bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparison of Responses to the Mentally Ill in Two Communities
Authors: Hall Peter , Brockington Ian F. , Levings Jenny , Murphy Christopher
Published: October 2008

Vignettes representing mentally ill people were presented to about 2000 randomly selected residents in Bromsgrove, served by a mental hospital, and Malvern, served by a community-based psychiatric service. They were asked about the likely cause of the condition, what action they would take, and what agencies were most likely to help. In Malvern, residents seemed more enterprising in involving various agencies and more tolerant. It is possible to derive simple ‘action scores' as an indicator of such tolerance. Although there were significant demographic differences between subgroups, overall identification of vignette subjects as mentally ill was surprisingly low, and so was knowledge both of community psychiatric nurses as an agency, and of the location of dispersed treatment facilities in both areas.
Evolutionary Biology and Psychiatry
Authors: Smith C. U. M.
Published: October 2008

“Every one of the twenty-eight bones of the human skull has been inherited in an unbroken succession from the air-breathing fishes of the pre-Devonian seas.” (Gregory, 1967)
The Nottingham Study of Neurotic Disorder
Authors: Tyrer Peter , Seivewright Nicholas , Ferguson Brian , Murphy Siobhan , Johnson A. L.
Published: October 2008

Repeated assessments of psychopathology, together with personality status, were made over two years on 181 psychiatric out-patients with generalised anxiety disorder (59), panic disorder (66), or dysthymic disorder (56) diagnosed using an interview schedule for DSM–III. Patients were randomly allocated to drug treatment, cognitive and behaviour therapy, or a self-help treatment programme. Although there were no overall differences in compliance rate and efficacy between the three modes of treatment, the psychological treatment methods, particularly self-help, were more effective in patients without personality disorder, and those with personality disorder responded better to drug treatment, primarily antidepressants. The findings suggest that assessment of personality status could be a valuable aid to selection of treatment in neurotic disorders and that self-help approaches are particularly valuable once personality disorder has been excluded.
Taste Responsiveness in Anorexia Nervosa
Authors: Simon Yves , Bellisle France , Monneuse Marie-Odile , Samuel-Lajeunesse Bertrand , Drewnowski Adam
Published: October 2008

Preferences for sugar/fat mixtures were examined in 12 anorectic females and in 14 normal-weight volunteer controls. The subjects, recruited at an eating-disorders clinic in Paris, were tested after an overnight fast and 2 hours after lunch. Anorectic patients disliked the taste of foods rich in fat more than did controls. Perceptions and preferences for sweet taste did not differ between anorectic females and controls. After lunch, taste preference ratings were equally reduced in both groups, suggesting that satiety aversion to sucrose is present even in anorexia nervosa.
In-patient Treatment of 165 Adolescents with Emotional and Conduct Disorders a Study of Outcome
Authors: Wells Peter , Faragher Brian
Published: October 2008

A two-year follow-up study of 165 teenagers with conduct and emotional disorders treated as in-patients on a regional adolescent unit (YPU) is described. The target types of behaviour for each subject were scored independently by the teenager, the parent or guardian, and the professional referrer before admission and at one month, one year and two years after discharge. The significant overall improvement in behaviour observed at one month after discharge was sustained at one and two years. Thirty-three subjects who abandoned treatment within six weeks of admission had made significantly less progress than the fully treated group at one month after discharge, but there were no significant differences at the one- and two-year evaluations. Two years after treatment, between 69% and 79% of the 132 subjects who completed treatment were regarded as improved, depending on which respondent made the assessment. Adolescents who completed treatment had different characteristics from those who terminated treatment prematurely and were more likely to be girls in care referred by social services.
The Efficacy and Tolerability of Combined Antidepressant Treatment in Different Depressive Subgroups
Authors: O'brien Sinead , McKeon Patrick , O'regan Myra
Published: October 2008

Eighty patients admitted to hospital with major depression were randomly allocated to six weeks of treatment with tranylcypromine, amitriptyline, or tranylcypromine and amitriptyline in combination, in a double-blind study. Scores on the HRSD improved significantly in all three groups, but there were no differences between the three groups. Patients on tranylcypromine and amitriptyline combined improved more according to their self-ratings after six weeks, and response was earlier as measured by a clinical global improvement scale. Those with endogenous depression improved more than those with neurotic depression, irrespective of treatment group. Combined treatment was less well tolerated than single treatments and gave rise to more side-effects, although there was no serious toxicity. Orthostatic hypotension was observed more frequently in patients on combined treatment. This group also experienced a significant increase in weight and prolongation of the P-R interval on ECG.
The Lewy-Body Variant of Alzheimer's Disease
Authors: Förstl Hans , Burns Alistair , Luthert Phil , Cairns Nigel , Levy Raymond
Published: October 2008

