bluuebunny/crossref_metadata_2025 huggingface dataset:
Issues in the measurement of violent incidents and the introduction of a new scale: the ‘attacks’ (attempted and actual assault scale)
Authors: Bowers L. , Nijman H. , Palmstierna T. , Crowhurst N.
Published: March 2003

Objective:  To review the strengths and weaknesses of existing violent incident measures, and introduce a new scale, the ‘attacks’. The new scale provides an objective measure of incident severity and focuses on interpersonal physical violence in isolation from other behaviours.

Method:  The new scale was piloted on six psychiatric wards in the East End of London over a period of 16 weeks. Descriptive data were obtained and validated against official violent incident records.

Results:  There were 40 incidents by 21 aggressive patients, most of which occurred on the psychiatric intensive care unit. Striking assaults predominated. Continuous holding of the patient by nurses occurred after 17% of incidents. Special observation was also used as a subsequent management method in more than half of the incidents.

Conclusion:  The scale is acceptable to nurses and valid. Interesting questions are raised about the content of training for staff in the prevention and management of violent incidents.
Perception of aggression, personality disorders and psychiatric morbidity in nursing students
Authors: Muro C. , Tomas C. , Moreno L. , Rubio V.
Published: March 2003

Objective:  To determine the relationship between perception of aggression, personality disorders and psychiatric morbidity.

Method:  Ninety nursing students were interviewed. A two‐stage transversal analysis was used, the first stage using the Spanish version of the general health questionnaire (GHQ‐28), the true‐false test of international personality disorders (IPDE) of Loranger, and the perception of aggression scale (POAS) of Jansen. For the second stage we used the Spanish version of the clinical interview schedule (CIS), and the full test of IPDE.

Results:  Perception of aggression was mainly described as a violent reaction. There were no significant differences in the perception of aggression according to GHQ(+), CIS(+) and IPDE(+). There was a significant relationship between perception of aggression as violent reaction and gender.

Conclusion:  Aggression was perceived by our nursing students as a violent reaction. A significant relationship with gender was observed.
The effects of drug abuse on the stress responsive hypothalamic–pituitary–adrenal axis and the dopaminergic and endogenous opioid systems
Authors: Schlussman S. D. , Nyberg F. , Kreek M. J.
Published: March 2003

Objective:  Drugs of abuse have a significant impact on the stress responsive hypothalamic–pituitary–adrenal (HPA) axis and an abnormal response to stress may mediate the development or maintenance of addictive diseases. In animals, drugs of abuse, such as cocaine, lead to an activation of the HPA axis. Drugs of abuse also have an impact on the endogenous opioid system (EOS) and the dopaminergic system. Each of these systems has also been implicated in the mediation of aggressive behaviors. This brief report focuses on the effects of drugs of abuse on the stress responsive HPA, EOS and dopaminergic systems, and the role of these systems in mediating aggression and comorbidity of substance abuse and aggressive behaviors.

Method:  Rodents were administered either ‘binge’ pattern cocaine (15 mg/kg × 3 each day) or the androgenic anabolic steroid nandrolone decanoate and the effects on mRNA levels, receptor binding and circulating levels of stress hormones were analyzed.

Results:  Both cocaine and nandrolone decanoate significantly impact the HPA axis, the EOS and the dopaminergic systems.

Conclusion:  Drugs of abuse impact substantially the same neural systems that affect aggressive behavior.
Bullying in the school environment: an injury risk factor?
Authors: Laflamme L. , Engström K. , Möller J. , Alldahl M. , Hallqvist J.
Published: March 2003

Objective:  To describe a research project assessing the role of bullying at school as an injury trigger and the modification effect of the socio‐economic environment of the victims. Preliminary results are also presented.

Method: A case‐crossover and a case‐referent design were combined. The study base consisted of all children aged 10–15 years residing in the Stockholm county in 2000–02. Cases were recruited at the county's children hospital and interviewed shortly after the injury, using a specially designed questionnaire.

Results:  Preliminary analyses (261 interviews) reveal that about two injured children out of 10 reported having been bullied during the school term. Also, one out of 10 had been bullied shortly enough before the injury for bullying to be considered as a trigger. The circumstances of occurrence of those injuries varied.

Conclusion:  Bullying, apart from being frequent in the school environment, is quite likely to act as an injury trigger.
Socio‐economic differences in intentional injuries: a national study of Swedish male and female adolescents
Authors: Engström K. , Laflamme L.
Published: March 2003

Objective:  To measure socio‐economic differences in intentional injuries among Swedish adolescents.

Method:  A cross‐sectional study, based on linkage of records from national registers, considering injuries incurred by all adolescents domiciled in Sweden in 1990–94. Absolute and relative differences between adolescents from four household socio‐economic groups (SEGs) were measured, considering separately males and females, two age categories (10–14 and 15–19 years) and injuries caused by interpersonal violence and self‐inflicted injuries.

Results:  Absolute differences (in injury incidence) between SEGs were greatest for self‐inflicted injuries, among older female adolescents. There were clear social gradients in all instances, but relative differences (relative risks) reached a peak for interpersonal violence among younger adolescents, for both boys and girls.

