bluuebunny/crossref_metadata_2025 huggingface dataset:
Seasonal Affective Disorder, Environmental Hypersensitivity and Somatisation
Authors: Hotopf Matthew
Published: October 2008

An association between seasonal affective disorder (SAD) diagnosed according to DSM–III–R criteria and ‘environmental hypersensitivity’, Candida hypersensitivity, and food allergies is reported in two patients. It is suggested that patients with somatisation disorder may present with symptoms of SAD and other media-popularised diagnoses in a form reminiscent of the cases of multiple media-popularised diagnoses.
Changes of Plasma Concentrations of Interleukin-1αand Interleukin-6 with Neuroleptic Treatment for Schizophrenia
Authors: Xu Hai-Min , Wei Jun , Hemmings Gwynneth P.
Published: October 2008

A significant difference of plasma interleukin (IL)-1αconcentration was found between schizophrenic patients taking neuroleptic drugs (n= 38) and those not taking them (n= 14;P< 0.02); Kruskal-Wallis analysis revealed a significant difference of plasma IL-6 concentration among the patients taking neuroleptic drugs, those not taking them, and healthy control subjects (H= 7.1, d.f. = 2,P< 0.05); also, there was a significant difference of plasma IL-6 concentration between the patients taking neuroleptic drugs (n= 32) and those not taking them (n= 13;P< 0.01). No significant differences were found between the three groups in the concentrations of IL-1β,IL-2 and tumour necrosis factor(TNF)-α.The present results suggest that neuroleptic treatment may change IL-1αand IL-6 production in schizophrenic patients.
Tourette's Syndrome in New Zealand
Authors: Robertson Mary M. , Verrill Mark , Mercer Michael , James Basil , Pauls David L.
Published: October 2008

It has become increasingly evident that Tourette's syndrome (TS) is not as rare as was once thought and substantial cohorts from various parts of the world have been reported. The clinical characteristics seem independent of culture as they appear to occur with some degree of uniformity irrespective of the country of origin. We investigated the point prevalence and report the clinical characteristics of TS in New Zealand. Forty probable cases were identified and the symptoms were similar to those described in cohorts from other parts of the world.
Suicide (Update 1988)
Authors: Morgan H. G.
Published: October 2008

A clinician who wants to read about suicide faces a problem which besets the whole of psychiatry: how to encompass the many perspectives, each with its own discipline, all of which have to be included in any comprehensive and complete explanation of the problem. Face-to-face contact with suicidal people is central to our own clinical experience, but if we are to build up any credible theory about causation and prevention then these have to withstand a vigorous challenge from others, for example community doctors who seek proof by controlled trials, or social scientists who accord paramount importance to social events in the causation of suicide. Careful selection of papers and reviews in our reading is rendered all the more important at the present time when suicide prevention finds itself centre-stage as a result of the Health of the Nation targets for suicide prevention (Department of Health, 1992).
The Social Competition Hypothesis of Depression
Authors: Price John , Sloman Leon , Gardner Russell , Gilbert Paul , Rohde Peter
Published: October 2008

Depressive personality and depressive illness are examined from an evolutionary adaptationist standpoint. It is postulated that the depressive state evolved in relation to social competition, as an unconscious, involuntary losing strategy, enabling the individual to accept defeat in ritual agonistic encounters and to accommodate to what would otherwise be unacceptably low social rank.
Future Imperfect: the Long-Term Outcome of Depression
Authors: Surtees P. G. , Barkley C.
Published: October 2008

During 1976, 80 patients with a primary depressive illness were selected from a consecutive series of referrals to the Royal Edinburgh Hospital for a short-term follow-up study. This paper concerns the 12-year longitudinal assessment of the survivors. During the follow-up, mortality risk for the sample was almost doubled. Of the series, 35% had experienced a recurrence within 2 years of the initial interview, and just over 60% within the entire study time of 12 years. The risk of recurrence was enhanced for those aged over 45 years at index, for those with a history of depressive disorder and for those who had not engaged in parasuicidal behaviour during the index episode. The observed effect of previous episodes was largely accounted for by age. The chance of recurrence was not affected by whether the treatment of the index episode included ECT, or by whether diagnosis was ‘endogenous’ or ‘neurotic’. Application of the Lee-Murray outcome criteria showed that about one-third of the Edinburgh series experienced a very poor outcome. Results are presented concerning the prediction of long-term outcome as represented by the Depression Outcome Scale (DOS), a measure specially constructed for this study.
Bipolar Affective Puerperal Psychosis Associated with Consanguinity
Authors: Craddock Nick , Brockington Ian , Mant Rebecca , Parfitt Elizabeth , McGuffin Peter , Owen Mike
Published: October 2008

Most clinical and genetic evidence suggests that puerperal psychosis is closely related to bipolar affective disorder. During a linkage study of bipolar disorder we ascertained a British family in which puerperal psychosis was associated with consanguinity in three sisters. All three subjects had lifetime RDC diagnoses of bipolar I or manic disorder. An inbred brother also had bipolar I disorder. The only female member of the sibship to escape puerperal psychosis was outbred. These findings are consistent with several genetic models for bipolar disorder in this family. The most interesting possibility is a single major susceptibility locus of recessive effect. Under this assumption, the family could be used for homozygosity mapping to help localise the putative recessive locus. If other inbred families can be found in which the same putative recessive locus is operating, the power to localise the gene by homozygosity mapping would be greatly increased.
Prescription-Event Monitoring of 10401 Patients Treated with Fluvoxamine
Authors: Edwards J. Guy , Inman William H. W. , Wilton Lynda , Pearce Gillian L.
Published: October 2008