At post-mortem, Lewy bodies (LBs) were found in the brainstem and neocortex of eight out of 65 patients who had been collected during a prospective long-term study on clinically diagnosed Alzheimer’s disease. All eight patients had accompanying Alzheimer pathology which was less severe than in a sample of eight age and sex-matched patients from the same study with neuropathologically verified Alzheimer's disease. Parkinsonian features were more common in patients with LBs. There were no particular differences in duration of illness, severity of cognitive impairment, presence of hallucinations, or fluctuations in the course of illness. Frontal cerebral atrophy was more marked in patients with LBs, as was the loss of neurons in the basal nucleus of Meynert and the substantia nigra. Cognitive performance correlated with the number of pigmented neurons in the substantia nigra. We conclude that the differential diagnosis of LB dementia should be considered in patients satisfying NINCDS-ADRDA criteria for Alzheimer-type dementia who show marked Parkinsonian features and a frontal accentuation of cerebral atrophy.
Towards a Cognitive-Behavioural Theory of Problem Gambling
Authors: Sharpe Louise , Tarrier Nicholas
Published: October 2008

A heuristic model to account for the development and maintenance of problem gambling is provided with the aim of directing clinical management and future research. Previous explanations of problem gambling have been limited in two main ways. Firstly, the models have been primarily descriptive, and secondly they have generally lacked clinical value. Most explanations have ignored the mechanisms through which this behaviour becomes problematic, and have not identified the relationships between different variables.
Human Sleep, Sleep Loss and Behaviour
Authors: Horne J. A.
Published: October 2008

The prefrontal cortex (PFC) consists of the cortex lying in front of the primary and secondary motor cortex, and includes the dorsolateral and orbital areas, frontal eye fields, and Broca's area. Not all of the functions of the PFC are known, but key ones are the maintenance of wakefulness and non-specific arousal, and the recruiting of various cortical areas required to deal with tasks in hand (Luria, 1973; Stuss & Benson, 1986; Fuster, 1989). Other roles include (Kolb & Whishaw, 1985) planning, sensory comparisons, discrimination, decisions for action, direction and maintenance of attention at a specific task, execution of associated scanning eye movements, and initiation and production of novel goal-directed behaviour (especially with speech). Of the senses, vision makes a particular demand of the PFC, and this is reflected by the frontal eye fields.
Techniques for Interviewing the Somatising Patient
Authors: Creed Francis , Guthrie Elspeth
Published: October 2008

Liaison psychiatrists need to interview somatising patients in a way which allows a full assessment of the problem. This can best be achieved if the psychiatrist has already discussed with the referring physician the reason for referral and what the patient has been told about it. The medical notes should always be reviewed in detail and independent data obtained from a relative or other informant. During the interview itself the psychiatrist must be prepared to use techniques which deepen rapport with the patient, who may be initially wary or hostile. The psychiatrist should attempt to establish early a treatment alliance. Special aspects of the mental state need to be noted, including the patient's attitude to his/her symptoms and the strength with which somatic beliefs are held. Different approaches may be used according to the nature of the problem and the therapeutic style of the doctor. An awareness of these interview techniques would greatly reduce the chances of fruitless interviews with a hostile patient who believes the symptoms are being dismissed as being ‘all in the mind’.
The Management of Chronic Somatisation
Authors: Bass Christopher , Benjamin Sidney
Published: October 2008

‘Somatisation’ is a process in which there is inappropriate focus on physical symptoms and psychosocial problems are denied. In some patients this process becomes chronic (in excess of six months). Special skills and strategies are required by non-psychiatrists to manage these patients, for whom the acceptance of psychiatric treatment should be facilitated. When taking the history, doctors should be aware of psychosocial cues; thereafter they should be consistent and unambiguous in their management. An agenda should be set early on, with limits on investigations. Failure to manage this group of patients is costly, and further intervention studies are required not only to reduce health service and other costs, but also to relieve the nonmonetary burden of physical and psychosocial disability on patients and their relatives.
The Premenstrual Syndrome: A Twin Study
Authors: Condon John T.
Published: October 2008

Data are presented from 157 monozygotic and 143 dizygotic female twin pairs of reproductive age who completed a self-report questionnaire on the premenstrual syndrome (PMS). For global PMS scores, the correlation coefficient for the monozygotic twins (0.55) was double that of the dizygotic ones (0.28). The results are consistent with the hypothesis that aggregation for global PMS scores is determined by genetic factors acting additively over a number of loci. Two alternative explanations are suggested: that monozygotic twins share greater environmental similarities than dizygotic ones; or that PMS scores may be a reflection of some other underlying characteristic (such as neuroticism), which is itself genetically determined.
How Important is the Assessment of Social Skills in Current Long-Stay In-patients?
Authors: Pryce I. G. , Griffiths R. D. , Gentry R. M. , Hughes I. C. T. , Montague L. R. , Watkins S. E. , Champney-Smith J. , McLackland B. M.
Published: October 2008

Service response to problems in 20 clinical and social competence areas was assessed in 156 long-stay in-patients, using the Needs for Care Assessment (NFC). Although there were few unmet needs for treatment, over 200 instances of unmet needs for the assessment of social skills were found, and reasons for this are discussed, as is the importance of social-skills assessment in this group. In around a third of the sample most of the social-skill areas in the NFC were not applicable.
Head Circumference in ‘Preschizophrenic’ and Control Neonates
Authors: McNeil Thomas F. , Cantor-Graae Elizabeth , Nordström Lars G. , Rosenlund Thomas
Published: October 2008

