bluuebunny/crossref_metadata_2025 huggingface dataset:
Reduction of Food Intake by Manipulation of Central Serotonin Current Experimental Results
Authors: Garattini S. , Mennini T. , Samanin R.
Published: August 2018

Serotonergic anorectics are correctly defined only if they enhance 5-HT transmission and have their anorectic effects inhibited by drugs that block 5-HT receptors. Fenfluramine, the prototype indirect 5-HT agonist, and its metabolite, norfenfluramine, act as 5-HT releasers and uptake inhibitors and are both more effective in the dextro form. They lack the stimulant activity and do not cause hyperthermia or stereotypical behaviour as is characteristic of amphetamines. The anorectic effect of those drugs is attenuated by metergoline, a 5-HT receptor antagonist, in animals and man; 5-HT uptake inhibitors such as fluoxetine, zimelidine, SL 810385, and sertraline also cause anorexia, but only sertraline antagonism by metergoline has been reported. The effect of serotonergic anorectics on 5-HT release has been poorly investigated. Quipazine and RU-24969 cause anorexia by acting directly on 5-HT post-synaptic receptors. Serotonergic nerve terminals take up [3H]-D-fenfluramine and bind with high affinity in rat brain; uptake, an active process, appears to occur at a different site than binding, which is not affected by ouabain or low temperature. Anorexia is probably induced by interaction with 5-HT1Breceptors in the rat; the human equivalent of this receptor is not known, but the 5-HT1Dtype is a likely candidate.
Is there a Relationship between Serotonin Receptor Subtypes and Selectivity of Response in Specific Psychiatric Illnesses?
Authors: Montgomery Stuart A. , Fineberg Naomi
Published: August 2018

Identification of 5-HT receptor subtypes — 5-HT1A, 5-HT1B, 5-HT1c, 5-HT1D, 5-HT2(possibly A and B), 5-HT3subtypes, and possibly 5-HT4— has encouraged the manufacture of 5-HT receptor inhibitors with greater subtype specificity. However, it appears that the receptors interact, and drugs initially thought to be specific may have multiple actions. For some conditions such as anxiety/depression, almost all receptors are implicated. Clinical studies provide clear evidence that manipulation of the 5-HT system has a role in treating depression, anxiety, obsessional illness, migraine, and eating disorders. Interactions between the various receptor subtypes make it difficult to identify specific clinical functions. The 5-HT1Areceptors may be involved in aggression, anorexia, and hypotension. The 5-HT1Breceptors may be involved in aggression, while the 5-HT1Creceptors may play a role in central aversion systems and anxiety/depression. The role of the 5-HT1Dreceptors remains speculative; 5-HT2receptors appear to be involved in depression, anxiety, appetite, sleep, vasoconstriction, and hypertension. Many drugs that are effective in treating migraine are potent 5-HT2antagonists. 5-HT3antagonists at high doses are effective in treating nausea and at low doses in treating anxiety. Treatment of aggression, suicidal behaviour, addiction behaviour, memory impairment, dementia, and schizophrenia with 5-HT inhibitors requires further testing.
Cognitive Brain Potentials and their Application
Authors: Blackwood D. H. R. , Muir W. J.
Published: August 2018

Computerised averaging methods have made it possible to extract and identify the electrical activity accompanying specific activities of the brain, including certain psychological processes, from the random background signals in electroencephalography (EEG). Event-related potentials (ERPs) and the way these change under various recording conditions are a powerful, non-invasive and relatively simple means of relating psychopathology to underlying physiology, and by comparing ERPs with imaging data it should be possible to compare electrical activity with changes in brain structure and blood flow in different disease states.
Women as Perpetrators and Victims of Crime
Authors: Heidensohn Frances M.
Published: August 2018

A strong emphasis on individual psychopathology has informed much discussion on female crime, although more recent research has stressed its social setting and influences. Women commit all types of crime, although to a much lesser extent than men, particularly with regard to violent crime. Social and economic marginalisation is a significant factor in female crime. Criminal convictions seem to be more stigmatising for women. In court, women are treated as doubly deviant and their actions are explained in psychopathological terms. Because of the small numbers of women offenders, non-custodial and custodial provisions for them are inadequate. Although men are more likely to be victims of, for example, street crime, women express more fear of crime. One reason for this may be the prevalence of domestic crime committed by men against women (and children) that is underestimated in some surveys.
Reliability and Validity of Two Self-Rating Scales in the Assessment of Childhood Depression
Authors: Fundudis T. , Berney T. P. , Kolvin I. , Famuyiwa O. O. , Barrett L. , Bhate S. , Tyrer S. P.
Published: August 2018

A comparison was made of the reliability and validity of two self-rating scales, the Children's Depression Inventory (CDI) and Depression Self-Rating Scale (DSRS), in the diagnosis of depression in 93 children (aged 8–16 years) attending a university child psychiatry department. The two scales were of comparable merit but had only moderate discrimination between depressed and non-depressed children, with each scale having a misclassification rate of 25%. Better agreement was obtained in more verbally intelligent children, irrespective of age. Girls scored higher on the instruments than boys. No significant relationship was found between teacher assessment of classroom behaviour and the two self-rating depression instruments.
The Dexamethasone Suppression Test in Children: Lack of an Association with Diagnosis
Authors: Tyrer Stephen , Barrett Lynn , Berney Thomas P. , Bhate Surya , Watson Malcolm J. , Fundudis Trian , Kolvin Israel
Published: August 2018