Prescription-event monitoring (PEM) is one of two national systems of drug safety monitoring practised in Britain. The objective of this PEM study was to assess the safety of fluvoxamine and to monitor the occurrence of untoward and other events during treatment. A total of 10 401 patients treated with the drug in general practices throughout England were studied and data were analysed in the Drug Safety Research Unit, Southampton. The main outcome measures were the overall incidence of events per 1000 patients; the incidence during the first month of treatment; the mean incidence for months 2–6 of treatment; and the ratio of these rates as a signal that an event could be drug related. The most commonly reported category of events was neuropsychiatric while the most commonly reported individual events were nausea and vomiting. Fluvoxamine was shown to be a safe drug and no unexpected or previously undetected drug-related events were encountered. There was a relatively high incidence of gastro-intestinal symptoms, but other adverse reactions often encountered during treatment with tricyclic antidepressants were not frequently reported.
Geomagnetic Storms: Association with Incidence of Depression as Measured by Hospital Admission
Authors: Kay Ronald W.
Published: October 2008

The hypothesis that geomagnetic storms may partly account for the seasonal variation in the incidence of depression, by acting as a precipitant of depressive illness in susceptible individuals, is supported by a statistically significant 36.2% increase in male hospital admissions with a diagnosis of depressed phase, manic-depressive illness in the second week following such storms compared with geomagnetically quiet control periods. There is a smaller but not statistically significant increase in female psychotic depression and non-psychotic depression admissions following storms. There was no correlation between geomagnetic storm levels and number of male admissions with psychotic depression, which is consistent with a threshold event affecting predisposed individuals. Phase advance in pineal circadian rhythms of melatonin synthesis may be a possible mechanism of causation or be present as a consequence of 5-hydroxytryptamine and adrenergic system dysfunction associated with geomagnetic disturbance. Effects on cell membrane permeability, calcium channel activity and retinal magneto-receptors are suggested as possible underlying biochemical mechanisms.
The Use of High-Dose Antipsychotic Medication
Authors: Thompson C.
Published: October 2008

Antipsychotic medication is the mainstay of treatment for the functional psychotic illnesses. Such drugs are also referred to as neuroleptics (meaning a drug with both antipsychotic effects and effects on movement) and major tranquillisers. The psychotic illnesses for which they are prescribed include schizophrenia, mania in the course of a bipolar mood disorder, and, more rarely, depression accompanied by psychotic symptoms. These are not uncommon illnesses. At some time during their lives approximately 1% of the population will suffer at least one episode of schizophrenia and a further 1% will suffer at least one episode of mania. During an episode some patients, but by no means all, suffer extreme changes in their thinking, mood and behaviour which can be very distressing to experience and which can make patients a danger to themselves or other people.
Schizophrenia in the Afro-Caribbean Community
Authors: Sugarman Philip A. , Craufurd David
Published: October 2008

Previous studies have shown high rates of schizophrenia among the Afro-Caribbean population in Britain. In order to assess the role of genetic factors in the aetiology of this phenomenon, we have used a standardised family history method (FHRDC) to compare lifetime morbidity risks for first-degree relatives of Afro-Caribbean and white patients with RDC schizophrenia admitted in Central Manchester between 1982 and 1988. Lifetime morbidity risk for parents of Afro-Caribbean subjects was 8.9%, and for parents of white patients 8.4%. For the siblings of black probands, however, the risk was 15.9%, as compared with 1.8% for white siblings (P< 0.05). Among siblings of UK-born Afro-Caribbean probands, morbid risk was even higher at 27.3% (P= 0.001). High rates among siblings of younger Afro-Caribbean patients are consistent with previous reports of a higher incidence in the UK-born. These observations suggest that schizophrenia among Afro-Caribbeans is no less familial than for the remainder of the population, but that the increased frequency of the disorder is due to environmental factors which are most common in the Afro-Caribbean community, and capable of precipitating schizophrenia in those who are genetically predisposed.
Heritability of Schizophrenia
Authors: Gureje O. , Bamidele R. , Aderibigbe Y. A.
Published: October 2008

Thirty-six consecutively admitted patients with schizophrenia and 20 with mania were studied for the morbid risk of psychosis in their first-degree relatives. Using the family history method of ascertainment, the morbid risk for schizophrenia in the relatives of schizophrenic probands was 4.12% compared with 1.42% in the relatives of manic probands. While this difference was not statistically significant, that between the morbid risk for affective psychoses in the relatives of manic patients (7.81%) was significantly higher than for the relatives of schizophrenic patients (0%).
Prodromal Symptoms in Schizophrenia
Authors: Malla Ashok K. , Norman Ross M. G.
Published: October 2008