Conclusion:  There is a clear association among Swedish adolescents between type of intentional injury and gender, with absolute differences remarkably wide for self‐inflicted injuries. For a given age category, gender‐specific social gradients are quite comparable within diagnosis.
Management of violence in the workplace: a New Zealand survey
Authors: Gale C. , Pellett O. , Coverdale J. , Paton Simpson G.
Published: March 2003

Objective: To estimate the rate of adverse events to staff, to survey the use of various preventative measures, and to assess any association between these factors and the reported event rate.

Method:  An anonymous postal nation‐wide survey of violence reported to managers of psychiatric units in New Zealand.

Results:  The mean rate of adverse event per 100 full time equivalent staff was 16.2 (range 0–187) for property damage, 16.3 (range 0–204) for attempted assault, 12 (range 0–194) for physical attack, 1.3 (range 0–33) for sexual harassment and 1.1 (range 0–17) for stalking. Inpatient units, the use of pocket alarms, and training in de‐escalation were associated highly with an increase risk of adverse events.

Conclusion:  There is a high variation in the rate of violence. The issue of increased rate of events with certain interventions will require further research.
How do you define remission?
Authors: Lecrubier Y.
Published: March 2003

Objective:  To underscore the need to attain remission in the treatment of depression, taking into consideration the appropriate definitions of response and remission, as well as the impact of residual symptomatology.

Method:  A review of research pertaining to successful response and remission of depression following antidepressant intervention, as identified by a comprehensive MEDLINE search.

Results:  Complete remission is both critical and attainable with appropriate antidepressant therapy.

Conclusion:  While adequate response to antidepressant medication is desired, the ultimate goal of therapy is remission, the achievement of an asymptomatic state characterized by complete functional recovery.
Achieving gains beyond response
Authors: Paykel E. S.
Published: March 2003

Objective:  To review adverse outcomes following response in treatment of depression.

Method:  Review of published literature with particular emphasis on key papers.

Results:  Moderately high rates of relapse and recurrence are found in naturalistic follow‐up studies of depressed patients receiving modern treatment. These are reduced but not abolished in controlled trials by continuation and maintenance treatment with antidepressants. Suicide rates in follow‐up studies are much elevated compared with the general population. Social function is impaired and remits more slowly than depressive symptoms. A key outcome is the occurrence of incomplete remission with residual symptoms, which is associated with high relapse rates and impaired social function.

Conclusion:  It is important to achieve complete remission in depression. Elimination of residual symptoms is an important target for full treatment of the depressive episode, in order to avoid later adverse outcomes.
Achieving remission from depression with venlafaxine and venlafaxine extended release: a literature review of comparative studies with selective serotonin reuptake inhibitors
Authors: Rudolph R. L.
Published: March 2003

Objective:  To evaluate data supporting the ability of venlafaxine, an antidepressant with a dual mechanism of action, to produce remission from depression.

Method:  Review of multicentre, double‐blind, randomized studies comparing venlafaxine or venlafaxine extended release (XR) with a selective serotonin reuptake inhibitor (SSRI), using Hamilton Depression Rating Scale total scores in the range of ≤7 and <10 as the final outcome measure, to evaluate the ability of venlafaxine/venlafaxine XR to produce full remission from depression.

Results:  Venlafaxine/venlafaxine XR demonstrated higher rates of remission than did the SSRIs and placebo.

Conclusion:  With full remission rather than response as the measure of outcome, venlafaxine/venlafaxine XR demonstrated more robust antidepressant efficacy than the SSRIs and placebo. This finding suggests that venlafaxine/venlafaxine XR are appropriate standard‐of‐care therapies for the treatment of patients with major depressive disorder.
Brain noradrenaline and the mechanisms of action of antidepressant drugs
Authors: Svensson Torgny H.
Published: March 2003

The basic mechanisms of action of presently used antidepressant drugs are still far from understood. This review will address a few critical issues in this area, namely (i) putative mechanisms underlying the delay in onset of action of monoamine reuptake inhibitors and potential limitations to the efficacy of these drugs, (ii) the significance of stress‐induced activation of the locus coeruleus noradrenergic system for the function of the mesolimbic reward system and the effect of chronic antidepressant treatment within this context and (iii) the interaction between brain noradrenaline and 5‐hydroxytryptamine systems and its significance for antidepressant drug action. Recent preclinical and clinical research which suggest novel strategies to enhance antidepressant drug efficacy will also be discussed. From this review emerges the notion that facilitation of brain noradrenergic neurotransmission may represent a more fundamental means to achieve maximal response in major depression than hitherto understood.
Traumatic events and post‐traumatic stress disorder in the community: prevalence,risk factors and comorbidity
Authors: Perkonigg A. , Kessler R. C. , Storz S. , Wittchen H‐U.
Published: March 2003

Objective: Lifetime and 12‐month prevalence of traumatic events and DSM‐IV post‐traumatic stress disorder as well as risk factors and comorbidity patterns were investigated in a representative community sample (n=3021, aged 14–24 years).

Method: Traumatic events and PTSD were assessed with the Munich Composite International Diagnostic Interview (CIDI).

Results: Although 26% of male subjects and 17.7% of female subjects reported at least one traumatic event, only a few qualified for a full PTSD diagnosis (1% of males and 2.2% of females). Traumatic events and PTSD were strongly associated with all other mental disorders examined. PTSD occurred as both a primary and a secondary disorder.