Head circumference, body weight, body length, and shoulder circumference at birth were studied in 70 RDC schizophrenic patients and 70 demographically matched controls from the same delivery series, using information recorded in the medical records at the time of birth. With preterm babies removed from both samples, only head circumference among preschizophrenic infants was significantly smaller than that of controls. Preschizophrenic infants also had a disproportionately smaller head circumference in relation to body length than did controls. Among the former, a small head circumference was systematically related to an absence of family history of psychosis, but was not related to season of birth or recorded pregnancy complications. The findings were strongest for females. The results suggest there is an unidentified non-genetic factor in schizophrenia that disturbs prenatal cerebral development.
Erotic Target Location Errors in Male Gender Dysphorics, Paedophiles, and Fetishists
Authors: Freund Kurt , Blanchard Ray
Published: October 2008

A clinical series of male paedophiles who dressed or fantasised themselves as children suggests that certain paraphilias represent developmental errors in locating erotic targets in the environment and that proneness to such errors is a paraphilic dimension in its own right, apart from the specific nature of the erotic target.
Evidence for Autosomal Dominant Transmission in Tourette's Syndrome
Authors: Eapen V. , Pauls D. L. , Robertson M. M.
Published: October 2008

Complex segregation analyses were performed on families ascertained through 40 unselected consecutive patients with Tourette's syndrome to examine the hypothesis that its transmission is consistent with genetic inheritance. Analyses were done using several diagnostic classifications. All results were consistent with an autosomal dominant gene with high penetrance. The penetrances ranged from 0.882 to 1.000 for males and 0.452 to 0.980 for females, depending upon the specific classification scheme incorporated into the analyses.
Quality of Life for Patients Detained in Hospital
Authors: Coid Jeremy W.
Published: October 2008

The quality of life of detained patients has not received adequate attention despite the responsibilities placed on hospital staff and the special problems faced by these patients. Legal principles to ensure quality of life have not been formalised, and the acceptable standards that a patient can expect have not been tested in the UK courts. Contemporary models of ensuring quality are being imposed with increasing pressure on health care professionals, but high-quality management has sometimes lagged behind. This has led to a poor quality of life for certain patients. It is important for future research to overcome difficulties in developing objective measurements and set the appropriate standards of quality of life that detained patients should expect. This would provide a basis against which both appropriate standards of care and the necessary resource allocation could be measured.
Sex and Schizophrenia: Effects of Diagnostic Stringency, and Associations with Premorbid Variables
Authors: Castle David J. , Wessely Simon , Murray Robin M.
Published: October 2008

In a case-record study, all first-contact patients with non-affective functional psychosis from a defined area over 20 years were diagnosed according to operational criteria of varying stringency and emphasis, and incidence rates for each set of criteria determined by sex and age at onset; data on premorbid adjustment were also analysed by sex and age at onset. The overall first-contact incidence of non-affective functional psychosis was approximately equal in men and women; however, the ratio of male to female incidence rates rose progressively when RDC (1.2), DSM-III-R (1.3), DSM-III (2.2), and Feighner (2.5) criteria for schizophrenia were applied. Schizophrenia was most common in young males and least common in older males, with females occupying an intermediate position. Schizophrenia in young males, particularly when stringently defined, was especially likely to be associated with single status, poor work and social adjustment, and premorbid personality disorder. The results suggest that schizophrenia syndrome is heterogeneous, and young males are especially prone to a severe neurodevelopmental form of illness associated with premorbid deficits.
Psychiatric Morbidity in the First-Degree Relatives of Schizophrenic Patients
Authors: Varma Shashjit L. , Sharma Indira
Published: October 2008

First-degree relatives (FDRs) of 1018 schizophrenic and 812 control probands were investigated. Psychiatric morbidity was present in 34.8% of FDRs of schizophrenic probands and in 9.2% of FDRs of controls. There was significantly more psychiatric illness in the siblings and parents than in the offspring of both schizophrenic and control subjects. The morbidity risks for schizoid-schizotypal personality disorders, cannabis-use disorder and paranoid personality disorder were significantly higher in the FDRs of schizophrenic patients than in those of controls, suggesting a biological relationship.
Clozapine-Induced Agranulocytosis Treated with Granulocyte Macrophage Colony Stimulating Factor
Authors: Oren Ran , Granat Elaine , Shtrussberg Shlomo , Matzner Yaacov
Published: October 2008

Clozapine-induced agranulocytosis is usually reversible after discontinuation of the drug. A patient who developed agranulocytosis after termination of clozapine therapy responded to treatment with granulocyte macrophage colony stimulating factor.
The Onset and Rate of the Antidepressant Effect of Electroconvulsive Therapy
Authors: Scott Allan I. F. , Whalley Lawrence J.
Published: October 2008

