bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Sexual Dysfunctions by Sex Therapy and Other Approaches
Authors: Hawton Keith
Published: October 2008

Background

The treatment of sexual dysfunctions underwent a great change when sex therapy was developed more than 25 years ago. Since then the treatment programme has been modified in various ways, the response to treatment evaluated and other treatment approaches introduced.

Method

A review of the literature concerning the application and outcome of sex therapy and other treatments for sexual dysfunction was conducted.

Results

The format of effective conjoint sex therapy is now fairly clear and there is good understanding of the sexual dysfunctions that respond best to this treatment and the couples most likely to benefit. Less is known about the effects of treatment of individuals without partners, bibliotherapy and combining sex therapy with marital therapy and with physical methods of treatment.

Conclusions

Sex therapy is now a well-established form of treatment. It should be more widely available for patients seen in psychiatry departments.
The Maine and Vermont Three-Decade Studies of Serious Mental Illness
Authors: DeSisto Michael J. , Harding Courtenay M. , McCormick Rodney V. , Ashikaga Takamaru , Brooks George W.
Published: October 2008

Background

This study compared long-term outcome of serious mental illness in two states using a matched design to assess psychiatric rehabilitation programmes; Vermont subjects participated in a model psychiatric rehabilitation programme, while the Maine group received more traditional care.

Method

Maine and Vermont subjects (n = 269) were matched by age, sex, diagnosis, and chronicity. Demographic, illness, and life history information were abstracted from hospital records by clinicians blind to outcome. DSM–III criteria were applied retrospectively. Outcome was assessed by clinicians blind to history.

Results

Vermont subjects alive at follow-up (n = 180) were more productive (P < 0.0009), had fewer symptoms (P < 0.002), better community adjustment (P < 0.001) and global functioning (P < 0.0001) than Maine subjects (n = 119).

Conclusions

Outcome differences may be due to Vermont's model programme and a policy of allowing an earlier opportunity for community life.
Somatic Delusions in Schizophrenia and the Affective Psychoses
Authors: McGilchrist Iain , Cutting John
Published: October 2008

Background

Delusions relating to the body, a ready source of information about the immediate experiences of psychotic patients, have not been systematically studied. We attempted an account of the phenomena, looking for differences between diagnostic groupings in the type and lateralisation of such phenomena, and for evidence of localisation.

Method

Somatic delusions elicited at interview with 550 Research Diagnostic Criteria-diagnosed psychotic patients were categorised according to content, and the results were compared across diagnostic groupings.

Results

Significant differences were demonstrated, both at the level of individual delusions and in the nature and overall pattern of such delusions. There were also differences between diagnostic groups in the choice of body parts involved. Among male patients there were significant differences in laterality between the groups, with schizophrenic subjects locating abnormal phenomena principally on the left and depressive subjects on the right. A provisional taxonomy of bodily delusions was developed.

Conclusion

Phenomenological differences between the psychoses were demonstrated and the results offer some support for current hypotheses of localisation of brain dysfunction in the psychotic illnesses.
Child and Adolescent Psychiatric Presentations of Second-Generation Afro-Caribbeans in Britain
Authors: Goodman Robert , Richards Hilary
Published: October 2008

Background

A clinical sample was used to investigate whether second-generation Afro-Caribbean children differed from other British-born children in their psychiatric presentation or vulnerability to risk factors.

Method

Second-generation Afro-Caribbean patients (n = 292) were compared with a predominantly white group of patients (n = 1311) who lived in the same inner-city area and attended the same child psychiatric clinic between 1973 and 1989. Data on psychiatric presentation and background factors were systematically recorded at the time of the initial clinical assessment.

Results

Afro-Caribbean patients were exposed to more socio-economic disadvantage but less family dysfunction. The ratio of emotional to conduct disorders was lower among Afro-Caribbean than among the comparison patients – an effect that was not evidently due to demographic factors or diagnostic bias. Most risk factors for emotional or conduct disorders had comparable effects on Afro-Caribbean and comparison patients. Psychotic and autistic disorders were disproportionately common among the Afro-Caribbean patients.

Conclusions

Second-generation Afro-Caribbean children differ somewhat from other British-born children in their psychiatric presentation – a difference that has persisted over the 1970s and 1980s and that deserves more investigation than it has received to date.
Nine Suicide Pacts a Clinical Study of a Consecutive Series 1974–93
Authors: Brown Martin , King Elizabeth , Barraclough Brian
Published: October 2008

Background

Suicide pacts are rarely discussed in the medical literature. We report here the medical and social aspects of a consecutive series of double or pact suicides.

Method

Coroners' records were examined for 722 consecutive suicides. Data were extracted from them and from medical and psychiatric records.

Results

Nine pacts (2.5% of suicides) were located: 11 of the 18 people appeared to have been mentally ill at the time of death and three more had a history of mental illness. Five had a significant medical history (three cancer).