The dexamethasone suppression test was carried out on 44 children to assess agreement with diagnosis of depression. No significant association was found between suppression of plasma cortisol and depression diagnosed clinically or by cluster analysis.
The TAPS Project. 13: Clinical and Social Outcomes of Long-Stay Psychiatric Patients After One Year in the Community
Authors: Anderson Jeremy , Dayson David , Wills Walter , Gooch Chris , Margolius Olga , O'Driscoll Catherine , Leff Julian
Published: August 2018

The first prospective, controlled study of a large, long-stay, in-patient population as their hospital services were reprovided in the community is reported. Two-hundred-and-seventy-eight patients were matched individually with similar patients who remained in hospital. Clinical and social outcomes over a one-year follow-up are presented for the first three years of the reprovision process. Compared with matches, the leavers at follow-up had more diverse social networks that contained a higher proportion of contacts named as friends. The care facilities in the community allowed more opportunities for patient autonomy than the hospitals across all aspects of the environments measured. At follow-up, more leavers than matches wanted to remain in their current placement, while fewer leavers than matches said there was nothing they liked about their current placement. More leavers than matches found their medication helpful.
Diagnosis and Treatment of Depression in General Practice
Authors: Freeling Paul
Published: August 2018

General practitioners (GPs) work in an environment different from that of most of their specialist colleagues. Some of these differences stem from being a doctor of first contact, some from working in one part of a multi-tier system for providing medical care, and some from the referral system which deals with the movement of patients between these tiers. Other differences stem from the GP's National Health Service contract to provide continuity of care 24 hours a day, and to make early diagnoses as well as monitoring normal development on one hand and chronic impairment, handicap, and disability on the other. The British GP works with a defined list of registered patients who can present symptoms representing disorders of a wide range of severity, originating in any bodily system. These symptoms can result from any type of pathogenic stimulus, including disordered perception: even temporary variation from the patient's usual subjective experience may arouse natural concern.
Can Computerised Tomography be Used to Predict Early Treatment Response in Schizophrenia?
Authors: Schröder J. , Geider F. J. , Sauer H.
Published: August 2018

The relationship between early treatment response and CT variables was investigated in 50 consecutively admitted patients with DSM-III schizophrenia. Treatment response was defined as the absolute BPRS improvement during patients' hospital stay and was found to be significantly correlated (P<0.05) with the frontal horn ratio (r = −0.36), ventricular ratio (r = −0.32), width of the third ventricle (r= −0.37), width of the frontal interhemispheric fissure (r = −0.33), and average width of the three largest cortical sulci (r = −0.46). According to the results of multiple regression analysis, 35% of the variance in the treatment response was accounted for by the average width of the three largest cortical sulci, the ventricular ratio and the frontal horn ratio. Thus, cerebral abnormalities associated with poor treatment response do not seem to be limited to one particular morphological site, but involve different brain regions.
Columbia Atypical Depression
Authors: Quitkin Frederic M. , Stewart Jonathan W. , Mcgrath Patrick J. , Tricamo Elaine , Rabkin Judith G. , Ocepek-Welikson Katja , Nunes Edward , Harrison Wilma , Klein Donald F.
Published: August 2018

We summarise a series of studies using a MAOI to help establish the validity of a subgroup of depressives referred to as atypical depressives. Patients with reactive mood meeting DSM-III criteria for depressive illness who had associated atypical features (which include hyperphagia, hypersomnolence, leaden paralysis, and rejection sensitivity) were randomised to imipramine, phenelzine and placebo. Non-responders were crossed over, and in all there were over 400 patient trials. Phenelzine consistently was found to be superior to imipramine. Only in trials which included patients lacking atypical, vegetative symptoms was imipramine found to equal phenelzine. We conclude that the researcher and the clinician should consider the relevance of the atypical depressive syndrome.
The Importance of Non-biological Factors in Influencing the Outcome of Clinical Trials
Authors: Gaebel W.
Published: August 2018

The outcome of clinical drug trials is influenced both by biological and by non-biological factors. Non-biological factors can be subdivided into methodological factors and non-drug factors. The former are related to the definition and measurement of treatment course, response, and outcome itself; the latter cover characteristics of the patient, the treatment milieu, the patient's milieu apart from treatment, and (planned) psychosocial interventions. Although their mechanism of interaction with treatment outcome is not yet fully understood, these non-drug factors should be routinely monitored in clinical trials for three practical reasons: (a) to control for the heterogeneity of outcome; (b) to develop individualised outcome predictors; and (c) to promote the development of individualised guidelines for treatment indication.
Identification with the Therapist's Functions and Ego-Building in the Treatment of Schizophrenia
Authors: Volkan Vamik D.
Published: August 2018

