bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment, outcome and predictors of response in elderly depressed in-patients
Authors: Heeren T. J. , Derksen P. , Ten Ham B. F. V. Heycop , Van Gent P. P. J.
Published: October 2008

Background

Full recovery rates in naturalistic studies of the treatment of elderly depressives are invariably lower than in clinical trials. This may be the result of inadequate treatment due to the lack of clear treatment strategy recommendations for the elderly.

Method

This is a naturalistic prospective study of depressed elderly in-patients in three Dutch psychiatric hospitals. Patients were included when they suffered from any mood disorder according to DSM - III - R criteria. Severity of the depression was measured on the Montgomery -Asberg Rating Scale.

Results

Antidepressants were prescribed to more than 90% of the patients. More than half of them received only one treatment. The dose of the antidepressants was less than the recommended dose for adults in 55% of cases. Full recovery from the depressive episode was achieved in less than half of the patients (33–45%).

Conclusions

In the present study a relatively poor outcome of the antidepressant treatment of elderly depressives has been found. A combination of low treatment expectations and fear of vigorous treatment seems to have been important.
Personality disorder and suicide
Authors: Cheng Andrew T. A. , Mann A. H. , Chan K. A.
Published: October 2008

Background

The relationships between personality disorders and suicide were investigated among two aboriginal groups and the Han Chinese in East Taiwan.

Method

Biographical reconstructive interviews were conducted for consecutive suicides from each of the three ethnic groups (116 suicides in total), 113 of whom were matched with two controls for age, gender, and area of residence.

Results

In all three groups, a high proportion of suicides suffered from ICD-10 personality disorder before suicide (46.7–76.7%), and the most prevalent category was emotionally unstable personality disorder (F60.3) (26.7–56.7%). The risk for suicide was mainly significantly associated with F60.3, comorbidity among personality disorders, and comorbidity of personality disorder with other psychiatric disorders, particularly severe depression.

Conclusion

The main category of personality disorder significantly associated with the risk of suicide is F60.3 in ICD-10. The risk is highest for a comorbidity of this category and severe depression.
The Bentham Unit: A pilot remand and assessment service for male mentally disordered remand prisoners
Authors: Murray Kevin , Akinkunmi Akintunde , Lock Martin , Brown Rosslyn
Published: October 2008

Background

Because of continuing concern regarding the inadequacy of existing NHS provision for mentally disordered remand prisoners, the Bentham Unit was commissioned as a pilot project to provide rapid assessment and, where appropriate, hospital admission for such prisoners from the former North West Thames catchment area.

Method

Information is presented on the 150 referrals and 62 admissions in the first year of the service's operation.

Results

The service met the Reed Report targets for assessment time. Most of those referred were previously known to psychiatric services. The alleged offences were more serious than anticipated. Those admitted were transferred to appropriate services of the conclusion of their court cases, and remained in contact with services three months later. Waiting for the conclusion of court proceedings significantly prolonged the length of stay. Substantial cost transfers from the criminal justice system to the health system were evident.

Conclusions

Adequate services for mentally disordered remand prisoners are entirely achievable; provision of such services is a resource issue, not a clinical problem.
Stress and psychiatric disorder in rural Punjab
Authors: Mumford David B. , Saeed Khalid , Ahmad Imtiaz , Latif Shazia , Mubbashar Malik H.
Published: October 2008

Background

The prevalence of psychiatric disorders in rural Punjab is unknown. Previous studies in rural areas elsewhere in the Indian subcontinent have yielded widely differing estimates.

Method

First-stage screening of a village near Gujar Khan used the Bradford Somatic Inventory and Self Reporting Questionnaire. Psychiatric interviews were conducted with stratified samples using the ICD-10 Diagnostic Criteria for Research.

Results

It is estimated that 66% of women and 25% of men suffered from anxiety and depressive disorders. Levels of emotional distress increased with age in both genders. Women living in unitary households reported more distress than those living in extended or joint families. With younger men and women, lower levels of education were associated with greater risk of psychiatric disorders. Social disadvantage was associated with more emotional distress.

Conclusions

This study in rural Punjab confirms the findings of a previous study in Chitral, northern Pakistan, of high levels of emotional distress and psychiatric morbidity among women in rural areas of Pakistan.
Bereavement and grief in adults with learning disabilities
Authors: Hollins Sheila , Esterhuyzen Alexander
Published: October 2008

Background

This paper reports the results of the first systematic study of the reaction of people with learning disabilities to bereavement.

Method

A sample of 5O parent-bereaved people with learning disabilities was compared with a matched control group of 50 non-bereaved people. A semi-structured bereavement questionnaire was used along with the following instruments: the Aberrant Behaviour Checklist (ABC), the Psychopathology Instrument for Mentally Retarded Adults (PIMRA) and the Life Events Checklist.

Results

Highly significant differences are demonstrated between bereaved and non-bereaved samples on both the total scores and most of the subscores of the ABC and PIMRA. Staff and carers did not usually attribute behaviour problems to the bereavement and its concomitant life events, nor was there a recognition of psychopathology due to bereavement.

