bluuebunny/crossref_metadata_2025 huggingface dataset:
Training in evaluation of expressed emotion using the Japanese version of the Camberwell Family Interview
Authors: Mino Y. , Tanaka S. , Tsuda T. , Babazono A. , Inoue S. , Aoyama H.
Published: August 2007

To evaluate the effect of training in rating expressed emotion (EE) using the Japanese version of the Camberwell Family Interview (CFI), interrater reliability between a certified rater and a trainee was examined. The material was 65 CFI interviews with the families of 46 schizophrenic patients. The two raters independently rated EE status, critical comments (CC), hostility (H), emotional overinvolvement (EOI), warmth (W) and positive remarks (PR). The interrater reliability was satisfactory with regard to EE status, CC, H, EOI and PR. In the category of W, however, the results were unsatisfactory, as there was no positive development of agreement over time. In fathers, the interrater reliability of W was lower than in other relationships. Use of interview transcripts could contribute to a more satisfactory interrater agreement in EOI, and this is recommended as a useful training tool in EE evaluation.
Risk factors for post‐stroke depression
Authors: Andersen G. , Vestergaard K. , Ingemann‐Nielsen M. , Lauritzen L.
Published: August 2007

An unselected cohort of 285 stroke patients, median age 69 years, were studied for correlation between potential risk factors and the 1‐year incidence of post‐stroke depression (PSD). The following factors correlated significantly with PSD: a history of previous stroke, a history of previous depression, female gender, living alone and social distress prestroke. Further, social inactivity, decrease in social activity, pathological crying and intellectual impairment at 1 month but not functional outcome correlated to PSD. A multivariate regression analysis showed that intellectual impairment explained 42% of variance of mood score. Major depression was unrelated to lesion location. We conclude that etiology to PSD is a complex mixture of prestroke personal and social factors, and stroke induced social, emotional and intellectual handicap.
The association between economic and social factors and mental health in Finland
Authors: Viinamäki H. , Kontula O. , Niskanen L. , Koskela K.
Published: August 2007

The aim of the study was to examine the social and economic variables associated with mental health by means of telephone interviews of a randomly chosen population sample (n= 1557) in Finland in 1993. Mental health was evaluated by means of a 12‐item General Health Questionnaire. A mental disorder, indicated by the GHQ score, was detected in 18.3% of the interviewees. Mental disorders were more common in women than in men. Other factors associated with a mental disorder were unemployment, financial difficulties and insufficient social support from other people. Mental disorders, indicated by the GHQ score, were common in the long‐term unemployed, users of hypnotics and sedatives, and in those who were uncertain about their future. In stepwise logistic regression analyses the statistically independent associates with impaired mental health were suicidal thoughts, receiving of housing allowance and female sex. On the other hand, being on salary was a protective factor.
Obstetric complications and autoantibodies in schizophrenia
Authors: Chengappa K. N. R. , Nimgaonkar V. L. , Bachert C. , Yang Z.W. , Rabin B. S. , Ganguli R.
Published: August 2007

Our hypothesis stated that patients with schizophrenia who had obstetric complications (OC) were more likely to have autoimmune abnormalities than those without OC. OC were rated using a checklist. Anti‐brain autoantibodies were measured in serum using an enzyme immunoassay. Autoantibodies to non‐CNS tissues were detected using serological procedures. There were no significant differences between the two groups with respect to anti‐brain antibodies, but patients with OC (n= 24) had a significantly higher prevalence of autoantibodies to non‐CNS tissues than patients without OC (n= 25). Both groups were receiving neuroleptic drugs. OC may contribute to autoimmune abnormalities among patients with schizophrenia.
From health locus of control to immune control: internal locus of control has a buffering effect on natural killer cell activity decrease in major depression
Authors: Reynaert C. , Janne P. , Bosly A. , Staquet P. , Zdanowiez N. , Vause M. , Chatelain B. , Lejeune D.
Published: August 2007

Decreased immunity in depressive as compared with control subjects has been well documented, although some depressed patients have severe alterations whereas others have milder ones or not at all. Since for equal severities of depression, there may be individual differences in the degree of perceived control over one's condition, we investigated the interaction of perceived control with immunological variations. Immune function (T and B lymphocytes, lymphocyte proliferation and natural killer cell activity (NKCA)) were evaluated in 34 adult major depressives and in 18 healthy controls. Lymphocyte proliferation did not differ between the two groups, but NKCA was significantly lower in the depressed patient group. Among the depressed subjects, those who experienced less subjective control also showed significantly lower NKCA. An internal locus of control appears to act as a buffer against the decrease in cellular immunity observed in major depression. Further studies should focus on methods of coping and on degree of perceived control rather than on diagnostic and nosographic variables alone.
Length of stay of acute psychiatric inpatients: an exponential model
Authors: Priest R. G. , Fineberg N. , Merson S. , Kurian T.
Published: August 2007