Conclusions

Mental disorder is common in those who enter suicide pacts (mainly depression, with alcohol dependence rare). Motivations for suicide appear to be relief of mental disorder and pain.
Immigrant Families Coping with Schizophrenia Behavioural Family Intervention v. Case Management with a Low-Income Spanish-Speaking Population
Authors: Telles Cynthia , Karno Marvin , Mintz Jim , Paz George , Arias Miguel , Tucker Douglas , Lopez Steven
Published: October 2008

Background

This investigation compared the effectiveness and cross-cultural applicability of behavioural family management (BFM) and standard case management in preventing exacerbation of symptoms and relapse in schizophrenia.

Method

Forty low-income Spanish-speaking people with a diagnosis of schizophrenia were randomly assigned to receive standard case management or behavioural family management after stabilisation with neuroleptic medication.

Results

Survival analyses indicated that among the less acculturated patients BFM was significantly related to greater risk of exacerbation of symptoms. Among the more acculturated patients, risk of exacerbation could be predicted by medication compliance but not by type of intervention. In analyses of symptom severity and functional status at 1-year follow-up, the level of patient acculturation was found to be significantly related to various measures of treatment outcome.

Conclusion

Sociocultural factors affect responses to different types of intervention. The results did not support earlier findings of a beneficial effect of BFM when applied to a socioculturally diverse population.
Cyproheptadine Treatment in Neuroleptic-Induced Akathisia
Authors: Weiss David , Aizenberg Dov , Hermesh Haggai , Zemishlany Zvi , Munitz Hanan , Radwan Margaret , Weizman Abraham
Published: October 2008

Background

Cyproheptadine, an antiserotonergic agent, was used to treat neuroleptic-induced akathisia.

Method

In an open clinical trial 17 neuroleptic-treated patients with akathisia were administered cyproheptadine (16 mg/day) over 4 days. Assessment of akathisia, psychosis and depression were monitored by BAS, BPRS and HAM-D.

Results

All subjects showed improvement in the severity of akathisia, which in the majority (15/17) was of a marked degree. There was no aggravation of psychosis or depression. Symptoms of akathisia returned when cyproheptadine was discontinued.

Conclusions

Cyproheptadine may be useful in neuroleptic-induced akathisia.
Neuraesthenia Revisited: ICD–10 and DSM–III–R Psychiatric Syndromes in Chronic Fatigue Patients and Comparison Subjects
Authors: Farmer Anne , Jones Irene , Hillier Janis , Llewelyn Meirion , Borysiewicz Leszek , Smith Andrew
Published: October 2008

Background

Different definitions of chronic fatigue syndrome (CFS) have different psychiatric exclusion criteria and this affects the type and frequency of associated psychiatric morbidity found. The operational criteria for neuraesthenia in ICD–10 vary in this and other respects from the Centers for Disease Control and Prevention (CDC) criteria for CFS. Neuraesthenia and associated psychiatric morbidity in CDC-defined CFS are evaluated.

Method

CFS subjects and controls were interviewed with the Schedule for the Clinical Assessment of Neuropsychiatry (SCAN). The computerised scoring program for SCAN (CATEG05) facilitates the assignment of operational definitions according to DSM–III–R and ICD–10. Subjects were re-interviewed with SCAN an average of 11 months later. No specific treatments or interventions were given during this period.

Results

The majority of subjects fulfilled ICD–10 operational criteria for neuraesthenia and had two and a half times the rate of psychiatric morbidity as the healthy comparison group according to the CATEG05 Index of Definition (ID). Approximately 80% of subjects fulfilled both DSM–III–R and ICD–10 criteria for sleep disorders. There was a significant fall in the number of subjects fulfilling criteria for depression and anxiety disorders and a significant increase in the number of subjects with no diagnosis for DSM–III–R criteria over time. There were no significant changes over time for any diagnosis according to ICD–10 criteria or for overall levels of psychopathology as reflected in CATEG05 ID levels.

Conclusions

The ICD–10 ‘neuraesthenia’ definition identifies almost all subjects with CDC-defined CFS. Fifty per cent of CFS subjects also had depressive or anxiety disorders, some categories of which remit spontaneously over time.
The Post-Concussional State: Neurophysiological Aspects
Authors: Watson M. R. , Fenton G. W. , McClelland R. J. , Lumsden J. , Headley M. , Rutherford W. H.
Published: October 2008

Background

Twenty-six young men admitted to an Accident and Emergency Department for observation following a minor closed head injury (post-traumatic amnesia (PTA) less than 12 hours) were investigated within 24 hours of admission (day 0) and followed up at 10 days, 6 weeks and 1 year after the trauma.

Method

Investigations at day 0 included physical examination, completion of post-concussional symptom and stress-arousal checklists, computerised EEG (CEEG) and auditory brainstem evoked potential (BAEP) recordings. These were repeated at ten days and six weeks. At 12 months follow-up, the Present State Examination (PSE) was carried out and a further post-concussional symptom checklist completed.

Results

Post-concussional symptomatology declined progressively from day 0 but half had residual symptoms at 1 year. Seventy-two per cent ran an acute course with recovery by 6 weeks, 8% a chronic unremitting course and 20% initially improved but had an exacerbation of symptoms between 6 weeks and 12 months. The CEEG alpha-theta ratios decreased significantly between days 0 and 10, reaching a baseline thereafter. Measures of CEEG recovery from all channels correlated with symptom counts at six weeks; the slower the recovery the greater the symptoms. A relative delay in left temporal recovery was associated with residual psychiatric morbidity (PSE ID scores) at 12 months. Prolonged central brainstem conduction times occurred in 27% of patients at day 0. These correlated positively with PTA and degree of psychiatric morbidity (PSE ID scores) at 12 months.

