bluuebunny/crossref_metadata_2025 huggingface dataset:
DSM‐III‐R self‐defeating personality disorder criteria evaluated by patients' self‐report questionnaire: relationships with other personality disorders and positive predictive powers of the individual criteria
Authors: Dowson J. H.
Published: August 2007

A self‐report questionnaire for DSM‐III‐R personality disorders (PDs) was completed by 64 patients in adult psychiatric practice and their informants. Various correlations and associations of the number of patients’ positive criteria (scores) for the controversial category of self‐defeating PD (SDPD) are reported. When evaluated by a patient's self‐report, the highest correlations of SDPD scores were with borderline PD in relation to individual PDs, and cluster C in relation to the 3 DSM‐III‐R PD clusters. Criteria 2 and 7 had positive predictive powers of 0.75 and 0.67 for membership of the subgroup based on scores of 5 or more positive criteria for SDPD. Positive ratings for criterion 5, involving anhedonia, were significantly associated with informants’ ratings. SDPD features appear to be present in many psychiatric patients with PD and should be evaluated in PD assessment.
Suicide in patients with Parkinson's disease
Authors: Stenager E. N. , Wermuth L. , Stenager E. , Boldsen J.
Published: August 2007

The purpose of this study was to estimate the risk of suicide for patients with Parkinson's disease (PD) in Denmark compared with that in the background population. The study involved 458 patients with a PD diagnosis, 226 men and 232 women. The follow‐up period to either death or end of follow‐up on December 31, 1990 was 0 to 17 years, mean 5.7 years. Deaths in the follow‐up period amounted to 254, 135 men and 119 women. Two women committed suicide. The number of expected suicides was 1.06 for men and 0.55 for women, a total of 1.62. Neither for men nor for women was the difference between expected and observed suicides statistically significant.
Electroencephalography, computed tomography and violence ratings of male patients in a maximum‐security mental hospital
Authors: Wong M. T. H. , Lumsden J. , Fenton G. W. , Fenwick P. B. C.
Published: August 2007

A retrospective study of brain investigations of 372 male patients in a maximum‐security mental hospital patients is described. All computed tomography (CT) scan and electroencephalography (EEG) reports were collected and rated blind; patients were subsequently divided into 3 groups according to the violence rating of their pre‐admission offending behaviour. The 3 groups were similar in their mean age, psychiatric diagnosis, Wechsler Adult Intelligence Scale score and proportions of patients investigated with EEG and CT. In the most violent group, 20% had focal temporal electrical abnormalities on EEG (slowing and/or sharp waves) and 41% had structural abnormalities localised to temporal lobe on CT (dilated temporal horn and/or reduced size of temporal lobe). The corresponding figures for the least violent group are 2.4% and 6.7% respectively. These results suggest that high violence rating scores are associated with temporal lobe abnormalities on CT and abnormal temporal electrical discharges on EEG.
Attempted suicide and contact with the primary health authorities
Authors: Stenager E. N. , Jensen K.
Published: August 2007

In a study describing suicide attempters’ approach to the health and social welfare authorities prior to a suicide attempt, it was found that one‐fourth of the patients seeking help requested therapeutic consultations and only a few asked for medicinal treatment. Forty‐four percent had taken newly prescribed medicine for the parasuicide. It is concluded that the availability of psychological support and a more restrictive prescription of medicine could have a preventive effect on parasuicidal behaviour. Patients suffering from depression and pain have more often than other patients been in contact with their general practitioner prior to the suicide attempt. Postgraduate courses for practitioners on depression diagnostics and suicidal behaviour are proposed as a measure in suicide prevention.
The development of the Self‐Rating Inventory for Posttraumatic Stress Disorder
Authors: Hovens J. E. , van der Ploeg H. M. , Bramsen I. , Klaarenbeek M. T. A. , Schreuder J. N. , Rivero V. V.
Published: August 2007

In this study a newly developed Self‐rating Inventory for Posttraumatic Stress Disorder (PTSD) is presented. The instrument consists of 47 items, reflecting DSM‐III‐R criteria, associated features and items corresponding to the disorder of extreme stress not otherwise specified. All items are phrased in a trauma‐independent way and are measured on an intensity scale. The instrument was validated on 76 subjects with war‐related trauma and 59 psychiatric outpatients, one third of whom were traumatized. Test‐retest for the scale was 0.90. The coefficient alpha appeared to be 0.96 for the 47‐items scale and 0.92 for the 22 DSM‐III‐R subscale. The scale correlated significantly with the Clinician Administered PTSD Scale, the Mississippi Scale for Combat‐related PTSD, the MMPI PTSD subscale and the Impact of Event Scale. The overall efficiency of the Self‐rating Inventory for PTSD was comparable to the overall efficiency of the Mississippi Scale and superior to the MMPI PTSD subscale. Factor analysis on the 22 DSM‐III‐R items showed 4 factors, representing numbing, intrusion, avoidance and sleeping problems. It is concluded that the Self‐rating Inventory for PTSD is a powerful instrument for diagnosing PTSD in survey research. The instrument appears to be capable of differentiating not only between PTSD and non‐PTSD subjects but also between traumatized non‐PTSD subjects and non‐traumatized psychiatric patients.
A comparison of the drugs taken in fatal and nonfatal self‐poisoning
Authors: Michel K. , Waeber V. , Valach L. , Arestegui G. , Spuhler T.
Published: August 2007