We examined the length of stay of inpatients admitted to a psychiatric unit in central London. The commonest length of stay (mode) was less than 1 week. In general, subsequent weeks showed successively fewer discharges, so that the distribution curve of the number of patients by length of stay showed a smooth decline. Analyzing the first 13 weeks of stay, the distribution curve corresponded very closely to a theoretical exponential decay curve. This has implications for recording the average length of stay and thus for comparing one hospital unit with another. It may also have implications for planning for acute psychiatric services. A plea is made for using the median rather than the mean for recording the average length of admission for some purposes.
Positive or negative symptoms — which are more appropriate as diagnostic criteria for schizophrenia?
Authors: Klosterkötter J. , Albers M. , Steinmeyer E. M. , Hensen A. , Saß H.
Published: August 2007

For over a decade there has been a consensus that the diagnosis of schizophrenia should rest upon the presence of positive symptoms. Recently it has been suggested to give negative symptoms, which have played a prominent role in research, more diagnostic importance again. This study investigated the usefulness of that suggestion. In a sample of 489 inpatients covering the whole range of psychiatric diagnoses, the frequencies and prevalences of positive and negative symptoms were determined. Analyses of variance were calculated to assess the diagnostic validity of the different classes of symptoms. The study demonstrates that positive symptoms are of much higher diagnostic value than negative symptoms. A change of diagnostic procedures giving more importance to negative symptoms is discouraged.
Family environment predictors of outcome in schizophrenic patients in Spain: a nine‐month follow‐up study
Authors: Cañivé J. M. , Sanz‐Fuentenebro J. , Vázquez C. , Qualls C. , Fuentenebro F. , Tuason V. B.
Published: August 2007

This study investigates the effects of perceived family environment on clinical outcome among patients in Spain who suffer from schizophrenia. Forty‐five consecutively admitted DSM‐111‐R schizophrenic patients were assessed monthly with the Brief Psychiatric Rating Scale during a 9‐month period. Patients and parents rated the family environment through the Family Environment Scale (FES). FES factors were considered separately for each family member, since parents' and patient's perceptions of the family environment were weakly correlated. Stepwise multiple regression analysis showed that patients' perceptions of family control and intellectual‐cultural orientation predicted rehospitalization. Patients' and mothers' ratings of family control and fathers' scores of conflict and moral religious emphasis predicted psychotic relapse. However, fathers' scores of family cohesion predicted higher negative symptoms. Prior admissions, age of onset and use of depot medication tended to predict outcome in conjunction with the family variables.
Clinical similarity and biological diversity in the response to alprazolam in patients with panic disorder and generalized anxiety disorder
Authors: Klein E. , Zinder O. , Colin V. , Zilberman I. , Levy N. , Greenberg A. , Lenox R. H.
Published: August 2007

Thirty‐six patients with panic disorder (PD) and 35 patients with generalized anxiety disorder (GAD) participated in an open alprazolam treatment phase that preceded controlled withdrawal from alprazolam. Clinical ratings, blood pressure and heart rate were obtained along with plasma measurements of Cortisol, ACTH, growth hormone and catecholamines. A similar clinical response profile was evident in both groups with rapid onset of improvement within the first week. The two diagnostic groups differed in their biological response to alprazolam. PD patients had a significant reduction in blood pressure, plasma Cortisol and a trend toward significant reduction in plasma epinephrine, which were not seen in the GAD patients. GAD patients showed a significant reduction in plasma norepinephrine. These findings provide further evidence that PD and GAD are biologically distinct syndromes.
Psychiatric morbidity in primary public health care: a Nordic multicentre investigation. Part I: method and prevalence of psychiatric morbidity
Authors: Fink P. , Jensen J. , Borgquist L. , Brevik J. I. , Dalgard O. S. , Sandager I. , Engberg M. , Hansson L. , Holm M. , Joukamaa M. , Karlsson H. , Lehtinen V. , Nettelbladt P. , Nordström G. , Stefansson C. G. , Sørensen L. , Munk‐Jørgensen P.
Published: August 2007

The prevalence of mental illness in five different Scandinavian primary care populations was investigated in this study. Patients consecutively consulting their general practitioner a particular week‐day were included in the study. Initially the SCL‐25 was applied and next the high scores and a sample of the low scores were interviewed by the PSE. In the analysis the screening procedure was first validated. The internal validity of the SCL was tested by means of Rasch latent structure analysis and the external validity tested by ROC/QROC analysis. Based on this, a short 8–item version of the SCL was developed. The prevalence of mental illness in all centres was 0.26 with a minimum of 0.14 in Nacka and a maximum of 0.34 in Turku.
Assessment of depression: comparison between Beck Depression Inventory and subscales of Comprehensive Psychopathological Rating Scale
Authors: Martinsen E.W. , Friis S. , Hoffart A.
Published: August 2007

