive-compulsive disorder (OCD) are variant expressions of TS since both CT and OCD are elevated among relatives of TS probands. In the current study, no other psychiatric disorder was significantly elevated among the relatives who did not have TS, CT or OCD when compared with a control sample. These findings are not consistent with the hypothesis that a wide range of psychiatric and behavioural disorders are variant expressions of TS.
Nosological Models in Psychiatry
Authors: Pichot Pierre
Published: October 2008

“Nature, in the production of diseases, is uniform and consistent; so much so, that for the same disease in different persons the symptoms are for the most part the same; and the self-same phenomena that you could observe in the sickness of a Socrates you would observe in the sickness of a simpleton. Just so the universal characters of a plant are extending to every individual of the species; and whoever (I speak in the way of illustration) should accurately describe the colour, the taste, the smell, the figure, etc. of the single violet would find that his description held good, there or thereabout, for all the violets of that particular species upon the face of the earth.”
Objective Evaluation of Pain Perception in Patients with Schizophrenia
Authors: Guieu R. , Samuélian J. C. , Coulouvrat H.
Published: October 2008

The pain thresholds of patients with schizophrenia often seem to differ from those of healthy subjects. In the present study we assessed the pain thresholds of ten patients with schizophrenia, and of ten controls, by measuring the leg flexion nociceptive reflex threshold: the stimulation threshold at which this reflex is triggered, is known to be correlated with the pain threshold. Our conclusion is that, in most cases, the increase in pain threshold is the result of ‘attitude’ and not of alterations in brain function.
‘Dyschronia’ in a Patient with Tourette's Syndrome Presenting as Maternal Neglect
Authors: McGilchrist Iain , Wolkind Stephen , Lishman Alwyn
Published: October 2008

We report an unusual and unsuspected cause of maternal neglect in a patient with Tourette's syndrome. An important cause of the behaviour appears to have been a form of dyscalculia characterised by a complete inability to appreciate the passage of time. To our knowledge this is the first case of its kind to be reported.
Defining Melancholia: Properties of a Refined Sign-Based Measure
Authors: Parker Gordon , Hadzi-Pavlovic Dusan , Wilhelm Kay , Hickie Ian , Brodaty Henry , Boyce Philip , Mitchell Philip , Eyers Kerrie
Published: October 2008

We hypothesised that psychomotor disturbance is specific to the melancholic subtype of depression and capable of defining melancholia more precisely than symptom-based criteria sets. We studied 413 depressed patients, and examined the utility of a refined, operationally driven set of clinician-rated signs, principally against a set of historically accepted symptoms of endogeneity. We specified items defining psychomotor disturbance generally as well as those weighted either to agitation or to retardation. We demonstrated the system's capacity to differentiate ‘melancholic’ and ‘non-melancholic’ depression (and the comparable success of DSM–III–R and Newcastle criteria systems) by reference to several patient, illness and treatment response variables, to an independent measure of psychomotor disturbance (reaction time) and to a biological marker (the dexamethasone suppression test).
Glucocorticoids and the Genesis of Depressive Illness a Psychobiological Model
Authors: Dinan Timothy G.
Published: October 2008

Abnormalities in the hypothalamic–pituitary–adrenal axis (HPA) have been the most consistently demonstrated biological markers in depressive illness. Numerous other neuroendocrine disturbances have also been described, including blunted clonidine-induced growth hormone release and blunted fenfluramine-induced prolactin release. These disturbances are generally interpreted in terms of monoaminergic receptor dysfunction. The theory presented here suggests that chronic stress which activates the HPA will in certain susceptible people produce changes in central monoamines. The high level of glucocorticoid receptors on such central neurons is postulated as mediating the alterations. Thus monoamine abnormalities, rather than being a core aetiological feature of depression, are seen as secondary to HPA overdrive.
5-HT1A Receptor Sensitivity in Major Depression
Authors: Cowen P. J. , Power A. C. , Ware C. J. , Anderson I. M.
Published: October 2008