The objective of this study was a) to compare patterns of drug use in fatal and nonfatal overdoses and b) to find out if toxic drugs are overrepresented in overdoses with fatal outcome. A total of 179 cases of fatal overdoses in Switzerland (population 6.6 million) were compared with 269 medically treated self‐poisoners from the agglomeration of Berne (population 301,630). Because of frequent multiple drug use, all the different compounds taken singly or in combination with other drugs were recorded and grouped according to drug types. The patterns of the frequencies of drugs used were remarkably similar in both groups. The majority of the drugs were psychotropics (81% in fatal and 68% in nonfatal overdose). Twenty‐nine completed suicides were the result of drug combinations specifically recommended by EXIT. In the remaining cases benzodiazepines were used most frequently in both attempted and completed suicide, often in combination with other drugs or alcohol. Barbiturates were the only drugs recorded significantly more often in fatal overdoses (9%vs 3%). No significant difference was found for tricyclic antidepressants (13%vs 10%), or other types of drugs. The results are consistent with our assumption that drugs with higher toxicity would be overrepresented in overdoses with fatal outcome. Barbiturates, which are well known to be dangerous in overdose, were clearly associated with fatal overdoses, but not tricyclic antidepressants. This, in our view, suggests that the risk of prescribing tricyclic antidepressants should not be overestimated. The frequent use of benzodiazepines in completed suicide, however, indicates that there are no truly safe drugs in overdose.
Posttraumatic stress reactions after single and double trauma
Authors: Goenjian A. K. , Najarian L. M. , Pynoos R. S. , Steinberg A. M. , Petrosian P. , Setrakyan S. , Fairbanks L. A.
Published: August 2007

This study evaluated the severity and symptom profile of posttraumatic stress reactions of 202 adults exposed in 1988 to political violence in Azerbaijan and/or the earthquake in Armenia. High rates of severe posttraumatic stress reactions were found among the most highly exposed individuals, irrespective of the type of trauma. There was no difference in symptom profile for subjects exposed to earthquake versus violence. These similarities in severity and symptom profile may be attributable to common features of the exposures, which included experiencing life‐threat and witnessing injury, mutilation and death. Recent prior exposure to violence contributed to the severity of reaction to the earthquake. The high rates of chronic and severe posttraumatic stress reactions in Armenia constitute a major public mental health problem.
Antipsychotic medication and suicide risk among schizophrenic and paranoid inpatients
Authors: Taiminen T. J. , Kujari H.
Published: August 2007

A retrospective analysis of the psychotrophic medication, illness history and recent mental symptoms of 28 schizophrenic or paranoid inpatients who had committed suicide and the same number of matched control subjects was carried out. The groups were first compared separately for every variable, and 6 statistically most significant variables in the paired comparisons were then entered into a stepwise linear logistic regression model. Four statistically significant differences between the groups were found with the paired comparisions. The suicide group had more often previous suicide attempts, lower neuroleptic doses, more depressive symptoms and less positive schizophrenic symtoms compared to their controls. The results of the regression analysis suggested that the lower neuroleptic doses in the suicide group were more probably a consequence of the differences in the symptom profile than in a direct causal relationship to the suicides per se.
Epidemiology of anorexia nervosa and bulimia nervosa in Bornholm County, Denmark, 1970–1989
Authors: Pagsberg A. K. , Wang A.‐R.
Published: August 2007

In a retrospective study of anorexia nervosa and bulimia nervosa, potential cases were traced, studied, and diagnosed according to ICD‐10. Forty‐two cases were found in Bornholm County, comprising the island of Bornholm in Denmark, in a population of 47,000 from 1970 to 1989. Less than half of these cases (n= 16) were registered in Danish psychiatric case registers, and 35% (n= 14) could be found only by search in primary care. The incidence rates were stable during most of the study period, but a significant increase occurred during the last 5 years. The prevalence rates, determined by counting the number of cases in the population year by year, also increased during the late part of the study period. In 1989 the incidence rate of the high‐risk group of females 10 to 24 years of age was 136 per 100,000 for anorexia nervosa and 45 per 100,000 for bulimia nervosa, and the prevalence rate was 222 per 100,000 for anorexia nervosa and 89 per 100,000 for bulimia nervosa.
Neurological abnormalities in patients with schizophrenia or schizophreniform disorder at first admission to hospital: correlations with computerized tomography and regional cerebral blood flow findings
Authors: Rubin P. , Vorstrup S. , Hemmingsen R. , Andersen H. S. , Bendsen B. B. , Strømsø N. , Larsen J. K. , Bolwig T. G.
Published: August 2007