People with schizophrenia lack the ability to develop – to differentiate and integrate – their self- and object-representations, and suffer from primitive ‘object-relations’ conflicts, which occur when they try to develop (to differentiate and integrate) their self- and object-world. When a therapist interacts beneficially with a schizophrenic patient and enables him/her to identify with the ego functions involved in this interaction, the patient's frail psychic structure receives nourishment that will strengthen it: this process is similar to human development, where a child attains psychic organisation by interacting with the one who nurtures him/her. The recommended approach in the psychoanalytic psychotherapy of schizophrenia is to ‘allow’ the natural evolution of the fusion–defusion and introjection–projection processes to appear in the experiences of transference and counter-transference.
The Intricacy of the Ordinary
Authors: Sørensen Tom
Published: August 2018

Schizophrenia constitutes a lifelong vulnerability in relation to life stresses and the maintenance of social networks. Satisfactory quality of life – understood as subjective well-being in a lifetime perspective – is the ultimate treatment objective. This paper draws on research and clinical experience from Lofoten – the catchment area of a psychiatric out-patient clinic in Northern Norway. This work stresses the quality of life for the social network around the psychiatric patient as a consideration in its own right. The patient's coping resources and social network are regarded as a continuous professional concern.
A Brief History of the Development of Rehabilitative Services in China
Authors: Tian Weicai , Pearson Veronica , Wang Ruiwen , Phillips Michael R.
Published: August 2018

In pre-revolutionary China most disabled persons had no opportunity to receive education or obtain employment, and many of them experienced social discrimination. After the founding of the People's Republic, the government adopted a number of measures aimed at guaranteeing their livelihood. Efforts were made to give those who maintained the ability to work the opportunity to do so; those who were unable to work were provided with emergency relief or, if they had no family members who could support them, placed in orphanages, long-term psychiatric hospitals, and other types of welfare institution. Once the basic livelihood needs of the disabled were met, the next objective was to provide rehabilitative services. The evolution of these services has depended on three separate but related developments: the maturation of an organisational structure for the co-ordination of the services; the promulgation of laws that safeguard the rights and privileges of disabled persons; and the formation of academic societies of medical rehabilitation. This paper first considers these three developments and then examines how they have influenced the evolution of psychiatric rehabilitation in China.
Rehabilitative Effect of Music Therapy for Residual Schizophrenia
Authors: Tang Wenzhong , Yao Xinwei , Zheng Zhanpei
Published: August 2018

Seventy-six in-patients who had the residual subtype of schizophrenia were randomly assigned to a treatment group or a control group. Both groups received standard medication as prescribed by their treating physicians, but the treatment group also received a one-month course of music therapy that included both passive listening to music and active participation in the singing of popular songs with other patients. Outcome was evaluated by four nurses using Chinese versions of the Scale for Assessment of Negative Symptoms and the in-patient version of the World Health Organization's Disability Assessment Scale. Music therapy significantly diminished patients' negative symptoms, increased their ability to converse with others, reduced their social isolation, and increased their level of interest in external events. As music therapy has no side-effects and is relatively inexpensive, it merits further evaluation and wider application.
Guardianship Networks for Rural Psychiatric Patients
Authors: Qiu Fugen , Lu Shouqing
Published: August 2018

This paper describes the ‘rural guardianship network’ method of managing persons with severe mental illnesses and reports on a retrospective case–control study that compares the outcome of 561 schizophrenic patients from townships with guardianship networks to that of 103 schizophrenic patients from a township without guardianship networks. Each patient enrolled in a guardianship network is assigned a guardian – usually a family member – who ensures that the patient takes medication and gets medical follow-up, and reports any changes in the patient's condition to the village health worker or the township doctor who is responsible for psychiatric care. These guardians are supported and supervised by management groups at the village and township levels composed of government officials, medical administrators, physicians from township hospitals, and village health workers. Compared with patients who are not enrolled in guardianship networks, enrolled patients have significantly lower rates of hospital admission, lower rates of socially disruptive behaviour, and lower levels of psychopathological symptoms. The rural guardianship network is an effective and economical means of providing close supervision of mentally ill patients in their homes.
Depression: A Long-Term Illness
Authors: Keller Martin B.
Published: August 2018

The realisation that major depression is often both chronic and recurrent has slowly begun to change the way that depression is diagnosed and treated. In particular, the need for continuation and maintenance treatment is an issue that now deserves increased attention, especially with the availability of new classes of antidepressant treatments, which have excellent efficacy and more favourable side-effect profiles. Although the serious consequences of depressive disorders clearly indicate the need for effective and prompt intervention on the part of clinicians, the results of several studies indicate that patients with depression consistently receive no or low levels of antidepressant therapy. It is hoped that, through continued education of health care providers and patients about the consequences of depression, the issue of undertreatment of this serious illness will be resolved.
Major Depression, Dysthymia and Depressive Personality Disorder
Authors: Hirschfeld Robert M. A.
Published: August 2018