Conclusion: The prevalence of PTSD in this young German sample is considerably lower than reported in previous studies. However, the conditional probability for PTSD after experiencing traumas, risk factors and comorbidity patterns are quite similar. Traumatic events and full PTSD may increase the risk for other disorders, and vice versa.
A transcultural outcome study of adolescent eating disorders
Authors: Steinhausen H‐C. , Boyadjieva S. , Grigoroiu‐Serbanescu M. , Seidel R. , Winkler Metzke C.
Published: March 2003

Objective: The aim of the study was to assess the treatment and outcome of adolescent eating disorders in an international study including Western and Eastern European clinical and research centres. Method: A total of 138 patients with adolescent onset of an eating disorder (primarily anorexia nervosa) were followed up after a mean interval of 5 years after first admission. Results: On average, the patients had spent 25% of the total follow‐up period in either in‐patient or out‐patient treatment. Half of them required a second hospitalization and a quarter required a third hospitalization for the eating disorder. At follow‐up, 68% of the total sample did not have an eating disorder. The prediction of outcome revealed different patterns of risk variables depending on the type of criterion. Conclusion: The outcome of adolescent eating disorders is relatively similar across cultures, and better than in patients with later onset of the disorder.
Dangerous female psychiatric patients: prevalences and characteristics
Authors: Linaker O. M.
Published: March 2003

Objective:We wanted to study the prevalence and characteristics of dangerousness among female psychiatric patients.

Method:A national survey was performed in Norway, covering all psychiatric in‐ and out‐patient units.

Results:There were 329 persons reported to have a psychiatric disorder and to satisfy our criteria for dangerousness, giving a total prevalence of 9.9/100 000 adults. There were 54 women, giving a female prevalence of 3.1/100 000. When compared to a matched sample of the men, fewer women were out‐patients or had had jail sentences. We found no sex differences with regard to frequencies of psychosis, mental retardation, personality disorders, or drug or alcohol abuse. The women had an increased frequency of suicide‐related and self‐injurious behaviours and previous commitment for arson.

Conclusion:The prevalence of women with psychiatric disorders who are considered to be dangerous was 3.1/100 000. The dangerous men did not show higher frequencies than the women for psychopathology, drug abuse, behaviour or criminality.
‘Everybody looks at my pubic bone’— a case report of an adolescent patient with body dysmorphic disorder
Authors: Sobanski E. , Schmidt M. H.
Published: March 2003

Objective: Body dysmorphic disorder (BDD) was described for the first time more than 100 years ago, but it is still unknown to many clinicians. Although the onset usually occurs during adolescence, BDD has received little attention in the adolescent psychiatric literature.

Method: The case and treatment of a 16‐year‐old female patient is described.

Results: The patient, suffering from the overvalued belief of a dislocated pubic bone, a comorbid mild depressive episode, BDD associated rituals and social avoidance, was treated successfully with a combination of exposure and response prevention and 125 mg/day of doxepine.

Conclusion: If BDD is diagnosed early in the course and treated appropriately, it is possible to obtain a satisfying outcome.
A placebo‐controlled comparison of zotepine versus chlorpromazine in patients with acute exacerbation of schizophrenia
Authors: Cooper S. J. , Tweed J. , Raniwalla J. , Butler A. , Welch C.
Published: March 2003

Objective:The aim was to evaluate the efficacy of zotepine in the treatment of acute episodes of schizophrenia.

Method:Patients with acute exacerbation of schizophrenia (DSM‐III‐R criteria; n=158) were allocated on a random, double‐blind basis to receive zotepine (150 or 300 mg/day), chlorpromazine (300 or 600 mg/day) or placebo for 8 weeks. Symptoms were assessed on the BPRS, SANS and CGI scales at baseline and weeks 1, 2, 4, 6 and 8 and patients were assessed at these times for adverse effects. Analysis was by analysis of variance on the intent‐to‐treat population, with last observation carried forward.

Results:Mean BPRS scores improved statistically significantly more with zotepine than chlorpromazine (point estimate of difference −12.4, 95% CI −18.3 to −6.5) or placebo (point estimate of difference −12.7, 95% CI −18.6 to −6.8). Zotepine produced significantly fewer extrapyramidal symptoms (EPS) than chlorpromazine.

Conclusion:Zotepine is an effective antipsychotic with low propensity for EPS.
Decreased platelet monoamine oxidase activity in female anorexia nervosa
Authors: Díaz‐Marsá M. , Carrasco J. L. , Hollander E. , César J. , Saiz‐Ruiz J.
Published: March 2003

Objectives: To study if platelet MAO activity, previously described as a serotonergic index, is modified in a sample of pure restrictive anorectic patients.

Method: Twenty five female patients with DSM‐IV anorexia nervosa restricting type were studied and compared with 30 healthy female controls. Platelet MAO activity was measured by isotopic methods using C‐14 benzylamine. Impulsive personality features were measured with specific rating scales and temperament studied with Cloninger's TCI.

Results: Platelet MAO activity was significantly lower (4.3+2.7 nmol/h/108 platelets) in the anorectic patients than in the control group (6.7+2.8) (P<0.01). Platelet MAO was inversely correlated with scores on impulsivity scales and positively correlated with the dimension ‘persistence’ of Cloninger's TCI.

