bluuebunny/crossref_metadata_2025 huggingface dataset:
Controlled trial of exposure and response prevention in obsessive–compulsive disorder
Authors: Lindsay Merran , Crino Rocco , Andrews Gavin
Published: October 2008

Background

Exposure and response prevention is considered a treatment of choice for obsessive–compulsive disorder (OCD). Yet there have been very few randomised controlled trials employing credible placebo conditions. This study compares exposure and response prevention with a general anxiety management intervention.

Method

Eighteen patients meeting DSM–IV criteria for OCD were randomly assigned to either exposure and response prevention or anxiety management. Both treatments involved approximately 15 hours of therapy over a three-week period.

Results

There was a significant reduction in obsessive–compulsive symptoms following treatment with exposure and response prevention, while no change occurred in the control group. This was found to be statistically significant using a composite measure of OCD symptom severity, patient ratings of interference and therapist ratings of symptom severity.

Conclusions

These findings suggest that the symptom reductions associated with behaviour therapy for OCD are a result of the specific techniques of exposure and response prevention, rather than non-specific aspects of the therapy process. General anxiety management techniques are not effective in the treatment of OCD.
Service provision for people with schizophrenia
Authors: Lang F. H. , Johnstone E. C. , Murray G. D. , Forbes J. F.
Published: October 2008

Background

The aim of this study was to provide information on patients' current service use which could inform future decisions on service planning and resource allocation.

Method

Individuals with a diagnosis of schizophrenia, who had received in-patient care in the previous five years, were identified from the Lothian Case Register. Information was obtained from 193 subjects. Patients' service use over a six-month period was examined. The costs incurred in service provision were determined.

Results

Patients differed markedly in their use of services. This was not found to be related to their mental state. Average care costs were high. In-patient care accounted for most of the overall expenditure.

Conclusions

There is considerable variation in the services used by patients with schizophrenia and in the costs incurred in service provision. When planning services it is therefore important that detailed information on the patient population is available if resources are to be allocated cost-effectively.
Integration between primary and secondary services in the care of the severely mentally ill: patients' and general practitioners' views
Authors: Bindman Jonathan , Johnson Sonia , Wright Steve , Szmukler George , Bebbington Paul , Kuipers Elizabeth , Thornicroft Graham
Published: October 2008

Background

Communication between secondary and primary care is an important aspect of continuity of care. We investigated communication between general practitioners (GPs) and psychiatric teams about a representative group of patients with severe mental illness (SMI). We also sought views on GP involvement in care from the patients and their GPs.

Methods

One hundred patients with SMI were randomly selected from those under the care of two psychiatric sector teams in inner London. The patients and their GPs were interviewed.

Results

GPs' knowledge about the care their patients received was limited. Most GPs perceived their role as providing physical care and prescribing. Few patients consulted GPs for mental health care. GPs perceived themselves as less involved in the care of Black Caribbean or Black African patients.

Conclusions

Considerable discontinuities of care between secondary and primary care were identified. GP involvement in the care of patients with SMI appears limited. Better communication is necessary if care is to be shared.
One hundred in-patient suicides
Authors: Proulx France , Lesage Alain D. , Grunberg Frédéric
Published: October 2008

Background

The study aimed to define the characteristics and assess the clinical predictability and possible prevention of psychiatric in-patient suicides.

Method

The coroner's files on all suicides in the Greater Montreal Region from 1 April 1986 to 31 March 1991 were examined. The medical records of each case of suspected in-patient suicide were then reviewed and rated for predictability and preventive measures taken.

Results

A total of 3079 suicides were recorded over this five-year period (mean annual rate of 16.4 per 100 000 inhabitants). Of these, 104 (3.4%) involved hospital in-patients. Nearly half (48%) of these in-patient suicides occurred outside the hospital setting. The methods most frequently employed were hanging (36%) and jumping from high places (24%). Patients suffering from an affective disorder (45%) or schizophrenia (35%) comprised the majority of the sample. Suicides were significantly more predictable in general hospital psychiatric wards. Suicide prevention measures did not differ significantly across settings.

Conclusions

The majority of in-patient suicides were not highly predictable. For highly predictable suicides, the results underline the importance of actively treating and protecting these patients.
Prospective study of clinical and social outcome of stay in small group homes for people with mental illness
Authors: Middelboe Thomas
Published: October 2008

Background

Small group homes operating according to the principles of supported housing have, during the past five years, become a cornerstone of the housing services for the long-term mentally ill in Copenhagen.

Method

During a 2.5-year period, 47 long-term mentally ill persons were examined at the time of entry to a group home programme. Residents' psychopathology, social integration, mastery and quality of life were measured by structured interviews, including the Present State Examination (PSE–10); and their social functioning was recorded by interview with the staff. Forty-four of the residents were re-examined at follow-up after a mean of 1.1 years using the same instruments. Data on hospitalisation were obtained through the Danish Psychiatric Case Register.