This annotation is concerned with how soon and at what rate antidepressant effects become apparent over a course of electroconvulsive therapy (ECT). The first question is of importance in the design and interpretation of biological studies of the mode of action of ECT. The second question is of practical interest to the treating psychiatrist when we ask how the speed of recovery is influenced by what the psychiatrist prescribes, that is, the number and frequency of treatments. These questions are little better answered now than 20 years ago. This may come as a surprise to many readers, who have been advised to use ECT when “seeking rapid improvement” in depressive disorders (ECT Sub-Committee of the Research Committee of the Royal College of Psychiatrists, 1989). This lack of progress is attributable to a dearth of appropriately designed ECT studies.
The Composition of the Negative Syndrome of Chronic Schizophrenia
Authors: Kibel D. A. , Laffont I. , Liddle P. F.
Published: October 2008

The clinical features of patients who satisfy a variety of criteria for the negative syndrome can be arranged in five groups of phenomena: (a) poverty of thought and speech, (b) blunted affect, (c) decreased motor activity, (d) apathy and avolition, and (e) diminished interpersonal interaction. We have shown that depressed mood and depressive cognition are not related to the negative syndrome, but there is some overlap between the specific phenomena of depressive illness and negative symptoms in schizophrenia. Items measuring cognitive impairment have a moderate correlation with the negative syndrome, but the negative syndrome accounts for less than half of the variance of cognitive performance. These items that define the negative syndrome can be as reliably measured as depressive and positive symptoms.
The Facilitation and Evocation of Seizures
Authors: Antebi D. , Bird J.
Published: October 2008

The finding that seizures can be precipitated in some epileptic patients by stimuli which originate from outside the central nervous system is not new. The influence of psychological changes on seizure frequency has, however, been much more difficult to determine. Patients who become aware of such associations may gain some control over their seizures. One hundred randomly selected out-patients with epilepsy were asked about their awareness of such associations and whether, as a consequence, they believed they had any control of their seizures. Ninety-two reported associations between seizures and facilitators or precipitants. The group who had made associations between independent states or stimuli and their seizures were more likely to have poorly controlled seizures and to be taking more anticonvulsants. Many had used this knowledge to control their seizures.
Low Serum Cholesterol and Suicide
Authors: Hawton Keith , Cowen Philip , Owens David , Bond Alyson , Elliott Martin
Published: October 2008

“Primary prevention trials which have shown that the lowering of serum cholesterol concentrations in middle-aged subjects by diet, drugs, or both leads to a decrease in coronary heart disease have also reported an increase in deaths due to suicide or violence. There has been no adequate explanation for this association. I have reviewed the relevant published work and describe a physiological mechanism that might account for this curious finding. One of the functions of serotonin in the central nervous system is the suppression of harmful behaviour impulses. When mouse brain synaptosomal membrane cholesterol is increased there is a pronounced increase in the number of serotonin receptors. Low membrane cholesterol decreases the number of serotonin receptors. Since membrane cholesterol exchanges freely with cholesterol in the surrounding medium, a lowered serum cholesterol concentration may contribute to a decrease in brain serotonin, with poorer suppression of aggressive behaviour.”
Difficulties in Managing a Case of Stupor
Authors: Conway Alison
Published: October 2008

Stupor is a rare and dramatic presentation of a number of neurological and psychiatric conditions which can cause problems in both diagnosis and management. A case is described which illustrates these difficulties.
‘Pick's Disease’–101 Years on Still There, But in Need of Reform
Authors: Baldwin Bob , Förstl Hans
Published: October 2008

On 23 April 1892, Arnold Pick reported the case of AH, who died aged 71 years following a two-year history of progressive ‘feeble-mindedness', outbursts of rage, fits and, in the later stages, severe aphasia (Pick, 1892). The post-mortem showed cerebral atrophy, particularly affecting the left temporal lobe. Pick went on to describe further cases of circumscribed atrophy affecting the temporal lobe (Pick, 1901, 1904), and parietal and frontal lobes (Pick, 1906). Although he believed the focal pathology represented a local emphasis of ‘senile cortical atrophy’, he wanted to show that a localised form of cerebral atrophy could nevertheless cause specific symptoms:

“… thereby bringing neuropathology and psychiatry into closer union … so that the latter may be brought nearer to medical understanding.”
Tourette's Syndrome and Right Hemisphere Dysfunction
Authors: Lanser J. B. K. , Van Santen W. H. C. , Jennekens-Schinkel A. , Roos R. A. C.
Published: October 2008

Poor performances of patients with Tourette's syndrome (TS) on tests requiring visual-perceptual abilities had led previous authors to the suggestion of right hemisphere involvement. We have compared the results of neuropsychological examination of 16 children with TS, with those of 16 children with a lesion of the right hemisphere. No evidence was found of a dysfunction of the right hemisphere in TS.