The separation of persistent depression into meaningful and useful subcategories, including major depression, dysthymia, recurrent brief depression, and depressive personality disorder, is the subject of much debate. Depressions can be grouped on the basis of their type and severity of symptoms, aetiology, clinical course, or their association with other psychiatric illnesses. Several investigators have conducted epidemiologic and family studies to evaluate the prevalence of depressive disorders, their diagnostic stability over time, and the amount of overlap among the disorders. Although progress has been made toward a better understanding of the different disorders, insufficient evidence exists to support the hypothesis that these disorders are separate and distinct from one another. However, preliminary data suggest that depressive personality disorder is separate from the other disorders. Additionally, several questions have been raised, particularly the extent to which differentiation between the depressive disorders, specifically major depression and dysthymia, has an impact on treatment decisions.
The Economic Burden of Affective Disorders
Authors: Rice Dorothy P. , Miller Leonard S.
Published: August 2018

Background. This paper summarises the methods and sources of data used to estimate costs of affective disorders and presents the results.

Method. A timing model employing regression analysis was developed to estimate morbidity costs. This model measures the lifetime effect on current income of individuals with affective disorders, taking into account the timing of onset and the duration of these disorders.

Results. Affective disorders imposed an estimated US$20.8 billion burden in 1985 and US$30.4 billion in 1990 in the US. Affective disorders represent 21 % of the costs of all mental illnesses. Direct treatment costs comprised 58.4% of the total in 1985; morbidity costs, 8.1%; mortality costs, the present value of future earnings lost due to premature mortality, 28.9%, based on a 6% discount rate; and other related costs, including the cost of crime, lost productivity due to incarceration, and caregiver services, 4.6%. Private sources account for 49% of the total direct expenditures for treatment of persons with affective disorders; state and local funds, 26%; and federal funds, 25%.

Conclusion. In light of the high burden of affective disorders on societal resources, more attention should be directed at comprehensive, research-based strategies to reduce the prevalence of these disorders in the United States.
Olanzapine in the long-term treatment of schizophrenia
Authors: Kane John
Published: August 2018

The primary aim of the long-term treatment of patients with schizophrenia is to prevent relapse, which is costly both in psychological and economic terms. Although with conventional antipsychotic drugs relapse may occur despite compliance with maintenance regimens, the rate of relapse is reduced in compliant patients. However, this benefit is achieved at the cost of side-effects and the risk of developing tardive dyskinesia, even among patients who have taken these drugs for only a year or two. To provide the therapeutic benefits of maintenance medication without its drawbacks, intermittent dosing and long-term therapy with reduced doses of conventional medications have been explored. The atypical antipsychotic agent, olanzapine, has been shown to be effective maintenance medication and has an improved safety profile.
Unexplained Physical Complaints
Authors: Escobar Javier I. , Canino Glorisa
Published: August 2018

‘Hypochondria’, ‘hypochondriasis’, and ‘somatisation’ are terms long used to characterise individuals who display unrelenting somatic symptoms that cannot be medically explained. A psychiatric aetiology for such phenomena is often assumed on the basis of potential psychological gain, the presence of ‘stressors’, the co-existence of unexplained somatic symptom and symptoms of depression or anxiety, or merely the absence of a medical explanation.
The Development of the Concept of Reactive Psychoses
Authors: Strömgren Erik
Published: August 2018

The concept of reactive or psychogenic psychoses has had a peculiar fate. Especially at the beginning of the century, under the influence of the writings of Jaspers (Jaspers, 1913) which included definitions of ‘psychogenic’ and ‘psychoses’, the term ‘psychogenic psychoses’ came into common use in European psychiatry. In Scandinavia, this trend was greatly reinforced by August Wimmer's monograph in 1916 on the subject. In the later editions of Kraepelin's standard textbook, the concept appeared quite frequently, and the same was the case in other leading textbooks, for instance in the Soviet Union and Japan.
The Dysphoric Syndrome in Schizophrenia and its Implications for Relapse
Authors: Hirsch Steven R. , Jolley Anthony G.
Published: August 2018

The presence of non-psychotic neurotic and dysphoric symptoms in schizophrenia has been recognised from the days of Bleuler (1908) and Kraepelin (1896) and is inherent in the hierarchical schema explicated by Foulds (1976) and commonly employed by psychiatrists in the diagnosis of psychotic disorder. Of such symptoms, those which may be characterised as depressive in nature have been the focus of much recent interest in view of claims that they may be iatrogenic. That such symptoms occur widely in schizophrenia is beyond dispute, but their relationship to the process of the illness and its treatment remains a subject of contention.
Coping with Attentional Disorders as a Systemic Process in Schizophrenic Patients
Authors: Andres Karl , Brenner Hans D.
Published: August 2018