The hypothermic, growth hormone and corticotrophin (ACTH) responses to the 5-HT1A receptor agonist buspirone (30 mg orally) were measured in 20 unmedicated patients with major depression and 20 healthy controls. Compared with the controls, the hypothermic responses of the depressed patients to buspirone were significantly attenuated, particularly in patients with melancholic depression. In contrast, the responses of growth hormone and ACTH to buspirone were unchanged. The data suggest that major depression may be associated with impaired sensitivity of 5-HT1A autoreceptors but that the function of the post-synaptic 5-HT1A receptors that mediate growth hormone and ACTH release is unaltered. Within the limitations that attend the use of buspirone as a 5-HT1A probe, our data suggest that the decrement in serotonin neurotransmission at post-synaptic 5-HT1A receptors in depression is due to decreased serotonin release rather than impaired responsivity of post-synaptic 5-HT1A receptors.
Depressive Disorders in Long-Term Survivors of Stroke
Authors: Sharpe Michael , Hawton Keith , Seagroatt Valerie , Bamford John , House Allan , Molyneux Andrew , Sandercock Peter , Warlow Charles
Published: October 2008

Sixty surviving patients from a community-based stroke register who had computerised tomography (CT) scan evidence of a single brain lesion were interviewed three to five years after their first ever stroke. Depression (DSM–III–R major depression, partially resolved major depression, and dysthymia) was present in 11 (18%) of the patients and was associated with impaired physical and cognitive functioning, greater age, residence in an institution, absence of a close personal relationship, and larger original brain lesion. Of these variables, only functional dependence (odds ratio 16.4; confidence interval 1.6–170), larger lesion volume (6.6; 1–50), and female sex (8; 1.1–56) remained significantly associated with depression after controlling for all other variables. We conclude that depression in long-term survivors of stroke has many of the same associations as depression in non-stroke elderly populations. Depression in long-term stroke survivors may also be associated with larger original brain lesions, although this requires confirmation in a prospective study.
Obsessive–Compulsive Disorder with and without a Chronic Tic Disorder
Authors: Holzer Jacob C. , McDougle Christopher J. , Boyarsky Beth K. , Price Lawrence H. , Goodman Wayne K. , Baer Lee , Leckman James F.
Published: October 2008

The phenomenological features of 35 obsessive–compulsive disorder (OCD) patients with a lifetime history of tics were compared to 35 age- and sex-matched OCD patients without tics. Seven categories of obsessions and nine categories of compulsions were determined using the symptom checklist of the Yale–Brown Obsessive–Compulsive Scale (YBOCS). Discriminant function analysis revealed that, compared to their counterparts without tics, OCD patients with tics had more touching, tapping, rubbing, blinking and staring rituals, and fewer cleaning rituals, but did not differ on obsessions. These preliminary findings suggest that the types of compulsions present may help to discriminate between two putative subgroups of OCD, i.e. those with and without tics.
Chromosomal Aberrations and Bipolar Affective Disorder
Authors: Craddock Nick , Owen Mike
Published: October 2008

Chromosomal abnormalities associated with bipolar disorder may help in the localisation of susceptibility genes for bipolar illness by pinpointing ‘candidate’ regions of the genome for further study using molecular genetic methods. We review descriptions of chromosomal abnormalities in association with bipolar and related affective disorders and evaluate their relevance for localising susceptibility genes for bipolar disorder, using standardised criteria. We found 28 reports. We identified four genomic regions of potential interest: 11q21-25; 15q11-13; chromosome 21; Xq28. It is important that clinicians are able to recognise patients who may have chromosome abnormalities which could help in the localisation of susceptibility genes for psychiatric disorders. We suggest referral for specialist investigation and karyotyping, to a psychiatric genetics research group, of any patient with functional psychosis and one or more of the following: (a) a strong family history of functional psychosis; (b) mental retardation; (c) another disease known to be caused by a single gene; or (d) congenital abnormalities.
Mild Hypomania (the Highs) can be a Feature of the First Postpartum Week
Authors: Glover Vivette , Liddle Peter , Taylor Alyx , Adams Diana , Sandler Merton
Published: October 2008