This paper describes a prospective study of the relationship between non-psychotic prodromal symptoms and psychotic symptoms in 55 schizophrenic (DSM–III–R) out-patients. Once a month, a number of non-psychotic symptoms generally regarded as prodromal symptoms in schizophrenia were assessed, as well as psychotic symptoms, with standardised self-administered instruments and rating scales for a minimum of 12 months (range 12–29). The data were analysed for each patient using a longitudinal correlational design with a 1-month lag between the prodromal and psychotic symptoms over the total period. Results showed that in less than one-fifth of subjects did any of the prodromal symptoms, individually or in combination, show a significantly positive correlation with the subsequent level of psychotic symptoms. Such relationships were significant in an even smaller proportion of subjects when the confounding effect of concurrent psychotic symptoms on prodromal symptoms was partialled out. High levels of prodromal symptoms appeared to have adequate specificity but low sensitivity in their power to predict high levels of subsequent psychotic symptoms. There were no differences in age, gender, medication levels, and the number of previous admissions between the subjects who did or did not show a relationship between putative prodromal symptoms and psychotic symptoms.
Is There Cognitive Decline in Schizophrenia?
Authors: Hyde Thomas M. , Nawroz Safia , Goldberg Terry E. , Bigelow Llewellyn B. , Strong David , Ostrem Jill L. , Weinberger Daniel R. , Kleinman Joel E.
Published: October 2008

The issue of progressive cognitive decline in patients with schizophrenia has been debated. We performed a cross-sectional study of patients with chronic schizophrenia, aged from 18 to 69 years, in order to address this issue. The patients included in this study passed a rigorous screen for any comorbid condition with an adverse impact on central nervous system function. We assessed intellectual deterioration with a battery of neuropsychological tests known to be sensitive to cognitive impairment in progressive dementia. No evidence of accelerated intellectual decline was found. No significant differences were found between the five age-derived cohorts (18–29, 30–39, 40–49, 50–59, and 60–69 years of age) on the Mini-Mental State Examination, Dementia Rating Scale, or other tests sensitive to dementia. While performance on the Boston Naming Test significantly declined with age, this was mainly due to age rather than duration of illness. However, it is important to note that mean performances on the majority of the tests were abnormal across all cohorts studied. These results suggest that intellectual function does not markedly decline during the adulthood of patients with schizophrenia. The course of schizophrenia is more consistent with a static encephalopathy than a dementing disorder.
Semi-structured Depression Scale Sensitive to Change with Treatment for Use in the Elderly
Authors: Ravindran A. V. , Welburn K. , Copeland J. R. M.
Published: October 2008

The construction of a semi-structured interview depression scale that is sensitive to change for use in the elderly is described. Depression items from a well validated diagnostic instrument, the Geriatric Mental State Schedule (GMSS), were used as the core items in the development of the instrument. Improvement in depression in 80 elderly patients was independently assessed with two standard rating scales for depression, the Hamilton Rating Scale for Depression and the Beck Depression Inventory, and by an independent clinician's judgement before and after standard antidepressant treatment. Depression items that were sensitive to change were retained from the core items to form the new instrument. Results indicate that this scale is reliable and valid, shows better correlation with both the clinician's and the patient's judgement of improvement than the standard instruments, and is sparing of the rater's time.
Eye-Movement Desensitisation
Authors: Vaughan K. , Wiese M. , Gold R. , Tarrier N.
Published: October 2008

A novel approach is described for the treatment of post-traumatic stress disorder (PTSD). Eye-movement desensitisation (EMD) requires the patient to generate images of the trauma in the mind and define physiological and emotional arousal states. While concentrating on these states, lateral multisaccardic eye movements are induced. Ten consecutive cases are reported who presented with symptoms originating from a range of traumas. The effectiveness of EMD in reducing symptoms outlined by DSM–III–R is described. An independent rater indicated that eight of the ten cases showed considerable improvement in PTSD symptoms following EMD, which was maintained at follow-up. Particular reference is given to the ‘specificity’ of EMD in treating symptoms and the changing pattern of effect at follow-up.
Sleep Deprivation as a Diagnostic Instrument
Authors: Williams C. J. , Yeomans J. D. I. , Coughlan A. K.
Published: October 2008

A 59-year-old man with chronic treatment-resistant depression developed severe cognitive impairment. The severity of depression and the mode of presentation led to difficulty in diagnosis between a dementing disorder and a depressive illness. The diagnostic conundrum was resolved by the use of sleep deprivation (SD), which demonstrated clear subjective and objective improvements in his condition. These changes were quantified by a range of psychometric tests, which showed that initial deficits in cognitive performance improved temporarily after SD, and these improvements were maintained after effective treatment of the depression with electroconvulsive therapy.
Three Cases of Capgras' Syndrome
Authors: Frazer Sheila J. , Roberts Jeremy M.
Published: October 2008

Three cases of Capgras' syndrome were identified in one psychiatric hospital within a 1-year period. These are presented and their psychopathology discussed. The traditional assumption that this is a rare syndrome is challenged.
South Westminster Schizophrenia Survey
Authors: Duke Peter J. , Pantelis Christos , Barnes Thomas R. E.
Published: October 2008