Conclusion: Platelet MAO activity is lowered in a group of patients with anorexia nervosa and might involve some dysfunction in the regulation of impulse control.
Low serum cholesterol levels and depressive state in human dock visitors
Authors: Terao T. , Iwata N. , Kanazawa K. , Takano T. , Takahashi N. , Hayashi T. , Sugawara Y.
Published: March 2003

Objective: The purpose of the present study was to investigate an association between serum cholesterol levels and depressive state. Method: Physical examinations and mental assessments were performed for 13 702 human dock visitors. We obtained 13 571 sets of complete data for serum total cholesterol, the scores for depressive state and possible confounders such as sex, age, body weight, body mass index (BMI), recent weight loss, total protein and concomitant medical diagnoses. Results: Their depressive state varied significantly across the serum cholesterol levels after adjusting age and gender. After controlling all the above confounding variables the significance still remained, not only in the categorical analysis but also in the continuous analysis. Conclusion: The present findings suggest that there is an association between cholesterol and depressive state.
Transcranial magnetic stimulation induces ‘pseudoabsence seizure’
Authors: Conca A. , König P. , Hausmann A.
Published: March 2003

Objective: Several studies support the hypothesis of an antidepressive or mood‐enhancing effect of repetitive transcranial magnetic stimulation (rTMS) on depressive patients. The most acute concern regarding rTMS is possible seizure induction; therefore reports on seizure during rTMS are of special significance.

Method: We describe a case in which high frequency rTMS over the left dorsolatero‐prefrontal cortex (DLPC) applied as an add‐on antidepressive strategy may have induced a frontal lobe complex partial seizure in a female patient affected by drug‐resistant depression.

Results: The epileptic seizure was self‐limited, and the patient did not report any physical sequelae. The psychopathological improvement, observed immediately after the incident in question, did not last.

Conclusion: We assume that in this case train duration in rTMS, combined with drugs modulating the norepinephrine turnover, may have contributed to the occurrence of this complex partial seizure, which neuroanatomically seems to be localized in the DLPC.
Cognitive dysfunctions and white matter lesions in patients with bipolar disorder in remission
Authors: Krabbendam L. , Honig A. , Wiersma J. , Vuurman E. F. P. M. , Hofman P. A. M. , Derix M. M. A. , Nolen W. A. , Jolles J.
Published: March 2003

Krabbendam L, Honig A, Wiersma J, Vuurman EFPM, Hofman PAM, Derix MMA, Nolen WA, Jolles J. Cognitive dysfunctions and white matter lesions in patients with bipolar disorder in remission. Acta Psychiatr Scand 2000: 101: 274–280. © Munksgaard 2000.

Objective: To compare cognitive functioning in relation to white matter lesions in bipolar disorder in remission and schizophrenia. Method: Cognitive performance and the occurrence of white matter lesions on MRI images of the brain were assessed in 22 patients with bipolar disorder in remission, 22 patients with schizophrenia and 22 healthy volunteers.

Results: Performance of tests of memory, speed and cognitive flexibility was significantly impaired in both patient groups. The frequency of white matter lesions did not differ significantly between the three groups. No differences in cognitive performance were found between patients with white matter lesions and patients without such lesions. Conclusion: White matter lesions apparently do not underlie cognitive deficits that are found in patients with bipolar disorder in remission and in patients with schizophrenia.
Cognitive dysfunction in obsessive‐compulsive disorder
Authors: Okasha A. , Rafaat M. , Mahallawy N. , Nahas G. El , Dawla A. Seif El , Sayed M. , Kholi S. El
Published: March 2003

Okasha A, Rafaat M, Mahallawy N, El Nahas G, Seif El Dawla A, Sayed M, El Kholi S. Cognitive dysfunction in obsessive‐compulsive disorder.

Acta Psychiatr Scand 2000: 101: 281–285. © Munksgaard 2000.

Objective: Assessment of cognitive functions among obsessive‐compulsive disorder (OCD) patients would help in understanding the neurobiology and brain areas involved in that disorder. The objective of this work was to study the cognitive dysfunction in OCD patients and to identify its correlation with both the clinical picture and the severity of the disorder.

Method: Neuropsychological and electrophysiological event‐related potentials were tested in 30 OCD patients and compared with 30 normal volunteers of a matched gender, age and education. Results: Results showed a defective visuospatial recognition, which worsens with chronicity, deteriorated set‐shifting abilities, overfocused attention to irrelevant stimuli and delayed selective attention to relevant tasks. Mild cases showed better selective attention than severe cases. Obsessive cases had a defective visual memory, while compulsive cases had delayed perception of task relevant stimuli. Mixed cases showed disturbed information‐processing both early and late.

Conclusion: OCD patients have a characteristic pattern of cognitive dysfunction that differs among patients of varied severity, chronicity and symptom type. We suggest a striatofrontoparietal neural pathophysiol‐ogy. OCD seems to be a heterogeneous disorder, both clinically and pathophysiologically.
Effects of a coping‐orientated group therapy for schizophrenia and schizoaffective patients: a pilot study
Authors: Andres K. , Pfammatter M. , Garst F. , Teschner C. , Brenner H. D.
Published: March 2003

Andres K, Pfammatter M, Garst F, Teschner C, Brenner HD. Effects of a coping‐orientated group therapy for schizophrenia and schizoaffective patients: a pilot study.

Acta Psychiatr Scand 2000: 101: 318–322.© Munksgaard 2000.