Conclusions

Symptom chronicity was accompanied by continuing brainstem dysfunction, while the degree of transient cortical dysfunction appeared to have a direct influence in the intensity of early organic symptom reaction to the trauma. Levels of perceived stress at the time of the injury, or afterwards, were not related to symptom formation.
Excess Mortality Among Elderly Psychiatric In-Patients with Organic Mental Disorder
Authors: Rössler W. , Hewer W. , Fätkenheuer B. , Löffler W.
Published: October 2008

Background

Many studies have shown hospitalised mentally ill patients to have a higher mortality risk than the general population.

Method

Data of patients with organic mental disorders of ICD–9 categories 290, 293, 294 and 310 from seven psychiatric hospitals with defined catchment areas were analysed. During an observation period of 2.5 years 1821 treatment periods in these diagnostic categories were recorded.

Results

During hospitalisation 137 patients died from natural causes. The age- and sex-adjusted mortality rates show an increased mortality risk of 7.5 times, compared to the general population. The odds ratio of a logistic regression demonstrate the overwhelming influence of the medical diagnosis.

Conclusion

Medical factors, particularly pneumonias, contribute most to the excess mortality.
Associations of Psychotic Symptoms in Dementia Sufferers
Authors: Ballard Clive , Bannister Carol , Graham Candida , Oyebode Femi , Wilcock Gordon
Published: October 2008

Background

Psychotic symptoms in dementia have been considered as a single category which may have masked important associations. An exploratory analysis was undertaken to look separately at delusions, visual hallucinations and delusional misidentification.

Method

Psychotic symptoms were assessed with the Burns' Symptom Checklist in 124 patients with DSM–III–R dementia.

Results

Eighty-three (66.9%) patients had psychotic symptoms. Deafness and life events were associated with delusions and visual impairment was associated with visual hallucinations, while senile dementia of Lewy body type and older age were associated with both.

Conclusions

Differences are evident in the associations of delusions and visual hallucinations. Sensory impairments were associated with both symptoms.
Characteristics of Outcome in Schizophrenia at 13 Years
Authors: Mason Peter , Harrison Glynn , Glazebrook Cristine , Medley Ian , Dalkin Tim , Croudace Tim
Published: October 2008

Background

This paper describes the 13-year outcome of an epidemiologically defined and representative cohort of patients selected when they were experiencing their first episode of schizophrenia.

Method

In a 13-year follow-up study of a cohort identified in Nottingham in 1978–80, the outcome (symptoms, disability, residence and treatment) was assessed using standardised instruments.

Results

Four of the original 67 patients with ICD–9 schizophrenia were lost to follow-up and five were dead: 52% were without psychotic symptoms in the last two years of follow-up, 52% were without negative symptoms and 55% showed good/fair social functioning. However, only 17% were alive at follow-up, without symptoms and disability, and receiving no treatment.

Conclusions

The findings reported are similar to those of other long-term follow-up studies of schizophrenia and also to 5-year follow-up studies. Kraepelin's emphasis on the longitudinal implications of a diagnosis of schizophrenia are supported, but may be over-pessimistic.
Insight and Psychotic Illness
Authors: David Anthony , van Os Jim , Jones Peter , Harvey Ian , Foerster Alice , Fahy Thomas
Published: October 2008

Background

Insight has recently re-emerged as an important aspect of psychopathology amenable to empirical study. We sought to examine the relationship between various aspects of insight into illness and clinical, sociodemographic and neuropsychological variables.

Method

From an inner-London catchment area population, 150 in-patients with recent onset of psychosis were assessed on a variety of measures, including the Present State Examination (PSE). Subjects were followed up for a mean of four years and reassessed.

Results

High IQ was associated with better insight as rated on the PSE, while gender, ethnicity and a diagnosis of schizophrenia appeared to be unrelated. At follow-up, similar associations were found, as well as correlations with attitudes to treatment and a more elaborate measure of insight. Cerebral ventricular enlargement and tests of frontal lobe function did not correlate with insight, but there was a curious, strong association with left-handedness at both assessment points. Initial insight correlated significantly but weakly with insight at follow-up.

Conclusions

The assessment of insight in psychosis has concurrent validity and is a distinct aspect of psychotic phenomenology. It may, in part, have a neuropsychological basis.
A Prevalence Study of Age-Associated Memory Impairment
Authors: Barker Andrew , Jones Roy , Jennison Chris
Published: October 2008

Background

Age-associated memory impairment (AAMI) describes a non-disease ageing-related decline in memory. Pharmacological treatment trials have been reported and DSM–IV has introduced a term for the disorder. No prevalence study with the original criteria has previously been published.

Method

An age-stratified sample was taken of 50–95-year-olds registered with a local health centre. Diagnosis of AAMI was made by questionnaire, cognitive testing, and medical and psychiatric assessment.