The purpose of this study was to investigate the relationship between self‐rating and therapist rating in nonpsychotic patients with unipolar depressive disorders. We also wanted to find out whether the presence of personality disorders would influence the results. At admission and discharge 117 patients filled in the Beck Depression Inventory (BDI) and were rated by a therapist on the Comprehensive Psychopathological Rating Scale (CPRS). Based on the CPRS‐scores, two indices of depression were calculated: CPRS‐dep and Montgomery Åsberg Depression Rating Scale (MADRS). Sixty‐three patients had DSM‐III‐R major depression, 30 had dysthymic disorder, while 24 had no depressive disorder. Eighty suffered from one or more personality disorders, mostly within cluster C. The self rating (BDI) and therapist ratings (CPRS‐dep and MADRS) were strongly intercorrelated, with a nonsignificant tendency for weaker correlations in patients with personality disorders. All scales were useful to separate depressed from non‐depressed, and to discriminate between major depression and dysthymic disorder, with a tendency in favour of BDI. As cut‐off scores for major depression we recommend the sum score of 23 on the BDI, and mean scores of 1 on CPRS‐dep and 1.1 on MADRS on a 0–3 scale. When these values are used, 70–79% of patients are correctly classified.
Mental comorbidity of chronic insomnia in general practice attenders using DSM‐III‐R
Authors: Schramm E. , Hohagen F. , Käppler C. , Grasshoff U. , Berger M.
Published: August 2007

The major aim of this study was to investigate links between chronic insomnia and mental and personality disorders using the DSM‐III‐R classification. Of a sample of 2512 general practice attenders, 105 with a chronic insomnia complaint over a 4‐month period were evaluated for mental and personality disorders. In addition, the significance of other factors such as personality traits, social functioning and the patient's own estimation of sleep quality was studied. Sixty‐six patients got a diagnosis of a current insomnia using a structured interview for DSM‐III‐R. Fifty percent of them had at least one additional current Axis I or II diagnosis. Affective disorders were most common as principal psychiatric diagnosis followed by substance use disorders. The general practitioners were poor in recognizing their patients' chronic insomnia complaints and the high percentage of substance abusers among them. The important role of psychopathology in chronic insomnia sufferers was indicated by the high number of patients who displayed prominent personality traits. The predominant personality pattern was characterized by a pattern of internalization of problems combined with an anxious‐depressive reaction style. In summary, strong associations between chronic insomnia, mental disorders and psychopathology were confirmed by this investigation.
The ability of general practitioners to detect mental disorders in primary health care
Authors: Joukamaa M. , Lehtinen V. , Karlsson H.
Published: August 2007

The ability to detect mental disorders varies greatly among general practitioners in primary health care. The aim of this study was to determine the factors underlying the differences between general practitioners in the ability to recognize mental disorders in Finnish patient populations. The group studied consisted of 1000 randomly selected adult patients of primary care facilities in the city of Turku. The Symptom Checklist (SCL‐25) was used as the reference method in the identification of psychiatric cases. According to the SCL‐25, one fourth of the sample had mental disorders. A good recognition ability was associated with postgraduate psychiatric training and qualification as a specialist in general practice. Surprisingly, Balint group training, which is a method intended to improve the ability of general practitioners to manage their patients' mental health problems, was associated rather with poor than good detection ability.
Orgasmic sexual experiences as a side effect of fluoxetine: a case report
Authors: Garcia‐Campayo J. , Sanz‐Carrillo C. , Lobo A.
Published: August 2007

We report a patient fulfilling DSM‐III‐R criteria for major depression who was treated with fluoxetine and later developed orgasmic sensations.
Cerebral dysfunction in fibromyalgia: evidence from regional cerebral blood flow measurements, otoneurological tests and cerebrospinal fluid analysis
Authors: Johansson G. , Risberg J. , Rosenhall U. , Örndahl G. , Svennerholm L. , Nyström S.
Published: August 2007

Measurements of regional cerebral blood flow (rCBF), analysis of cerebrospinal fluid, auditory brain stem responses (ABR) and oculomotor tests were performed in 19 patients with fibromyalgia. The results from the rCBF measurements showed a normal flow level with slight but significant focal flow decreases in dorsolateral frontal cortical areas of both hemispheres. The ABR results showed signs dysfunction at least at the brain stem level and the oculomotor tests showed high frequency of pathology. The cerebrospinal fluid analysis showed discrete changes in the cell differential count. Possible explanations for the involvement of the central nervous system in fibromyalgia are discussed.
Individual coping style and psychological attitudes during pregnancy predict depression levels during pregnancy and during postpartum
Authors: Demyttenaere K. , Lenaerts H. , Nijs P. , Van Assche F.A.
Published: August 2007

Fifty primigravidae were investigated from 30 weeks of gestation until 6 months after delivery to assess the predictive value of individual coping style, conception time and specific psychological changes during pregnancy for the depression levels assessed during the third trimester of pregnancy and 5 days, 6 weeks and 6 months after delivery. The individual coping style is an effective predictor of depression levels during the third trimester of pregnancy and 6 months after delivery, but not for the depression levels 5 days and 6 weeks after delivery. A path analysis revealed that high depressive coping and low social support‐seeking predict a longer conception time, which all predict a more important lack of spousal support during pregnancy. Higher depressive coping, a longer conception time and a more important lack of spousal support during pregnancy all predict high depression levels 6 months after delivery. The present findings thus suggest helpful predictors for the psychological adaptation during the transition to parenthood.
Personality dimensions of opiate addicts
Authors: Vukov M. , Baba‐Milkic N. , Lecic D. , Mijalkovic S. , Marinkovic J.
Published: August 2007