Around the turn of the last century, Kraepelin and Bleuler developed the theory that some schizophrenic symptoms can be traced back to attentional disorders and in contemporary experimental research on attention, this reappears in the thesis that attentional disorders cause a vulnerability to schizophrenia. Empirical studies (Nuechterlein & Dawson, 1984) showed that attentional deficits before, during, and after an episode of such illness are consistent with the vulnerability model. However, if attentional disorders really do play a fundamental role in the development of schizophrenic symptoms, how do patients handle their more-or-less intact attentional capabilities? Thus, at the current level of research, the relevant question is not only whether attentional disorders occur, but – more and more – how such patients process information in the presence of these disorders.
Distractibility in Schizophrenia: State and Trait Aspects
Authors: Spring Bonnie , Lemon Martin , Weinstein Lisa , Haskell Alison
Published: August 2018

Cognitive deficits in schizophrenia can be differentiated into state-linked accompaniments of psychotic episodes and trait-linked signs of a more enduring vulnerability to schizophrenia (Zubin & Spring, 1977; Cromwell & Spaulding, 1978). Elsewhere (Spring & Zubin, 1978) we suggested that a marker of psychotic episodes is one that deviates in highly symptomatic schizophrenic patients and normalises as their florid psychotic symptoms remit. A stable vulnerability marker, in contrast, continues to deviate in remitted patients, their biological relatives, and others who are vulnerable to schizophrenia but not floridly psychotic. In addition, Nuechterlein & Dawson (1984) proposed a mediating vulnerability marker which demonstrates characteristics of both vulnerability and episode markers. On such a marker, asymptomatic vulnerable individuals differ from normal; the advent of psychosis magnifies the deviation.
Vulnerability-linked Deficiencies, Psychopathology and Coping Behaviour of Schizophrenics and their Relatives
Authors: Böker Wolfgang , Brenner Hans D. , Würgler Sybylle
Published: August 2018

It has repeatedly been demonstrated that both acutely psychotic and remitted schizophrenics, as well as some relatives of schizophrenics, show experimentally assessable cognitive dysfunctions, i.e. attentional or information-processing deficits. It is therefore assumed that these are at least potential vulnerability indicators for schizophrenia (Nuechterlein & Dawson, 1984; Nuechterlein, 1987).
V. Cause of Death
Authors: Anderson C. , Connelly J. , Johnstone Eve C. , Owens D. G. C.
Published: August 2018

High mortality rates among schizophrenic patients from infectious diseases, particularly tuberculosis, pneumonia and gastro-enteritis, reported for periods up to the 1940s were shown not to be specific for schizophrenia, but were characteristic of the mental hospital population as a whole (Alstrom, 1942). Studies covering more recent times confirm the decline and virtual disappearance of mortality from tuberculosis (Baldwin, 1979), but an extensive literature continues to emphasise the relatively high mortality of the mentally ill, including those defined as schizophrenic (Innes & Millar, 1970; Tsuang & Woolson, 1977), and more recent record linkage studies (Herrman et al, 1983; Allebeck & Wistedt, 1986) have continued to show an excess of both natural and unnatural deaths. Long follow-up studies of reasonably large groups of well documented cases are relatively uncommon in this area and therefore the 532 cases in the Harrow study were carefully followed up from the point of view of the occurrence and cause of death.
IX. Concluding Remarks
Authors: Johnstone Eve C. , Frith C. D. , Leary J. , Owens D. G. C.
Published: August 2018

This report concerns 532 patients with schizophrenia. Many items of information have been recorded and the results have been quickly drawn together for publication. It is likely that more detailed analyses of the data will be conducted in time, but this publication reports the central facts derived from this extensive investigation. They can be simply stated. The disorder remains very common. Five hundred and thirty-two individuals with schizophrenia as defined by the Feighner criteria were discharged from Harrow services over 10 years. It was possible to trace the great majority of these patients. In many cases the illness was clearly associated with recurrent or persistent problems. The mean number of admissions required was 5.37 (Fig. 1) and on average patients spent 13.7 of the 120 months between 1975 and 1985 in hospital (Fig. 2).
The Person with Delusions
Authors: Strauss John S.
Published: August 2018

“And the end of our exploring Will be to arrive where we started And know the place for the first time.” (Eliot, 1952, p. 145)

In preparing this report I made the mistake of looking back in the literature, the literature not only of delusions, but also including some more general works of the earlier clinical writers, such as Birnbaum (1923), Conrad (1958), Jaspers (1963) and Kretschmer (1927). It was a humbling experience; these were obviously people who knew something about patients and about the realities of symptoms. For these writers, notions such as delusions were not just abstractions, not even just abstractions with operational definitions. These authors described real experiences of people, and their descriptions reflect the importance of studying patients from close clinical contact.
Animal Behavioural Studies in the Evaluation of Antidepressant Drugs
Authors: Thiébot M.-H. , Martin P. , Puech A. J.
Published: August 2018