Results

Prevalence rates for the total population and for the over-50s were estimated to be 5.8% and 18.5%, respectively. These rates are dramatically affected by minor alterations to individual criteria.

Conclusions

It appears AAMI is less common than previous estimates suggested, although the diagnostic criteria do not satisfactorily define people with an age-related decline in memory. Complaint of memory decline is more strongly correlated with measures of affect and personality than with measures of current memory test performance or estimates of memory decline.
Depression in Later Life
Authors: Baldwin R. C. , Tomenson Barbara
Published: October 2008

Background

Depression in later life is often thought to differ from that at other times of adulthood. The evidence for this is controversial but is important to any proposed organic model of depression in the elderly. Here, early- and late-onset depressions in later life are compared.

Method

Fifty-seven depressed patients with a mean age of 74 were studied, 21 with an early onset (aged 59 or less) and 36 with a late onset. All were suffering from major depression according to DSM–III–R. The measures at entry included severity and symptoms, cognitive function, antecedent life events, physical health and vascular risk factors and/or vascular disease. We also recorded any family history of mood disorders, as well as the course of illness.

Results

The anxiety item scores of the Hamilton Depression Rating Scale were significantly higher in those with an early onset, but otherwise symptoms differed little. Heritability was greater in the early-onset group. There was a striking association of vascular disease and/or risk with late-onset patients.

Conclusions

Vascular disease is associated with late-onset depression. This is consistent with the hypothesis that depression in later life is a more ‘biological’ disorder.
Further Evidence that Reading Ability is not Preserved in Alzheimer's Disease
Authors: O'Carroll R. E. , Prentice N. , Murray C. , Van Beck M. , Ebmeier K. P. , Goodwin G. M.
Published: October 2008

Background

Pre-morbid intelligence level is routinely assessed in Alzheimer's disease using the National Adult Reading Test (NART). This practice is based on the assumption that pronunciation of irregular words remains unaffected by the disease process. Recent reports have suggested that reading ability may become compromised in moderately demented subjects.

Method

Sixty-eight probable Alzheimer patients were classified into stages of severity (minimal, mild and moderate) using the Mini-Mental State Examination (MMSE). NART and demographic equations were used to estimate pre-morbid ability.

Results

A significant correlation emerged between dementia severity and reading ability, NART v. MMSE scores, r = 0.46, P < 0.01. When the total sample was subdivided into moderate, mild and minimal subgroups, significant between-group differences emerged, despite the groups being well matched for age, sex, and years of full-time education. Pre-morbid IQ, as estimated by demographic regression equations, did not correlate with dementia severity.

Conclusion

NART performance is compromised in moderate Alzheimer disease, and the measure provides a serious underestimate of pre-morbid IQ in patients with an MMSE of 13 or less.
Psychiatric Symptoms Associated with Dementia in Older People with Learning Disability
Authors: Moss Steve , Patel Pradip
Published: October 2008

Background

This paper describes a study of non-cognitive features of dementia in a population of 105 people over 50 years of age, with learning disability.

Method

The study involved psychiatric assessment using the Psychiatric Assessment Schedule for Adults with a Developmental Disability (PAS-ADD), a semi-structured psychiatric interview developed specifically for people who have learning disability. Dementia was diagnosed using a combination of informant interviewing and observation of cognitive change over a three year period.

Results

Sample members with definite dementia had higher levels of sleep difficulty, hypersomnia, irritability, inefficient thought, loss of interest and anhedonia. Discriminant function analysis showed that non-cognitive features could help discriminate between definite and probable cases.

Conclusions

Results support the previously reported observation for the general population that cognitive and non-cognitive features are only weakly related. The study suggests that psychiatric symptom information may be useful in screening for dementia in people with learning disability.
Morbid Jealousy in Alcoholism
Authors: Michael Albert , Mirza Sudeshni , Mirza K. A. H. , Babu V. S. , Vithayathil Empee
Published: October 2008

Background

Morbid jealousy is an incompletely understood syndrome. The association between morbid jealousy and alcoholism is unclear.

Method

Morbid jealousy was assessed in 207 male patients with alcohol dependence (DSM–III–R) using a semi-structured interview schedule administered both to patients and their spouses.

Results

Thirty-four per cent (71 out of 207) suffered from morbid jealousy. Morbid jealousy had different manifestations. Some patients expressed it only when intoxicated, others even when sober and in some the jealousy took the form of a delusional disorder.

Conclusions

Alcoholism appears to have an aetiological role in the development of morbid jealousy. Detecting morbid jealousy when it is expressed only under the influence of alcohol has preventive implications.
Epidemiology of Presenile Alzheimer's Disease in Scotland (1974–88)
Authors: Whalley Lawrence J. , Thomas Brenda M. , Starr John M.
Published: October 2008

Background and Method

We related geographical variation of ‘probable’ presenile Alzheimer's disease (AD PSD) to exposures to possible risk factors for AD PSD and vascular dementia (VaD) and to geographical differences in survival times after presentation with AD PSD.