Forty‐five patients with schizophrenia or schizophreniform disorder admitted to hospital for the first time had a neurological examination, including integrative sensory and complex motor acts, by a trained neurologist. The patients were studied by CT (computerized tomography) and rCBF (regional cerebral blood flow) as well. A control group of 24 healthy volunteers was included. The patients had significantly more neurological abnormalities (NA) than the healthy volunteers. Medication did not explain the discrepancy. The NA were associated with sulcal enlargement and smaller brains as visualized by CT but not with ventricular enlargement. There was no association between the regional flow values and NA.
Multidimensional hierarchic ordering of psychopathology
Authors: Goekoop J. G. , Zwinderman A. H.
Published: August 2007

Both the classification based on independent psychiatric categories as well as the concept of an underlying 1‐dimensional hierarchy of syndromes are insufficiently valid. At symptom level we previously found 5 factor‐analytical components representing 6 dimensions of psychopathology. Rasch analysis based on the prevalence of signs and symptoms now demonstrates the presence of hierarchic patterns in each of these dimensions. Manic, psychotic and rare neurotic symptoms, being the negative instances of the 1‐dimensional hierarchy, contribute to high rates of hierarchic patterns in this multidimensional hierarchic model. Depending on the dimension tested, 5% to 13% of the patterns were nonhierarchic.
Stability trends and longitudinal correlations of negative and positive syndromes within a three‐year follow‐up of initially hospitalized schizophrenics
Authors: Rey E.‐R. , Bailer J. , Bräuer W. , Händel M. , Laubenstein D. , Stein A.
Published: August 2007

Our study investigates whether the distinction between positive and negative symptoms in schizophrenia – as discussed in the literature – can be confirmed by a factor analysis and whether such a distinction proves stability over time. In a further step, symptom factors are correlated to different external variables for the purpose of validation. Processed data cover 36 months obtained from a prospective 5‐year follow‐up study of 163 initially hospitalized schizophrenics. The results permit for dividing the symptoms into a total of five factors – two representing positive and negative symptoms and one representing the general neurotic syndrome. This factor structure proved to be stable over time. Correlations between symptom factors and external variables justify a trait‐interpretation of the negative factor anhedonia.
Associations between the mental health and social networks of children and parents in single‐parent families
Authors: Samuelsson M. A. K.
Published: August 2007

The parents and children in single‐parent families were studied. A group of 39 children ages 9–16 years who had been patients at a child and adolescent psychiatric clinic and a control group with an equal number of children were interviewed together with their single parent regarding social network and mental health. The networks of children and parents in the control group were more similar to each other than the networks of parents and children in the patient group. The crosswise influence of parents’ mental health, children's behavioural disturbances and social networks showed associations between parents’ mental health and children's behavioural disturbances, between parents's social networks and children's behavioural disturbances and between parents’ mental health and their social networks. There was, on the other hand, no association between parents’ mental health and the social networks of their children.
Length of hospitalization in an acute patients’ therapeutic community ward
Authors: Nieminen P. , Isohanni M. , Winblad I.
Published: August 2007

A total of 1330 patients in an acute patients’ therapeutic community ward were treated in 1977–1991. Their 2384 treatment episodes were analyzed, mainly 1–6 episodes per patient. The median length of hospitalization for all episodes was 40 days; during the first episode it was 39 days, during the 2nd 46 days, the 3rd 49 days, the 4th 48 days, the 5th 33 days and the 6th 47 days. The residents with a better immediate outcome usually stayed 10–20 days longer in hospital than those with an inferior outcome. The associations of length of hospitalization with some predictor variables were analyzed by a linear regression model. A long stay was associated with young age, a psychosis‐level diagnosis, and active, motivated participation in individual and milieu therapy. Although economic reasons and expansion of the outpatient care may favor a short stay policy, some motivated borderline and psychosis patients seem to benefit from an individually timed inpatient experience in the therapeutic community setting.
Drug Abuse and Dependence
Authors: Russell J.M. , Newman S.C. , Bland R.C.
Published: August 2007

3258 randomly selected adult household residents of Edmonton were interviewed by trained lay interviewers using the Diagnostic Interview Schedule (DIS). The lifetime prevalence of drug abuse/dependence was 6.996, with a male:female ratio of 3:1. The most commonly used drug was cannabis followed by amphetamines, opiates, barbiturates, hallucinogens and cocaine. 80.370 of those with drug abuse/dependence also had a lifetime diagnosis of another psychiatric disorder. In those with a comorbid diagnosis, the mean age of onset for the other psychiatric disorder was generally found to be younger than for the onset of drug abuse/dependence. Different comorbid disorders were found to significantly affect patterns of drug use.
Alcohol and depression in panic disorder
Authors: Lepola U.
Published: August 2007