In the context of a prevalence survey of schizophrenia in South Westminster, a questionnaire was administered to 271 patients to assess alcohol-related morbidity. In this epidemiologically based sample, the lifetime prevalence of alcohol abuse was 22.1 %. Compared with control patients matched for age and sex, these index cases had a significantly shorter duration of illness. A possible explanation is that drinking may mask the onset of schizophrenia, leading to a delay in diagnosis. The index cases also had significantly higher ratings for hallucinations and for hostility, anxiety and depression, and a greater number of disturbed types of behaviour. The highest levels of alcohol consumption were associated with more severe orofacial dyskinesia, suggesting that alcohol use may be an added risk factor for the development of tardive dyskinesia in some patients. The severity of akathisia was also related to alcohol use, and there were significant relationships between the subjective distress related to akathisia and the level of abuse. A possible interpretation is that alcohol had been used by patients with akathisia to alleviate the associated agitation and dysphoria.
The Defensive Function of Persecutory Delusions
Authors: Lyon Helen M. , Kaney Sue , Bentall Richard P.
Published: October 2008

Abnormalities of ‘social’ reasoning were investigated in patients suffering from persecutory delusions and in matched depressed and normal controls using transparent (obvious) and opaque (unobvious) tests of attributional style. Whereas depressed and normal subjects yielded similar causal inferences for both attributional measures, the deluded subjects showed a marked shift in internality, attributing negative outcomes to external causes on the transparent Attributional Style Questionnaire but, on the more opaque Pragmatic Inference Task, attributing negative outcomes to internal causes and thus showing a cognitive style resembling that of the depressed group. This finding, interpreted in terms of explicit versus implicit judgements, supports the hypothesis that delusions function as a defence against underlying feelings of low self-esteem.
Relationship of Panic, Anticipatory Anxiety, Agoraphobia and Global Improvement in Panic Disorder with Agoraphobia Treated with Alprazolam and Exposure
Authors: Başoglu Metin , Marks Isaac M. , Kiliç Cengiz , Swinson Richard P. , Noshirvani Homa , Kuch Klaus , O'Sullivan Geraldine
Published: October 2008

In a controlled trial of alprazolam and exposure in 154 patients with panic disorder with agoraphobia, relations between panic, anticipatory anxiety, and phobic avoidance were examined. The three symptoms were independent of one another at baseline and improved largely independently during treatment; only early improvement in avoidance predicted global improvement after treatment. Global improvement was more related to reduction of avoidance than a decrease in panics. Panic was not a valuable outcome measure in panic disorder with agoraphobia.
A Ratio Estimation Method for Determining the Prevalence of Cocaine Use
Authors: Gossop Michael , Strang John , Griffiths Paul , Powis Beverly , Taylor Colin
Published: October 2008

This paper presents an approach to estimating the prevalence of cocaine use, based upon a new ratio estimation technique. This method can be applied to random samples of overlapping populations for which no sampling frames exist. When the ratio estimation method is applied to the two study samples (drawn from populations of people using cocaine and people using heroin) the ratio of cocaine users to heroin users (C/H) was 1.55, with a 95% confidence interval of ±0.48. Such estimates should be applied with caution. However, if used with reference to national estimates of about 75 000 heroin users, application of the present estimate suggests that there may be about 116 000 cocaine users in the UK.
ANA Negative Systemic Lupus Erythematosus
Authors: Moorhead Stephen R. J. , Lee Alan S.
Published: October 2008

It is usually assumed that psychiatric disturbance cannot be caused by SLE alone. We report two cases of ANA-negative SLE presenting with psychiatric features.
Schizophrenic Psychosis and Associated Aqueduct Stenosis
Authors: O'Flaithbheartaigh S. , Williams P. A. , Jones G. H.
Published: October 2008

In two adults, both schizophrenia and hydrocephalus were associated with aqueduct stenosis. The prevalence is argued to be above chance, and may contribute to the neurodevelopmental hypothesis of the causality of schizophrenia.
Dysthymia and Mental Handicap
Authors: Jancar J. , Gunaratne I. J.
Published: October 2008

Two cases of dysthymia in mentally handicapped patients are described. The absence of publications on dysthymia in the mentally handicapped is noted. The importance of early diagnosis and treatment with advanced antidepressants and psychotherapy is emphasised.
Lithium Prophylaxis in Recurrent Affective Illness
Authors: Guscott R. , Taylor L.
Published: October 2008

The efficacy of lithium prophylaxis for recurrent mood disorders is well established. Despite concern that the later efficacy studies have shown poorer results, these studies (after 1980) are equally confirmatory of lithium's efficacy. However, questions have been raised with regards to the effectiveness of lithium prophylaxis under ‘ordinary’ clinical conditions. Part of the confusion stems from the failure to distinguish clearly efficacy (the potential of a treatment) from effectiveness (the results obtained under clinical conditions). Studies of effectiveness or naturalistic studies show poorer results than efficacy studies in all areas of medicine. The major reason for this discrepancy with lithium prophylaxis is poor compliance. Estimations of the efficiency (cost benefits) of lithium prophylaxis are flawed by the failure to consider such issues. It is proposed that specialised lithium or mood disorders clinics have the potential to narrow the gap between efficacy and effectiveness – efficiency.
A Comparison of Cognitive Therapy, Applied Relaxation and Imipramine in the Treatment of Panic Disorder
Authors: Clark David M. , Salkovskis Paul M. , Hackmann Ann , Middleton Hugh , Anastasiades Pavlos , Gelder Michael
Published: October 2008