About 10% of women show elation and associated features of hypomania in the first 5 days following childbirth. These symptoms can be detected using a self-rating scale (the ‘Highs’) based on SADS-L criteria. This phenomenon has been confirmed using the observer-rated Comprehensive Psychopathological Rating Scale, which also revealed a high degree of related irritability. Significantly more women scoring ⩾ 8 on the Highs scale at 3 days postpartum went on to manifest depression at 6 weeks than did subjects with no psychopathology in the early puerperium. It is suggested that the ‘highs’ followed by depression may be a mild and common form of bipolar disorder.
Unipolar Mania Reconsidered: Evidence from an Elderly Cohort
Authors: Shulman Kenneth I. , Tohen Mauricio
Published: October 2008

Earlier studies have failed to differentiate the unipolar manic subtype from bipolar patients with both manic and depressive episodes. This retrospective cohort study of 50 elderly manic in-patients identified six patients (12%) who met strict criteria for a course of unipolar mania. Significant differences emerged in age at onset, with a mean of 41.2 years for unipolar mania compared with 64.7 years for the others. Consequently, clinical course was significantly longer, 27.7 v. 7.4 years. Elderly patients pursuing a unipolar manic course are among the very few elderly ‘bipolars’ whose illness begins early in life. Recent neuroradiological investigations and data from geriatric studies suggest that the concept of unipolar mania is worthy of further investigation.
Alprazolam and Exposure for Panic Disorder with Agoraphobia
Authors: Başoglu Metin , Marks Isaac M. , Kiliç Cengiz , Swinson Richard P. , Noshirvani Homa , Kuch Klaus , O'Sullivan Geraldine , Brewin Chris R.
Published: October 2008

Patients with panic disorder plus agoraphobia had 8 weeks of drug treatment (alprazolam or placebo) plus psychological treatment (exposure or relaxation). At the end of treatment at week 8, 40 patients who had become much/very much improved rated how much their gains were attributable to medication or to their own efforts. During the tapering-off to week 16, and treatment-free follow-up to week 43, patients who at week 8 had attributed their gains to medication and felt less confident in coping without tablets had more severe withdrawal symptoms and greater loss of gains than did patients who at week 8 had attributed their gains to their own efforts during treatment. Baseline illness severity, greater age, higher expectations from drug treatment, and more side-effects of drugs during treatment all predicted more external attributions (i.e. to the effect of drugs) but did not independently predict relapse. Patients on alprazolam compared with placebo had more drug attributions. Though drug attributions predicted relapse in both alprazolam and placebo groups, predictions were stronger in the alprazolam group.
Cocaine: Patterns of Use, Route of Administration, and Severity of Dependence
Authors: Gossop Michael , Griffiths Paul , Powis Beverly , Strang John
Published: October 2008

We contacted and interviewed 150 cocaine users in south London community settings. Most were taking cocaine regularly, but not daily, and in substantial doses. Three main routes of administration were used: smoking (40%), intranasal (32%), and injecting (24%). Injectors reported having used cocaine more frequently, in higher doses and for longer periods of time. Despite their frequent and extensive use of cocaine, the overall level of dependence was low for the great majority of the sample. Two-thirds (66%) of the full sample (and two-thirds (65%) of the crack smokers) reported only minor signs of dependence during the year prior to interview. Route of drug administration was related to severity of dependence. Cocaine taken by injection was associated with the highest levels of dependence; intranasal use was associated with the lowest levels, and crack smoking was intermediate between the two. There had been substantial changes in the initial route by which cocaine was used, with a clear trend away from injection on the first occasion of use. Those who first used cocaine before 1986 were more likely to have used the drug either intranasally or by injection. Cocaine users who first tried the drug after 1987 were increasingly likely to take it by smoking crack. Women and black (predominantly Afro-Caribbean) subjects were more evident in this sample of cocaine users than has previously been reported in many UK studies.
Recurrent Sinus Arrest in Association with Neuroleptic Malignant Syndrome
Authors: Parry A. K. , Ormerod L. P. , Hamlin G. W. , Saleem P. T.
Published: October 2008