Panic disorder (PD) is a common psychiatric illness, which has many complications such as major depression, increased suicide risk, agoraphobic avoidance behaviour, alcohol abuse and dependence. A number of studies have now documented increased rates of anxiety disorders among alcoholics and of alcoholism among patients presenting with anxiety disorders. In general, it appears that PD is more prevalent in alcoholics than would be expected on the basis of general population rates. Alcohol withdrawal is clearly asSociated with severe anxiety symptoms. It is suggested that repeated withdrawal episodes may trigger panic through a kindling process by causing subconvulsive stimuli with increasing amounts of electrical excitability or even spontaneous seizures. Serotonergic medications are effective in treating PD and depression. They also diminish interest in drinking in ethanol‐dependent patients. Serotonergic agents can also affect conditioning and learning as well as behavioral control and self‐administration. The treatment of panic patients with depressive and alcohol problems usually requires long‐term treatment.
Food and mood: relationship between food, serotonin and affective disorders
Authors: Wallin M. S. , Rissanen A. M.
Published: August 2007

The relationship of food and eating with affective and other clinical disorders is complex and intriguing. Serotoninergic dysfunction in seasonal affective disorder, atypical depression, premenstrual syndrome, anorexia and bulimia nervosa, and binge eating disorder is reviewed. Patients exhibiting a relationship between food and behaviour are found in various diagnostic categories. This points to a need to shift from nosological to functional thinking in psychiatry. It also means application of psychopharmacological treatments across diagnostic boundaries. The use of phototherapy and psychotropic drugs (MAO inhibitors and selective serotonin reuptake inhibitors like fluoxetine) in these disorders is discussed.
Personality in Anorexia nervosa: An update and a theoretical integration
Authors: Sohlberg S. , Strober M.
Published: August 2007

No single cause is likely to be of supreme importance in the etiology of Anorexia nervosa, but personality factors continue to attract researchers' attention. This paper is a review of evidence on the subject, covering psychometric, interview, and projective investigations. Significant methodological problems exist in the literature, but do not suffice to explain findings of obsessive and inhibited features intermixed with impulsivity, and a high prevalence of defined personality disorders. Adding to previous work by Cloninger and Strober we suggest that vulnerable individuals are temperamentally incapable of coping with the challenges of adolescence by anything other than repetitive, reward seeking behavior. In a social environment that greatly emphasizes thinness as a criterion for self‐worth and success, the outcome may be Anorexia nervosa.
Is there any drug treatment of choice for the borderline patient?
Authors: Soloff P. H.
Published: August 2007

Psychotropic medication is used extensively in the borderline patient in an effort to treat the cognitive, affective, impulsive‐behavioral and anxious‐fearful symptoms which comprise the state symptoms and trait vulnerabilities of BPD. This paper reviews the efficacy of neuroleptics, antidepressants (TCA, MAOI and SSRI), lithium carbonate, carbamazepine and benzodiazepines against these 4 symptom domains. There is currently no single drug treatment of choice in BPD. Current research supports acute treatment. Maintenance trials are generally lacking or show limited efficacy. A dimensional approach is recommended for clinical practice and future research trials. targeting specific symptom domains with selective medication. Pharmacotherapy should be viewed as a useful adjunct to psychotherapy in the long‐term treatment of the borderline patient.
Borderline states: pharmacotherapy and psychobiology of personality:
Authors: Rosenberg R.
Published: August 2007

The question of the existence of rational drug treatment of borderline personality disorder is discussed from two different positions. To the empiricists, the answer must rely on rigorous analysis of controlled drug trials, while to the realists theoretical conceptions of borderline personality disorder must also be seriously addressed. A rational pharmacotherapy can be claimed even when the nosological status of the disorder is not clarified but must be based on a dimensional analysis of psychopathology. Current psychotropic drugs have some but not any too impressive efficacy in the treatment of borderline personality disorder. It is argued that future drug treatment may benefit from the progress in neuroscience, especially within the area of psychobiology of personality.
Dialectical behavior therapy for borderline personality disorder: theoretical and empirical foundations
Authors: Shearin E. N. , Linehan M. M.
Published: August 2007

Dialectical behavior therapy (DBT) is a cognitive‐behavioral psychotherapy developed by Linehan for parasuicidal patients with a diagnosis of borderline personality disorder (BPD). DBT is based on a biosocial theory that views BPD as primarily a dysfunction of the emotion regulation system. The treatment is organized around a hierarchy of behavioral goals that vary in different modes of therapy. In two randomized trials, DBT has shown superiority in reducing para‐suicide, medical risk of parasuicides, number of hospital days, dropout from treatment and anger while improving social adjustment. Most gains were maintained through a 1‐year follow‐up. In one process study testing DBT theory, dialectical techniques balancing acceptance and change were more effective than pure change or acceptance techniques in reducing suicidal behavior.
Historical introduction
Authors: Lader M.
Published: August 2007