Conclusions

The impact in terms of psychiatric and behavioural morbidity of loss of a parent, with its concomitant life events, in adults with learning disabilities has been underestimated.
The familial aggregation of common psychiatric and substance use disorders in the National Comorbidity Survey: A family history study
Authors: Kendler Kenneth S. , Davis Christopher G. , Kessler Ronald C.
Published: October 2008

Background

Most family studies of psychiatric disorders examine one syndrome at a time, and identify probands in clinical rather than epidemiological settings.

Method

In the National Comorbidity Survey, 5877 respondents were asked about the history of five psychiatric disorders in their parents: major depression (MD), generalised anxiety disorder (GAD), antisocial personality disorder (ASP), alcohol abuse/dependence (AAD) and drug abuse/dependence (DAD).

Results

Significant familial aggregation was seen for all disorders. Controlling for other disorders produced only modest reductions in the odds ratios for MD. GAD and AAD and larger reductions for ASP and DAD. The familial transmission of these disorders can be explained by underlying vulnerabilities to internalising and to externalising disorders transmitted across generations with moderate fidelity.

Conclusions

Familial aggregation of common psychiatric and substance use disorders is substantial in epidemiologic samples. The examined environmental adversities account for little of the observed parent-offspring transmission of these conditions.
Appraisal, psychological adjustment and expressed emotion in relatives of patients suffering from schizophrenia
Authors: Barrowclough Christine , Parle Michael
Published: October 2008

Background

It is argued that coping theory may be useful in attempting to understand how relatives adapt to the demands of living with a schizophrenia sufferer.

Method

In a prospective study, univariate and multivariate relationships were explored between appraisal variables (appraisal of symptom threat (primary appraisal) and perceived symptom control (secondary appraisal)) and (a) expressed emotion, and (b) psychological distress in relatives of schizophrenic patients. The profile of relatives who showed sustained distress over time was also examined.

Results

The appraisal variables were found to be related to both the concurrent distress (GHQ scores), EE ratings of relatives at the time of the patients relapse and hospitalisation, as well as the subsequent GHQ scores of relatives when the patient was discharged back home. Relatives who showed sustained distress were likely to show high EE and have a longer caring history.

Conclusions

The study gives some support to the theory that appraisal processes underlie how relatives react to having a family member with schizophrenia, and may have implications both for identifying those at risk of poor adaptation, and for understanding strategies that improve well-being.
Bereitschaftpotential in schizophrenia
Authors: Karaman Taha , Özkaynak Sibel , Yaltkaya Korkut , Büyükberker Çetin
Published: October 2008

Background

Several reports have documented the presence of motor abnormalities in schizophrenic patients.

Method

Thirty schizophrenics and 28 healthy controls were included in the study. Scalp-recorded bereitschaftpotentials (BPs) generated prior to voluntary movements were recorded in all subjects.

Results

The early (NSI) and late components of BP and peak negativity were reduced in all schizophrenic patients. In particular, the NSI was reduced in patients with positive symptoms, and the late component in patients with negative symptoms.

Conclusions

These findings provide further support for the involvement of frontal cortex, subcortical structures and their connections in schizophrenia, and highlight some differences between positive and negative symptom clusters.
Prospective longitudinal study of depression and anosognosia in Alzheimer's disease
Authors: Starkstein Sergio E. , Chemerinski Erán , Sabe Liliana , Kuzis Gabriela , Petracca Gustavo , Tesón Alejandro , Leiguarda Ramón
Published: October 2008

Background

The aim was to examine the longitudinal evolution of depression and anosognosia in patients with probable Alzheimer's disease (AD).

Method

Sixty-two of a consecutive series of 116 AD patients that were examined with a structured psychiatric interview had a follow-up evaluation between one and two years after the initial evaluation.

Results

At the initial evaluation 19% of the 62 patients had major depression, 34% had dysthymia, and 47% were not depressed. After a mean follow-up of 16 months, 58% of patients with major depression at the initial evaluation were still depressed, whereas only 28% of patients with initial dysthymia and 21% of the non-depressed patients were depressed at follow-up. During the follow-up period, all three groups showed similar declines in cognitive status and activities of daily living. At the initial evaluation, 39% of the patients had anosognosia, and there was a significant increment of anosognosia during the follow-up period.

Conclusions

While dysthymia in AD is a brief emotional disorder, major depression is a longer-lasting mood change. Anosognosia is another prevalent disorder among AD patients, and increases with the progression of the illness.
Seasonal changes in psychological well-being in an elderly population
Authors: Eagles John M. , McLeod Isabella H. , Douglas A. Stuart
Published: October 2008

Background

Little is known about seasonal fluctuations in psychological well-being among elderly people.

Method

Over a period of 21 months, 1466 elderly people completed the General Health Questionnaire and the Leeds Scales for Depression and Anxiety. Scores during the winter months (December to February) were compared with those during other months of the year.