We report a case of neuroleptic malignant syndrome where the catatonia clearly followed the administration of neuroleptics and where the neurovegetative disturbance was remarkably severe, including episodes of tracheal spasm, apnoea and episodes of bradycardia, and sinus arrest requiring insertion of a temporary external pacing wire. To our knowledge, such severe disturbance has not previously been reported.
Results of Computerised Tomography During First Admission for Psychosis
Authors: Gewirtz George , Squires-Wheeler Elizabeth , Sharif Zafar , Honer William G.
Published: October 2008

A cohort of 168 psychotic patients underwent computerised tomography (CT) during their first admission. Cortical atrophy was present in 40% of patients. The frequency of atrophy increased with age, but did not differ between patients with schizophrenia, schizoaffective disorder, bipolar disorder or psychotic depression. Other CT findings of note were present in 6.6% of patients, and included four infarctions, three arachnoid cysts, and one each of venous angioma, colloid cyst, cavum vergae and post-traumatic changes. The frequency of CT findings other than atrophy was increased in the psychotic depression group. The findings support the proposal of the onset of psychosis being an indication for CT.
Dementia among the Elderly in a Rural Korean Community
Authors: Park Jonghan , Ko Hyo Jin , Park Young Nam , Jung Chul-Ho
Published: October 2008

The age-specific prevalence of dementia, its sex difference, and the relative prevalence of important types of dementia were studied in the elderly people in a Korean rural community. A two-stage approach was employed, involving screening and clinical assessment. The prevalence among individuals aged 65 and over was found to be 10.8%, with rates of 7.2% in men and 14.5% in women. The dementia was of the Alzheimer type in 60.0% of cases, multi-infarct dementia in 12.0%, mixed dementia of Alzheimer type and multi-infarct in 10.7%, alcoholic dementia in 8.0%, and others and unclassifiable in 9.3%. The prevalence of dementia of the Alzheimer type was significantly higher in women and rapidly increased with age in both sexes. The prevalence of multi-infarct dementia was not related to sex or age. Alcoholic dementia was identified only in men. These findings indicate that the prevalence of dementia in rural Korea is similar to that reported in Western countries and that the prevalence of dementia of the Alzheimer type in rural Korea is greater than that of multi-infarct dementia.
Nefazodone and Imipramine in Major Depression: A Placebo-Controlled Trial
Authors: Rickels Karl , Schweizer Edward , Clary Cathryn , Fox Ira , Weise Charles
Published: October 2008

Nefazodone is a phenylpiperazine antidepressant with 5-HT2 antagonism and 5-HT reuptake inhibition. Two hundred and eighty-three out-patients with a diagnosis of DSM–III–R major depression of at least one-month duration (65% ill for over 6 months), and a mean score of 24 on the 17-item Hamilton Rating Scale for Depression (HRSD), were randomised to treatment with nefazodone, imipramine, or placebo. The double-blind treatment period was 8 weeks in duration. Nefazodone's antidepressant efficacy was comparable with imipramine's, with both drug treatments significantly better than placebo in a variety of outcome measures. For example, after 8 weeks of therapy, 78% of nefazodone and 83% of imipramine but only 55% of placebo patients (P < 0.01) were globally much or very much improved. Nefazodone was better tolerated than imipramine, with fewer drop-outs and a lower incidence of side-effects during treatment.
Panic Disorder
Authors: Okasha A. , Bishry Z. , Khalil A. H. , Darwish T. A. , El Dawla A. Seif , Shohdy A.
Published: October 2008