The treatment of psychotic illness has long been inextricably associated with society's view in general on social deviance. In medieval times, psychotic individuals were contained within the community, a situation which still prevails in many developing countries. Aggregation of such patients in asylums followed the increasing industrialization of communities in the nineteenth century, when the ability of the disadvantaged of all kinds to survive was greatly jeopardized. The twentieth century has seen a gradual reversal of this process, as attitudes towards mentally ill people have become a little more enlightened and liberal. However, the swing against the great lunatic asylums of the last century has proceeded at such an administrative rate that our patients are again in danger of succumbing medically and economically within our communities. It is common to see desperately poor and damaged psychotic individuals on our streets. The advent of neuroleptics was a major factor in the change from a custodial to an ostensibly rehabilitative approach in the treatment of schizophrenia. However, classic neuroleptics have a long list of well‐recognized side effects such as affective and cognitive impairment that lead to poor treatment compliance, psychiatric relapse and social decompensation, the state of affairs of our street psychotics. Treatments that lessen the probability of this unfortunate process are desperately needed. The introduction of new neuroleptic drugs with favourable side effect profiles is to be welcomed as a major step in increasing the quality of life of our patients, both in hospital and functioning in the community.
Antipsychotic drug mechanisms and neurotransmitter systems in schizophrenia
Authors: Reynolds G. P.
Published: August 2007

The dopamine hypothesis of schizophrenia has been central to the understanding of the mechanism of action of the antipsychotic drugs. Certainly the close correlation between drug dosage and affinity for Dz dopainine receptors indicates the importance of these receptors in the antipsychotic response, although D2 antagonism can also induce acute extrapyramidal side effects. The antipsychotic drugs also act at other neurotransmitter reccptors, and these actions contribute to the unwanted side effects of treatment. The use of selective D, antagonists can diminish such effects, although effects at other receptors are reported to be of value in minimizing extrapyramidal syndromes as well as in enhancing response either directly or by diminishing negative symptoms. The present understanding of these receptor mechanisms is reviewed.
Overcoming the neuroleptic‐induced deficit syndrome: clinical observations with remoxipride
Authors: Lewander T.
Published: August 2007

Remoxipride is a selective dopamine D2 antagonist with virtually no activity on other transmitter receptors. It antagonizes dopamine agonists within a wide dose range in animals when it does not cause sedation or akinesia. Clinical studies with remoxipride have demonstrated antipsychotic efficacy apparently equal to classical neuroleptics in short‐ and long‐term treatment of schizophrenia. Remoxipride has a low extrapyramidal syndrome (EPS) profile, and it is generally well tolerated. In clinical practice remoxipride has been reported to differ from classical neuroleptics with regard to subjective side effects. On switching to remoxipride, patients report improvement in cognitive, conative, affective and emotional functions. In many cases the reports are supported by family members and/or caregivers. Although anecdotal, such reports are in line with the low EPS profile of remoxipride and its weak sedative properties. It may indicate that remoxipride does not elicit the neuroleptic‐induced deficit syndrome, commonly experienced with classical neuroleptics, or that remoxipride improves the deficit syndrome (or primary negative symptoms) of schizophrenia. These and other hypotheses need to be confirmed by formal clinical studies.
Antideficit properties of neuroleptics
Authors: Colonna L.
Published: August 2007

The antidelusion effect, in the antiproductive sense of the term, represents the essential property of neuroleptics in research and publications in the United States. In France and in other European countries, however. a particular effect was observed early on that received various labels: disinhibitor, stimulant, antiautistic and anti‐deficit, and that involved the beneficial action of certain neuroleptics on the negative symptoms of schizophrenia. The first period, ranging from 1952 to 1976, was characterized by a number of clinical observations and attempts at classification. In the second period, 1976 to 1984, much work was done in pharmacology and biochemistry. In the third period, 1984 to 1989, double‐blind studies confirmed, among others, the disinhibiting effect, first of low doses of sulpride and then of amisulpride.
The clinical utility of expressed emotion in schizophrenia
Authors: Bebbington P. , Kuipers L.
Published: August 2007

The measure expressed emotion (EE) has been developed over the course of the last 35 years, but it is only over the last decade that there has been an explosion of interest in it. It taps attitudes and behaviour in those who care for people with a range of psychiatric and physical conditions. It has been the basis for successful studies of psychosocial intervention in schizophrenia. However, several questions remain to be answered concerning EE. This article summarizes the results of an aggregate analysis of 25 studies of EE, which appears to be a robust predictor of relapse, in a range of locations and cultures, and in both sexes. Medication and family atmosphere exert effects on relapse that are completely independent. High contact with high‐EE relatives increases relapse rates still further, while if anything contact with low‐EE relatives is protective. We describe what is known about the relationship of EE with the behaviour of patients and carers. It is now clear that staff members can exhibit the same range of behaviours as the relatives of sufferers. Finally, we set out the implications for the routine management of people with longstanding schizophrenia.
The vulnerability/stress model of schizophrenic relapse: a longitudinal study
Authors: Nuechterlein K. H. , Dawson M. E. , Ventura J. , Gitlin M. , Subotnik K. L. , Snyder K. S. , Mintz J. , Bartzokis G.
Published: August 2007

A tentative model for conceptualizing the interplay of vulnerability factors, stressors, and protective factors in the course of schizophrenia is discussed. A study of the initial years after a first schizophrenic episode is testing the predictive role of key factors. During an initial 1‐year period of depot antipsychotic medication, independent life events and expressed emotion were found to predict the likelihood of psychotic relapse. Initial analyses indicate that independent life events play less of a role in relapse prediction during a medication‐free period. These results suggest that maintenance antipsychotic medication raises the threshold for return of psychotic symptoms, such that relapses are less likely unless major environmental stressors occur. A low expressed emotion environment may be a protective factor.
Does community care reduce the need for psychiatric beds for schizophrenic patients?
Authors: Dencker S. J. , Dencker K.
Published: August 2007