Animal behavioural models of psychiatric disorders cannot exactly simulate human psychopathology, but they can be used to evaluate the behavioural changes induced by drugs and to suggest hypotheses about the functions of the CNS and its involvement in psychiatric disorders. This should lead to a more heuristic classification of psychotropic drugs and to clarification of their therapeutic possibilities. The following animal models simulate aspects of depressive disorders and are sensitive to the antidepressant effects of drugs. (i) The forced swimming test: described as ‘behavioural despair‘ on the assumption that the animal has given up hope of escaping. (ii) The ‘restraint stress‘ test: this may indicate a failure to adapt to stress. (iii) The learned-helplessness model: exposed to uncontrollable events, animals exhibit learning performance deficit and behavioural changes, including decreased locomotor activity and loss of appetite. (iv) Waiting behaviour: improvement in the ability to wait for and/or postpone an active response; this could be related to the reported beneficial effects of antidepressants on impulsive behaviour.
The Effects of Tianeptine and other Antidepressants on a Rat Model of Depression
Authors: Curzon G. , Kennett G. A. , Sarna G. S. , Whitton P. S.
Published: August 2018

A model of depression based on measurements made after restraining rats for two hours has been developed. The model is associated with elevation in corticosterone, reflects the higher incidence of depression in women, and shows increased post-synaptic 5-HT function with adaptation. The effects of tianeptine and other antidepressants on the model were studied. Chronic pre-treatment with desipramine, sertraline (amine uptake inhibitors), and chlordiazepoxide normalised open field activity after restraint. Single high doses, post-restraint, of 8-OH-DPAT, gepirone (5-HT agonists), and tianeptine normalised open field activity, whereas desipramine, chlordiazepoxide, and diazepam did not. It is of considerable interest that tianeptine decreased the availability of 5-HT to receptors.
II. Brief Reactive Psychosis and the Major Functional Psychoses: Descriptive Case Studies in Africa
Authors: Guinness E. A.
Published: August 2018

In a three-year prospective study of service-based incidence of functional psychoses in Africa, 94 cases of brief reactive psychosis were compared with 56 cases of schizophreniform syndromes, 29 cases of DSM-III schizophrenia and 14 of manic-depressive psychosis. This was supplemented by retrospective study of the same syndromes not in their first episode. Brief reactive psychosis was found to be a composite syndrome. The 50% with preceding depression were a distinct group, in terms of course and demographic features. Of those with intense prodromal anxiety, most were a single episode precipitated by a major life event, a few showed a recurrent long-term pattern. Schizophrenia was heralded, or presented unequivocally months or years later, in 10-20%. The schizophreniform group comprised a range of atypical psychoses intermediate between the transient and major psychoses. The pattern of precipitants and the over-representation of education and paid employment in the acute syndromes, compared with the major psychoses, in a society which was largely first-generation educated, suggested a link with rapid social change.
Clinical Efficacy of Clozapine in Treatment-Refractory Schizophrenia: An Overview
Authors: Kane John M.
Published: August 2018

The treatment of patients with schizophrenia who fail to respond to antipsychotic medications remains a challenge. Despite numerous attempts to establish effective somatic treatment approaches for this population, clozapine appears to be the only well established alternative. Depending upon trial duration and response criteria, between 30% and 60% of previously unresponsive patients appear to derive clinically significant benefit from clozapine. Clozapine also has important advantages in terms of its reduced propensity to produce extrapyramidal side-effects. Agranulocytosis remains an important risk, so strategies to improve the benefit-to-risk ratio should be explored. Issues such as trial duration, dosage, blood levels and predictors of response require additional study.
Fluoxetine vs Amitriptyline in the Treatment of Depressed Out-patients
Authors: Laakmann G. , Blaschke D. , Engel R. , Schwarz A.
Published: August 2018

As a result of research in recent years, therapeutic possibilities for the treatment of depressive illnesses have been significantly expanded. Monoamine oxidase inhibitors and selective noradrenaline (e.g. oxaprotiline) or serotonin-reuptake inhibiting (e.g. fluoxetine, fluvoxamine) substances have been added to the classical tricyclic antidepressants, whose mode of action is primarily based upon combined noradrenaline and serotonin reuptake inhibition. Furthermore, the extent to which benzodiazepine derivatives or neuroleptics can be successfully used at low dosages for the treatment of depressive illness is currently being investigated.

For these compounds to be used in an individualised manner, however, agreed diagnostic criteria must be taken into consideration, as well as other factors such as the severity and type of depressive syndrome (mild, marked, or severe, retarded or agitated). For example, the benzodiazepine derivative alprazolam has a therapeutic efficacy comparable to amitriptyline for the treatment of milder depressive syndromes, but is significantly less effective for a severe depressive disorder.

We undertook a study of fluoxetine, a selective serotonin-reuptake inhibitor (Wong et al, 1974, 1975), in a double-blind comparison with amitriptyline. We particularly wanted to know if the efficacy of fluoxetine was comparable to that of amitriptyline, and whether fluoxetine caused less adverse effects as a result of its selectivity, which remains unchanged even after its metabolisation to desmethyl fluoxetine (Fuller et al, 1978).
The Pharmacology of Reversible Monoamine Oxidase Inhibitors
Authors: Amrein R. , Allen S.R. , Guentert T.W. , Hartmann D. , Lorscheid T. , Schoerlin M.-P. , Vranesic D.
Published: August 2018