Results

Eighty-three per cent of the residents remained in the programme during the first year. They showed a significant improvement in subjective quality of life, PSE total score, social integration, functioning and hospitalisation index. The number of reciprocal supportive contacts in the social network increased. Lower baseline PSE total score was associated with adherence to the programme, and the improvement in quality of life during their stay was predicted by reduction in symptoms and improvement in social integration.

Conclusions

A rehabilitation strategy of supplementing standard psychiatric treatment with a programme of small supportive group homes improves the quality of life, psychosocial functioning and community tenure of the long-term mentally ill.
Ethnic differences in satisfaction with mental health services among representative people with psychosis in South London: PRiSM Study 4
Authors: Parkman Sue E. , Davies Sara N. , Leese Morven , Phelan Michael , Thornicroft Graham
Published: October 2008

Background

Previous studies show that among Black Caribbeans there is a higher prevalence of schizophrenia and higher levels of both voluntary and compulsory admissions. These suggest that Black Caribbean patients may find psychiatric services less appropriate to their needs. The aim of this study was to establish the satisfaction with mental health services of representative psychosis patients in South London, especially in relation to ethnic group.

Method

A random sample of all cases of psychotic disorder identified in the two sectors was interviewed using the Verona Service Satisfaction Schedule. Questionnaires from 50 Black Caribbean patients and 134 White patients were analysed.

Results

Black Caribbean patients, particularly those of second generation born in the UK, were significantly less satisfied with almost every aspect of the services that they received than either older Black Caribbean patients born in the Caribbean or White patients. Using multiple regression analysis it was found that among the younger Black Caribbean patients, unlike the other patients, the number of previous admissions was a significant predictor of dissatisfaction.

Conclusion

Patients' ratings of satisfaction with mental health services are significantly worse for UK-born Black Caribbean than other patients with psychotic disorder in South London.
Brain 5-HT function in obsessive-compulsive disorder
Authors: Fineberg N. A. , Roberts A. , Montgomery S. A. , Cowen P. J.
Published: October 2008

Background

Drugs that potentiate brain serotonin (5-HT) neurotransmission are effective in the treatment of obsessive–compulsive disorder (OCD), but it is unclear whether disturbances in brain 5-HT function play a role in the pathophysiology of OCD.

Method

We studied the prolactin response to the selective 5-HT releasing agent d-fenfluramine in 14 non-depressed, drug-free OCD patients, and 14 healthy controls matched for age and gender.

Results

The prolactin response to d-fenfluramine was significantly increased in OCD patients compared with controls.

Conclusions

The disparate results of studies of 5-HT neuroendocrine function in OCD make it unlikely that disturbances of brain 5-HT function play a central role in the pathophysiology of OCD. Increased brain 5-HT neurotransmission in non-depressed OCD subjects may represent an adaptive neurobehavioural mechanism which can be amplified to therapeutic advantage by treatment with 5-HT potentiating drugs.
London–East Anglia randomised controlled trial of cognitive–behavioural therapy for psychosis
Authors: Kuipers Elizabeth , Garety Philippa , Fowler David , Dunn Graham , Bebbington Paul , Freeman Daniel , Hadley Clare
Published: October 2008

Background

A series of small, mainly uncontrolled, studies have suggested that techniques adapted from cognitive–behavioural therapy (CBT) for depression can improve outcome in psychosis, but no large randomised controlled trial of intensive treatment for medication-resistant symptoms of psychosis has previously been published.

Method

Sixty participants who each had at least one positive and distressing symptom of psychosis that was medication-resistant were randomly allocated between a CBT and standard care condition (n=28) and a standard care only control condition (n=32). Therapy was individualised, and lasted for nine months. Multiple assessments of outcome were used.

Results

Over nine months, improvement was significant only in the treatment group, who showed a 25% reduction on the BPRS. No other clinical, symptomatic or functioning measure changed significantly. Participants had a low drop-out rate from therapy (11%), and expressed high levels of satisfaction with treatment (80%). Fifty per cent of the CBT group were treatment responders (one person became worse), compared with 31% of the control group (three people became worse and another committed suicide)

Conclusions

CBT for psychosis can improve overall symptomatology. The findings provide evidence that even a refractory group of clients with a long history of psychosis can engage in talking about psychotic symptoms and their meaning, and this can improve outcome.
Controlled acute and follow-up trial of cognitive therapy and pharmacotherapy in out-patients with recurrent depression
Authors: Blackburn I.-M. , Moore R. G.
Published: October 2008

Background

We report a randomised controlled trial, in both the acute and maintenance stage of treatment, in 75 outpatients with recurrent major depression.

Method

Patients were allocated to three groups: 16 weeks of acute treatment and two years' maintenance treatment in the following way: antidepressants and maintenance antidepressants; cognitive therapy and maintenance cognitive therapy: antidepressants and maintenance cognitive therapy. Both completers' and end-point data were analysed.