Objective: This controlled pilot study was designed, first, to examine the efficacy of two different group therapy formats for schizophrenia and schizoaffective patients: a patient‐centred, psychoeducative and coping‐orientated group therapy approach and a supportive therapy group. Secondly, it intended to establish preliminary hypotheses on the therapeutically relevant factors.

Method: In a sample of 32 patients suffering from schizophrenia or a schizoaffective disorder the effect sizes of the coping‐orientated therapy approach and a supportive group therapy on several outcome variables were examined and the predictive power of different effect variables on outcome was analysed.

Results: The effect sizes show improvements in the cognizance of the disorder and the related pharmacotherapy, the psychopathology and the Social functioning for both therapy conditions. Moreover, outcome as measured after 1 year was best predicted by the patient's mastery of active, problem‐focused coping strategies.

Conclusion: The results corroborate the appropriateness of focusing on aspects of coping‐behaviour in psychological interventions.
Patient satisfaction: a valid index of quality of care in a psychiatric service
Authors: Shipley K. , Hilborn B. , Hansell A. , Tyrer J. , Tyrer P.
Published: March 2003

Shipley K, Hilborn B, Hansell A, Tyrer J, Tyrer P. Patient satisfaction: a valid index of quality of care in a psychiatric service.

Acta Psychiatr Scand 2000: 101: 330–333. © Munksgaard 2000.

Objective: To assess patients, clinicians' and referrers' satisfaction with care in newly referred psychiatric patients and to compare these with standard quality indicators such as waiting times used by the service.

Method: A random sample of all new adult psychiatric patients presenting over a 4–month period in 2 successive years to an inner‐city psychiatric service was assessed.

Results: One hundred and thirteen (68%) of 167 randomly selected patients were seen. Independent evidence of service performance showed that patient satisfaction, but not clinician or referrer satisfaction, was a more accurate indicator of quality of care than standard indicators.

Conclusion: Simple ratings of patient satisfaction alone may be useful indicators of quality of psychiatric care.
Clozapine and risperidone: combination/ augmentation treatment of refractory schizophrenia: a preliminary observation
Authors: Raskin S. , Katz G. , Zislin Z. , Knobler H. Y. , Durst R.
Published: March 2003

Raskin S, Katz G, Zislin Z, Knobler HY, Durst R. Clozapine and risperidone: combination/augmentation treatment of refractory schizophrenia: a preliminary observation.

Acta Psychiatr Scand 2000: 101: 334–336. © Munksgaard 2000.

Objective: Clozapine and risperidone were the first two antipsychotic drugs of a new class of agents for the pharmacotherapy of schizophrenia. It has been suggested that refractory schizophrenic patients who fail to respond to neither clozapine nor risperidone may respond to a combination/augmentation strategy of both medicaments.

Method: Three cases of individuals with unremittent schizophrenia treated via this combination are presented. Response was evaluated by clinical follow‐up and PANSS rating scale.

Results: Good clinical results with no noticeable adverse side effects, ascertained by a reduction from baseline scores of the Positive and Negative Syndrome Scale (PANSS) were obtained in all three patients.

Conclusion: The findings from this pilot study suggest this combination as a possible therapeutic approach for treating resistant schizophrenic patients.
European Consultation–LiaisonPsychiatric Services:the ECLW Collaborative Study
Authors: Huyse F. J. , Herzog T. , Lobo A. , Malt U. F. , Opmeer B. C. , Stein B. , Creed F. , Crespo M. D. , Gardoso G. , Guimaraes‐Lopes R. , Mayou R. , Moffaert M. van , Rigatelli M. , Sakkas P. , Tienari P.
Published: March 2003

Objective: To describe the patterns of organization of consultation–liaison (C‐L) services in 11 European countries in relation to hospital characteristics and national approaches to C‐L psychiatry.

Method: Cross‐sectional survey.

Results: Services can best be described in terms of their size and seniority of their staff and whether or not they are multidisciplinary. Single‐discipline services are based upon the standard medical consultant model, whereas those with multidisciplinary teams work in a way that is comparable with community mental health teams. German psychosomatic C‐L services belonged to either model. National differences were found.

Conclusion: This first international study provides empirical evidence for the wide variation in the organization of C‐L services. In view of the increasing numbers of patients with psychiatric disorder who are being treated in general hospitals and the changing patterns of medical care there are important implications for clarification and improvement of the role of C‐L services.
Predictors for readmission risk of new patients: the Nordic Comparative Studyon Sectorized Psychiatry
Authors: Øiesvold T. , Saarento O. , Sytema S. , Vinding H. , Göstas G. , Lönnerberg O. , Muus S. , Sandlung M. , Hansson L.
Published: March 2003

Objective: Predictors for readmission risk were investigated in this study, which forms part of the Nordic Comparative Study on Sectorized Psychiatry.

Method: Included were a total of 837 consecutive ‘new’ patients (not in contact with the psychiatric services for at least 18 months) admitted to in‐patient stay during a period of 1 year to seven psychiatric hospitals in four Nordic countries.

Results: Multivariate survival analyses showed that younger age predicted increased readmission risk. Stratifying on gender, diagnostic group and sector revealed a general pattern concerning age which was the only consistent main effect. Living alone and unemployed increased readmission risk in the non‐psychosis group, while receipt of aftercare decreased readmission risk in the psychosis group. A curvilinear relationship was found between availability of psychiatric resources and readmission risk: an intermediate amount of resources was associated with increased risk.