A survey of 80 opiate addicts included in a detoxification program was conducted at the Institute on Addictions in Belgrade. In addition to a dependence diagnosis and mental disorders based on DSM‐III‐R, we applied a Tridimensional Personality Questionnaire (TPQ) that measures the 3 major personality dimensions: novelty‐seeking (NS), harm avoidance (HA) and reward dependence (RD). When compared with a control group (a sample of Yugoslav undergraduate students), the opiate addicts demonstrate significantly high NS dimension as well as significant divergences of HA and RD subscales. The surveyed opiate addicts demonstrate a high percentage of personality disorders specifically in cluster B. The personality dimensions of opiate addicts showed certain temperament traits, such as: impulsiveness, shyness with strangers, fear of uncertainty and dependence. NS, HA and RD determined by temperament specifics may be an etiological factor in forming of a personality disorder, an affective disorder as well as of a drug choice.
The Cantabria first episode schizophrenia study: a summary of general findings
Authors: Vázquez‐Barquero J. L. , Nuñez M. J. Cuesta , de la Varga M. , Castanedo S. Herrera , Gaite L. , Arenal A.
Published: August 2007

This article describes the general findings of the initial cross‐sectional stage of a prospective follow‐up study of all first episodes of schizophrenia that occurred in the Autonomous Community of Cantabria over a 2‐year period and that established contact with any mental health service. The project comprises: i) a 2‐year cross‐sectional stage, in which the sample was gathered and studied with structured psychiatric instruments such as the Present State Examination and the Scales for the Assessment of Negative and Positive Symptoms (SANS and SAPS), and; ii) a continuous follow‐up. We detected, in the risk age ranged of 15–54 years, an incidence of 1.9 per 10,000 inhabitants per year for schizophrenia and of 1.3 per 10,000 inhabitants per year for the S + CATEGO diagnosis, without any significant gender difference of morbidity. The mean age for the total schizophrenic population was 26 years, being significantly higher in women than in men. In contrast with what happens with marital status, type of household or urban/rural way of life, there was no gender difference in relation to the other sociodemographic variables. The way in which nosological and clinical variables are associated with first episodes of schizophrenia was also examined in this study. We found that 75% of patients reached a maximum CATEGO‐ID level, 71% received a S + CATEGO diagnosis, 59% presented first‐rank symptoms of schizophrenia and that the percentage of a schizophrenic negative syndrome, as identified by the SANS and SAPS, was very low. Finally, among the clinical variables investigated, only premorbid adjustment, personal history of mental illness and length of admission presented significant gender differences.
The clinical impact of reported variance in potency of antipsychotic agents
Authors: Dewan M. J. , Koss M.
Published: August 2007

There is significant disagreement on the clinical equivalence (or potency) of antipsychotic agents, with up to 500% variance reported in texts. To address the extent and consequences of these discrepancies, we took a random sample of 18 common psychiatry, psychopharmacology and pharmacology texts for antipsychotic equivalence tables. We found a marked variation in stated equivalences for the majority of antipsychotics. Most affected were the high potency (haloperidol, fluphenazine) and newer (molindone) drugs, which had a 500% variance. This variation inadvertently contributes to the misuse of these agents. For instance, high‐potency antipsychotics are prescribed in far larger doses than necessary, leading to decreased efficacy and increased side effects. Steps to simplify and rationalize the use of these agents are recommended.
Cognitive function, thyroid status and postpartum depression
Authors: Mallett P. , Andrew M. , Hunter C. , Smith J. , Richards C. , Othman S. , Lazarus J. , Harris B.
Published: August 2007

Impairment of cognitive function can occur with thyroid disorder and also with depression. Since depression occurs in conjunction with postpartum autoimmune thyroiditis, the question arises as to whether any impairment of cognitive function in postpartum women is related to change in thyroid status or to depressed mood. A total of 242 women (110 thyroid antibody‐positive and 132 antibody‐negative) were assessed at 8, 12, 20 and 28 weeks postpartum in the outpatients of a district general hospital. Thyroid antibody levels (antimicrosomal and antithyroglobulin) were monitored at monthly intervals, together with plasma T3, T4 and thyroid‐stimulating hormone. The main outcome measures were Research Diagnostic Criteria for depression, the 17‐item Hamilton Depression Rating Scale and the Edinburgh Postnatal Depression Scale, together with reaction time and digit span. Subjects with postnatal depression showed detectable cognitive impairment independent of thyroid antibody status and actual thyroid dysfunction.
Reliability, validity and factorial dimensions of the Interactive Observation Scale for Psychiatric Inpatients
Authors: Zuardi A. W. , Loureiro S. R. , Rodrigues C. R. C.
Published: August 2007