Results

In the acute phase of treatment, all patients improved significantly and there was no significant difference among treatments, or in the pattern of improvement over time. In the maintenance stage of treatment, patients kept improving over time in all three groups and there was no significant difference among treatments. Cognitive therapy was consistently superior to medication.

Conclusions

The results indicate that maintenance cognitive therapy has a similar prophylactic effect to maintenance medication and is a viable option for maintenance after acute treatment with medication in recurrent depression.
Risk factors for suicide in patients with schizophrenia: Nested case–control study
Authors: Rossau Charlotte Dahl , Mortensen Preben Bo
Published: October 2008

Background

Of 9156 patients admitted to psychiatric hospitals in Denmark between 1970 and 1987 and diagnosed for the first time as having schizophrenia, 508 committed suicide. The purpose of the study was to identify risk factors for suicide among patients with schizophrenia, particularly factors relating to hospitalisation.

Method

From the cohort of all 9156 patients, the 508 who had committed suicide were individually matched to 10 controls from the same cohort, and data were analysed using conditional logistic regression.

Results

Suicide risk was particularly high during the first 5 days after discharge, and increased risk was also associated with multiple admissions during the previous year, previous suicide attempts, previous diagnosis of depression, male gender, and previous admissions to general hospitals for physical disorders. After adjusting for these factors, no effect was found for age. There was some evidence of an excess of suicides during temporary leave from the psychiatric department.

Conclusions

The findings suggest that preventive measures could be focused on the first period after discharge, when closer monitoring and better social support may be needed. This may also apply to patients on temporary leave during a period of admission.
Adverse social circumstances and depression in people of Pakistani origin in the UK
Authors: Husain Nusrat , Creed Francis , Tomenson Barbara
Published: October 2008

Background

The social origins of depression in people of Pakistani origin in the UK are not fully understood; they may not be the same as for the indigenous White population.

Method

Patients attending a GP's surgery were screened with the Personal Health Questionnaire to detect depressive illness, which was confirmed using the Psychiatric Assessment Schedule; the estimated prevalence of major depression was 42%. Forty-four people with depression and 33 non-depressed comparison subjects were successfully interviewed using the Life Event and Difficulty Schedule, either in Urdu or English.

Results

Seventy-five per cent of the sample were Pakistani born; 57% of cases and 33% of non-cases spoke English with difficulty. Seventy-five per cent of the cases and 36% of the non-cases had experienced an independent severe event and/or a major difficulty (P=0.0015). Difficulties associated with depression were most commonly in the marital, health and housing categories; overt racial harassment and discrimination were rare.

Conclusions

This is a preliminary study because of the small sample of GP attenders. The somatic presentation of depression in this population is clear. Acceptable forms of social support and help with marital, housing and employment problems will be needed to help relieve the depression in this population.
Expressed emotion and depression
Authors: Hayhurst H. , Cooper Z. , Paykel E. S. , Ramana R. , Vearnals S.
Published: October 2008

Background

Previous studies show that criticism by relatives during acute depressive illness predicts relapse over nine months, but the course of criticism over time and its relation to the course of illness, have not been examined in depressed patients.

Method

Thirty-nine depressed patients and their partners, were interviewed separately at three-monthly intervals over about one year. Illness was assessed by Research Diagnostic Criteria and Hamilton Depression Rating Scale. Criticism was measured by the Camberwell Family Interview.

Results

Criticism when patients were most depressed predicted neither remission nor subsequent relapse. Patients who fully recovered, with or without later relapse, had partners who were consistently uncritical, or critical only at presentation. Patients with residual symptoms during remission had more persistently critical partners.

Conclusions

The nature of the association between criticism and depression could not be unequivocally established, although it appeared likely that continuing criticism was a result of continuing depression. Relatives' understanding of the illness may mediate between levels of criticism and the course of depression.
Social indicators and the prediction of psychiatric admission in different diagnostic groups
Authors: Boardman Anthony P. , Hodgson Richard E. , Lewis Martyn , Allen Keith
Published: October 2008

Background

Recent findings indicate that the established association between social indicators of deprivation and psychiatric admission rates may not hold across all diagnoses.

Method

Admission rates in individuals aged 16–64 years for 71 electoral wards in North Staffordshire were calculated for six diagnostic groups using data from the Korner Episode System for 1987–1993. These were correlated with selected individual census variables, Townsend and Jarman indices. The ability of regression models to predict admission rates was tested.

Results

The strongest correlations were found for total admissions (r0.44–0.79). Strong correlations were found for neurotic disorders/depression (r0.29–0.62), schizophrenia (r0.24–0.59), all non-psychotic disorders combined (r0.41–0.71) and all psychotic disorders combined (r0.33–0.67). Predicted admission rates for total admissions, psychotic and non-psychotic admissions using regression models showed strong positive correlations with observed admission rates.