The older monoamine oxidase inhibitors (MAOIs) are mechanism-based, irreversible inhibitors of MAO; most inhibit both the A and B forms of MAO. Several of the drugs are hydrazine derivatives which have non-specific effects other than MAO inhibition. These properties convey disadvantages, which may be seen as serious, though infrequent, adverse events — the ‘cheese effect’, hepatotoxicity, amphetamine-like activity, orthostatic hypotension and anticholinergic effects. New, reversible MAOIs stem from a variety of chemical classes and are more specific in their effects, with relatively rapid onset of action, direct relationship between plasma concentration and pharmacological effect, and no prolonged carry-over phenomena.
Preventive strategies in early psychosis: verging on reality
Authors: McGorry Patrick
Published: August 2018

“Very early schizophrenia still constitutes a relatively unexplored territory. Entry into this territory calls for new ideas on the social problems involved in bringing the early schizophrenic promptly under treatment, or where the treatment should be carried out and in what it should consist.” D. Ewen Cameron (1938)
Analysis of the initial treatment phase in first-episode psychosis
Authors: Power Paddy , Elkins Kathryn , Adlard Steven , Curry Christina , McGorry Patrick , Harrigan Susan
Published: August 2018

Background The Early Psychosis Prevention and Intervention Centre (EPPIC) commenced operation in Melbourne, Australia, in 1992. It offers a model for management of first-episode psychosis, utilising principles of early detection, low-dose medication and comprehensive psychosocial interventions within the least restrictive setting.

Method Data were examined from the first three months of treatment for all consecutive people with first-episode psychosis (n=231) accepted in the programme in 1995–1996. A subsample of patients (n=120) was assessed comparing clinical ratings with variables of gender, diagnosis, hospitalisation, and medication.

Results Hospitalisations were brief, and avoided for a third of the people. Low-dose antipsychotic medication was maintained in both in-patient and community settings. Those people with manic psychosis were more likely to be hospitalised. Hospitalised people received higher antipsychotic dosages, and had a greater rate of reduction in Brief Psychiatric Rating Scale psychotic sub-scale scores at three months follow-up. Eighty per cent of a representative subsample had responded to treatment and 63% were in remission by the end of the three months.

Conclusion This naturalistic study suggests that the feasibility of implementing the EPPIC model in a range of clinical settings is promising and applicable in practice.
Individual cognitive–behavioural interventions in early psychosis
Authors: Haddock Gillian , Morrison Anthony P. , Hopkins Richard , Lewis Shôn , Tarrier Nicholas
Published: August 2018

BackgroundCognitive-behavioural treatments have previously been explored in the treatment of chronic psychotic problems, but recently, the effectiveness of these treatments has been investigated with regard to recent onset and acute psychosis.

MethodThe literature relating to cognitive-behavioural treatments in psychosis is explored and the application of the approach to recent onset psychosis is described in detail.

ResultsThere appears to be a growing body of evidence that the advances made in the treatment of people with chronic treatment resistant psychosis can be similarly applied to people with recent onset and acute psychosis.

ConclusionsCognitive-behavioural treatments are feasible with recent onset psychotic patients although further evaluation of their effectiveness is necessary.
Stress and coping in early psychosis
Authors: MacDonald Elspeth M. , Pica Simone , McDonald Shelley , Hayes Robyn L. , Baglioni Anthony J.
Published: August 2018

BackgroundAlthough coping with stress is important in early psychosis, little is known about how this population copes with the range of stressors they encounter in their daily life. This study aims to identify how people with early psychosis cope with a range of stressful situations and to identify what factors might influence their use of coping strategies.

MethodParticipants included a clinical group of 50 people with early psychosis and a non-clinical group of 22 people matched on age and gender. Data were obtained on symptomatology and social support for the clinical group, and stress and coping, and self-efficacy for all participants.

ResultsThe clinical group reported coping less well than the non-clinical group and they most commonly used emotion-focused coping. For the clinical group, effective coping correlated with less severe negative symptoms, greater perceived self-efficacy social support and greater use of problem-focused coping. Self-efficacy and social support predicted increased frequency of the use of problem-focused coping.

ConclusionPeople with early psychosis who have greater feelings of self-efficacy and perceived social support, and the flexible use of problem-focused coping strategies, appear to be more likely to cope with day-to-day stressors.
Emotional management therapy in early psychosis
Authors: Hodel Bettina , Brenner Hans D. , Merlo Marco C. G. , Teuber Jeffrey F.
Published: August 2018

Background Emotional management therapy (EMT) aims to improve handling of emotional stress in schizophrenia. It consists of two sub-programmes: the first includes relaxation techniques, the second stress coping skills.

Method A pilot study of EMT in 19 patients with early psychosis produced positive results and a post-hoc study of 16 patients was commenced.

Results EMT showed positive results, with chronic patients improving more than patients with early psychosis.

Conclusion EMT can be effective in early psychosis, especially for cognitive functioning.
Different roles for serotonin in anti-obsessional drug action and the pathophysiology of obsessive-compulsive disorder
Authors: Delgado Pedro L. , Moreno Fransisco A.
Published: August 2018

Background There is a major role for serotonin in the mechanism of anti-obsessional drug action. Drugs that block uptake of noradrenaline are not effective in the treatment of obsessive-compulsive disorder (OCD), while drugs that potently bock serotonin reuptake are effective. While enhancement of serotonin neurotransmission is clearly involved in the treatment of OCD, the role of serotonin in the pathophysiology of OCD is less clear.