The Interactive Observation Scale for Psychiatric Inpatients (IOSPI) is characterized by the necessity of interaction between the rater and the patient during the evaluation process. The reliability, validity and factor structure of the IOSPI were evaluated by using a total of 186 sets of ratings accomplished by 2 nursing aides on 34 adult psychiatric inpatients submitted to weekly evaluations during the 3 first weeks of hospitalization. The patients were observed by the 2 nursing aides simultaneously during the morning shift (5 h). In the afternoon of the same day, they were interviewed by two psychiatrists who filled in separately the Brief Psychiatric Rating Scale (BPRS). Factor analysis of the 16 IOSPI items revealed 5 distinct clusters of items, which represented higher‐order constructs of social interest, psychomotor agitation, psychoticism, neatness and irritability. It was found that the IOSPI has significant interrater reliability, estimated by an intraclass correlation coefficient of total score and factor score. The total scores of the IOSPI showed a significant correlation with the total scores of the BPRS, meeting the criteria of concurrent validity. The criteria of predictive validity were also met, since the patients who could be discharged presented IOSPI scores significantly lower than the patients who could not be discharged. In conclusion, the IOSPI met the requirements of an evaluation scale and can stimulate therapeutic attitudes of the nursing staff by its characteristics of interactive observation.
Screening instruments for depression and anxiety following stroke: experience in the Perth community stroke study
Authors: Johnson G. , Burvill P. W. , Anderson C. S. , Jamrozik K. , Stewart‐Wynne E. G. , Chakera T.M.H.
Published: August 2007

Evaluation of the relative efficacy of three screening instruments for depression and anxiety in a group of stroke patients was undertaken as part of the Perth community stroke study. Data are presented on the sensitivity and specificity of the Hospital Anxiety and Depression Scale (HAPS), the Geriatric Depression Scale and the General Health Questionnaire (GHQ) (28‐item version) in screening patients 4 months after stroke for depressive and anxiety disorders diagnosed according to DSM‐III criteria. The GHQ‐28 and GDS but not the HADS depression, were shown to be satisfactory screening instruments for depression, with the GHQ‐28 having an overall superiority. The performance of all 3 scales for screening post‐stroke anxiety disorders was less satisfactory. The HADS anxiety had the best level of sensitivity, but the specificity and positive predictive values were low and the misclassification rate high.
Neuropsychological assessment of schizophrenic patients during a psychotic episode: persistent cognitive deficit?
Authors: Cantor‐Graae E. , Warkentin S. , Nilsson A.
Published: August 2007

Neuropsychological test performance and clinical symptoms were assessed in 14 schizophrenic patients at admission to and discharge from an acute inpatient psychiatric service. Despite significant clinical improvement at discharge, no major change in cognitive performance was observed. Furthermore, patients at discharge were significantly impaired compared with normal control subjects case‐matched for gender, age, handedness and level of education. The results suggest that some degree of cognitive impairment may be relatively independent from schizophrenic symptoms and that such impairment may represent part of a residual enduring “trait” vulnerability.
Slow‐wave sleep deficits and outcome in schizophrenia and schizoaffective disorder
Authors: Keshavan M. S. , Reynolds C. F. , Miewald J. , Montrose D.
Published: August 2007

Schizophrenia is associated with altered sleep architecture, particularly in regard to delta sleep. We examined the relation between the baseline polysomnographic measures in schizophrenic and schizoaffective patients and psychosocial outcome as measured by the Strauss & Carpenter scale at 1 (n = 20) and 2 (n = 7) years. The percentages of delta sleep at baseline were significantly correlated with total outcome scores at 1 and at 2 years. These preliminary findings suggest that delta sleep deficits may be associated with relatively poor outcome in this disorder.
Classification of patients with affective disorders using platelet monoamine oxidase activity, serum melatonin and post‐dexamethasone Cortisol
Authors: Wahlund B. , Sääf J. , Wetterberg L.
Published: August 2007

Platelet monoamine oxidase activity (MAO), melatonin and Cortisol post‐dexamethasone suppression test (DST) were examined in 28 patients with major affective disorder and in 20 controls. MAO activity was lower and Cortisol post‐dexamethasone was higher in depressed patients. Platelet MAO activity and Cortisol in depressed and controls yielded high sensitivity (90%) and specificity (89%). The patients were re‐examined after 10 years and categorized into affective psychosis or neurotic depression (ICD‐9). Multidimensional analysis identified one subgroup coinciding in 92% with affective psychosis and another subgroup coinciding in 87% with neurotic depression. Combination of MAO, melatonin and post‐DST Cortisol may be useful in the diagnosis of subgroups of depressed patients and in choice of therapy.
Citalopram, a selective serotonin reuptake inhibitor, in the treatment of aggression in schizophrenia
Authors: Vartiainen H. , Tiihonen J. , Putkonen A. , Koponen H. , Virkkunen M. , Hakola P. , Lehto H.
Published: August 2007

The aim of this double‐blind cross‐over study was to investigate whether treatment with the selective serotonin reuptake inhibitor, citalopram reduces aggressiveness in chronically violent schizophrenic inpatients. Initially 19 patients were enrolled into this double‐blind cross‐over study in which the patients were treated for 24 weeks with placebo and 24 weeks with citalopram (20–60 mg/day) as a supplement to their previous neuroleptic medication. Fourteen patients completed the entire study, but sufficient data on 15 patients could be used in the end–point analysis of efficacy. Psychiatric assessments (Brief Psychiatric Rating Scale, Clinical Global Impression Scale for Severity of Illness, Social Dysfunction and Aggression Scale and the Global Aggression Scale) and side effects (UKU Side Effect Scale) were recorded at baseline and 4 times during both periods. Aggressive incidents (Staff Observation Aggression Scale) were recorded throughout the study. During citalopram treatment, the frequency of aggressive incidents was significantly lower and the mental state did not deteriorate. Patients either experienced no side effects or else side effects were equally mild during both periods.
Schizophrenia in Greenland: a follow‐up study
Authors: Lynge I. , Jacobsen J.
Published: August 2007