Recent studies have shown that cognitive therapy is an effective treatment for panic disorder. However, little is known about how cognitive therapy compares with other psychological and pharmacological treatments. To investigate this question 64 panic disorder patients were initially assigned to cognitive therapy, applied relaxation, imipramine (mean 233 mg/day), or a 3-month wait followed by allocation to treatment. During treatment patients had up to 12 sessions in the first 3 months and up to three booster sessions in the next 3 months. Imipramine was gradually withdrawn after 6 months. Each treatment included self-exposure homework assignments. Cognitive therapy and applied relaxation sessions lasted one hour. Imipramine sessions lasted 25 minutes. Assessments were before treatment/wait and at 3, 6, and 15 months. Comparisons with waiting-list showed all three treatments were effective. Comparisons between treatments showed that at 3 months cognitive therapy was superior to both applied relaxation and imipramine on most measures. At 6 months cognitive therapy did not differ from imipramine and both were superior to applied relaxation on several measures. Between 6 and 15 months a number of imipramine patients relapsed. At 15 months cognitive therapy was again superior to both applied relaxation and imipramine but on fewer measures than at 3 months. Cognitive measures taken at the end of treatment were significant predictors of outcome at follow-up.
Month of Birth and Schizophrenia in Korea
Authors: Kim Chul-Eung , Lee Young-Sook , Lim Young-Hee , Noh In-Young , Park S. H.
Published: October 2008

This study investigates whether there is any difference in the month of birth between people with schizophrenia and controls in Korea. When 1606 patients with schizophrenia were compared with 4582 age- and sex-matched controls, there was no statistically significant difference in the month of birth, the season of birth of schizophrenic patients was not related to sex, family history or handedness.
What Events Precede Violent Incidents in Psychiatric Hospitals?
Authors: Powell Georgia , Caan Woody , Crowe Michael
Published: October 2008

Background

The study aimed to identify, classify and measure the relative frequency of events preceding violent incidents in psychiatric hospitals.

Method

Possible antecedents for 1000 incidents in three associated psychiatric hospitals over 13 months were investigated with an ‘untoward incident database’.

Results

From eyewitness accounts, 921 incidents (92%) could be related to one of 15 categories of antecedent involving characteristics of the patient, or of the hospital regime, or interactions with other individuals. Overall, the most common antecedents involved patients who were generally agitated or disturbed (286), restrictions on patients associated with the routine hospital regime (192) or provocation by other patients, relatives or visitors (175). Incidents arising from staff members initiating contact with patients were very rare (7). Twenty-one patients were involved in 10 or more incidents, including 19 (90%) who were detained under the Mental Health Act. These patients were more likely to commit assaults after certain antecedents (self-harm, absconding or arson) which were serious incidents in themselves.

Conclusions

Staff training on specific safety issues will be needed under the new Management of Health and Safety at Work Regulations.
The Effect of Child Sexual Abuse on Social, Interpersonal and Sexual Function in Adult Life
Authors: Mullen P. E. , Martin J. L. , Anderson J. C. , Romans S. E. , Herbison G. P.
Published: October 2008

Background

The association was examined between reporting child sexual abuse (CSA) and a range of social, interpersonal and sexual difficulties in adult life.

Method

A random sample of 2250 women were posted a questionnaire exploring a range of abuse experiences. All 248 reporting CSA were invited for interview, together with an equal number of controls. At interview a detailed inquiry was made into the CSA and into current interpersonal, social and sexual function.

Results

Significant associations emerged between reporting CSA and a decline in socioeconomic status, increased sexual problems, and the disruption of intimate relationships by difficulties with trust as well as a propensity to perceive their partners as uncaring and overcontrolling. CSA was more common in those from disturbed and disrupted families and in those who also reported physical and emotional abuse. This explained part, but not all, of the apparent association between CSA and negative outcomes.

Conclusions

Those reporting CSA are more likely to suffer social, interpersonal and sexual difficulties in adult life.
Neuropathological Correlates of Psychotic Phenomena in Confirmed Alzheimer's Disease
Authors: Förstl Hans , Burns Alistair , Levy Raymond , Cairns Nigel
Published: October 2008

Background

The prevalence of psychotic phenomena in confirmed Alzheimer's disease (AD) and their potential neuropathological correlates have rarely been the subject of prospective investigation.

Method

Psychopathological disturbances were recorded prospectively according to the Geriatric Mental State Schedule and the CAMDEX. The frequency of these phenomena and neuropathological changes were examined in 56 patients with definite AD.

Results

Hallucinations had been documented in 13 patients, paranoid delusions in 9 and delusional misidentification (e.g. the Capgras-type and the ‘phantom boarder’ symptoms) in 14 patients. Misidentifications were associated with lower neurone counts in the area CA1 of the hippocampus. Delusions and hallucinations were observed in patients with less severe cell loss in the parahippocampal gyrus and with lower cell counts in the dorsal raphe nucleus. A decrease of neurones in the locus coeruleus in a subset of depressed patients with AD had been reported earlier. Delusions and delusional misidentification were common in 5 patients with basal ganglia mineralisation, but there was no statistically significant association of these symptoms with the presence of Lewy bodies in the brainstem and neocortex of our patient sample.