Results

Scores on all scales were significantly higher during the winter months, but there was no difference in rates of caseness. Unlike younger populations, elderly women did not exhibit greater seasonality in well-being than did elderly men.

Conclusions

Elderly people exhibit a small seasonal fluctuation in psychological well-being, which is probably of little clinical importance, and there is no gender difference. The findings support the contention that seasonal mood changes are most pronounced among females of reproductive age.
Postpartum psychiatric illness in Arab culture: Prevalence and psychosocial correlates
Authors: Ghubash R. , Abou-Saleh M. T.
Published: October 2008

Background

There have been numerous studies of the prevalence of postpartum depression and its putative risk factors in Western Europe and North America, but very few studies in developing countries including the Arab world.

Method

Ninety-five women admitted to the New Dubai Hospital in Dubai, United Arab Emirates, for childbirth were studied. All subjects were assessed in the postpartum period using clinical and socio-cultural instruments: the Self Report Questionnaire (SRQ) at day 2, the Edinburgh Postnatal Depression Scale (EPDS) at day 7, and the Present State Examination (PSE) at week 8 ± 2 and week 30 ± 2 after delivery.

Results

The prevalence rate of psychiatric morbidity was 24.5% by the SRQ, 17.8% by the EPDS, and 15.8% by the PSE. A number of psychosocial factors emerged as putative risk factors for postpartum depression.

Conclusions

The prevalence rates of postpartum psychiatric morbidity and its risk factors in this Arab culture are similar to the results obtained in numerous previous studies in industrialised countries. These findings have implications for the early detection and care of women at risk for postpartum depression.
History of violent behaviour and schizophrenia in different cultures
Authors: Volavka Jan , Laska Eugene , Baker Sheryl , Meisner Morris , Czobor Pal , Krivelevich Ilya
Published: October 2008

Background

Information on patterns and correlates of the violent behaviour of individuals with schizophrenia is largely limited to populations in developed countries. Data from a World Health Organization epidemiological study of schizophrenia and related disorders, the Determinants of Outcome of Severe Mental Disorders (DOSMD), presented an opportunity to study patterns of violence across multinational settings.

Method

Centres in 10 countries participated in the DOSMD study. An incidence sample of 1017 patients with schizophrenia who had their first-in-lifetime contact with a helping agency as a result of their psychotic symptoms was obtained. Data were available on their history of violent behaviour, substance use, and demographics.

Results

The occurrence rate of assault in the entire cohort was 20.6 per hundred, but the rate was three times higher in the developing countries (31.5 per hundred) than in the developed countries (10.5 per hundred). History of assault was associated with positive symptoms, such as excitement and auditory hallucinations, and with serious alcohol problems.

Conclusions

The cultural context and the specific characteristics of the disease in individuals with schizophrenia may interactively affect rates of violent behaviour.
Cost-effectiveness of clozapine
Authors: Aitchison Katherine J. , Kerwin Robert W
Published: October 2008

Background

Schizophrenia is highly expensive in calculable and incalculable costs. Measures which impact the cost in the most severely affected are likely to produce the greatest cost reductions. Studies regarding clozapine in the USA have demonstrated clear cost-effectiveness, despite the high prescription costs. There are no prior UK studies.

Method

We performed a cost-effectiveness analysis comparing the three years prior to commencing clozapine to the period following establishment of clozapine treatment (mean 36.4 months) for 26 patients with chronic schizophrenia or schizoaffective disorder.

Results

There was a significant improvement in all clinical ratings applied (and a mean net saving of £3768 per annum). The cost-effectiveness of clozapine was double that of conventional neuroleptics (15.2 pre-, 33.0 post-clozapine, P < 0.005).

Conclusions

As a naturalistic study our data provide valuable information on the cost-effectiveness of clozapine in the UK. Our methodology could be applied in a community setting or in the study of another atypical neuroleptic.
Acute and one-year outcome of a randomised controlled trial of brief cognitive therapy for major depressive disorder in primary care
Authors: Scott Christine , Tacchi Mary Jane , Jones Roger , Scott Jan
Published: October 2008

Background

The consensus statement on the treatment of depression (Paykel & Priest, 1992) advocates the use of cognitive therapy techniques as an adjunct to medication.

Method

This paper describes a randomised controlled trial of brief cognitive therapy (BCT) plus ‘treatment as usual’ versus treatment as usual in the management of 48 patients with major depressive disorder presenting in primary care.

Results

At the end of the acute phase, significantly more subjects (P < 0.05) met recovery criteria in the intervention group (n=15) compared with the control group (n=8). When initial neuroticism scores were controlled for, reductions in Beck Depression Inventory and Hamilton Rating Scale for Depression scores favoured the BCT group throughout the 12 months of follow-up.

Conclusions

BCT may be beneficial, but given the time constraints, therapists need to be more rather than less skilled in cognitive therapy. This, plus methodological limitations, leads us to advise caution before applying this approach more widely in primary care.
Incidence of schizophrenia in Nottingham
Authors: Brewin J. , Cantwell R. , Dalkin T. , Fox R. , Medley I. , Glazebrook C. , Kwiecinski R. , Harrison G.
Published: October 2008

Background

Several studies have reported a decline of up to 50% in the incidence of schizophrenia over recent decades. We aimed to measure changes in the incidence and diagnostic patterns of first-episode psychosis by comparing two Nottingham cohorts, identified in two equal periods separated by 14 years.