A total of 289 Greenlanders admitted for the first time to a mental hospital from 1980 to 1983, were followed for 7 years. Thirty‐seven patients, 24 men and 13 women, were diagnosed with schizophrenia at least once during the follow‐up period. The annual first admission rate per 100,000 was 41 for men and 23 for women. The schizophrenics were compared with a group of non‐schizophrenics at the same age admitted in the same period. The main results were young age at first admittance, high male‐female ratio and poor clinical and social outcome. The results were compared with WHO's cross‐cultural studies. Young age and a high male‐female ratio are in accordance with the developing countries, whereas poor outcome is in accordance with the industrialized countries.
Minimizing the non‐extrapyramidal side‐effects of antipsychotics
Authors: Keks N. A.
Published: August 2007

Standard neuroleptic medications have been augmented by the introduction of risperidone and clozapine into clinical practice. A great deal of attention has also been focused on efficacy and the lower propensity to extrapyramidal side‐effects associated with the new agents. However, antipsychotic medication, both old and new, can cause a range of other adverse effects, some of which are serious, and many of which have the potential greatly to diminish the quality of life of patients who need to take medication in the long term. Of particular significance are postural hypotension, cardiotoxicity, peripheral and central anticholinergic effects, sedation, weight gain, and endocrine and haematological effects. Various antipsychotic compounds differ substantially with regard to propensity to adverse effects. Side‐effects can be minimized by optimization of clinical strategies, including choice of appropriate drug, slow titration and dosage reduction. It is also vital to explain carefully to both patients and carers the nature of the side‐effects which can be anticipated. The choice of antipsychotic is often determined by evaluation of the potential impact of the various adverse effects on a particular patient. New drugs, such as risperidone, are well tolerated, with fewer side‐effects, and should now be considered as a first‐line option.
Excess mortality among former adolescent male out‐patients
Authors: Pelkonen M. , Marttunen M. , Pulkkinen E. , Koivisto A.‐M. , Laippala P. , Aro H.
Published: August 2007

Mortality among 156 males and 122 females referred to an out‐patient adolescent psychiatric clinic in a Finnish town between 1984 and 1989 was examined. During the follow‐up (mean duration 6 years; range 0–6.3 years for the deceased, 0.6–10.3 years for the survivors), 16 male subjects but no females had died. Among those who had died, the mode of death was suicide in 11 cases. The mortality for any cause for males was 10.3% and that for suicide was 7.1%. All male victims had similar high levels of individual and familial disturbances. Current suicidal ideation and suicide attempts, poor psychosocial functioning and a recommendation for psychiatric hospital treatment during the index treatment were associated with male mortality/suicidality. A high risk for mortality for several years after psychiatric treatment was found. It is concluded that, in clinical settings, perceived current suicidal tendencies should be assessed carefully.
Is there a suicidality syndrome independent of specific major psychiatric disorder? Results of a split half multiple regression analysis
Authors: Ahrens B. , Linden M.
Published: August 2007

Biological findings such as low 5‐HIAA levels in cerebrospinal fluid (CSF) in suicidal patients compared to non‐suicidal patients independent of the type of psychiatric disorder indicate a broad basis for suicidality. It is therefore important to ask whether a suicidality syndrome can be delineated on a phenomenological level, and whether it is independent of specific major psychiatric disorders which are otherwise considered to be aetiologically different. This paper reports on a study of 2383 schizophrenic and 1920 depressive unselected patients with and without suicidality. They were assessed during the first 24 h after admission to a psychiatric in‐patient facility using a comprehensive psychopathological assessment (AMDP system). Using multiple variance analysis and logistic regression analysis based on single symptoms, for both suicidal and non‐suicidal patients it was shown that a suicidality syndrome independent of the underlying illness can be delineated. In schizophrenia as well as in major affective disorders it was found that hopelessness, ruminative thinking, social withdrawal and lack of activity are core symptoms of this suicidal syndrome. The finding of a suicidality syndrome, not associated with a specific major affective disorder, indicates the need to identify this syndrome, which should be seen as an independent dimension and diagnosed separately, and not regarded merely as a secondary symptom of major psychiatric disorders, particularly affective disorders.
Quality of life in schizophrenia: relationship to sociodemographic factors, symptomatology and tardive dyskinesia
Authors: Browne S. , Roe M. , Lane A. , Gervin M. , Morris M. , Kinsella A. , Larkin C. , O'Callaghan E.
Published: August 2007

The influence of sociodemographic, clinical and treatment factors on the quality of life of patients with schizophrenia has yet to be fully defined. We evaluated the quality of life of patients with schizophrenia who were attending a catchment area rehabilitation centre, in order to establish its clinical correlates. These patients had a poor to moderate quality of life which was inversely related to negative symptom severity, illness duration, the cumulative length of previous hospitalization and patient age. Patients residing in hostels or group homes had a poorer quality of life than those living independently or with their family. The presence of tardive dyskinesia was associated with a poorer quality of life. This association merits further invesigation.
Living conditions of female suicide attempters: a case—control study
Authors: Runeson B. , Eklund G. , Wasserman D.
Published: August 2007