Results

We found that an ecological measure of socio-economic deprivation was related to VaD but not to AD PSD. Among men with AD PSD and VaD, specific occupations conveyed no altered risk but having fathers who were coal miners was associated with AD PSD and VaD in offspring. Increased paternal age was associated with AD PSD but only in men. These factors acted independently of one another and did not distinguish between geographical areas of high and low incidence.

Conclusions

The length of survival after presentation with AD PSD distinguished between these areas, and when migration between these areas was taken into account, a plausible multifactorial model of the harmful effects of environment emerged, which acted independently of risk factors acting earlier in life.
Brain Atrophy in Normal Ageing and Alzheimer's Disease
Authors: Förstl Hans , Zerfaß Rainer , Geiger-Kabisch Claudia , Sattel Heribert , Besthorn Christoph , Hentschel Frank
Published: October 2008

Background

We examined the differences in volume of the ventricular and extracerebral cerebrospinal fluid spaces in normal ageing and in probable Alzheimer's disease (AD) and we tried to investigate the effects of the severity of illness on the morphometric differentiation of AD and ageing, the principal components underlying brain atrophy in both conditions, and the correlations of these measurements with clinical findings.

Method

Forty patients with probable AD were matched with 40 non-demented elderly controls. Both groups underwent standardised clinical tests and unenhanced cranial computed tomography for post hoc volumetric analysis.

Results

The lateral and third ventricles and the anterior and lateral fissures were significantly larger in AD than in normal ageing. The volumes of the lateral ventricle and lateral fissure permitted a highly efficient differentiation between normal ageing and AD even at the mild stage of dementia, and this differentiation was improved further in the more severe stages of illness. We identified one principal component underlying brain atrophy in normal ageing and two components in AD: a ‘grey matter’ component accounting for sulcal and third ventricular enlargement, and a ‘white matter’ component for lateral ventricular enlargement. In AD, most of the volumetric measurements were significantly correlated with cognitive impairment, but in the group of non-demented elderly controls they were correlated with age.

Conclusion

Volumetric indices of brain atrophy permit a highly efficient differentiation between normal ageing and AD even in the mild stages of illness and this demonstrates that substantial structural brain changes have developed in the preclinical phase of illness. We suggest that there is an uncoupling between lateral ventricular enlargement and cortical brain atrophy in AD.
Time Trends in the Care-Based Incidence of Schizophrenia
Authors: Oldehinkel A. J. , Giel R.
Published: October 2008

Background

Several studies have suggested a declining first-admission rate for schizophrenia. This study examines the care-based incidence of schizophrenia in a Dutch register area.

Method

Data from Groningen psychiatric case register were used to compare first-admission rates for schizophrenia over 1976–90 with those of other functional psychoses, and to consider various potential biases.

Results

Diagnostic habits probably affected time trends in incidence rates. Using a broader definition of schizophrenia, no evidence was found for a decrease in the incidence of schizophrenia. Although first admissions to intramural services showed a (non-significant) decrease, this effect seemed to be neutralised when all mental health services were taken into account.

Conclusions

Care-based studies of time trends in psychiatric disorders should embrace all mental health services. Furthermore, unless a diagnostic classification system with univocal criteria is used, bias caused by changing diagnostic habits cannot be ruled out.
Month of Birth, Hemisphere of Birth and Schizophrenia
Authors: Mcgrath John , Welham Joy , Pemberton Michael
Published: October 2008

Background

To assess quarterly fluctuations in schizophrenia births in a southern hemisphere data set, and to compare the quarterly birth distributions of patients born in the northern and southern hemisphere.

Method

The month and place of birth of patients with schizophrenia (n = 9348) were extracted from a mental health register.

Results

The quarterly birth distribution of patients with schizophrenia differed significantly from the estimated general population distribution in SH-born patients. The quarterly distribution of patient births differed significantly when the two hemispheres were compared.

Conclusion

These data support the hypothesis that there is a risk for schizophrenia that is related to the time of birth, and which fluctuates across the year.
Obstetric Complications and Schizophrenia: A Meta-Analysis
Authors: Geddes John R. , Lawrie Stephen M.
Published: October 2008

Background

This systematic review of the association between schizophrenia and obstetric complications (OCs) was performed to assess the degree of heterogeneity between studies and to quantify the increased risk of schizophrenia in exposed subjects.

Method

Twenty case-control, one prospective cohort and two historical cohort studies were identified using a medline search supplemented by a manual search and direct communication with other researchers. Individual odds ratios were calculated for each study and a pooled estimate produced. The effect of methodological variation between studies was further assessed by partitioning studies according to study characteristics.

Results

Overall, there was no significant heterogeneity of effect between studies, and the pooled odds ratio for the exposure to OCs on subsequent development of schizophrenia was 2.0 (95% CI 1.6–2.4). However, partitioning according to study design revealed significant heterogeneity (z = –2.60, P < 0.01) between the pooled estimate from the case-control studies and that from the historical cohort studies. There was a gap on the funnel plot in the region of small studies finding no effect.