Conclusion: Our findings support a hyphothesis that readmission risk is multifactorially determined and that interactions have to be considered.
Effect of number of episodes on wellbeing and functioning of patients with bipolar disorder
Authors: MacQueen Glenda M. , Young L. Trevor , Robb Janine C. , Marriott Michael , Cooke Robert G. , Joffe Russell T.
Published: March 2003

Objective: To examine the relationship between number of episodes and inter‐episode functioning in bipolar disorder.

Method: Sixty‐four euthymic subjects with bipolar affective disorder completed the Medical Outcomes Questionnaire Short Form and the Global Assessment of Functioning Scale. Goodness‐of‐fit models were used to define the relation between episode number and level of function.

Results: Non‐linear logarithmic and power relations best described the association between number of episodes and outcome. Number of past depressions was a stronger determinant of outcome than past manias.

Conclusion: Strategies to minimize the number of episodes experienced by patients with bipolar illness must be pursued aggressively if function is to be maintained, with particular attention given to minimizing episodes of depression.
Excess cancer mortality in Western Australian psychiatric patients due to higher case fatality rates
Authors: Lawrence D. , D'Arcy C. , Holman J. , Jablensky A. V. , Threfall T. J. , Fuller S. A.
Published: March 2003

Objective: To investigate the association between mental illness and cancer incidence, mortality and case fatality.

Method: A population‐based record linkage study was undertaken based on 172 932 patients of mental health services in Western Australia. Records of mental health service contacts were linked with cancer registrations and death records.

Results: While there was little difference in overall cancer incidence rates between psychiatric patients and the general community (RR in males 1.05, 95% CI 1.02–1.09, RR in females 1.02, 0.98–1.05), cancer mortality was 39% higher in males (95% CI: 32–46%) and 24% higher in females (17–32%).

Conclusion: People with mental illness in Western Australia do not show an increased incidence rate of cancer, but do have higher cancer mortality. This was attributed to a higher cancer case fatality rate among people with mental illness.
Systemic lupus erythematosus presenting as mania
Authors: Khan S. , Haddad P. , Montague L. , Summerton C.
Published: March 2003

Objective: Psychiatric manifestations of systemic lupus erythematosus (SLE) are well recognized but usually occur in the later stages of the illness, with organic syndromes being the most common. This case highlights the fact that SLE can present with mania.

Method: Single case report.

Results: A 32‐year‐old woman was admitted to hospital with her first manic illness. Physical examination and investigations revealed her to be suffering from SLE although this had not been previously diagnosed. Her physical and psychiatric symptoms settled rapidly following treatment with prednisolone and chlorpromazine.

Conclusion: The case emphasizes the polymorphous manifestations of SLE and the importance of considering physical disorders in patients with a first episode of psychosis.
Mania: differential effects of previous depressive and manic episodes onresponse to treatment
Authors: Swann A. C. , Bowden C. L. , Calabrese J. R. , Dilsaver S. C. , Morris D. D.
Published: March 2003

Objective: We compared effects of previous depressive or manic episodes on antimanic response.

Method: In‐patients in a parallel‐groups, double‐blind comparison of lithium, divalproex or placebo for manic episodes had comprehensive evaluations of illness history. We used non‐linear curve fitting of change in Manic Syndrome Score (MSS) of the Schedule for Affective Disorders and Schizophrenia (SADS) versus previous depressive or manic episodes to investigate their relationships to MSS improvement.

Results: Response to lithium, but not to divalproex or placebo, worsened with increased depressive or manic episodes. More than 11 manic, or four depressive, episodes was associated with response to lithium that did not differ from placebo. Effects of previous depressive and manic episodes appeared independent, and could not be accounted for by increased rapid cycling or mixed states.

Conclusion: At least four previous depressive or 12 previous manic episodes are associated with reduced antimanic response to lithium.
Are fish oils an effective therapy in mental illness — an analysis of the data
Authors: Maidment Ian D.
Published: March 2003

Objective: To review the literature regarding the use of fish oils in the treatment of psychiatric illness.

Method: A Medline search was conducted in September 1999.

Results: Five papers have investigated omega‐3 fatty acids levels in depression. One study used omega‐3 fatty acids as an adjunctive therapy in bipolar disorder. Four studies used fatty acids as an adjunctive therapy in schizophrenia.

Conclusion: There is a great deal of current research in this field. While omega‐3 fatty acids levels may be lowered in depression, there are no data suggesting that omega‐3 fatty acids are effective. One paper indicates that omega‐3 fatty acids are effective in bipolar disorders. The data on schizophrenia are conflicting. Omega‐3 and omega‐6 fatty acids have proved effective. Most of the evidence suggests that the main effect is an improvement in negative symptoms. One recent study showed that omega‐3 fatty acids had no effect on negative symptoms.
Brain imaging in childhood‐ and adolescence‐onset schizophrenia associated with obsessive‐compulsive symptoms
Authors: Aoyama F. , Iida J. , Inoue M. , Iwasaka H. , Sakiyama S. , Hata K. , Kishimoto T.
Published: March 2003

Objective: Childhood‐ and adolescence‐onset schizophrenic patients with obsessive‐compulsive symptoms (OCS) constitute a specific subgroup of schizophrenia. We performed magnetic resonance imaging in this group seeking evidence of neurodevelopmental insults.