Method

Two prospectively ascertained cohorts of first-episode psychotic disorder were identified over the time periods 1978–80 and 1992–94. The earlier cohort was of the World Health Organization Determinants of Outcome of Severe Mental Disorder (DOSMD) ten-country study. The later cohort was obtained using similar methodology. Both groups were diagnosed using ICD-10 diagnostic criteria and age-standardised incidence rates were compared.

Results

The standardised incidence rate for all psychotic disorders rose slightly from 2.49 to 2.87 per 10 000 population per year, but the F20 classification fell significantly by over a third (1.41 to 0.87 per 10 000 per year). The second study group (1992–1994) included a greater diversity of psychotic diagnoses compared with the first, in particular an increased proportion of acute and drug-related psychoses.

Conclusions

Methodological considerations call for caution in interpreting such data, but we conclude that the significant fall in the narrowly defined diagnostic category of schizophrenia reflects a real change in the syndromal presentation of psychotic disorders.
Executive (frontal) dysfunction and negative symptoms in schizophrenia: Apparent gender differences in ‘static’ v. ‘progressive’ profiles
Authors: Scully Paul J. , Coakley Grainne , Kinsella Anthony , Waddington John L.
Published: October 2008

Background

While executive (frontal lobe) dysfunction appears to be a core feature of schizophrenia, its relationship to psychopathology, age and duration of illness has yet to be explored systematically between the genders.

Method

Executive dysfunction, positive and negative symptoms were evaluated in 27 male and 21 female in-patients who were unusually well-matched on numerous demographic and clinical measures.

Results

Measures of executive dyscontrol and negative symptoms were highly associated in both genders. However, while both executive dyscontrol and negative symptoms increased prominently with age/duration of illness among women, no such relationship was evident among men.

Conclusions

The similarly prominent levels of current executive dyscontrol and negative symptoms in male and female patients appear to have emerged via processes that differ fundamentally between the genders; among males these deficits appear to emerge and become ‘locked in’ earlier in the course of illness and to show little subsequent increase, while among females these same deficits appear to be less evident early in the course but to increase in prominence thereafter.
Service provision for people with schizophrenia
Authors: Lang F. H. , Johnstone E. C. , Murray G. D.
Published: October 2008

Background

This second report of a study of service provision for patients with schizophrenia describes patients' contact with general practice and general practitioners' (GPs’) views of the mental health services.

Method

A postal questionnaire was sent to the GPs, and patients' primary care records were examined.

Results

Data were collected on 131 subjects. The majority of patients (96) (73%) were in regular contact with their GP and were consulting for many different reasons; 27 (21%) were posing particular difficulties for the primary care team. GPs reported that 27 (21%) patients required additional support and that the care arrangements for 50 (38%) patients could be improved if alterations were made to the roles of the professionals already involved.

Conclusions

GPs are central to service provision for patients with schizophrenia. Both additional resources and changes in working practices are required to improve patient care. The service implications of these findings are discussed.
“Anybody's child”: severe disorders of mother-to-infant bonding
Authors: Kumar R. Channi
Published: October 2008

Background

This paper describes severe, disorders of maternal affection and behaviour and suggests that there is an early process of mother-to-infant bonding which can go seriously wrong.

Method

Forty-four self-selected women who had suffered from at least one episode of postnatal mental illness described an unexpected and often catastrophic failure to love one or more of their babies.

Results

These women reported absent affection, sometimes hate, rejection, neglect or impulses to harm, in relation to at least one of their children. These feelings often began immediately or very shortly after the birth, and with one exception, were specific to one child; such characteristics are best encapsulated by the term ‘maternal bonding disorder’. Twenty-nine of the women were multiparae; first-borns were not significantly more likely to be the focus for such feelings. There was no direct evidence of predisposing maternal personality traits or previous experiences. Postnatal mental illness and recalled severe pain during labour were significantly associated with such disorders which, in their severe forms, did not occur in the absence of postnatal mental illness.

Conclusions

The nature of the link between postnatal mental illness and disorders of maternal bonding remains unclear. Because, in multiparae, the disorder often ‘missed’ the first child, factors such as maternal personality traits or early childhood experiences cannot be regarded as sufficient causes.
Opportunities for psychiatry from genetic findings
Authors: Rutter Michael , Plomin Robert
Published: October 2008

Background

The opportunities for psychiatry deriving from available or likely genetic advances are reviewed.

Method

Clinical implications are considered in the context of both the misconceptions and benefits associated with relevant genetic findings.