Conclusions

Although the result indicates that subjects exposed to OCs are twice as likely to develop schizophrenia, the analysis suggests that the observed association could be inflated by both selection and publication biases.
Gender Differences in Parental Psychological Distress Following Perinatal Death or Sudden Infant Death Syndrome
Authors: Vance John C. , Boyle Frances M. , Najman Jackob M. , Thearle M. John
Published: October 2008

Background

Stress responses of bereaved parents (mothers 194, fathers 143) who experienced infant loss were compared with parents (mothers 203, fathers 157) with a live born child.

Method

Psychological distress using scales of anxiety, depression and alcohol use was compared at 2, 8, 15 and 30 months post-loss.

Results

Bereaved mothers showed significantly more anxiety/depression than controls at all four interviews. For bereaved fathers, anxiety/depression differed significantly from controls only at two months. Heavy alcohol use was significantly more prevalent at 2 and 30 months. Relative risks showed significant gender differences between bereaved parents at all four interviews for anxiety/depression. When this outcome was extended to include heavy drinking in addition to anxiety/depression, these differences diminished and were significant only at 2 and 8 months.

Conclusion

Female responses are longer lasting and reflected by elevated levels of anxiety/depression. Male responses equally involve anxiety, depression and heavy alcohol consumption.
Psychotherapy Assessment and Treatment Selection
Authors: Tillett Richard
Published: October 2008

Background

Current acceptance of the need for a wide range of treatments and growing pressure for cost-effectiveness suggest the need for a more discriminating approach to assessment of psychotherapy.

Method

Medline and manual literature searches, and personal experience of over 1000 assessments in a district psychotherapy service.

Results

There is substantial evidence for the general efficacy of psychotherapy; differential benefits are beginning to be identified. Short-term treatments are appropriate in a wide variety of situations and can be surprisingly effective. Chronic/complex psychopathology is likely to need longer term therapy.

Conclusions

Effective use of scarce psychotherapy resources requires knowledge of the research evidence of treatment effectiveness, careful assessment of the patient and a logical and collaborative approach to treatment planning.
Plasma Beta-Endorphin Concentrations in People with Learning Disability and Self-Injurious and/or Autistic Behaviour
Authors: Willemsen-Swinkels Sophie H. N. , Buitelaar Jan K. , Weijnen Florence G. , Thijssen Jos H. H. , Engeland Herman Van
Published: October 2008

Background

It has been suggested that the key variable in reduced plasma immunoreactive β-endorphin concentrations in autistic subjects may be concomitant self-injurious behaviour.

Method

We studied morning levels of plasma β-endorphin in 33 learning disabled people with self-injurious and/or autistic behaviour.

Results

The β-endorphin level of the subjects with severe self-injurious behaviour proved to be significantly lower than that of autistic subjects without severe self-injurious behaviour (3.6 (1.4) pmol/l v. 5.8 (4.3) pmol/l; t-test: P = 0.045. Replication: 3.7 (1.1) pmol/l v. 5.7 (3.8) pmol/l; t-test P = 0.043). Individuals with mild and occasional self-injurious behaviour were found to have β-endorphin levels comparable to those without self-injurious behaviour. Further, subjects being treated with neuroleptics had lower β-endorphin levels than untreated subjects.

Conclusions

These results stress that in any study of opioid systems of learning disabled people, it is very important to differentiate between people with and without severe self-injurious behaviour. The results support the idea that severe self-injurious behaviour may be related to functional disturbances in the endogenous opioid system.
Effect of Early Life Experiences and Personality on the Reporting of Psychosocial Distress in General Practice: A Preliminary Investigation
Authors: Weich Scott , Lewis Glyn , Mann Anthony
Published: October 2008

Background

About 25% of primary care attenders are ‘somatic presenters’; individuals consulting for physically-attributed somatic symptoms in the presence of psychiatric morbidity. We tested the hypothesis that somatic presenters differed from psychological presenters on measures of personality and childhood experience.

Method

Case-control study of ‘psychological presenters’ and ‘somatic presenters’.

Results

Psychological presenters reported significantly greater insecurity in intimate relationships, and recalled their fathers as significantly less caring and more over-protective, than somatic presenters. These differences remained after adjusting for differences in the severity and duration of psychiatric symptoms.

Conclusions

Personality and childhood experiences may be associated with specific types of adult illness behaviour, independent of associations with the prevalence of psychiatric disorder.
Assessment of Personality Functioning in the Transition from Adolescent to Adult Life: Preliminary Findings
Authors: Naughton Mary , Oppenheim Audrey , Hill Jonathan
Published: October 2008

Background

The Adolescent to Adult Personality Functioning Assessment (ADAPFA) a modification of the Adult Personality Functioning Assessment (APFA) is described. It may be used to assess specific and general social dysfunction in the transition from childhood to adult life.

Method

Two raters independently rated 38 audiotaped interviews to test the interrater reliability of the instrument. The relationship between dysfunction in specific domains and overall psychosocial dysfunction was examined.

Results

Interrater reliabilities for the total ADAPFA score and for the majority of the domains were high. Agreement on type of dysfunction and on categorical ratings indicating the presence of personality disorder were good.