British Journal of Psychiatry (1993), 163, 116–118
A Controlled Trial of Home-Based Acute Psychiatric Services
Authors: Burns Tom , Raftery James , Beadsmoore Alan , McGuigan Sean , Dickson Mark
Published: October 2008

Treatment records of 94 patients treated in an experimental home-based psychiatric service and 78 control patients in standard care were collected over one year. There was a substantial reduction in in-patient care in the experimental group, both in terms of proportion admitted and duration of admissions, despite similar out-patient and general practice care. The total treatment costs were significantly larger (>50%) for standard care when controlled for by diagnostic grouping. Costs were further examined by including all specialist psychiatric care, and by excluding patients with primary diagnoses of brain damage or alcoholism. Sensitivity analysis explored the effects of increasing the cost of home visits. The relative cost effectiveness of the experimental service persisted. Clinical and social outcome was similar in control and experimental groups.
Acting on Delusions. I: Prevalence
Authors: Wessely S. , Buchanan A. , Reed A. , Cutting J. , Everitt B. , Garety P. , Taylor P. J.
Published: October 2008

Associations between delusions and abnormal behaviour were retrospectively assessed in a sample of 83 consecutively admitted deluded subjects. All were interviewed about events in the previous month using a new measure of delusional phenomenology and action. For 59 subjects this information was supplemented by informant interviews. Clinical consensus was reached concerning the probability that actions reported by informants were linked to delusions. Half of the sample reported that they had acted at least once in accordance with their delusions. Violent behaviour in response to delusions was uncommon. Information provided by informants suggested that some aspect of the actions of half of the sample was either probably or definitely congruent with the content of their delusions. However, there was no link between self-reports and informants' reports of such action. A latent class analysis of self-reported delusional action suggested three classes of action, namely aggressive to self or other, defensive action, and either none or single action. Self-reported action was associated with delusions of catastrophe. Informant data suggested that persecutory delusions were the most likely to be acted upon, but in contrast delusions of guilt or catastrophe appeared to decrease the chance of delusional behaviour. Actions associated with abnormal beliefs are more common than has been suggested.
Acting on Delusions. II: The Phenomenological Correlates of Acting on Delusions
Authors: Buchanan Alec , Reed Alison , Wessely Simon , Garety Philippa , Taylor Pamela , Grubin Don , Dunn Graham
Published: October 2008

The aim of the study was to identify the phenomenological characteristics of those delusions which are associated with action. The sample consisted of 79 patients admitted to a general psychiatric ward, each of whom described at least one delusional belief. The variables studied included the phenomenology of the delusions, and behaviour. Two behavioural ratings were used, one derived from the subjects' own description of their behaviour and the other from information provided by informants. There was no association between delusional phenomenology and acting on a delusion when the subjects' behaviour was described by informants. When action was described by the subjects themselves, acting was associated with: being aware of evidence which supported the belief and with having actively sought out such evidence; a tendency to reduce the conviction with which a belief was held when that belief was challenged; and with feeling sad, frightened or anxious as a consequence of the delusion.
Self-damaging and Addictive Behaviour in Bulimia Nervosa
Authors: Lacey J. Hubert
Published: October 2008

This study examines the prevalence of self-damaging and addictive behaviour in a consecutive series of 112 normal-weight bulimic women all stemming from the same urban catchment area. A quarter reported consuming over 36 units of alcohol a week, and nine drank over 50 units. Twenty-eight per cent abused drugs, 21% repeatedly stole, 18% repeatedly overdosed, and 8% regularly cut themselves. In all, 40% reported self-damaging and addictive behaviour, 80% of whom gave a history of three or more behaviours together. Alcohol abuse was significantly associated with drug abuse and repeated overdosing; repeated cutting was significantly associated with drug abuse. Repeated stealing and overdosing were markers of severity and did not occur in isolation. A core group, termed and defined by the author as ‘multi-impulsive bulimics', were older, less likely to be employed, married, or in a stable union, but were more likely to have an alcohol-abusing partner or to come from a family with a history of alcohol abuse. They were also more likely to give a history of sexual abuse.
How Well are ‘Cured’ Anorexia Nervosa Patients?
Authors: Windauer Ulricke , Beumont Pierre J. V. , Lennerts W. , Talbot Peter , Touyz Stephen W.
Published: October 2008

Eating behaviour, nutritional intake and psychopathology were examined in 16 weight-recovered anorexia nervosa patients. The Eating Disorders Examination (EDE) and a food diary were the main outcome measures, but body fat content and psychosocial adjustment were also assessed. Although body fat and overall psychosocial adjustment had returned to normal in most patients, 12 still had a restricted eating pattern with nutritional intake below 90% of their energy requirements. These results suggest that weight, menstruation, and psychosocial criteria are not sufficient to determine full recovery from anorexia nervosa, and that attention should be given also to measures of the specific behavioural and attitudinal disturbance.
Subtyping of Panic Disorder by Symptom Profile
Authors: Briggs Andrew C. , Stretch David D. , Brandon Sydney
Published: October 2008

During Phase II of the Cross-National Panic Study, descriptions of the patient's last severe panic attack were collected for 1168 patients. Statistical analysis indicated that patients could be divided into two groups, characterised by the presence or absence of prominent respiratory symptoms. The two groups did not differ on demographic variables or coexisting diagnoses, but they did differ on psychopathology on entry to the study and treatment outcome. The group with prominent respiratory symptoms suffered more spontaneous panic attacks and responded to imipramine, whereas the group without prominent respiratory symptoms suffered more situational panic attacks and responded more to alprazolam. It is important to distinguish spontaneous and situational panic attacks, to aid choice of treatment.
Postnatal Psychiatric Illness: the Impact on Partners
Authors: Lovestone S. , Kumar R.
Published: October 2008