Conclusions

The strong correlations between social indicators of deprivation and total psychotic admission rates are consistent with the results of previous studies. The strong associations between social indicators and admissions for non-psychotic disorders is contrary to previous findings and may be partly explained by the relatively high admission rates for neurotic disorders.
Driver suicides
Authors: Ohberg Annakatri , Penttila Antti , Lonnqvist Jouko
Published: October 2008

Background

To study driver suicides, all motor vehicle driver fatalities in Finland from 1987 to 1991 were analysed.

Method

Cases were collected from all driver fatalities (n=1419), as those that accident investigation teams considered possible suicides (n=99). Drivers committing suicide classified according to ICD–9 by two forensic pathologists were selected as cases (n=84). Drivers of unintentional motor vehicle fatalities served as the control group.

Results

While 5.9% of all driver fatalities were classified as suicides, the figure given in the official statistics was 2.6%. Driver suicides accounted for 1.2% of all suicides. Fifty per cent of driver suicides were committed by men aged between 15 and 34 years. The victims had often suffered from life-event stress, mental disorders and had alcohol misuse problems. The cases were usually head-on collisions between two vehicles with a large weight disparity.

Conclusions

Misclassification of driver suicides does not significantly influence the total suicide rate. However, people who commit suicide by this method could often be recognised, and prevention of these events would improve traffic safety.
Weather conditions and fatal self-harm in North Cheshire 1989–1993
Authors: Salib Emad , Gray Nicola
Published: October 2008

Background

We aimed to study the effect of weather conditions on the rate of all deaths due to fatal self-harm (FSH) reported in a population of 350 000. In this study the term FSH refers to all coroners' verdicts which were recorded in a specified period and included suicide, misadventure and open verdict.

Method

Five-year data of FSH in North Cheshire was analysed in relation to meteorological data, which were measured at the nearest meteorological office to the study population.

Results

Small but significant positive correlations were demonstrated between occurrence of FSH and hours of sunshine (P < 0.01) and diurnal variations in daily temperature (P < 0.05). These effects were independent of gender and psychiatric history.

Conclusions

Weather may influence the occurrence of FSH, probably interacting with biological and social variables. The rate of FSH death appears to be positively related to fine weather conditions, during early summer, and not to extreme weather conditions as previously reported.
Minor psychiatric disorder in NHS trust staff: Occupational and gender differences
Authors: Wall T.D. , Bolden R.I. , Borrill C.S. , Carter A.J. , Golya D.A. , Hardy G.E. , Haynes C.E. , Rick J.E. , Shapiro D.A. , West M.A.
Published: October 2008

Background

It is widely suggested that many National Health Service (NHS) workers experience high levels of minor psychiatric disorder. However, inadequacies of sampling and measurement in studies to date have not allowed this suggestion to be properly evaluated.

Method

The present study was designed to overcome these methodological weaknesses by using a sample of over 11 000 employees from 19 NHS trusts and a well-established measure of minor psychiatric disorder for which there are comparative data.

Results

The findings show that 26.8% of the health service workers reported significant levels of minor psychiatric disorder, compared with 17.8% of people in the general population. Psychiatric morbidity was highest among managers, doctors, nurses and professions allied to medicine, with each of these groups recording higher rates than their professional counterparts outside the health service. It was lower among those in support occupations, such as administrative and ancillary staff. A feature of the findings was that female doctors and managers showed a much higher prevalence of minor psychiatric disorder than their male colleagues.

Conclusion

Studies are required to establish the organisational, occupational and individual determinants of minor psychiatric disorder among NHS employees.
Brazilian multicentric study of psychiatric morbidity
Authors: Almeida-Filho Naomar , De Jesus Mari Jair , Coutinho Evandro , França Josimar Farias , Fernandes Jefferson , Andreoli Sérgio Baxter , Busnello Ellis D'Arrigo
Published: October 2008

Background

Psychiatric morbidity studies in developing countries have used diagnostic procedures of low reliability, without a clinical definition of caseness, producing descriptive data with limited application for mental health planning.

Method

A two-stage cross-sectional design (with a sample size of 6476) was conducted to estimate the prevalence of DSM–III psychiatric diagnoses in three metropolitan areas of Brazil (Brasília, São Paulo and Porto Alegre). All subjects were screened for the presence of psychopathology with a 44-item instrument (the QMPA) and a subsample was selected for a psychiatric interview.

Results

Age-adjusted prevalence of cases potentially in need of care ranged from 19% (São Paulo) to 34% (Brasília and Porto Alegre). Anxiety disorders comprised the highest prevalences (up to 18%). Alcoholism yielded the most consistent prevalence levels, around 8% in all sites. Depression showed great variation between areas: from less than 3% (São Paulo and Brasília) to 10% (Porto Alegre)

Conclusions

Overall prevalences were high in comparison with previous studies conducted in Brazil. A female excess of non-psychotic disorders (anxiety, phobias, somatisation and depression) and a male excess for alcoholism were consistently found.
Urban environment and mental health
Authors: Dalgard Odd Steffen , Tambs Kristian
Published: October 2008

Background

In a follow-up survey from Oslo, 503 persons were re-interviewed using the same questionnaire after 10 years.