Conclusion

The ADAPFA is a useful measure of interpersonal and social role performance in the transition between adolescent and adult life.
A One Year Prospective Study of the Effect of Life Events and Medication in the Aetiology of Schizophrenic Relapse
Authors: Hirsch Steven , Bowen Jo , Emami Javad , Cramer Philip , Jolley Anthony , Haw Camilla , Dickinson Mark
Published: October 2008

Background

We set out to determine whether and to what degree life events independent of illness increase the risk of relapse in schizophrenia following withdrawal from medication in the previous 6 months, either by triggering a relapse in the following 4 weeks or by acting cumulatively over time.

Method

Seventy-one patients fulfilling DSM–III–R criteria for schizophrenia with chronic illness were followed for 48 weeks and assessed on the LEDS scale. Half were treated with regular neuroleptic medication and half had been recently withdrawn from medication. A subgroup was randomised double-blind to treatment or placebo.

Results

A proportional hazards regression model showed that life events made a significant cumulative contribution over time (P< 0.05) to the risks of relapse and that ceasing medication made an independent contribution. The risk of relapse increased in proportion to the number of life events but no interaction between medication status and events could be detected, i.e. life events were not more closely associated with relapse on medication than off medication. For those of the sample exposed to the mean rate of life events during the study period, it was estimated that 23% of the relapse risk could be attributed to life events, and for those with twice the mean rate of events, 41%. In contrast, patients who continued on regular medication had 80% less risk of relapse than those who had been withdrawn from medication either by choice or under double-blind controlled conditions.

Conclusion

A contribution of life events to the risk of relapse in schizophrenia was confirmed by this study but the hypothesis that life events trigger relapse was not supported, nor was the hypothesis that life events are more relevant to relapse in patients on maintenance medication than in patients off medication.
Effect of Age on the Outcome of Hospital Treated Depression
Authors: Tuma T. A.
Published: October 2008

Background

Depression affects a significant proportion of the expanding elderly population in the UK. Reports of a poorer prognosis for older than for younger adult patients have been challenged by recent papers.

Method

The casenotes of 56 adults (mean age 47.8 years) and 54 elderly (mean age 72.9 years) patients with primary depression were assessed one year after receiving hospital treatment. Outcome measures were compared with earlier reported findings and factors possibly influencing outcome were explored.

Results

The pattern of outcome in both age groups was broadly similar, thus: adults v. elderly: recovered 44.6% v. 44.4%; relapsed and recovered 23.2% v. 24%; residual symptoms 19.6% v. 13% and chronic depression 7.1% v. 5.5%. In the adults there were two natural deaths and one suicide. In the elderly there were two cases of dementia and five natural deaths, which was double the expected death rate. Predictors of poor outcome were melancholic depression in adults and longer duration of illness at intake and an increasing number of previous episodes of affective disorder in the elderly.

Conclusion

The outcome of treated depressive illnesses appears similar in elderly and adult patients. Associated physical ill health did not adversely affect outcome in the elderly group.
Young ‘Psychopaths’ in Special Hospital: Treatment and Outcome
Authors: Reiss D. , Grubin D. , Meux C.
Published: October 2008

Background

The ‘Young Persons Unit’ (YPU) at Broadmoor Hospital offers psychotherapeutic treatment for young adult male patients. The study objective was to report background details, treatment and outcome of the ward's personality disordered patients.

Method

The sample consisted of 49 patients, with the legal classification of psychopathic disorder, treated on the unit for at least one year. Data were collected from existing case records. Outcome was recorded until discharge from statutory supervision. Outcome measures were recidivism and a variety of social factors.

Results

At follow-up 10 patients had reoffended, with four having committed serious violent or sexual offences. Two patients had died. A history of sex offending was the strongest predictor of subsequent reoffending. No patients with good social outcome reoffended.

Conclusions

Young patients with personality disorder can be successfully treated on the YPU. The management of sex offenders in this group requires further attention. Successful social integration within the community after discharge may help prevent future reoffending.
Suicides by Burning in England and Wales
Authors: Prosser David
Published: October 2008

Background

The aim was to examine suicides by burning (SBB) occurring in England and Wales.

Method

The method was a retrospective case note examination of death certificates, coroners' inquest notes and GP notes for all SBBs registered in 1991 by OPCS in England and Wales, and an examination of SBB statistics from 1979–1992.

Results

In 24% of cases the incident involved others either as intended or actual victims or as witnesses, and three distinct groups (Asian-born women, schizophrenics, and homicide–suicides) were over-represented. The majority were not in contact with current psychiatric services, and 43% had never had contact with psychiatric services. There was no trend in SBB compared to other suicides in 1979–1992.

Conclusions

While SBB may be associated with Asian-born women, homicide–suicide and schizophrenia, the majority of cases did not have these characteristics, and the overall psychiatric contact rate was similar to suicide by unspecified means.
Negative Symptoms, Neurological Signs and Neuropsychological Impairments in 204 Hong Kong Chinese Patients with Schizophrenia
Authors: Chen E. Y. H. , Lam L. C. W. , Chen R. Y. L. , Nguyen D. G. H.
Published: October 2008

Background

Studies of the relationship between negative symptoms, neuropsychological impairments and neurological signs in schizophrenia have yielded inconsistent results. In addition, little attention has been directed to address the extent of cultural modulation of negative symptoms.