Results

Misconceptions include that: heritability estimates have a ‘true’ fixed value; a high heritability means that environmental interventions will be ineffective; a high heritability within groups means that differences between groups will also be due to genes; genetic effects are determinative; ‘genetic’ means single abnormal genes; genes associated with disease must be bad and justify eugenic measures; gene therapy will be widely applicable; and genetic screening of the general population will be useful. The benefits include demonstrations that: both genes and environment have an ubiquitous influence; some prevailing diagnostic assumptions are mistaken; genes influence development; the effects of nature and nurture are not separate; and environmental effects tend to be person-specific. The potential value of molecular genetics lies in elucidation of causal processes as they apply to both brain systems and nature—nurture interplay; improving diagnosis and genetic counselling; and the development of improved pharmacological interventions.

Conclusion

Advances in genetics will make a major impact on clinical psychiatry, and should bring practical benefits for both prevention and treatment.
Psychiatrists and their patients: Views on forms of dress and address
Authors: Gledhill Julia A. , Warner James P. , King Michael
Published: October 2008

Background

Dress styles and forms of address vary among psychiatrists.

Method

A semi-structured interview was administered to a sample of psychiatric in-patients, and a questionnaire was sent to junior and consultant psychiatrists, to identify preferences for dress styles and terms of address.

Results

Forty-nine (71%) of the inpatient sample participated. A preference was found for smart attire and white coats. Of the 69 (80%) doctors returning questionnaires, the majority supported smart dress as the most appropriate attire. Most patients preferred to be called by their first name while addressing doctors by title and surname. Junior doctors preferred to use first names when talking to patients while almost all consultants used title and surname. Doctors of all grades liked to be called by their title and surname.

Conclusions

Paying more attention to the way we present ourselves and interact at work may help to facilitate the therapeutic alliance.
Ethnicity and use of acute psychiatric beds: One-day survey in North and South Thames regions
Authors: Koffman Jonathan , Fulop Naomi J. , Pashley David , Coleman Ken
Published: October 2008

Background

Previous studies have shown higher rates of psychiatric admissions, compulsory admissions, and diagnosed schizophrenia in Black ethnic groups compared with other population groups.

Method

In a point-prevalence study, demographic and clinical data were collected for adult acute and low-level secure psychiatric in-patients in all National Health Service and seven private psychiatric units in North and South Thames regions on 15 June 1994

Results

A total of 3710 adult acute and 268 low-level secure psychiatric patients were surveyed; 75% of the patients were White, 16% were Black, and 4% were Asian. Analysis reveals that a high proportion of the Black population were admitted to a psychiatric unit; that Black patients are more likely to be admitted under Section; to be located in locked wards; have an inpatient diagnosis of schizophrenia; and not be registered with a general practitioner.

Conclusions

These findings demonstrate the over-representation of Black ethnic groups within current psychiatric provision. The complement of services to all minority ethnic groups should be examined in terms of access, appropriateness and quality of care. Racism awareness and staff training need to be incorporated into mental health service provision as a matter of priority.
Disability, outcome and case-mix in acute psychiatric in-patient units
Authors: Boot Brendon , Hall Wayne , Andrews Gavin
Published: October 2008

Background

Eighteen acute in-patient psychiatric units in Australia funded a syndicate to measure case-mix, disability and outcome of treatment. This syndicate included eight units in public general hospitals, five in stand-alone public psychiatric hospitals and five in private psychiatric hospitals.

Method

Up to 100 in-patients admitted consecutively to each hospital (1359 in all) were assigned to a Diagnosis-Related Group (DRG), rated on the Health of the Nation Outcome Scales (HoNOS) and asked to complete the Medical Outcomes Trust Short Form 36 (SF36). These scales were administered again at discharge. Demographic information and length of stay were also recorded. Disability was measured by scores on the HoNOS and SF36 at admission, and outcome was assessed by the change in scores between admission and discharge.

Results

The public hospitals treated significantly more patients with schizophrenia and fewer with affective disorders, and their case load on admission was more disabled, on the whole, than that of the private hospitals. They achieved the same outcome or health gain as the private hospitals, but needed a shorter length of stay to do so. The addition of disability scores to DRG moderately increased the ability to predict length of stay.

Conclusions

Routine outcome assessment using reliable and valid instruments is practical, and could lead to improvements in the quality of care for psychiatric patients.
Prevalence of spontaneous dyskinesia in schizophrenic and non-schizophrenic psychiatric patients
Authors: Fenton Wayne S. , Blyler Crystal R. , Wyatt Richard J. , McGlashan Thomas H.
Published: October 2008

Background

Although movement disorders have been noted among patients never exposed to neuroleptic medications, the specificity of spontaneous dyskinesia to schizophrenia has rarely been examined.

Method

By abstracting detailed case records, we compared the prevalence of dyskinetic movements between 94 neuroleptic-naïve schizophrenic patients and 179 patients with other psychiatric disorders.

Results

Dyskinetic movements were more common among patients with schizophrenia than among those with all other diagnoses, and were most often noted in the body areas typically associated with tardive dyskinesia.