We compared three groups of patients with panic disorder, generalised anxiety disorder and major depressive episode with a control group. Methods of comparison included a clinical profile of the patients, assessed by the Arabic version of the Present State Examination (PSE), a psychological battery of tests measuring personality traits and depressive and anxiety states, and the dexamethasone suppression test (DST) as a biological marker. Our data showed that psychological assessment and DST did not significantly differentiate between the three disorders. Despite a symptom overlap between the disorders, however, some symptoms were associated significantly more often with one disorder than another. Patients with panic disorder differed from patients with major depressive episode in showing more situational, avoidance and free floating anxiety, and more anxious foreboding. They showed less self-negligence, ideas of guilt, early awakening and social withdrawal. Compared with patients with generalised anxiety disorder, patients with panic disorder showed more loss of interest and muscle tension and less anxious foreboding, restlessness, inefficient thinking, social withdrawal and delayed sleep. Our conclusion is that the clinical course and the symptom profile of panic disorder justifies its existence as an independent diagnostic category.
Violent Incidents in a Psychiatric Intensive Care Unit
Authors: Walker Zuzana , Seifert Ruth
Published: October 2008

A prospective study was undertaken of physical assaults over six months in a newly opened psychiatric intensive care unit. There were 58 admissions of 48 patients, and 37 assaults, three against other patients, and 34 against nursing and medical staff. Features which correlated with committing assault were a criminal record and previous drug abuse. Assaults occurred most frequently during the week, at times when staff were actively involved with the patients.
Successful Treatment of Fluvoxamine-Induced Anorgasmia by Cyproheptadine
Authors: Arnott Steve , Nutt David
Published: October 2008

We present the first report of the use of cyproheptadine to treat fluvoxamine-induced anorgasmia, in a 63-year-old man suffering from recurrent severe unipolar depression.
Emergence of Symptoms of Tourette's Syndrome during Fluvoxamine Treatment of Obsessive–Compulsive Disorder
Authors: Fennig S. , Fennig S. Naisberg , Pato M. , Weitzman A.
Published: October 2008

A 14-year-old boy with obsessive–compulsive disorder (OCD) developed, under fluvoxamine treatment, acute symptoms of Tourette's syndrome (TS) with aggravation of the OCD. The TS symptoms did not respond to dopamine blockers and disappeared only after withdrawal of fluvoxamine. Readministration of fluvoxamine caused a re-emergence of the same symptoms.
Homosexual Erotomania and HIV Infection
Authors: Boast Neil , Coid W. Jeremy
Published: October 2008

A case of homosexual erotomania is described in a patient with AIDS-related complex. Direct involvement of the central nervous system was thought an unlikely cause, as specific stressors appeared to have precipitated a reactive psychosis. A psychodynamic understanding of these factors and their interaction with the patient's masochism, fetishism, and personality disorder provided an alternative explanation for the onset of the paranoid illness and its symptom content. The psychodynamic aspects of acute psychotic disorders without evidence of cognitive impairment in patients with HIV infection is a neglected area of study.
Cognitive Therapy
Authors: Scott Jan
Published: October 2008

The scientific approach advocated in CBT has increased its credibility with more biologically orientated therapists (who have remained sceptical of other psychodynamic models), making the approach acceptable to a broad group of psychiatrists. There is a rich clinical literature describing the techniques and applications of CBT in a wide variety of settings. The acquisition of a selection of the above texts offers a useful starting point, and scanning of major British and American psychiatry and psychology journals is likely to turn up at least one important paper every few months. Those with a commitment to research would benefit from subscribing to the journal Cognitive Therapy and Research.

CBT does not aim to be a panacea for every disorder, and cognitive therapists are critical of its overzealous use by inadequately trained or poorly informed therapists. To practise effectively, the therapist needs a coherent cognitive model of the problem being treated and, as such, must explore the theoretical background literature and critically evaluate the data from process and outcome research. Hopefully, this ‘scientist-practitioner’ approach, tracing the emergence and development of the theory and principles of the model underpinning the therapy, means that cognitive therapists practise what they preach.
Reason and Emotion in Psychotherapy: Albert Ellis
Authors: Dryden Windy , Bond Frank W.
Published: October 2008

To summarise then, in 1962 RET displayed important features still current. These include the inter-relatedness of cognitive, emotive and behavioural processes, the important role that cognition plays in psychological problems, its humanistic view of the self, and the futility and dangers of self-rating. The emphasis on perpetuation rather than acquisition processes of emotional disturbance holds good now as it did then, and the core view of therapeutic change is essentially the same now as it was in 1962, despite further, more recent elaborations.