Method

The questionnaire includes questions about social support, social characteristics of the neighbourhood and mental health. Information about the neighbourhood was also gathered from key informants.

Results

Of the five types of neighbourhoods surveyed, only one showed marked change over time with respect to social characteristics. This was an initially poorly functioning neighbourhood with poor mental health among the residents, where substantial improvement took place as part of the further development of the area. Parallel with the improvement in social environment there was a significant improvement in mental health among those who continued to live in the same area, as opposed to those who continued to live in the other areas. Selective migration could not explain this finding.

Conclusions

The findings support the environment stress hypothesis, implying that the quality of a neighbourhood has an impact on mental health. The implications for psychiatric prevention are discussed.
Postnatal depression and elation among mothers and their partners: Prevalence and predictors
Authors: Lane Abbie , Keville Rita , Morris Mary , Kinsella Anthony , Turner Michael , Barry Siobhan
Published: October 2008

Background

Correlates and predictors of mood disturbance at 3 days and 6 weeks postpartum were assessed in Irish mothers and their partners.

Method

The Edinburgh Postnatal Depression Scale (EPDS) and the Highs Scale were used to assess 370 mothers and their partners. Socio-demographic, clinical and obstetric data were collected at patients' first antenatal visit. Factors associated with EPDS scores of ≥ 13 and Highs scores of ≥ 8 were examined.

Results

On the EPDS 11.4% of mothers scored ≥ 13 at 3 days postpartum and 11% at 6 weeks, while 18.3% of mothers scored ≥ 8 on the Highs Scale at 3 days and 9% at 6 weeks. Scores on the EPDS and Highs Scale were interrelated. Factors associated with EPDS scores of ≥ 13 at 6 weeks were single status, unemployment, unplanned pregnancy, public status and bottle-feeding. The best predictors of EPDS ≥ 13 at 6 weeks were mothers' scores on the EPDS and the Highs Scale at 3 days. Three per cent of partners scored ≥ 13 on the EPDS at 3 days postpartum and 1.2% at 6 weeks.

Conclusions

Factors associated with mothers' mood disturbance were readily identifiable and collected routinely at antenatal intake. Mothers' mood within 3 days of delivery was the best predictor of later postnatal depression. Paternal mood disturbance was rare. Certain women may be at increased risk for postnatal mood disturbance and may be amenable to early identification and intervention.
One-year, low-dose neuroleptic study of in-patients with chronic schizophrenia characterised by persistent negative symptoms
Authors: Speller Jeremy C. , Barnes Thomas R. E. , Curson David A. , Pantelis Christos , Alberts J. L.
Published: October 2008

Background

Amisulpride is a potent substituted benzamide antipsychotic drug claimed to improve the negative symptoms of schizophrenia, particularly at low dosage.

Method

Sixty long-term in-patients with schizophrenia and selected for predominant negative symptoms were randomised to receive either haloperidol or amisulpride. Over a year there was systematic dose reduction, as symptoms allowed.

Results

There were no significant differences between the treatment groups in the proportion receiving low-dose treatment, the control of positive symptoms, or ratings of social behaviour, side-effects or tardive dyskinesia. For negative symptoms, there were consistent but non-significant trends in favour of amisulpride. The amisulpride patients required significantly less anticholinergic medication.

Conclusions

In chronically-hospitalised in-patients with schizophrenia characterised by persistent negative symptoms, amisulpride was a well-tolerated maintenance antipsychotic medication. The drug had only a limited effect in reducing negative symptoms, which were relatively stable, enduring phenomena in this sample, despite dosage reduction.
Health of the Nation Outcome Scales (HoNOS)
Authors: Wing J. K. , Beevor A. S. , Curtis R. H. , Park S. G. B. , Hadden J. , Burns A.
Published: October 2008

Background

An instrument was required to quantify and thus potentially measure progress towards a Health of the Nation target, set by the Department of Health, “to improve significantly the health and social functioning of mentally ill people”

Method

A first draft was created in consultation with experts and on the basis of literature review. This version was improved during four stages of testing: two preliminary stages, a large field trial involving 2706 patients (rated by 492 clinicians) and tests of the final Health of the Nation Outcome Scales (HoNOS), which included an independent study (n=197) of reliability and relationship to other instruments.

Results

The resulting 12-item instrument is simple to use, covers clinical problems and social functioning with reasonable adequacy, has been generally acceptable to clinicians who have used it, is sensitive to change or the lack of it, showed good reliability in independent trials and compared reasonably well with equivalent items in the Brief Psychiatric Rating Scales and Role Functioning Scales.