Conclusions

Spontaneous dyskinesia appears to be relatively specific to schizophrenia and may be intrinsic to the pathophysiology of the disorder.
Prevalence of dementia and depression among elderly people in Black and ethnic minorities
Authors: McCracken C. F. M. , Boneham M. A. , Copeland J. R. M. , Williams K. E. , Wilson K. , Scott A. , McKibbin P. , Cleave N.
Published: October 2008

Background

This study was designed to identify all elderly people of ethnic minorities living in a defined geographical area in inner-city Liverpool and to identify psychiatric morbidity and barriers to use of services. This paper reports the prevalence of dementia and depression.

Method

A survey of the community was carried out using the Geriatric Mental State Examination, AGECAT and ethnically matched interviewers. The sampling frame consisted of Family Health Services Authority lists as a basis, with additional information from community lists, ‘snow-balling’ and a door-to-door survey.

Results

418 people were interviewed, with a high percentage (55%) of young elderly (65–74) men. The prevalence of dementia ranged from 2 to 9% and of depression from 5 to 19%, and there were no significant differences in levels between English-speaking ethnic groups and the indigenous population. Higher levels of dementia were found among non-English-speaking groups.

Conclusions

A complete enumeration of the elderly in ethnic minority groups is best achieved by using several different methods. Diagnosis of dementia may be misleading among those who do not speak the dominant language.
Change in borderline symptoms one year after therapeutic community treatment for severe personality disorder
Authors: Dolan Bridget , Warren Fiona , Norton Kingsley
Published: October 2008

Background

The view that severe personality disorder (SPD) is untreatable derives from poor-quality studies of treatment outcome which use indirect measures of SPD pathology. This study evaluates the impact of psychotherapeutic in-patient treatment on core personality disorder symptoms.

Method

137 SPD patients completed the Borderline Syndrome Index (BSI) on referral and one year post-treatment (‘admitted’, n=70) or one year post-referral (‘non-admitted’, n=67); 22 of the non-admitted group were refused extra-contractual referral funding for their treatment.

Results

There was a significantly greater reduction in BSI scores in the treated than in the non-admitted group. Changes in BSI scores were significantly positively correlated with length of treatment. Assessment of the reliability and clinical significance of changes in individual subjects showed that the magnitude of this change was reliable and clinically significant in 42.9% of the admitted sample, compared with only 17.9% of the non-admitted sample (18.2% of the unfunded group)

Conclusions

Specialist in-patient treatment is effective in reducing core SPD psychopathology.
Personality disorder and psychopathology in Tourette's syndrome: A controlled study
Authors: Robertson Mary M. , Banerjee Sube , Fox-Hiley Paul J. , Tannock Charles
Published: October 2008

Background

Some specialists associate a wide variety of psychopathologies with Tourette's syndrome (TS), while others suggest that there is no psychopathology specifically associated. Few controlled studies have been conducted to address this issue, and none has investigated personality disorder in TS.

Method

Adults with TS and controls were evaluated using standardised psychiatric rating scales, including self-rated (STPCD) and clinician-rated (SCID–II) assessments of personality disorder, to investigate associations between personality disorder, other psychopathology and TS.

Results

Significantly more TS patients (25/39 (64%)) than controls (2/34 (6%)) had one or more personality disorders. TS subjects were also more likely to have more personality disorders. TS patients had significantly more depression, anxiety and obsessionality than controls. The SCID–II and STCPD were moderately well correlated.

Conclusions

TS patients have a high prevalence of personality disorder and psychopathology when compared with controls. These results are the first to suggest a high level of personality disorder in a TS clinic population.
A very British kind of social psychiatry
Authors: Eisenberg Leon
Published: October 2008

Social psychiatry, as represented in the work of Michael Shepherd, his pupils, and his colleagues at the Maudsley, all intellectual progeny of Sir Aubrey Lewis, is a very British kind of science. Lest this arouse your ire, implying an insult hurled at his betters in the mother country by a colonial parvenu, I hasten to add that “very British” refers to the best in your long and admirable scientific tradition in medicine: an unswerving commitment to empiricism, one which rarely moves much beyond its database; sober understatement, which makes no claim of possessing an exclusive path to salvation; sound methodology; and epistemological caution. It is aptly described by the adjective Apollonian, defined in my New Shorter Oxford English Dictionary (NSOED) as “serene, rational, self-disciplined”.
The evolving face of psychiatric epidemiology
Authors: Mann Anthony
Published: October 2008

In 1978, Michael Shepherd gave a Maudsley Bequest Lecture in which it was necessary for him to argue from first principles for the need for epidemiological research within clinical psychiatry (Shepherd, 1978). This paper will take stock of the 20 years since his lecture and point to the new directions for this research approach. Shepherd listed the contributions of psychiatric epidemiology as follows:

(a)

the completion of the spectrum of disease;

(b)

the establishment of outcome;

(c)

the actuarial assessment of morbidity risk;

(d)

the evaluation of efficacy of treatment; and

(e)

the conceptual construction of diag nosis/classification.
DSM–IV and ICSD–90 insomnia symptoms and sleep dissatisfaction
Authors: Ohayon Maurice M. , Caulet Malijaï , Priest Robert G. , Guilleminault Christian
Published: October 2008

Background

The complex nature of insomnia and its relationship with organic and mental disorders render diagnosis problematic for epidemiologists and physicians.