A total of 51 hospitalized female suicide attempters (17–64 years old) were interviewed according to a questionnaire used by Statistics Sweden, SCB (ULF 88: 1) for investigation of living conditions. Control subjects from similar geographical areas included in the ULF investigation in 1988, and matched for age and nationality, were identified through the SCB (n= 153). Odds ratios (OR) and 95% confidence limits were estimated. Correlation coefficients were used to study the relative importance of specific factors. Not less than 26 items reached the level of statistical significance, but only four of them (mental disorder, use of anxiolytics, unemployment at some time during the last 5 years, and no professional work during the past year) showed a considerable excess risk (lower 95% CI limit for OR > 3). Physical illness was relevant as an independent factor. Although of secondary importance, hospitalization during the previous 3 months was also a characteristic of suicide attempters.
Marked symptom reduction in two women with bulimia nervosa treated with the testosterone receptor antagonist flutamide
Authors: Bergman L , Eriksson E.
Published: August 2007

Previous reports indicate that elevated serum levels of androgens in women may contribute to the development of bulimia nervosa and other conditions characterized by impaired impulse control and/or depressed mood. This report describes the effect of treatment with the testosterone antagonist flutamide (250–500 mg daily) in two women with severe bulimia. Both subjects reported a marked improvement with respect to bulimic behaviour within a week after initiation of flutamide treatment; when the drug was withdrawn, both patients relapsed. It is concluded that further investigations of the possible efficacy of androgen antagonism in eating disorders are warranted.
The Edinburgh Postnatal Depression Scale: validation on a Swedish community sample
Authors: Wickberg B. , Hwang C. P.
Published: August 2007

The Edinburgh Postnatal Depression Scale (EPDS) was designed to be used by community health workers to screen for postnatal depression. We report data from a population‐based sample of 1655 women who completed the EPDS at 2 months and 3 months postpartum. A total of 128 women were interviewed with the Montgomery Asberg Depression Rating Scale (MADRS) and assessed according to DSM‐III‐R criteria for major depression. A cut‐off score of 11.5 on the EPDS identified all but two women with major depression, giving it a sensitivity of 96%, a specificity of 49% and a positive predictive value of 59%. This study supports the validity of the EPDS shown in earlier studies, and indicates that the scale is a useful screening instrument for identifying postnatal depression in primary health care in Sweden.
An open trial of adjunctive sertraline in the treatment of chronic schizophrenia
Authors: Thakore J. H. , Berti C. , Dinan T. G.
Published: August 2007

While the positive symptoms of schizophrenia are amenable to treatment with standard neuroleptics, negative symptoms are often difficult to treat. Co‐prescribing antidepressants, such as sertraline, for patients on stable neuroleptic depot preparations is one pharmacological method of overcoming this problem. A total of 20 patients with chronic schizophrenia were enrolled in an open trial over a 12‐week period during which sertraline was added to their usual antipsychotic medication. Prior to this, baseline scores for positive and negative symptoms, and extrapyramidal side‐effects, were measured. The addition of sertraline resulted in global improvement, with a significant reduction in positive and negative symptom scores and no increase in undesirable neuroleptic side‐effects. Sertraline may act by indirectly reducing dopaminergic activity.
Major depressive disorder is associated with elevated monocyte counts
Authors: Seidel A. , Arolt V. , Hunstiger M. , Rink L. , Behnisch A. , Kirchner H.
Published: August 2007

One of the most consistently reported findings in depression has been leucocytosis. In 33 in‐patients with major depressive disorder, we assessed white blood cell count (WBC) and lymphocyte subsets four times over a period of 6 weeks. The control group consisted of 44 healthy subjects. Shortly after admission, we detected significant increases in the numbers of leucocytes, granulocytes, platelets and monocytes in the depressed patients. Patients who recovered well during hospitalization showed a decrease in monocyte counts, whereas those with slower clinical improvement had significantly higher monocyte counts than the control group. This longitudinal study demonstrates that monocytes may play a role in the acute phase of depression and could provide an explanation for immunological dysfunction in depressive states.
Public attitude towards psychiatric treatment
Authors: Angermeyer M. C. , Matschinger H.
Published: August 2007

Past research on help‐seeking behaviour and compliance among the mentally ill has mainly been focused on the examination of individual and structural determinants, while the impact of the socio‐cultural context has been largely neglected. To examine this impact, we conducted a representative survey among German citizens who were eligible to vote. By means of vignettes describing different mental disorders we recorded the lay public's for various treatment methods, together with their subjective reasons for voicing these particular preferences. While we found that psychotherapy was generally held in high esteem by the lay public, psychopharmacotherapy was rejected by the vast majority of respondents. This pattern was observed for all of the mental disorders included in our survey. While the public's image of psychotherapy is largely determined by popular views on psychoanalysis, public opinion about psychotropic drugs is strongly influenced by characteristics associated with tranquillizers. Among the different psychotherapeutic approaches, psychoanalysis is the preferred method among respondents in the western part of Germany, while the lay public in the eastern part tends to endorse group therapy. Finally, our research showed a considerable difference between the conceptions held by the lay public and those of psychiatric experts with regard to the adequate treatment of mental disorders. This, in turn, should not be without consequence for help‐seeking behaviour and patient compliance.
Mortality of patients who dropped out from regular lithium prophylaxis: a collaborative study by the International Grow for the Study of Lithium‐Treated Patieits (IGSLI)
Authors: Müller‐Oerlinghausen B. , Wolf T. , Ahrens B. , Glaenz T. , Schou M. , Grof E. , Grof P. , Lenz G. , Simhandl C. , Thau K. , Vestergaard P. , Wolf R.
Published: August 2007