Conclusions

These findings are compatible with the view that morphological changes in certain brain areas may promote the development of psychotic phenomena in AD. AD may offer a model for the understanding of pathomechanisms underlying the development of psychopathological disturbances in other psychoses with more discrete neuropathological changes.
Community Psychiatric Nurse Teams: Cost-effectiveness of Intensive Support Versus Generic Care
Authors: McCrone Paul , Beecham Jennifer , Knapp Martin
Published: October 2008

Background.

Part of the community psychiatric nurse (CPN) service was reorganised into a community support team (CST), with staff acting as case managers. An economic evaluation ran parallel to the comparison with generic CPN care.

Method.

Eighty-two clients were randomly allocated to experimental and control groups. Costs were comprehensively measured over a pre-referral period (three months), and then at 6, 12, and 18 months.

Results.

The economic evaluation found a cost difference between the groups. Generic group costs averaged £89 per patient per week more than CST group costs. The difference was only significant for the first six months. Changes in the burden of cost across agencies were observed.

Conclusions.

Although CPN inputs and costs were higher for the CST group, there was a significant short-term reduction in total cost. Beyond the short term, the CST did not confer cost or cost-effectiveness advantages.
Psychiatry and the Concept of Evil
Authors: Prins Herschel
Published: October 2008

The Editor's initiative in seeking this Editorial was inspired no doubt by a number of recent cases and events in which the behaviour of those concerned seems to have defied rational explanation, and the power of ‘evil’ has been invoked in order to provide one. Perhaps the most compelling was that of the trial for murder of two ten-year-old boys for the murder of the infant James Bulger.
The Relationship of Schizophrenic Births to 16 Infectious Diseases
Authors: O'Callaghan E. , Sham P. C. , Takei N. , Murray G. , Glover G. , Hare E. H. , Murray R. M.
Published: October 2008

Background

Recently, several investigators have reported an association between influenza epidemics and increased birth rates of ‘preschizophrenic’ individuals some four to six months later. Here we examine whether maternal exposure to other infectious diseases can also predispose the foetus to later schizophrenia.

Method

Two independent sets of dates of birth of first admission schizophrenic patients, born between 1938 and 1965 in England and Wales, were obtained from the Mental Health Enquiry in England and Wales. Data on the number of deaths per month from 16 infectious diseases between 1937 and 1965 in England and Wales were also collected. We used a Poisson regression model to examine the relationship between deaths from infectious diseases and schizophrenic births.

Results

In the two separate data sets, increased national deaths from bronchopneumonia preceded, by three and five months respectively, increased numbers of schizophrenic births. We did not find any other significant associations between schizophrenic births and any of the other 15 infectious diseases.

Conclusions

The association between deaths from bronchopneumonia and increased schizophrenic births some months later may be a reflection of the fact that bronchopneumonia deaths increase markedly during influenza epidemics.
Low Birth Weight and Schizophrenia
Authors: Rifkin Larry , Lewis Shôn , Jones Peter , Toone Brian , Murray Robin
Published: October 2008

Background

Low birth weight has been postulated to be a risk factor for schizophrenia.

Method

Obstetric history, premorbid adjustment, and cognitive function during admission were assessed in 167 patients with DSM–III schizophrenia or affective psychosis.

Results

A birth weight of less than 2500 g was significantly more common in patients with schizophrenia than in those with affective psychosis. Schizophrenic patients as a group had significantly lower mean birth weight, a finding which was particularly marked after controlling for sociodemographic confounders. In schizophrenic men, lower birth weight was highly significantly correlated with poorer premorbid social and cognitive ability, and with impairment of adult cognitive function.

Conclusions

Neurodevelopmental impairment may cause poor foetal growth, and schizophrenia in adult life.
Clonidine is not a Useful Adjunct to Methadone Gradual Detoxification in Opioid Addiction
Authors: Ghodse Hamid , Myles Judith , Smith Stephen E.
Published: October 2008

Background

The role of clonidine in the management of opioid-dependent individuals undergoing gradual detoxification.

Method

A double-blind placebo-controlled trial was conducted on 86 voluntary in-patients (59 male, 27 female) aged 18–47 years, at a specialist drug-dependence treatment unit. Patients entered the trial when on 40 mg of methadone daily or less, and were randomised to receive incremental doses of clonidine (increasing from 0.2 mg daily to 1.2 mg daily) during a 14-day period of gradual methadone detoxification and for four weeks thereafter. Blood pressure was monitored and severity of opioid abstinence was assessed by questionnaire and by clinical examination.

Result

Half the subjects were withdrawn or defaulted from the trial by the end of two weeks, those receiving clonidine earlier than those receiving dummy medication (9 of the former and only one of the latter because of systemic hypotension). Similar proportions of subjects completed detoxification in the two groups. In those who completed detoxification, clonidine did not significantly reduce either the symptoms or objective signs of opioid withdrawal.