Method

A representative UK sample (non-institutionalised, > 14 years old) was interviewed by telephone (n=4972; 79.6% participation rate) with the Sleep-EVAL system. Subjects fell into three groups according to presence of insomnia symptom (s) and/or sleep dissatisfaction.

Results

Insomnia symptoms occurred in 36.2% of subjects. Most of these (75.9%), however, reported no sleep dissatisfaction. In comparison, those also with sleep dissatisfaction had higher prevalence of sleep and mental disorders and longer duration of insomnia symptoms, and were more likely to take sleep-promoting medication, dread bedtime, and complain of light sleep, poor night-time sleep and daytime sleepiness.

Conclusions

Insomnia sufferers differ as to whether they are satisfied or dissatisfied with sleep. Although insomnia symptoms are common in the general population, sleep disturbances among sleep-dissatisfied individuals are more severe. Sleep dissatisfaction seems a better indicator of sleep pathology than insomnia symptoms.
Four-year remission of transsexualism after comorbid obsessive–compulsive disorder improved with self-exposure therapy
Authors: Marks Isaac M. , Mataix-Cols David
Published: October 2008

Background

There has been no report of comorbid transsexualism and obsessive–compulsive disorder (OCD) or of their differential course over follow-up.

Method

Such comorbidity and follow-up are documented in a case report.

Results

A man who had been transsexual and homosexual since early adolescence developed severe OCD at age 40 as he became depressed when his mother, to whom he was very close, died. Two years later he was referred for his OCD. He refused treatment for his transsexualism. As his OCD and mood improved with self-exposure therapy, his transsexualism and homosexuality remitted also. Four years later depression and transsexualism recurred and remained to six-year follow-up despite full remission in OCD continuing throughout.

Conclusions

The sequence is like that in other cases in whom unusual sexual behaviour remitted for years after comorbid disorders improved with various treatments, or after circumstances changed.
Needs assessment for mentally disordered offenders and others requiring similar services
Authors: Cohen Andrea , Eastman Nigel
Published: October 2008

Background

The government has highlighted the service needs of mentally disordered offenders (MDOs) and has introduced policies which have driven MDO needs assessment.

Method

Based on a literature review and a national survey of agencies likely to be conducting needs assessment, the paper reviews government policy regarding MDO needs assessment and examines the particular problems of conducting needs assessment for MDOs.

Results

A methodological framework for MDO needs assessment is presented, and different needs assessment approaches are discussed. The methodological and practical limitations of conducting MDO needs assessment are emphasised, as is the role of subjective judgement in both research design and interpretation.

Conclusions

Needs assessment is value-laden. Also, no single needs assessment approach can address all the issues of importance to purchasers and providers. Substituting the term ‘perspectives on need’ for the term needs assessment would help to reflect the lack of a single ‘truth’ about need and emphasise the role of subjective political judgement in designing and interpreting research on ‘need’.
London–East Anglia randomised controlled trial of cognitive–behavioural therapy for psychosis
Authors: Garety Philippa , Fowler David , Kuipers Elizabeth , Freeman Daniel , Dunn Graham , Bebbington Paul , Hadley Clare , Jones Steven
Published: October 2008

Background

Despite growing evidence of the effectiveness of cognitive–behavioural therapy (CBT) for psychosis, typically only about 50% of patients show a positive response to treatment. This paper reports the first comprehensive investigation of factors which predict treatment outcome.

Method

In a randomised controlled trial of CBT for medication-resistant psychosis (see Part I) measures were taken at baseline of demographic, clinical and cognitive variables. Changes over time were assessed on the Brief Psychiatric Rating Scale and the relationship between potential predictor variables and outcome was investigated using analysis of variance and covariance.

Results

A number of baseline variables were identified as predictors of good outcome in the CBT group. Key predictors were a response indicating cognitive flexibility concerning delusions (P=0.005) and the number of recent admissions (P=0.002). Outcome was less predictable in the control group and was not predicted by any cognitive variable.

Conclusions

Good outcome is strongly predicted in patients with persistent delusions by a cognitive measure, while this was not the case in controls. Thus we argue that positive outcome in CBT is due in part to specific effects on delusional thinking.
Serotonin 5-HT2 receptor imaging in major depression: focal changes in orbito-insular cortex
Authors: Biver Françoise , Wikler David , Lotstra Françoise , Damhaut Philippe , Goldman Serge , Mendlewicz Julien
Published: October 2008

Background

Serotonin receptors may play an important role in the pathophysiology of affective disorders. We studied type-2 serotonin (5-HT2) receptors in the brain of patients with major depression.

Method

Using positron emission tomography (PET) and the selective radioligand [18F]altanserin, we investigated 5-HT2 receptor distribution in eight drug-free unipolar depressed patients and 22 healthy subjects. Data were analysed using Statistical Parametric Mapping 95.