Out of 24 spouses of women with postnatal psychiatric illness admitted to a mother and baby unit over 12 months, 12 were found to be psychiatrically ill, as defined by RDC or DSM-III criteria. The rate of psychiatric disorder was higher in these men than in a control group of men whose partners remained well after childbirth and a group of men whose partners were admitted to a psychiatric hospital with non-puerperal illness. The onset of psychiatric illness in the men typically followed admission of their wives to the mother and baby unit. Other associations with illness in the man were a history of chronic social problems, previous psychiatric episodes, and a poor relationship with his own father.
Evaluation of a Neural Network Model of Amnesia in Diffuse Cerebral Atrophy
Authors: Carrie James R. G.
Published: October 2008

A digital computer program generating a simulated neural network was used to construct a model which can show behaviour resembling human associative memory. The experimental network uses distributed storage, and, in this respect, its functional organisation resembles that suggested by reported observations of neuronal activity in the human temporal lobe during memory storage and recall. Inactivation of increasing numbers of randomly distributed network units simulated advancing cerebral atrophy. This caused progressive impairment of performance, resembling the gradual deterioration of memory function observed in chronic diffuse cerebral degeneration. Unit inactivation had similar effects on recall whether the same units were inactivated before or after learning. This differs from most relevant observations of amnesia resulting from diffuse cerebral disease. While the model may functionally resemble long-term information storage sites in the brain, other cerebral mechanisms participating in learning and remembering are also damaged by diffuse cerebral atrophy.
The Treatment of Severe, Chronic, Resistant Obsessive-Compulsive Disorder
Authors: Drummond Lynne M.
Published: October 2008

This study examined 49 in-patients with obsessive-compulsive disorder who were treated over three years. The patients had failed to respond to previous treatment. Treatment consisted of in-patient exposure, occasionally combined with other interventions individually tailored to the patient's specific difficulties. This resulted in significant clinical improvements and an average 40% reduction in rituals in 31 (63.3%) of these chronic patients. These gains were maintained at an average 19-month follow-up. Checking rituals were more likely to be associated with good outcome. Women had a later onset of the disorder and a slight tendency to better prognosis. No other predictors of outcome were found.
What Do Depression Rating Scales Measure?
Authors: Snaith Philip
Published: October 2008

A large number of rating scales have been devised to assess the clinical construct of ‘depression’. These scales have been universally used in research with little consideration of their content, or how they relate to accepted definitions of depressive disorder. The scales are often arbitrarily selected and used for the study on the assumption that all measure the same construct. The item analysis of a number of the most widely used depression scales reveals a variation in the areas of psychopathology they cover; some scales place greater emphasis upon the assessment of anxiety than upon depressed mood. Since disturbance in neurobiological systems is manifest by specific aspects of affective and behavioural malfunction, and since psychodynamic factors lead to particular cognitive sets, the advancement of research will depend upon the construction and validation of more refined measures than are provided by the present approach.
Genotypes, Phenotypes, and the Brain
Authors: Tsuang Ming T.
Published: October 2008

The history of psychiatric research on genotypes, phenotypes, and the brain reveals much about the role of these concepts in our past and current understanding of schizophrenia and other psychiatric illnesses. Although interest in each topic is old by the standards of our young science, all have waxed and waned in their influence during our brief history. By ‘genotype’ I mean the hereditary constitution consisting of the genetic code, and by ‘phenotype’ I mean the physical expression of those genes throughout the life cycle of the individual. The relevance of the genotype to our field was recognised during the time of Charles Darwin, and reflected in the views of Henry Maudsley. Early optimism about the role that genetics would play in our understanding of mental disorder was tempered by the failure to find patterns of inheritance that corresponded to those described by Mendel. Enthusiasm about the study of genetic influences on human attributes was further attenuated when pseudo-genetics was embraced as a rationale for the horror of genocide. There has been a long and honourable history of genetic research in psychiatry, sustained by individuals such as Dr Eliot Slater (the 35th Maudsley lecturer and then Director of the Medical Research Council Psychiatric Genetics Research Unit at the Maudsley Hospital), but a renewal of the early excitement about genetic research has been engendered largely by recent developments in molecular biology.
Cognitive Impairments in Patients with Seasonal Affective Disorder
Authors: O'Brien John T. , Sahakian Barbara J. , Checkley Stuart A.
Published: October 2008

Eleven patients with seasonal affective disorder (SAD) and ten controls matched for age, IQ, and education were tested on a number of computerised tests designed to assess attention, memory, and learning. When depressed, patients showed no deficit in attention but were impaired on spatial memory and learning. They were also significantly slower to respond than controls, with a pattern that suggested slowed information processing centrally, rather than simple sensory or motor slowing. On recovery from depression, improvement was seen in most tests, although impairment remained in latency to respond on a test of spatial memory. This continuing impairment correlated with residual depressive symptoms but not with ventricular brain ratio (VBR).
Positive, Negative, and Disorganisation Factors from the Schedule for Affective Disorders and Schizophrenia and the Present State Examination
Authors: Thompson Paul A. , Meltzer Herbert Y.
Published: October 2008