For schizophrenics, the closing down of the old traditional hospital has in many places ended up in a scenario characterized by homelessness, relapse, patients overcrowding acute psychiatric but also somatic hospital wards, increased suicide figures, low living standards — and an increased burden on the family. The beds for schizophrenics have been considerably reduced in many countries. For schizophrenia the critical low number of institution beds — hospital as well as nursing home — seems to be 0.07% of the general population. Schizophrenia in all phases must be treated as the disease it is, not as a social problem.
Health and economic evaluation in schizophrenia: implications for health policies
Authors: Moscarelli M.
Published: August 2007

Programmes for controlling health care costs and improving the quality of care are going to be developed in some countries, with the development of health services research and outcome evaluation. The reliable and comprehensive evaluation of the specific health and economic picture of each illness as well as of the health care results and costs savings related to the treatments or coordination of treatments requires close, interdisciplinary collaboration between the clinician and the health economist. The production and diffusion of health and economic evaluation results is aimed at informing policy makers, providers, consumers, health technology producers, etc. in order to enable them to do their best choices. The allocation in each country of a significant percentage of the annual health expenditures to economic evaluation in mental health seems important for the international development of this field.
Dysthymic disorder: a comparison of DSM‐IV and ICD‐10 and issues in differential diagnosis
Authors: Lopez Ibor J. J. , Frances A. , Jones C.
Published: August 2007

Dysthymic disorders are a major category among the mood disorders but the concept is not widely understood in many parts of the world, where it is often considered as a new name for familiar categories, such as neurotic depression, depressive personality or even neurasthenia (which is still a frequent diagnosis in many Far East countries). The purpose of this chapter is to compare the definitions of Dysthymic Disorder that are contained in the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM‐IV) with the definitions in the International Classification of diseases Tenth Edition (ICD‐10). The two systems are in fact quite congruent both in their overall approach and their specific contents; this has resulted from the fact that many of the DSM‐IV Task Force and Work Group members have participated in the ICD‐10 expert committees and many of the ICD‐10 experts have been advisors to the DSM‐IV revision process.
Course, outcome and impact on the community
Authors: Keller M. B.
Published: August 2007

Recent studies have indicated the pernicious nature of dysthymia; its low‐grade chronicity probably contributes most to the problem of undertreatment and misdiagnosis. A high prevalence of morbidity and comorbidity is associated with dysthymia: major depression, alcoholism, anxiety and personality disorders are present in the vast majority of sufferers. It is also very unusual for people with dysthymia to not develop superimposed episodes of major depressive disorder, resulting in a longer time to recover and high rates of recurrence and chronicity. Approximately 3.1% of the population have dysthymia including children and adolescents who, like adults, exhibit a higher risk for new episodes of depressive illness if they have this disorder. Children and adolescents with depressive illnesses have higher rates of scholastic failure and school‐related problems. Dysthymia can affect every aspect of a person's quality of life including relationships with significant others, earning potential and, most importantly, mental and physical well‐being. Available data is not yet sufficient to differentiate dysthymia as a disease entity from the other depressive disorders such as major depression or double depression, or to conclude to what extent dysthymia should be thought of as a personality disorder. However, the DSM‐IV Mood Disorders Field Trial results help identify new criteria for the DSM‐IV Appendix. The relationship between dysthymic disorder and major depression needs more definition, especially in regard to course and severity, so that an accurate diagnosis can lead to expeditious and appropriate treatment.
Empirical correction of seven myths about schizophrenia with implications for treatment
Authors: Harding Courtenay M. , Zahniser James H.
Published: August 2007

This paper presents empirical evidence accumulated across the last two decades to challenge seven long‐held myths in psychiatry about schizophrenia which impinge upon the perception and thus the treatment of patients. Such myths have been perpetuated across generations of trainees in each of the mental health disciplines. These myths limit the scope and effectiveness of treatments offered. These myths maintain the pessimism about outcome for these patients thus significantly reducing their opportunities for improvement and/or recovery. Counter evidence is provided with implications for new treatment strategies.
What has become of the psychotherapy of schizophrenia?*
Authors: McGlashan Thomas H.
Published: August 2007

The psychotherapy of schizophrenia has undergone major changes in the past two generations and mirrors larger paradigmatic shifts in thinking about severe mental illness and its treatment. Despite being endangered acutely by fiscal crises in our current health care systems, the psychotherapy of schizophrenia continues to evolve in a healthy manner as advances are made In our understanding of schizophrenia.
Anthropology and psychiatric epidemiology
Authors: Murphy Jane M.
Published: August 2007