Conclusions

These findings suggest that clonidine has no place as an adjunct to a programme of gradual opioid detoxification.
Diversity of Psychopathology Associated with use of 3,4-Methylenedioxymethamphetamine (‘Ecstasy’)
Authors: Mcguire Philip K. , Cope Helen , Fahy Thomas A.
Published: October 2008

Background

3,4-methylenedioxymethamphetamine (MDMA or ‘Ecstasy’) has become one of the most widely used illicit substances in the UK. Little is known of the psychiatric morbidity which may be associated with its use. We have examined this association by collecting a series of psychiatric cases in which MDMA use was a prominent feature.

Method

Patients presenting between 1990 and 1992 with psychiatric symptoms which developed in the context of MDMA use (n= 13) were interviewed, and their psychiatric, medical and drug history, sociodemographic background and mental state were examined in detail. The psychopathology of cases with psychosis (n= 8) was assessed with the Present State Examination and compared with that of substance-naïve psychotic controls (n= 40).

Results

Eight patients presented with psychotic syndromes, two experienced visual illusions, hallucinations and palinopsia, one had panic attacks, one suffered from depression, and one described chronic depersonalisation and derealisation. The psychopathology of the patients with psychoses was very similar to that of controls.

Conclusions

Use of MDMA may be associated with a broader spectrum of psychiatric morbidity than heretofore suspected. Cases with psychosis may be clinically similar to psychotic patients with no history of substance use.
‘Psyche’ – Spirit as well as Mind?
Authors: Sims Andrew
Published: October 2008

Much has been written about the dangers of Cartesian dichotomy for psychiatry, with its equally perilous errors of ‘mindless’ or ‘brainless’ psychiatry (Eisenberg, 1986), as well as the nonsense of talking about disease as either ‘mental’ or ‘physical’, or with ‘somatic’ or ‘psychological’ symptoms. Kendell (1993) has made this point eloquently; this paper further extends the theme. We psychiatrists complain when our medical colleagues cannot get beyond the physical, even when evidence for psychosocial aetiology is quite blatant, but we may be guilty of an equivalent error in almost totally excluding spiritual considerations from the way we understand our patients. This was alluded to in the address to the Royal College of Psychiatrists by our patron (HRH the Prince of Wales, 1991). We ask patients to which religion they ascribe, but we neglect the much more important question of “what does your religion and your faith mean to you?”
Suicide in Scotland 1988–1989
Authors: Milne Steven , Matthews Keith , Ashcroft G. W.
Published: October 2008

Background

The aim was to identify the amount of psychiatric and physical morbidity identified in suicide victims prior to death.

Method

A survey was made of primary care records of Scottish suicide victims in the years 1988 and 1989.

Results

Less morbidity was encountered than in previous studies. Single persons and persons from lower socio-economic groups were less likely to have a diagnosis of depression. No association was found between physical and psychiatric morbidity. Depressed single persons and depressed persons from lower socio-economic groups were less likely to receive antidepressants. GPs prescribed lower dosages of antidepressants than psychiatrists. Patients receiving antidepressants were more likely to die by drug overdose.

Conclusions

There are groups in whom depression may be being overlooked and others in whom depression could be treated more vigorously. There are risks in prescribing antidepressants which are potentially fatal in overdose.
A Controlled Evaluation of Psychoeducational Family Intervention in a Rural Chinese Community
Authors: Xiang Mengze , Ran Maosheng , Li Sigan
Published: October 2008

Background

The shortage of mental health care in rural China might be tackled by community care. This study tests the hypothesis that family intervention increases patients' treatment compliance, which is crucial in community care.

Method

A cohort of psychiatric patients were randomly selected to a controlled trial for four months. Compliance rates, clinical and social outcomes were measured double-blindly.

Results

The compliance rate was increased significantly in the trial group, and they had better clinical and social outcomes.

Conclusions

Family intervention is an effective method of improving treatment compliance and should be an important part of community mental health care.
Predictors of Psychiatric Morbidity in Cancer Patients
Authors: Harrison Judy , Maguire Peter
Published: October 2008

Background

A significant proportion of cancer patients experience psychiatric morbidity in association with diagnosis and treatment. If this morbidity is to be reduced, a better understanding is needed of the factors which influence adjustment to cancer.

Method

A review of the literature was carried out to explore those factors associated with poor psychological adjustment to cancer. These are described under four headings: characteristics of the patient; disease and treatment variables; the interaction between patient and illness; and environmental factors.

Results

A number of risk factors for psychiatric morbidity can be identified from each of the four areas. Methodological limitations are highlighted, in particular the preponderance of cross-sectional study designs.

Conclusions

Increased awareness of the risk factors for psychiatric morbidity should lead to earlier detection and more appropriate treatment. Future research should focus on those risk factors which are potentially modifiable.
The Pathological Extensions of Love
Authors: Mullen Paul E. , Pathé Michele
Published: October 2008

Background

Clarification is still required of the nature of pathological love.

Method

A series is presented of 16 personally assessed cases with pathologies of love (erotomania).