Results

In depressed patients, [18F]altanserin uptake was significantly reduced in a region of the right hemisphere including the posterolateral orbitofrontal cortex and the anterior insular cortex. A trend to similar changes was found in the left hemisphere. No correlation was found between the uptake and the Hamilton rating scale score.

Conclusions

Pathophysiology of depression may involve changes in 5-HT2 receptor in brain regions selectively implicated in mood regulation.
Post-traumatic stress disorder symptoms and the Clapham rail accident
Authors: Selley Carolyn , King Elizabeth , Peveler Robert , Osola Karen , Martin Nick , Thompson Chris
Published: October 2008

Background

Post-traumatic stress disorder is a well recognised condition which can have long-term consequences. A rail accident to commuter trains in south London provided an opportunity, within the context of a Psychological Therapies Service, to study the prevalence and associations of the condition in a follow-up study.

Method

Postal questionnaires were completed by 187 survivors (52% response rate) 10 to 22 months after the accident, and their symptoms were compared with a commuter control group.

Results

The accident group scored significantly higher on the Impact of Events scale (IES) than the control group. Severity of physical injury was significantly associated with high IES scores. Thirty per cent of those moderately or severely injured showed high levels of intrusion or avoidance symptoms (sub-scores of 20 or more). Thirty per cent of those nearest the accident focus had high sub-scores, associated variables being the accident experience of risk of death, feeling trapped and seeing death. For those less directly involved the proportions with symptoms were similar to those of controls.

Conclusions

It is recommended that disaster services should provide for long-term psychological effects, particularly for those survivors who are injured, who experience risk of death, feeling trapped or who witness death.
Prevalence and significance of weight and shape concerns in girls aged 11–16 years
Authors: Cooper Peter J. , Goodyer Ian
Published: October 2008

Background

The prevalence of the core ideational component of eating disorders among the at-risk population (11 – to 16-year-old girls) is not known.

Method

A community survey of 11 – to 16-year-old girls was conducted to establish the prevalence of significant concerns about body weight and shape characteristics of eating disorders. A total of 1068 girls were screened and 368 interviewed using standardised measures.

Results

Significant weight and/or shape concerns were estimated to be present in 14.5% of the 11-to 12-year-olds, 14.9% of the 13-to 14-year-olds and 18.9% of the 15-to 16-year-olds. Only among those aged 15 to 16 was the presence of such concerns associated with a significant level of concurrent behavioural and ideational disturbance.

Conclusions

Significant concerns about weight or shape are present in almost one in five 15-to 16-year-old girls, many of whom evidence high levels of ancillary disturbance.
Trends in deliberate self-harm in Oxford, 1985–1995
Authors: Hawton Keith , Fagg Joan , Simkin Sue , Bale Elizabeth , Bond Alison
Published: October 2008

Background

Deliberate self-harm (DSH) has been a major health problem in the UK for nearly three decades. Any changes in rates of DSH or the demographic characteristics of the patient population are likely to have important implications for clinical services and suicide prevention.

Method

Data collected by the Oxford Monitoring System for Attempted Suicide were used to review trends in DSH between 1985–1995

Results

There was a substantial increase in DSH rates during the 11-year study period, with a 62.1% increase in males and a 42.2% increase in females. The largest rise was in 15–24-year-old males (+194.1%). Changes in DSH rates correlated with changes in national suicide rates in both males and females in this age group. Rates of repetition of DSH increased in both genders during the study period. Paracetamol self-poisoning has continued to increase, half of all overdoses in 1995 involving paracetamol, and antidepressant overdoses have become more common.

Conclusions

The increase in DSH, especially in young males, has important implications for general hospital DSH and medical services. It may herald a reversal of recent progress towards achievement of national suicide targets.
Sulpiride augmentation in people with schizophrenia partially responsive to clozapine
Authors: Shiloh Roni , Zemishlany Zvi , Aizenberg Dov , Radwan Marguerite , Schwartz Bruria , Dorfman-Etrog Pnina , Modai Ilan , Khaikin Marina , Weizman Abraham
Published: October 2008

Background

We hypothesised that a combined regimen of clozapine, a relatively weak D2-dopaminergic antagonist, and sulpiride, a selective D2 blocker, would demonstrate a greater antipsychotic efficacy by enhancing the D2 blockade of clozapine.

Method

Twenty-eight people with schizophrenia, previously unresponsive to typical antipsychotics and only partially responsive to current treatment with clozapine, received, double-blind, 600 mg/day sulpiride or placebo, in addition to an ongoing clozapine treatment. The clinical status was evaluated before, during, and at the end of 10 weeks of sulpiride addition using the Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms, and Hamilton Rating Scale for Depression.

Results

The clozapine–sulpiride group exhibited substantially greater and significant improvements in positive and negative psychotic symptoms. About half of them, characterised by a younger age and lower baseline SAPS scores, had a mean reduction of 42.4 and 50.4% in their BPRS and SAPS scores, respectively.

Conclusions

A subgroup of patients with chronic schizophrenia may substantially benefit from sulpiride addition to clozapine.