Excess mortality has repeatedly been found in patients with recurrent affective disorders. In previous studies our group has shown that during long‐term lithium treatment the mortality of such patients is not significantly higher than that of the general population. In the present study, we extended our investigation to 273 patients from the earlier IGSLI cohort who subsequently dropped out from regular lithium prophylaxis. The standardized mortality ratio (SMR) for the whole group was 2.5, significantly higher (P < 0.01) than 1.0, which is the SMR of the general population. Furthermore, the SMR of the patients from each of the participating countries, namely Denmark, Germany and Austria, was significantly higher than 1.0. These findings strengthen the evidence accumulated in previous investigations that regular long‐term lithium treatment does in fact markedly reduce the excess mortality of patients with recurrent affective disorders.
Factors predicting psychosocial recovery in psychiatric patients
Authors: Viinamäki H. , Niskanen L. , Jääskeläinen J. , Antikainen R. , Koivumaa‐Honkanen H. , Tanskanen A. , Lavonen T. , Lehtonen J.
Published: August 2007

We examined factors associated with psychosocial recovery in patients receiving specialist psychiatric treatment by means of a questionnaire directed at staff and patients (n= 1084) in an extensive study performed in North Savo, Kuopio, Finland. Psychosocial recovery was considered to have taken place if the Global Assessment Scale (GAS) score had increased from the lowest estimate obtained during the preceding year by at least 28 points at the time of the study (n= 102). The remaining cases (n= 982) served as controls. In the univariate analysis of all of the patients, the factors associated with good recovery were a high level of basic education, a diagnosis of major depression and adequate social support. The opportunity to contact a therapist outside fixed treatment visits was also a factor predicting psychosocial recovery. In the multivariate analysis, independent factors predicting recovery were the high frequency of treatment contacts in cases of schizophrenia, previous hospitalization in major depression, and a high level of basic education and hospitalization in personality disorders.
Biological predictors of suicidality in schizophrenia
Authors: Lewis C. F. , Tandon R. , Shipley J. E. , DeQuardo J. R. , Jibson M. , Taylor S. F. , Goldman M.
Published: August 2007

The objective of this study was to determine whether polysomnographic rapid eye movement (REM) sleep abnormalities and Cortisol response to the dexamethasone suppression test (DST) differentiate between schizophrenic patients with and without a history of suicidal behaviour. We assessed a sample of 96 schizophrenic in‐patients at the end of a 2‐week medication‐free period with the DST, polysomnography, and an extensive clinical assessment battery. Patients exhibiting suicidal behaviour were significantly more likely to have increased total REM time and increased total REM activity. We found no significant relationship between suicidal behaviour and DST non‐suppression. This study confirms a previous finding suggesting an association between REM sleep abnormalities and suicidal behaviour in schizophrenia. It is postulated that this observed association may be related to serotonergic dysfunction in schizophrenia.
Preservation of hypothalamic‐pituitary‐adrenal axis fast‐feedback responses in depression
Authors: Cooney J. M. , Dinan T. G.
Published: August 2007

Depression is associated with overactivity of the hypothalamic‐pituitary‐adrenal (HPA) axis, which may be attributable to defective negative feedback. Fast feedback is the earliest phase of this, and has previously been suggested to be abnormal. A total of 30 physically healthy volunteers, 15 patients with DSM‐III‐R major depression and an age‐ and sex‐matched control group received a standardized challenge of hydrocortisone (5 μg kg‐1 min‐1) or placebo over a period of 1 h. ACTH1‐39 responses to hydrocortisone challenge did not differ significantly between healthy volunteers and patients with major depression. The fast‐feedback response to hydrocortisone challenge is preserved in major depression when ACTH is measured directly.
Acute and transient psychotic disorder: comorbidity with personality disorder
Authors: Jørgensen P. , Bennedsen B. , Christensen J. , Hyllested A.
Published: August 2007

A study sample of 51 patients with acute and transient psychotic disorder (ATPD) (ICD‐10) is presented. The findings suggest that, in hospital settings, ATPD is a non‐frequent condition with onset in early adult life and most often associated with female sex, good premorbid social functioning and no or minor/moderate psychosocial stressors. The DSM‐IV criteria distribute the patients into three diagnostic categories: schizophreniform disorder (41%), brief psychotic disorder (33%) and psychotic disorder not otherwise classified (25%). A high prevalence (63%) of personality disorders (PD) is revealed after recovery from the psychotic episode. The ATPD is not related to any specific PD, and in a substantial minority (37%) of cases no PD is found. The unspecified category is by far the most frequent PD in patients with ATPD. The sample will be followed up and reassessed.