Method: Thirty‐two schizophrenic patients were compared with 19 controls. Schizophrenic subjects were divided into 15 patients with OCS (SOCS+ group; onset at 15.5±1.6 years) and 17 without OCS (SOCS− group; onset at 15.3±1.3 years). Areas of the hippocampus, frontal lobe, corpus callosum and putamen were analysed morphometrically.

Results: The left hippocampus was significantly smaller in the SOCS+ group than in the SOCS− and control groups.

Conclusion: Reduced size of the left hippocampus in the SOCS+ group supports a neurodevelopmental etiology in this subgroup.
Seasonal variation in hospital admission for bipolar disorder, depression and schizophrenia in Tasmania
Authors: Daniels B. A. , Kirkby K. C. , Mitchell P. , Hay D. , Mowry B.
Published: March 2003

Objective: Seasonal variation has been reported for both affective disorders and schizophrenia. The current study examines seasonal variation in admissions in schizophrenia, depression and bipolar disorder in Tasmania, the southernmost state of Australia.

Method: All admissions with a diagnosis of schizophrenia, bipolar disorder and depression in Tasmania between 1983 and 1989 were examined for evidence of seasonal variation in admission patterns.

Results: Using the modified Kolmogorov–Smirnov statistic defined by Freedman no significant seasonal variation was found in admissions with diagnoses of mania, depression or schizophrenia. There was a significant seasonal variation in admissions with schizoaffective disorder (winter peak).

Conclusion: There is no significant seasonal variation in admissions with schizophrenia, depression or bipolar disorder in Tasmania. This may be due to a combination of geographical location and the stringent test of seasonal variation used in the current study.
Delusion and desire: erotomania revisited
Authors: Kelly B. D. , Kennedy N. , Shanley D.
Published: March 2003

Objective: This paper examines the phenomonology in a case of erotomania and reviews classical and contemporary treatment options.

Method: A case of primary erotomania is described.

Results: Treatment with hospitalization and risperidone produced rapid clinical improvement.

Conclusion: Atypical antipsychotic drugs may be useful in the treatment of this interesting syndrome.
Suicide attempts and personality disorder
Authors: Suominen Kirsi H. , Isometsä Erkki T. , Henriksson Markus M. , Ostamo Aini I. , Lönnqvist Jouko K.
Published: March 2003

Objective: The purpose of the present study was to compare clinical characteristics of suicide attempters with or without personality disorders.

Method: A systematic sample (n=114) of patients from consecutive cases of attempted suicide referred to general hospitals in Helsinki was interviewed and diagnosed according to DSM‐III‐R. Forty‐six subjects with DSM‐III‐R personality disorders were identified and divided into clusters A (n=4), B (n=34) and C (n=8). These subjects were compared with 65 suicide attempters without personality disorders in terms of clinical characteristics and treatment received.

Results: Suicide attempters with personality disorders more often had a history of previous suicide attempts and lifetime psychiatric treatment than comparison subjects. However, suicide attempts did not differ in terms of suicide intent, hopelessness, lethality or impulsiveness between subjects with or without personality disorders.

Conclusion: Although suicidal behaviour is a more persistent feature among those with personality disorders, their clinical characteristics at the time of a suicide attempt may not differ from those without personality disorders.
Granulocyte colony‐stimulating factor plasma levels during clozapine‐ and olanzapine‐induced granulocytopenia
Authors: Schuld Andreas , Kraus Thomas , Hinze‐Selch Dunja , Haack Monika , Pollmächer Thomas
Published: March 2003

Objective: Recent case studies suggest that impaired granulopoiesis, well‐known to occur during clozapine treatment, may also be observed when olanzapine is administered. The underlying mechanisms are unknown, but haematopoietic cytokines such as granulocyte colony‐stimulating factor (G–CSF) are likely to be involved.

Method: We measured the plasma levels of G–CSF and of other cytokines longitudinally in a female patient who developed granulocytopenia twice, first during clozapine treatment and again when olanzapine was administered.

Results: G–CSF levels, but not those of other cytokines, closely paralleled granulocyte counts, yielding a significant positive correlation. G–CSF was not detectable in plasma when granulocytopenia occurred. Granulocytopenia resolved spontaneously despite continuing treatment with olanzapine.

Conclusion: The present case suggests that clozapine and olanzapine both are able to induce transient granulocytopenia through a similar or common mechanism that does not involve a compensatory increase in G–CSF levels.
The 12‐month prevalence and risk factors for major depressive episode in Finland: representative sample of 5993 adults
Authors: Lindeman Sari , Hämäläinen Juha , Isometsä Erkki , Kaprio Jaakko , Poikolainen Kari , Heikkinen Martti , Aro Hillevi
Published: March 2003

Objective: This study reports the 12‐month prevalence of major depressive episode and its risk factors in a representative nationwide sample.

Method: A random sample of non‐institutionalized Finnish individuals aged 15–75 years (N=5993) was interviewed in 1996. Major depressive episode during the last 12 months was assessed using the Short Form of the University of Michigan version of the Composite International Diagnostic Interview (the UM‐CIDI Short Form).