Conclusions

The key test for HoNOS is that clinicians should want to use it for their own purposes. In general, it has passed that test. A further possibility, that HoNOS data collected routinely as part of a minimum data set, for example for the Care Programme Approach, could also be useful in anonymised and aggregated form for public health purposes, is therefore testable but has not yet been tested.
Lifetime risk of suicide for affective disorder, alcoholism and schizophrenia
Authors: Inskip Hazel , Harris Clare , Barraclough Brian
Published: October 2008

Background

The lifetime risks of suicide are generally quoted as 15% for affective disorder and alcoholism and 10% for schizophrenia, based on data from 1921–1975 and on calculations performed before computerised modelling techniques became available. This study recalculates the risk using contemporary data and modern techniques.

Method

Twenty-seven mortality studies provided data for affective disorder, 27 for alcohol dependence and 29 for schizophrenia. The proportion of the cohort who had died was plotted against the proportion of deaths from suicide. Modelling techniques fitted curves through the data points extrapolating them to cohort extinction, thus estimating the lifetime risk of suicide for each disorder.

Results

The lifetime risk was estimated at 6% for affective disorder, 7% for alcohol dependence and 4% for schizophrenia.

Conclusions

The lifetime suicide risk figures often quoted in the literature appear to be too high.
Prospective study into factors associated with aggressive incidents in psychiatric acute admission wards
Authors: Kho King , Sensky Tom , Mortimer Ann , Corcos Christopher
Published: October 2008

Background

Factors associated with aggression among psychiatric in-patients are still poorly understood. Inconsistent published findings are partly attributable to methodological problems. Much previous research has been undertaken in specialist settings, where conditions are likely to differ from those in acute admission wards.

Method

Levels of aggression were ascertained weekly by staff report, using a reliable measure, for every patient on five acute admission wards and one locked intensive care ward at two hospitals prospectively over a five-month period.

Results

Levels of aggression varied considerably among the admission wards. Aggression was more common on the locked ward and among younger patients. Factors associated with aggression changed with time since admission (seldom examined in previous studies). Complex associations were found with gender, ethnic group and diagnosis.

Conclusions

Some of the findings might be explicable by differences in ward environment, and staff–patient interactions. Further investigation into these is warranted.
Cost and benefit in the choice of ECT schedule
Authors: Shapira Baruch , Tubi Nurith , Drexler Heinz , Lidsky David , Calev Avraham , Lerer Bernard
Published: October 2008

Background

We compared the anti-depressant and cognitive effects of up to eight sessions of bilateral, brief pulse electroconvulsive therapy (ECT) administered twice (ECT x 2) or three times weekly (ECT x 3), to confirm that ECT x 3 acts more rapidly although the two schedules are equivalent in antidepressant outcome, and to establish whether ECT x 3 is indeed associated with more severe memory impairment.

Method

Patients with major depression, endogenous subtype were randomly assigned to ECT x 3 or ECT x 2 plus one simulated ECT per week, both up to a maximum of eight real ECT. Depression was evaluated by the Hamilton Depression Scale the day after each treatment and cognitive function by a test battery administered before and after the ECT series and at one month follow-up.

Results

Assessed categorically or parametrically, there was no significant difference in antidepressant outcome between the two schedules. Rate of response was significantly more rapid with ECT x 3 but was associated with more severe memory impairment.

Conclusions

Twice weekly administration is an optimum schedule for bilateral ECT unless clinical indications require the more rapid antidepressant effect of three times weekly treatment.
Outcome of common mental disorders in Harare, Zimbabwe
Authors: Patel Vikram , Todd Charles , Winston Mark , Simunyu Essie , Gwanzura Fungisai , Acuda Wilson , Mann Anthony
Published: October 2008

Background

Little is known about the outcome of common mental disorders (CMD) in primary care attenders in low income countries.

Method

Two and 12 month (T1 and T2) follow-up of a cohort of cases of CMD (n=199) recruited from primary health, traditional medical practitioner, and general practitioner clinics in Harare, Zimbabwe. The Shona Symptom Questionnaire (SSQ) was the measure of caseness.

Results

The persistence of case level morbidity was recorded in 41% of subjects at 12 months. Of the 134 subjects interviewed at both follow-up points, 49% had recovered by T1 and remained well at T2 while 28% were persistent cases at both T1 and T2. Higher SSQ scores, a psychological illness model, bereavement and disability predicted a poor outcome at both times. Poorer outcome at T1 only was associated with a causal model of witch-craft and an unhappy childhood. Caseness at follow-up was associated with disability and economic deprivation.

Conclusions

A quarter of cases of CMD were likely to be ill throughout the 12 month follow-up period. Targeting risk groups for poor outcome for interventions and policy interventions to reduce the impact of economic deprivation may provide a way of tackling CMD in primary care in low income countries.
Effects of postnatal depression on children's adjustment to school
Authors: Sinclair Dana , Murray Lynne
Published: October 2008

Background

Little is known of the behavioural adjustment of children of postnatally depressed mothers. Previous studies have relied on maternal reports, and have produced inconsistent findings.

Method

In a prospective, longitudinal study of the five-year-old children of a community sample of postnatally depressed and well women, evidence was collected concerning the children's adjustment in the context of school, teachers being asked to complete questionnaires after the children had finished their first term.