Method

We carried out cross-cultural validation of the High Royds Evaluation of Negativity Scale (HEN) in 50 Hong Kong Chinese patients with schizophrenia. We then investigated the relationship between negative symptoms, neurological signs and neuropsychological impairment in 204 patients.

Results

Good interrater reliability, internal reliability, convergent and discriminant validity were found with the HEN. The HEN contained four factors corresponding to ‘behaviour‘, ‘functioning‘, ‘thought’ and ‘appearance’. Negative symptoms were correlated with semantic fluency but not with Wisconsin Card Sorting Test performance or sustained attention. Negative symptoms were also correlated with tardive dyskinesia and catatonia but not with soft neurological signs.

Conclusions

Cross-cultural robustness of the negative symptoms construct is supported. Association of negative symptoms with a specific profile of neurocognitive impairment suggests diversity within deficit domains in schizophrenia.
Mixed-Handedness in Patients with Functional Psychosis
Authors: Malesu R. R. , Cannon M. , Jones P. B. , McKenzie K. , Gilvarry K. , Rifkin L. , Toone B. K. , Murray R. M.
Published: October 2008

Background

An excess of non-right-handedness has been shown among patients with schizophrenia. However it is not clear whether this finding can be accounted for by an increase in left-handedness, mixed-handedness or both. It is not known whether atypical patterns of hand preferences occur in other functional psychotic illnesses.

Method

The Annett hand preference questionnaire was administered to patients with schizophrenia (n=120); affective psychosis (n=55); schizoaffective psychosis (n=41), and control subjects (n=86). Handedness was classified into three categories: right, mixed and left-handedness.

Results

The hand preference patterns of patients with functional psychotic illnesses were not significantly different from controls. Patients with schizophrenia showed a non-significant excess of mixed-handedness compared with controls. Patients with schizophrenia and affective psychosis showed a non-significant decrease in left-handedness compared with controls.

Conclusions

Although our results showed a trend in the hypothesised direction, we failed to demonstrate that patients with psychotic illness differed from controls on self-reported hand preference patterns.
Negative Interaction between Lithium and Electroconvulsive Therapy – A Case-Control Study
Authors: Jha A. K. , Stein G. S. , Fenwick P.
Published: October 2008

Background

Concurrent use of lithium and ECT is suspected to increase neurotoxicity.

Method

A retrospective case-control study over an eight-year period was conducted to investigate the adverse effects of a combined lithium/ECT treatment Thirty-one subjects with combined lithium/ECT treatment were compared with a control group (ECT only) of 135 cases matched for age and sex.

Results

Most cases in both groups had no adverse effects. Three (10%) study group subjects and 15 (11 %) controls experienced brief delirium. Three controls and none of the subjects developed a prolonged confusion. There were no significant differences in the profile of other adverse effects between the two groups.

Conclusion

Prescription of lithium together with ECT was not associated with higher frequency of adverse effects.
A Case-Control Study of Alzheimer's Disease and Aluminium Occupation
Authors: Salib Emad , Hillier Valerie
Published: October 2008

Background

We examined clinically diagnosed Alzheimer's disease patients and controls, and collected information from informants, to examine the association between Alzheimer's disease and aluminium occupation.

Method

An unmatched case-control study comparing 198 cases of Alzheimer's disease (ADRDA–NINCDS diagnostic criteria), to selected controls (164 other dementias and 176 non-dementing group) in respect of their occupational history. The subjects included all patients referred to and seen by the first author during a 2 year study period.

Results

Twenty-two of 198 patients with Alzheimer's disease (11.1 %) reported having an aluminium occupation at some stage in their working life compared with 39 of 340 controls (11.5%), odds ratio 0.98, 95% CI 0.53–1.75, P > 0.05. Aluminium workers reported to have worked in direct contact with aluminium dust and fumes did not appear to be at any greater risk than other workers who were employed at the same factory, odds ratio 1.19, 95% CI, 0.64–4.18, P > 0.05.

Conclusion

There is no evidence to support an association between having previously worked in an aluminium factory and the risk of Alzheimer's disease later in life.
A One-Year Follow-Up Study of Depression in Dementia Sufferers
Authors: Ballard C. G. , Patel A. , Solis M. , Lowe K. , Wilcock G.
Published: October 2008

Background

Little data are available about the course or incidence of depression in dementia sufferers.

Method

Monthly follow-up data over one year is reported regarding depression in a cohort of 124 dementia sufferers. Dementia was diagnosed according to DSM–III–R criteria. Depression was assessed with the Cornell Depression Scale and diagnosed according to RDC criteria. Cognitive functioning was assessed with the CAMCOG.

Results

Eighty-nine of the 124 patients completed the follow-up. The annual incidence rates of RDC major depression and RDC minor depression were 10.6% and 29.8%, respectively. Twenty per cent of patients with depression experienced these symptoms for six months or longer. Patients with vascular dementia were significantly more likely to experience three or more months of depression than patients with other dementias. RDC minor depression was highly persistent among 23.8% of sufferers.

Conclusions

Depression is persistent in patients with vascular dementia. Some patients with minor depression have a dysthymia-like disorder.