Results: The population prevalence of major depressive episode was 9.3% [95% CI 8.5,10.0], and the age‐adjusted prevalences for females and males were 10.9% [95% CI 9.7,12.0] and 7.2 [95% CI 6.2,8.2], respectively. In logistic regression analyses the factors associated with major depressive episode after adjustment for age were urban residency, smoking, alcohol intoxication and chronic medical conditions. In addition, being single and obese were found to be risk factors for males.

Conclusion: The female to male risk ratio for major depressive episode was smaller than in many previous studies. The sex‐specific risk factor associations warrant further investigation into sex differences in depression.
Swedish universities Scales of Personality (SSP): construction, internal consistency and normative data
Authors: Gustavsson J. Petter , Bergman Hans , Edman Gunnar , Ekselius Lisa , Von Knorring Lars , Linder Jürgen
Published: March 2003

Objective: A thorough revision of the Karolinska Scales of Personality (KSP) was made by reducing the number of items and improving the psychometric quality as concerns face validity, internal consistency and response differentiation. The revised version was labelled The Swedish universities Scales of Personality (SSP) and now include 91 items divided into 13 scales.

Method: The SSP were evaluated in a normative, randomly drawn sample (n=741). All scales were found to be approximately normally distributed.

Results: The Cronbach's α coefficients ranged from 0.59 to 0.84. The mean inter‐item correlations (MIIC) ranged from 0.17 to 0.43. The scale intercorrelation matrix yielded a three‐factor solution with Factor 1 reflecting Neuroticism; Factor 2 Aggressiveness; and Factor 3 reflecting Extraversion.

Conclusion: The original KSP scales were revised, shortened, modernized and psychometrically evaluated. The psychometric properties and the usefulness of the test battery were found to be substantially improved.
Prospective evaluation of circulatory levels of catecholamines and serotonin in neuroleptic malignant syndrome
Authors: Spivak Baruch , Maline Dimitri I. , Vered Yaffa , Kozyrev Vladimir N. , Mester Roberto , Neduva Sender A. , Ravilov Renat S. , Graff Eran , Weizman Abraham
Published: March 2003

Objective: Neuroleptic malignant syndrome (NMS) may be associated with a dysregulation of the catecholaminergic and serotonergic systems. The objective of the present study was to evaluate prospectively the circulatory levels of serotonin (5‐HT), epinephrine (E) and dopa in patients suffering from NMS.

Method: Platelet‐poor plasma (PPP) levels of serotonin, epinephrine and dopa in eight NMS patients were measured twice: in the acute state and in the state of remission.

Results: PPP dopa concentration was significantly lower in acute NMS state compared to the remission state (P=0.023). In contrast, PPP E level was significantly higher (P=0.019) in the acute NMS state and PPP 5‐HT concentrations in the acute state tended to be higher than those at remission (P=0.078). 5‐HT/dopa ratio was significantly higher in the acute NMS (P=0.015).

Conclusion: These results may reflect reduction in dopaminergic function and increase in adrenergic and serotonergic activity in the acute NMS state.
Age‐related change in personality disorder trait levels between early adolescence and adulthood: a community‐based longitudinal investigation
Authors: Johnson Jeffrey G. , Cohen Patricia , Kasen Stephanie , Skodol Andrew E. , Hamagami Fumiaki , Brook Judith S.
Published: March 2003

Objective: To investigate change in personality disorder (PD) traits between early adolescence and early adulthood among individuals in the community.

Method: PD traits were assessed in 1983 (mean age=14), 1985–86 (mean age=16) and 1992 (mean age=22) in a representative community sample of 816 youths.

Results: Overall, PD traits declined 28% during both adolescence and early adulthood. PD traits were moderately stable during the first 2‐year interval, and were as stable as they have been reported to be among adults over similar intervals. PD trait stability declined slightly as the inter‐assessment interval increased. Adolescents with PDs tended to have elevated PD traits during early adulthood.

Conclusion: PD traits tend to decline steadily in prevalence during adolescence and early adulthood. However, adolescents with PDs often have elevated PD traits as young adults, and the stability of PD traits appears to be similar during adolescence and early adulthood.
The relationship of symptoms and level of functioning in schizophrenia to general wellbeing and the Quality of Life Scale
Authors: Norman Ross M.G. , Malla Ashok K. , McLean Terry , Voruganti L. Panth N. , Cortese Leonard , McIntosh Elizabeth , Cheng Stephen , Rickwood Ann
Published: March 2003

Objective: Reports suggesting that quality of life in schizophrenia is more highly related to negative rather than positive symptoms are largely based on use of the Quality of Life Scale which was devised to assess deficit symptoms and does not include an assessment of subjective general wellbeing. In the current paper we examined symptoms, level of community functioning as well as living circumstances as correlates of Quality of Life Scale scores and scores on the General Well‐Being Scale.

Method: One hundred and twenty‐eight patients completed the General Well‐Being Scale and were rated on the Quality of Life Scale as well as scales assessing positive and negative symptoms.

Results: While negative symptoms, level of functioning and positive symptoms all were related to the scores on the Quality of Life Scale, General Well‐Being Scale scores were primarily related to positive symptoms, particularly reality distortion.

Conclusion: The results highlight the importance of recognizing the complex nature of the concept of quality of life. They demonstrate that varying indices of quality of life are likely to have different predictors.