Results

Family social class and the child's gender had the most pervasive influences on adjustment. However, both postnatal and recent maternal depression were associated with significantly raised levels of child disturbance, particularly among boys and those from lower social class families.

Conclusions

The findings indicate a persistent effect of postnatal depression on child adjustment. They highlight the need for resources devoted to supporting mothers of young children and particularly routine screening and treatment for postnatal mood disorder.
Psychological sequelae of torture and organised violence suffered by refugees from Iraq
Authors: Gorst-Unsworth Caroline , Goldenberg Eva
Published: October 2008

Background

Refugees who have suffered traumatic events present complex therapeutic challenges to health professionals. There is little research into post-exile factors that may be amenable to change, and therefore reduce morbidity. We examined the importance of social factors in exile and of trauma factors in producing the different elements of psychological sequelae of severe trauma.

Method

Eighty-four male Iraqi refugees were interviewed. Adverse events and level of social support were measured. Various measures of psychological morbidity were applied, all of which have been used in previous trauma research.

Results

Social factors in exile, particularly the level of ‘affective’ social support, proved important in determining the severity of both post-traumatic stress disorder and depressive reactions, particularly when combined with a severe level of trauma/torture. Poor social support is a stronger predictor of depressive morbidity than trauma factors.

Conclusions

Some of the most important factors in producing psychological morbidity in refugees may be alleviated by planned, integrated rehabilitation programmes and attention to social support and family reunion.
Brain abnormality in schizophrenia
Authors: Lawrie Stephen M. , Abukmeil Suheib S.
Published: October 2008

Background

Numerousin vivobrain imaging studies suggest that cerebral Structure is abnormal in schizophrenia, but implicate different regions to varying extents.

Method

We identified published MRI studies in schizophrenia with searches of the computerised literature and key Journals. Reports giving the volumes of cortical structures in people with schizophrenia and controls were included. The percentage differences in volumes were calculated and the median taken as a summary measure for each brain region.

Results

Forty relevant studies were identified. The median percentage volume differences revealed overall reductions in the whole brain (3%), temporal lobe (6% left. 9.5% right), and the amygdala/hippocampal complex (6.5%, 5.5%); and increases in the lateral ventricles (44%, 36%), that were greatest in the body and occipital horns. Segmentation studies suggest that grey matter is reduced but that white matter volumes may actually be increased. In men, substantial reductions were also evident in the amygdala and hippocampus, as well as the largest reductions of all in the parahippocampus (14%, 9%). Few studies gave figures for women alone.

Conclusions

Several brain structures in schizophrenia are affected to a greater extent than expected from overall reductions in brain volume. Further studies are required in affected women, and to try to identify clinical and aetiological associations of these findings.
Linguistic performance in children who develop schizophrenia in adult life
Authors: Done D. John , Leinonen Eeva , Crow Timothy J. , Sacker Amanda
Published: October 2008

Background

Less syntactically complex speech in patients with schizophrenia has been thought to represent a premorbid dysfunction, of possible prognostic value and indicative of a neurodevelopmental origin for schizophrenia.

Method

Narratives written at age 11 by children who then developed psychiatric disorders in adult life (using PSE CATEGO diagnoses), especially schizophrenia, were compared with matched controls on syntactic complexity syntactic maturity, grammatical deviance and spelling ability.

Results

Children who later developed either schizophrenia, affective psychosis or a neurotic type of disorder in adulthood did not differ from normal controls on any of the measures of syntactic production, grammatical errors or spelling.

Conclusions

it is probable that previous reports of reduced syntactic complexity in schizophrenic speech are a consequence of being in a psychotic state and do not represent a premorbid deficit.
Disability pensions in severely disturbed in-patient adolescents
Authors: Pelkonen M. , Marttunen M. , Pulkkinen E. , Laippala P. , Lönnqvist J. , Aro H.
Published: October 2008

Background

Knowledge of working capacity from adolescence until adulthood among severely disturbed in-patients is scarce.

Method

In a follow-up study of 61 adolescent in-patients, we studied associations between being on a disability pension 20 years after hospitalisation, and the patients' psychopathology and treatment-related factors during the hospitalisation and seven-year follow-up.

Results

Of the former in-patients. 27% had not been on a disability pension, 20% had short-term pension periods, and 53% were pensioned. Subjects whose overall psychosocial functioning had improved and who had not utilised in-patient services until the seven-year follow-up, had a better prognosis in terms of working capacity Half of the subjects who had not been on pension during the follow-up had received a diagnosis of conduct disorder at discharge, and half of those pensioned had a psychotic disorder.

Conclusions

The patients' level of psychosocial functioning and capability to work in young adulthood were associated with long-term prognosis in terms of working capacity Adolescence seems to be the critical time for intensive psychiatric care combined with vocational rehabilitation programmes.
Chromosome 22qll deletions
Authors: Murphy K. C. , Jones R. G. , Griffiths E. , Thompson P. W. , Owen M. J.
Published: October 2008

Background

Velo-cardio-facial syndrome (VCFS), a syndrome of multiple congenital abnormalities including characteristic dysmorphology, congenital heart defects and learning disability is associated with small interstitial deletions of chromosome 22qll. We tested the hypothesis that VCFS may be significantly under-diagnosed by screening a learning-disabled population for chromosome 22qll deletions.