Method This paper provides a brief, focused review ofthe literature regarding treatment of OCD, the effects of drugs with selective action at various serotonin receptors and results of neurotransmitter depletion studies in patients with OCD.

Results Some patients with OCD may experience remission of OCD symptoms during intoxication with psychedelic drugs that have potent 5-HT2A/2c agonist activity. These findings, coupled with results from serotonin depletion studies in depressed and OCD patients, suggest that enhancement of serotonin neurotransmission may underlie both antidepressant and anti-obsessional drug action, although the targeted brain areas may differ.

Conclusions OCD may not involve a dysfunction ofthe serotonin system. Rather, it is more likely to involve a dysfunction of specific brain circuits, particularly in the frontal cortex. Modulation of these circuits by serotonin neurons may underlie the specific action of anti-obsessional drugs.
Making music out of noise – the cost function approach to evaluation∗
Authors: Knapp Martin
Published: August 2018

In good health care systems, the planning and purchasing of services for individual people should be based on individual needs assessments and outcome expectations. No two patients or users of a given service or programme are likely to present exactly the same symptoms or needs, or to experience exactly the same outcomes. They will have different personal and family circumstances, resources and preferences. Consequently, service responses should rarely be exactly identical.
Research policy implications of cost-of-illness studies for mental disorders
Authors: Rupp Agnes , Gause Emily M. , Regier Darrel A.
Published: August 2018

Basic, clinical and services research all play important roles in generating scientific knowledge and, ultimately, in discovering and developing cost-effective treatments that help people with a given illness. Benefits of the treatments then extend to patients' families, their communities and the entire society – all of which are impacted by the negative economic and social consequences of the disease.
Estimating the cost impact of three case management programmes for treating people with severe mental illness
Authors: Hu Teh-Wei , Jerrell Jeanette M.
Published: August 2018

The treatment of people with severe and persistent mental illness entails long-term intervention and may be very costly, primarily due to their frequent use of acute and subacute treatment services or because of prolonged stays in health care institutions. Given the rising costs of health care and the decreasing public funding for treating people with severe mental illness, mental health professionals are adopting case management approaches to provide more efficient care to these individuals.
In vivo neuropharmacology of schizophrenia
Authors: Bigliani V. , Pilowsky L. S.
Published: August 2018

Since the introduction of chlorpromazine in the 1950s, followed by the discovery (with in vitro receptor binding assays), in the mid-1970s, that antipsychotic drugs block a subtype of dopamine receptor (D2/D2-like) (Creese et al, 1976) and that affinity for these receptors appears to correlate directly with clinical potency for antipsychotics (Peroutka & Synder, 1980), the study of neurotransmitters and receptors has been a major target of schizophrenia research (Owens, 1996). In 1983, the first visualisation, by positron emission tomography (PET), of the binding of D2 dopamine receptors in the brain of a living human subject was reported (Wagner et al, 1983). Following this, the number of research studies using PET and single photon emission tomography (SPET) has increased enormously.
What is Comorbidity – Fact or Artefact?
Authors: Wittchen Hans-Ulrich
Published: August 2018

Comorbidity can be described broadly as the presence of more than one disorder in a person in a defined period of time (Wittchen & Essau, 1993). Stimulated by the introduction of explicit diagnostic criteria and operationalised diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (DSM–III; APA, 1980) and the Diagnostic Criteria for Research in ICD–10 (WHO, 1991), numerous studies in the 1980s and early 1990s, have assessed the extent, the nature, and more recently, the implications of comorbidity for a better understanding of mental disorders. Most studies investigated the association of anxiety and mood disorders, but increasingly there are also studies looking into the association of mood disorders with other disorders (such as somatoform and substance use disorders (Wittchen et al, 1993, 1996)) as well as with somatic conditions (axis II) and personality disorders (axis III).
Critical Issues in the Evaluation of Comorbidity of Psychiatric Disorders
Authors: Wittchen Hans-Ulrich
Published: August 2018

Comorbidity has become an increasingly popular theme in psychiatry and clinical psychology, although its heuristic value was recognised long ago. Frequently used in research and practice, no definition of comorbidity is uniformly accepted and it has no comprehensive and coherent theoretical framework. These factors have led to substantial variation in the magnitude of comorbidity across studies. The variability in the definition, assessment and design of comorbidity studies has led to an increasingly complex and confusing picture about the potential value of this concept. The full exploration of mechanisms of comorbidity requires an interdisciplinary approach to investigating nosology, assessment, and underlying models of comorbidity, as well as experimental study designs beyond the scope of clinical and epidemiological studies. A more precise specification of comorbidity patterns might help identify common biochemical and cognitive markers relevant in the aetiology of specific mental disorders as well as comorbid conditions. Critical issues that might help us understand and explain the variability of findings are described.