Results

The pathologies of love usually involve a mixture of morbid infatuation and a morbid belief in being loved. They occur both in a symptomatic form, as part of an underlying mental illness, as well as in a pure form, where their emergence is to some extent understandable in a vulnerable personality. These disorders often go unrecognised to the detriment of clinical management.

Conclusions

Pathologies of love create distress and disruption to the patient, and place the objects of their unwarranted affection at risk of at best harassment and at worst violence. Although this series of cases, which is drawn predominantly from forensic practice, overemphasises the risk of overt violence, the distress occasioned by pursuit and harassment alone should not be underestimated.
Male Mentally Handicapped Sex Offenders
Authors: Day Kenneth
Published: October 2008

Background

Sex offences are overrepresented in the mentally handicapped, but information about the characteristics and offence behaviour of this group is limited.

Method

A retrospective case note survey was made of 47 male patients referred for antisocial sexual behaviour.

Results

Of 191 offences and/or incidents committed, 55.5% were heterosexual, 24% indecent exposure, 12.4% homosexual, 13.6% serious and 3.6% involved physical assault. Average age of the offenders was 23.9 years, with a mean IQ of 59.5, and there was a high prevalence of family psychopathology, psychiatric illness, minor physical disabilities, sexual experience, impaired relationship skills and sexual recidivism. Recidivists showed a low specificity for offence type and age and sex of victim. Categorical analysis differentiated a ‘sex offences only’ group from a ‘sex plus other offences’ group in the key areas of psychopathology, offence behaviour and outcome; this was supported by factor analysis.

Conclusion

The finding of two subgroups of mentally handicapped male sex offenders has important implications for prevention, assessment and treatment.
A Validity Study of the Hospital Anxiety and Depression Scale in General Hospital Units and a Community Sample in Nigeria
Authors: Abiodun O. A.
Published: October 2008

Background

The utility of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument for anxiety and depressive disorders in non-psychiatric units (medical & surgical wards; gynaecology & antenatal clinics of a teaching hospital) and a community sample in Nigeria was investigated.

Method

A two-stage screening procedure was employed. This involved the use of GHQ–12/GHQ–30 and HADS against the criteria of a standardised (PSE schedule) psychiatric interview, with psychiatric diagnosis assigned in accordance with ICD–9 criteria.

Results

Sensitivity for the anxiety sub-scale ranged from 85.0% in the medical and surgical wards to 92.9% in the ante-natal clinic, while sensitivity for the depression sub-scale ranged from 89.5% in the community sample to 92.1% in the gynaecology clinic. Specificity for the anxiety sub-scale ranged from 86.5% in the gynaecology clinic to 90.6% in the community sample, while specificity for the depression sub-scale ranged from 86.6% in the medical and surgical wards to 91.1 % in the ante-natal clinic and community sample. Misclassification rates ranged from 9.9% in the community sample to 13.2% in the medical and surgical wards. Relative Operating Characteristic (ROC) analyses showed the HADS and the GHQ–12 to be quite similar in ability to discriminate between cases (anxiety and depression) and non-cases.

Conclusions

The HADS is valid for use as a screening instrument in non-psychiatric units and although initially developed for use in hospital settings, it could be usefully employed in community settings of developing countries to screen for mental morbidity.
Understanding the Symptoms of Schizophrenia Using Visual Scan Paths
Authors: Phillips Mary L. , David Anthony S.
Published: October 2008

Background

This paper highlights the role of the visual scan path as a physiological marker of information processing, while investigating positive symptomatology in schizophrenia.

Method

The current literature is reviewed using computer search facilities (Medline).

Results

Schizophrenics either scan or stare extensively, the latter related to negative symptoms. Schizophrenics particularly scan when viewing human faces.

Conclusions

Scan paths in schizophrenics are important when viewing meaningful stimuli such as human faces, because of the relationship between abnormal perception of stimuli and symptomatology in these subjects.
Inner London Collaborative Audit of Admission in Two Health Districts
Authors: Flannigan C. B. , Glover G. R. , Wing J. K. , Lewis S. W. , Bebbington P. E. , Feeney S. T.
Published: October 2008

Background

In this series, rates of admission and daily bed use in south Southwark were 30% higher than in Hammersmith & Fulham, principally because of a higher rate of admission for affective disorders. Factors associated with compulsory admission did not differ between the districts. This final paper examines the severity of symptoms, the reasons given for admission and factors relevant to the judgement to admit, in order to test the hypothesis that more resources mean better service.

Method

Sampling and data collection methods were described in the first paper.

Results

In both districts, major reasons for admission were self-neglect and risk of self-harm, poor adaptive functioning, and poor acceptance of medication. In south Southwark, a group of patients had affective disorders and less severe symptoms but a stated risk of suicide. Rates for, and severity of, schizophrenia were similar in the two districts. Social and preventive reasons for admission were given more frequently in south Southwark, where patients had more often been in contact with services before admission. Staff there, but not in Hammersmith & Fulham, suggested that many could have benefited from alternative forms of residential care.

Conclusions

A ‘buffer’ of hospital beds in south Southwark may have allowed a more acceptable service, particularly for affective disorders. The possibility that this buffer could be replaced by a wider range of residential accommodation, including hostels away from the District General Hospital, is discussed. Ten recommendations are listed.