The use of items from the Schedule for Affective Disorders and Schizophrenia and from the Present State Examination scales for assessing positive and negative symptoms in schizophrenia was examined using factor analysis. The factorial structure of the items which putatively assess positive and negative symptoms was examined. A three-factor solution was obtained with factors identified as: a negative symptom factor (factor 1); a positive symptom factor (factor 2); a ‘disorganisation’ factor (factor 3), consisting primarily of items related to disordered thinking. A solution which was highly similar in important loadings was obtained with an independent sample of patients. High correlations of the rotated factors with the external criteria supported the interpretations of the factors. The results indicate that symptoms generally classified as negative or positive are factorially independent. Furthermore, a disorganisation factor, consisting of items previously included in positive and negative symptoms factors, is necessary for a full representation of the factor structure.
A Community Study of Depression in Adolescent Girls
Authors: Cooper Peter J. , Goodyer Ian
Published: October 2008

A community study was conducted to determine the prevalence of depressive symptoms and syndromes in 11–16-year-old girls. Girls from three secondary schools (1072 girls in total) were administered questionnaires and 375 were selected for direct interview. The estimated prevalence for current major depressive disorder (within the past month) for the population was 3.6%, and for the past year was 6.0%. Scores on the self-report questionnaire of mood disturbance increased with age, as did the prevalence of depressive disorder. A large proportion of interviewed girls reported depressive symptoms which did not meet the DSM-III-R criteria for major depressive disorder. The estimated prevalence of this ‘partial syndrome’ group was 8.9% for a current episode and 20.7% for the past year.
Fatal Poisonings Attributed to Benzodiazepines in Britain during the 1980s
Authors: Serfaty Marc , Masterton George
Published: October 2008

The fatal toxicity indices of benzodiazepines during the 1980s were calculated from national prescribing data and mortality statistics. The overall rate was 5.9 deaths per million prescriptions for benzodiazepines taken alone or with alcohol only, anxiolytics being less toxic than hypnotics. Diazepam appeared more toxic than average among anxiolytics (P<0.05), and flurazepam and temazepam more toxic than average among hypnotics (bothP<0.001). It was shown that the finding for diazepam was probably explained by concurrent use of alcohol, which implies that other anxiolytics may be safer in cases where there is alcohol misuse; but the greater toxicity of flurazepam and temazepam remained unexplained. Benzodiazepines are indeed much less toxic than the barbiturates they superseded, but they are not innocuous and temazepam in particular requires further evaluation.
Self-mutilation in Four Historical Cases of Bulimia
Authors: Parry-Jones Brenda , Parry-Jones William Li.
Published: October 2008

Current theories suggest that there is a relatively frequent association of self-mutilative behaviour with eating disorders, particularly with the modern binge-purge syndrome, bulimia nervosa. In order to consider this association on a historical dimension. 25 bulimic cases, reported from the late 17th to the late 19th century, were investigated. These were found to include four examples of self-mutilative behaviour, in three males and one female: these cases are described and discussed. The historical evidence lends some support for the suggested connection between eating pathology and self-mutilation.
Epilepsy and Schizophrenia
Authors: Mace Christopher J.
Published: October 2008

Slater's work on the schizophrenia-like psychoses of epilepsy is re-examined in the light of subsequent developments in psychiatry and neurology. Simple causal links of the sort he postulated between epilepsies and psychoses appear increasingly tenuous, despite indications that some psychotic symptoms and some localised structural changes are linked. A resumption of the study of electrophysiological similarities between schizophrenia and limbic epilepsy may offer a useful alternative programme for research.
Epilepsy and Psychiatric Disturbance
Authors: Fiordelli Ebe , Beghi Ettore , Bogliun Graziella , Crespi Vittorio
Published: October 2008

One hundred patients with cryptogenic epilepsy and normal intelligence and 100 age- and sex-matched controls were submitted to psychiatric interview using the Clinical Interview Schedule. Nineteen patients and 15 controls were identified as having psychiatric disorders. Anxiety and depression were the predominating diagnoses in both groups. Personality disorders were occasionally present in subjects with epilepsy. The study shows that patients with cryptogenic epilepsy and normal neuropsychological abilities should not be considered at any higher risk of psychiatric disturbance than a non-neurological patient population.
Incidence of Dementia in a Representative British Sample
Authors: Morgan Kevin , Lilley Jeanette M. , Arie Tom , Byrne E. Jane , Jones Rob , Waite Jonathan
Published: October 2008