Significant change has occurred in RET since 1962 that updates several of Ellis' original ideas. These include the distinction between interpretations (or inferences) and evaluations, the primary of musts in accounting for psychological disturbance, the clear distinction between healthy and unhealthy negative emotions and the greater role according to force and energy in the change process. In addition, a greater emphasis is placed on biological aspects of emotional disturbance now than 30 years ago. Finally, a greater range of cognitive, imaginal, emotive and behavioural methods are found in current RET literature than in Reason and Emotion in Psychotherapy, where Ellis restricts himself to illustrating a few cognitive and behavioural techniques.

RET, then, has grown and developed over the past 30 years. In large part, this reflects the theory's flexibility and the competent people who have worked to make RET one of the most viable and widely used cognitive-behaviour therapies.
Creativity and Psychopathology a Study of 291 World-Famous Men
Authors: Post Felix
Published: October 2008

Background

This investigation sought to determine the prevalences of various psychopathologies in outstandingly creative individuals, and to test a hypothesis that the high prevalence of mental abnormalities reported in prominent living creative persons would not be found in those who had achieved and retained world status.

Method

The family background, physical health, personality, psychosexuality and mental health of 291 famous men in science, thought, politics, and art were investigated. The membership of the six series of scientists and inventors, thinkers and scholars, statesmen and national leaders, painters and sculptors, composers, and of novelists and playwrights was determined by the availability of sufficiently adequate biographies. Extracted data were transformed into diagnoses in accordance with DSM–III–R criteria, when appropriate.

Results

All excelled not only by virtue of their abilities and originality, but also of their drive, perseverance, industry, and meticulousness. With a few exceptions, these men were emotionally warm, with a gift for friendship and sociability. Most had unusual personality characteristics and, in addition, minor ‘neurotic’ abnormalities were probably more common than in the general population. Severe personality deviations were unduly frequent only in the case of visual artists and writers. Functional psychoses were probably less frequent than psychiatric epidemiology would suggest, and they were entirely restricted to the affective varieties. Among other functional disorders, only depressive conditions, alcoholism, and, less reliably, psychosexual problems were more prevalent than expected in some professional categories, but strikingly so in writers.

Conclusions

Similar findings have been reported for living artists and writers, and this suggests that certain pathological personality characteristics, as well as tendencies towards depression and alcoholism, are causally linked to some kinds of valuable creativity.
Psychological Sequelae Following the Gulf War
Authors: Deahl Martin P. , Gillham Adrian B. , Thomas Janice , Searle Margaret M. , Srinivasan Michael
Published: October 2008

Background

The aim was to study the effect of brief counselling and psychological debriefing following a trauma on subsequent morbidity.

Method

We investigated psychological morbidity in 62 British soldiers whose duties included the handling and identification of dead bodies of allied and enemy soldiers during the Gulf War. Of these soldiers, 69% received a psychological debriefing on completion of their duties. The subjects completed by post a demographic questionnaire, the General Health Questionnaire (GHQ-28) and the Impact of Events Scale.

Results

After nine months 50% had evidence of some psychological disturbance suggestive of posttraumatic stress disorder (PTSD); 18% had sought professional help; 26% reported relationship difficulties. Neither prior training nor the psychological intervention appeared to make any difference to subsequent psychiatric morbidity. Morbidity at nine months was more likely in those with a history of psychological problems and those who believed their lives had been in danger in the Gulf.

Conclusions

These findings show that a psychological debriefing following a series of traumatic events or experiences does not appear to reduce subsequent psychiatric morbidity and highlights the need for further research in military and civilian settings.
The Ward Daily Behaviour Scale
Authors: Blunden J. , Hodgkiss A. , Klemperer F. , McCarthy A. , Watson J. P.
Published: October 2008

Background

The Ward Daily Behaviour Scale is a new rating instrument that can be used to measure all the daily noteworthy behaviour of patients of various ages and diagnoses on psychiatric wards.

Method

The reliability and validity of the scale were tested on 40 patients.