Psychiatric epidemiologic research has been criticized by anthropologists for ignoring cultural variation in the definitions of psychiatric disorders. While recognizing the importance of this issue, it is suggested here that a considerable amount of ethnographic evidence indicates that many types of comparative effort can be carried out without cultural injustice. It is also urged that anthropologists provide a system for classifying cultures so as to foster an understanding of the ways in which shared beliefs and meanings can influence psychiatric illness. Categorizing populations as Western versus Non‐Western or Developed versus Developing is inadequate as a basis for studying the cultural context of psychiatric illness in different parts of the world.
Age and other factors relevant to the rehospitalization of schizophrenic outpatients
Authors: Hoffmann H.
Published: August 2007

In this study 50 of 51 schizophrenic long‐term patients treated by a community‐based outpatient service were followed‐up for 2 years. Factors known to be relevant for rehospitalization were correlated with the rate of hospitalizations 1) in the past, 2) during the last year and 3) during the follow‐up period. We were particularly interested in the influence of the patient's age on readmission. In agreement with previous research, the results showed that the best predictor of future admissions was the number of previous hospitalizations. Age also has a high predictive value and correlates not only significantly with the hospitalization rates but also with other factors relevant for readmission such as drug compliance, antisocial behavior and suicidal risk. This, however, only partly explains the frequency of rehospitalization, as partial correlation shows. Although items concerning compliance were highly correlated with previous hospitalizations, they had less predictive value, contrary to the findings in the literature.
Principal components and further possibilities with the PANSS
Authors: von Knorring L. , Lindström E.
Published: August 2007

At the end of the last century, Hughlings‐Jackson suggested that positive and negative syndromes should be kept apart in psychotic disorders. When the concepts of dementia praecox and schizophrenia were introduced by Kraepelin and Bleuler, emphasis was laid on the negative symptoms, regarded as fundamental. After the introduction of the “first rank symptoms” by Schneider emphasis switched to the positive symptoms in schizophrenia and these symptoms were included in most diagnostic criteria. In the 1980s Andreasen and Crow suggested a dichotomy into positive and negative syndromes in schizophrenia. Kay and co‐workers introduced a Positive And Negative Syndrome Scale (PANSS) for schizophrenia. In the original studies satisfactory construct validity and inter‐rater reliability were demonstrated. However, in studies outside the USA a high construct validity was found for the negative scales but not for the positive and general psychopathology scales. Furthermore, the inter‐rater reliability of the negative scale was a problem. After introduction of the Structured Clinical Interview for the PANSS (SCI‐PANSS) the inter‐rater reliability increased for all three scales.

In an early study Kay and Sevy found seven factors in a principal component analysis of the PANSS and suggested a four factor pyramidical model. Later principal component analyses by Lepine, Peralta et al. and Kawasaki et al. suggested that the four factor model was an oversimplification and Lindstrijm and von Knorring suggested a five factor pyramidical model. A similar model was later suggested by Bell et al. after a reanalysis of the original series of Kay and Sevy.

In short‐ and long‐term studies of the new balanced serotonin SHT2 ‐dopamine D, antagonist, risperidone, it has been demonstrated that all five factors, the positive, the negative, the excited, the anxious/depressive and the cognitive, are sensitive to changes induced by means of psychopharmacological drugs. Thus the five factor model of schizophrenia seems to be an interesting tool when new, selective, psychopharmacological drugs are to be evaluated and when differences in clinical profiles are sought between different drugs.
New drugs for the treatment of schizophrenic patients
Authors: Fleischhacker W.W.
Published: August 2007

Conventional neuroleptics are widely accepted as being effective against the positive symptoms of schizophrenia, but do not benefit all patients. Furthermore, they are relatively ineffective against negative symptoms and cognitive disorders, and most have unpleasant side effcct profiles. New strategies for treating schizophrenia include the development of dopamine antagonists with high selectivity for different subtypes of dopamine receptors, dopamine partial agonists, antagonists at different serotonin (5–hydroxytryptamine; 5–HT) receptor subtypes, drugs with mixed pharmacological profiles and drugs which modify transmission via amino acids or peptides in the brain.

The prospect is that some of these strategies will lead to the introduction of new drugs and that some of these will become the standards against which future drugs will be compared. The search for new drugs and their use in clinical practice will also lead to developments in our knowledge and understanding of schizophrenia.
Genetic factors in early separation anxiety: implications for the genesis of adult anxiety disorders
Authors: Silove D. , Manicavasagar V. , O'Connell D. , Morris‐Yates A.
Published: August 2007

An important contemporary conceptualization of anxiety has suggested that heightened early separation anxiety is specifically associated with the risk of adult panic disorder, with hereditary factors underlying that cluster of anxiety disorders. Yet there is a dearth of studies examining whether early separation anxiety is inherited. The present twin study, based on a retrospective approach, revealed a substantial genetic contribution to separation anxiety in females but not in males, with unique environmental influences being important in both gender groups. Although speculative, an evolutionary explanation is offered to account for the apparent gender difference in the inheritance of early separation anxiety. It is hypothesized that, in some women, phylogenetic vestiges of separation anxiety may conflict with their need to compete in an individualistic manner in the modern workplace. Whether such an attachment‐autonomy conflict accounts for the increased rate of panic disorder and agoraphobia in women is worthy of further study.
Efficacy of a self‐control therapy program in a psychiatric day‐treatment center
Authors: van den Hout J. H. C. , Arntz A. , Kunkels F. H. J.
Published: August 2007