In a four-year follow-up study of 1042 elderly people (aged 65 years or older), randomly sampled from the community, levels of dementia were assessed using a two-phase case-finding procedure (screening followed by clinical interview) among survivors. Clinical information on those not reinterviewed was provided by death certificates, hospital case notes, or postal questionnaires. The weighted four-year cumulative incidence of dementia was 3.7% (95% confidence intervals: 2.4%-5.0%), with age-specific rates of 0.9%, 2.8%, 5.2%, 9.0%, and 8.7% for the age groups 65–69, 70–74, 75–79, 80–84, and 85–89 years respectively. While consistent with data from other British regions, it remains likely that these rates underestimate true incidence.
Psychosocial Dysfunction in Somatising Patients
Authors: Chadda R. K. , Bhatia M. S. , Shome S. , Thakur K. N.
Published: October 2008

Somatising patients present with a variety of psychosocial dysfunctions. Using the Dysfunctional Analysis Questionnaire and the Global Assessment of Functioning scale, we studied the nature and severity of psychosocial dysfunction in a group of somatising patients. Dysfunction was less marked in the cognitive area than in social, vocational, personal and familial areas. Patients with depressive disorders showed more dysfunction than those with somatoform disorders in all psychosocial areas except cognitive.
Is There a Lithium Withdrawal Syndrome?
Authors: Schou Mogens
Published: October 2008

The evidence for abstinence phenomena after discontinuation of lithium is weak and ambiguous. Early manic and depressive recurrences after lithium discontinuation may suggest rebound, but studies carried out with appropriate methodology have failed to confirm its reality. Discontinuation of prophylactic lithium treatment of recurrent manic-depressive illness, whether abrupt or gradual, involves risk of relapse, but the existence of a special lithium withdrawal syndrome remains unproven.
An Association Between Low Levels of 5-HIAA and HVA in Cerebrospinal Fluid and Early Mortality in a Diagnostically Mixed Psychiatric Sample
Authors: Faustman William O. , Ringo David L. , Faull Kym F.
Published: October 2008

We followed up a sample of psychiatric patients (diagnoses predominantly schizophrenia and depression) who had participated in in-patient studies of their CSF over the past 15 years. The status of 73 former patients was confirmed, of whom 12 had died. Seven of these patients died at age ⩽40, largely of suicide, homicide, or accidental causes. These seven patients had significantly lower CSF 5-HIAA and HVA than living control patients. There were significant direct correlations between age at death and both CSF 5-HIAA and HVA in the deceased patients. The results offer support for CSF monoamine metabolites relating to early death in a diagnostically diverse sample of psychiatric patients.
McHugh's “A Structure for Psychiatry at the Century's Turn-The View from Johns Hopkins”
Authors: Mindham R. H. S. , Scadding J. G. , Morgan H. G.
Published: October 2008

“I have three specific aims: firstly, to review some of the concepts supporting contemporary American (USA) Psychiatry; secondly, to explain the origins, strengths and frailties of these particular foundations; and thirdly, to provide examples of activity in the Department of Psychiatry at Johns Hopkins School of Medicine that intends to both revise and restructure these foundations in ways that enhance teaching, practice, and research.”
Brain, Mind and Behaviour
Authors: Fenwick Peter
Published: October 2008

The advent of new imaging techniques is broadening our understanding of the major psychiatric illnesses. The increased knowledge of brain function will have consequences for the expert medical witness who has to give evidence in court. Both the insanity defence and the defence of automatism depend on disorders of the mind. Psychiatry is now able in many cases to produce evidence that these are consequent upon disorders of the brain. In presenting evidence in court there is an apparent conflict between ‘brain words' and ‘mind words'.
Risk of Schizophrenia and Age Difference with Older Siblings
Authors: Sham Pak C. , Maclean Charles J. , Kendler Kenneth S.
Published: October 2008

Recent reports that some influenza epidemics may be followed by a transient increase in the births of schizophrenic patients have led to the hypothesis that maternal viral infections contribute to the aetiology of schizophrenia. It is well known that respiratory viral infections are frequently brought into the home by young children. We tested the predictions that the risk of schizophrenia is decreased in first-born children, and increased in individuals who had siblings of a young age whilein utero, using data from a Swedish family study. Our results are consistent with these predictions. In particular, having siblings three to four years older was associated with a significantly increased risk of schizophrenia, even after allowing for birth order, sibship size, and other potential confounders. If replicated, these results provide indirect support for the maternal viral infection hypothesis, although there are alternative explanations.
Remands and Psychiatric Assessments in Holloway Prison
Authors: Dell Susanne , Robertson Graham , James Katie , Grounds Adrian
Published: October 2008

Non-psychotic remand prisoners who were referred by Holloway's doctors to outside psychiatrists, or who were the subject of court reports, or who were diagnosed as mentally handicapped, were followed up to the time of sentence. Most of the referred women were minor offenders with diagnoses of mental handicap or personality disorder. They were usually refused beds on treatability criteria and then released with non-custodial sentences. Some were highly disturbed, and it seemed that the police who charged them, the courts who remanded them and the prison psychiatrists who referred them, all found it hard to accept that psychiatry had so little to offer these people. Local health and social services need to address the problems raised by this small group of women. Arsonists more often obtained beds than minor offenders, and were likely to be imprisoned when hospital places were not forthcoming.