Results

This instrument proved to be both reliable and valid for use on adult acute in-patient wards.

Conclusions

The scale will be a valuable tool in a wide range of ward-based studies.
The World Bank World Development Report 1993: Investing in Health: Reveals the burden of common mental disorders, but ignores its implications
Authors: Blue Ilona , Harpham Trudy
Published: October 2008

The annual World Development Report which the World Bank produces has for the first time focused upon health issues. Central to its 1993 report Investing in Health was an analysis of the “global burden of disease”, addressing both mortality and morbidity. Previous attempts to prioritise health problems on a worldwide scale have focused on mortality, so common mental disorders have not appeared to be significant. The method of measuring the burden of disease described here has highlighted neuropsychiatric disorders, particularly depression, which accounts for around 30% of neuropsychiatric disorders. Neuropsychiatric diseases account for 5.7% of the total burden of disease for women in the developing world, and rank fifth in this respect. In the rest of the world, they account for 13.3% of the total burden of disease for women, and rank third. Prioritising health interventions is crucial given the scarce resources available. Sufficient evidence now exists to warrant greater emphasis on common mental disorders.
A National Audit of New Long-Stay Psychiatric Patients
Authors: Lelliott Paul , Wing John
Published: October 2008

Background.

This second report of a national audit of new long-stay (NLS) psychiatric patients describes the services caring for the patients and the reasons why patients were still in hospital.

Method.

Data analyses addressed the prevalence of NLS patients, the residential resources available to services, the distributions of patients within services, clinicians' views as to the appropriateness of current placement and the reasons for any inappropriate placements.

Results.

The average point prevalence was 6.1 per 100 000 population; it was significantly lower in England and Wales (5.6, s.d. = 3.2) than in Scotland and Northern Ireland (10.7, s.d. = 6.4, ANOVA F ratio = 10.9, P < 0.01). The estimated rate of accumulation was 1.3 per 100 000 population per year. Many English services had very few non-acute psychiatric beds and 31 % of English NLS patients, despite their protracted lengths of stay, were housed on acute wards. Assessors thought that 61 % of patients would be better placed in a non-hospital setting; 47% were thought to require a community-based residential setting, and of these over one-half were still in hospital because no suitable community placement was available.

Conclusions.

Many NLS patients remain in hospital because their residential needs are not met by existing community provision.
Home-Based Versus Hospital-Based Care for People with Serious Mental Illness
Authors: Marks I. M. , Connolly J. , Muijen M. , Audini B. , McNamee G. , Lawrence R. E.
Published: October 2008

Background.

A controlled study tested whether the superior outcome of community care for serious mental illness (SMI) in Madison and in Sydney would also be found in inner London.

Method.

Patients from an inner London catchment area who faced emergency admission for SMI (many were violent or suicidal) were randomised to 20 months or more of either home-based care (Daily Living Programme, DLP; n = 92), or standard in-patient and later out-patient care (controls, n = 97). Most DLP patients had brief in-patient stays at some time. Measures included number and duration of in-patient admissions, independent ratings of clinical and social function, and patients' and relatives' satisfaction.

Results.

Outcome was superior with home-based care. Until month 20, DLP care improved symptoms and social adjustment slightly more, and enhanced patients' and relatives' satisfaction. From 3 to 18 months DLP care greatly reduced the number of in-patient bed days as long as the DLP team was responsible for any in-patient phase its patients had. Cost was less. DLP care did not reduce the number of admissions, nor of deaths from self-harm (3 DLP, 2 control). One DLP patient killed a child. Even at 20 months many DLP and control patients still had severe symptoms, poor social adjustment, no job, and need for assertive follow-up and heavy staff input. (Beyond 20 months most gains were lost apart from satisfaction.)

Conclusions.

It is unclear how much the gain until 20 months from home-based care was due to its site of care, its being problem-centred, its teaching of daily living skills, its assertive follow-up, the home care team's keeping responsibility for any in-patient phase, its coordination of total care (case management), or to other care components. Home-based care is hard to organise and vulnerable to many factors, and needs careful training and clinical audit if gains are to be sustained.