A 12‐week self‐control therapy program based on the self‐control model proposed by Rehm was added to the routine program for depressed patients in a psychiatric day‐treatment center. It was hypothesized that addition of the self‐control therapy would accelerate the recovery of depressed patients. Twenty‐five depressed patients were randomly assigned to either standard treatment or standard treatment plus the self‐control therapy program. At post‐test, patients in the self‐control condition showed significant improvement with regard to self‐control, self‐esteem, depression, depressed mood and frequency and potential enjoyability of pleasant events, whereas the control patients did not. On 5 of 6 measures the differences between the groups were significant in the hypothesized direction. Although at the 13‐week follow‐up the positive effects of the self‐control therapy were maintained, between‐group differences were no longer significant, except for self‐control.
Mental symptoms, hostility features and stressful life events in people with cancer
Authors: Angelopoulos N. V. , Tzivaridou D. , Nikolaou N. , Pavlidis A.N.
Published: August 2007

Hostility features, mental symptoms, and stressful life events were investigated in 100 patients (59 men and 41 women) suffering from cancer. Fifty‐seven healthy men (n= 26) and women (n= 31) were used for comparison purposes. The assessment instruments were the Hostility and Direction of Hostility Questionnaire, the Delusions Symptoms States Inventory/states of anxiety and depression and a modified version of the Schedule of Life Experiences. Women patients reported lower scores than healthy women on total hostility, but men patients reported higher scores than healthy men. Introverted hostility was increased in both male and female patients, but due to different patterns: in women due to lower scores on extroverted hostility subscales, especially acting‐out hostility, whereas in men due to higher scores on introverted hostility subscales, especially guilt. Female patients, compared with healthy women, reported significantly higher scores on the depressive and anxiety subscales, whereas in the man the differences were not statistically significant even though patients reported higher scores than normals. On the Schedule of Life Experiences, female patients reported statistically significant higher scores than healthy women.
Seasonal mood variation among Japanese residents of Stockholm
Authors: Murase S. , Murase S. , Kitabatake M. , Yamauchi T. , Mathe A. A.
Published: August 2007

Depressive symptoms estimated by the Beck Depression Inventory (BDI) were examined in winter and summer in a total of 242 Japanese adults staying less than 2 years or longer than 10 years in Stockholm, where the length of daylight changes dramatically throughout the winter and summer seasons. In spite of the difference in the period of residency, both groups of subjects showed more mental and somatic depressive symptoms in the winter than in the summer. Moreover, the winter BDI score of long stayers was significantly higher than that of short stayers. Accordingly, our results suggest that, although seasonal mood variation is essentially produced by a chronobiological factor, Swedish lifestyle to which long stayers have been accustomed also influences the seasonal mood variation.
Genes and psychosis: old wine in new bottles?
Authors: Baron M.
Published: August 2007

Despite initial setbacks, linkage studies with DNA markers continue to occupy center stage in psychiatric research. Advances in molecular and statistical techniques have revived the search for disease genes, leading to a new harvest of findings. Most interest in recent years has focused on potential linkages between schizophrenia and chromosomes X‐Y (the pseudoautosomal region) and 22ql2‐13.1, and between bipolar affective disorder and chromosomes 18 (pericentromeric region) and 21q22.3. This article provides a critical evaluation of theses studies, with implications for future research. Concerns over earlier linkage trials make this scrutiny current and topical.
Clinical characteristics of auditory hallucinations
Authors: Oulis P. G. , Mavreas V. G. , Mamounas J. M. , Stefanis C. N.
Published: August 2007

We studied 25 clinical characteristics of auditory hallucinations by means of 3‐point observer‐rated scales in a sample of 60 inpatients with mainly schizophrenic or schizophreniform disorders. The interrater reliability of the scales was found to be satisfactory. High levels of conviction about the reality of the sensory stimuli, clarity of content, location of their source of origin and lack of volitional control were found to be the hallmarks of verbal hallucinations. In general, the characteristics studied were not strongly intercorrelated. This finding supports the hypothesis that the concept of auditory hallucinations represents many aspects of patients’ hallucinatory experiences, which are relatively independent of one another.
Adoption as a risk factor for mental disorders
Authors: Sullivan P. F. , Wells J. E. , Bushnell J. A.
Published: August 2007

Although adoption has been viewed as a risk factor for mental disorders in children and adolescents, few studies have investigated this association in adults. To address this question, we analyzed data from a random community sample of adults where the presence of adoption in the first year of life was systematically noted and where the presence of lifetime mental disorders was determined by structured interview. In comparison to individuals raised by both biological parents, adoption was strongly associated with a history of childhood conduct disorder, antisocial personality and drug abuse or dependence. Adoption may thus be a risk factor for these mental disorders.