Method

Two hundred and sixty-five people with learning disability residing in two learning disability hospitals in South Wales were reviewed. They were selected for inclusion in the study if they fulfilled any of the following criteria: psychotic disorder (schizophrenia or affective disorder), family history of psychotic disorder, cleft palate and/or lip, congenital heart disease, broadly defined facial dysmorphism or a history of hypocalcaemia. Fluorescencein situhybridisation studies were performed on 74 selected individuals.

Results

Cytogenetic analysis revealed that two people demonstrated a previously undetected chromosome 22qll deletion. A third person demonstrated a previously undetected cytogenetically visible deletion on chromosome 15.

Conclusions

VCFS appears to be aetiologically significant in a proportion of individuals with idiopathic learning disability especially in those where psychosis is associated with mild learning disability. We suggest that clinicians should consider a chromosome 22qll deletion in people who meet selection criteria.
Polydactyly and psychosis
Authors: Cardno Alastair G. , Murphy Kieran C. , Jones Lisa A. , Gray Jonathon , McGuffin Peter , Owen Michael J. , Cobb Andrew M.
Published: October 2008

Background

Abnormalities presumed to occur during foetal life have been associated with schizophrenia. Polydactyly is a developmental abnormality but no previous association has been reported between Polydactyly and functional psychotic illness.

Method

Individuals with both Polydactyly and a functional psychosis were ascertained during a study of familial schizophrenia.

Results

Five such individuals were ascertained in the course of assessing 234 individuals with familial psychosis, giving a rate of Polydactyly in the sample of around 10 times the general population rate.

Conclusions

This study provides preliminary evidence that Polydactyly is over-represented in individuals with familial schizophrenia and related psychotic illnesses.
Substance misuse and risk of aggression and offending among the severely mentally ill
Authors: Scott Helen , Johnson Sonia , Menezes Paulo , Bindman Jonathan , Thornicroft Graham , Marshall Jane , Bebbington Paul , Kuipers Elizabeth
Published: October 2008

Background

The aim of this study was to investigate whether ‘dual diagnosis' (substance misuse and severe mental illness) is associated with aggression and offending.

Method

Twenty-seven people meeting the criteria for both psychotic illness and a substance use disorder and 65 people with psychosis only were interviewed. Case notes were also examined and key workers asked to rate substance misuse and aggression.

Results

The severity of aggression and offending among this community treatment sample was low. Individuals with a dual diagnosis were significantly more likely than those with psychosis only to report any history of committing an offence (P=0.001), or recent hostile behaviour (P=0.001). Keyworkers were more likely to report recent aggression among the dually diagnosed (P=0.01). Significant differences persisted when we used logistic regression to control for potentially confounding demographic and clinical variables.

Conclusions

Dual diagnosis may be an important factor in aggression and offending among severely mentally ill individuals in inner-city areas. Accurate risk assessment requires examination of substance use.
Neuroendocrine, appetitive and behavioural responses to d-fenfluramine in women recovered from anorexia nervosa
Authors: Ward Anne , Brown Nigel , Lightman Stafford , Campbell Iain C. , Treasure Janet
Published: October 2008

Background

Increased central serotonin (5-HT) function has been hypothesised to be a vulnerability trait in anorexia nervosa.

Methods

Eighteen women with a history of DSM–III–R anorexia nervosa and 18 female controls were examined. The subjects had recovered weight and menstrual function. A placebo-controlled d-fenfluramine test was used. Subjects ingested d-fenfluramine or placebo and after three hours were offered a ‘free’ meal. The amounts eaten were recorded and plasma Cortisol and prolactin levels were measured. Questionnaires related to eating attitudes and behaviour, to personality, and to mood were administered.

Results

Unlike the control subjects, those recovered from anorexia nervosa did not show the expected appetite-suppressing responses to d-fenfluramine; their eating attitudes and behaviour were more restrained, ‘negative’ perfectionism was more pronounced, and post-meal plasma Cortisol levels did not rise as expected.

Conclusions

Our results do not suggest that increased central 5-HT function is a trait marker in anorexia nervosa, but dysregulation in part of the central 5-HT system may be a vulnerability factor. The flattened post-meal response to Cortisol in the subjects who had recovered from anorexia nervosa suggests that their hypothalamic–pituitary–adrenal axis may be altered and deserves further investigation.
Self-injurious behaviour as part of genetic syndromes
Authors: Deb Shoumitro
Published: October 2008

Background

The purpose of this paper is to review the association between genetic syndromes and self-injurious behaviour.

Method

The information available from the literature on the subject of self-injurious behaviours and genetic syndromes was collated and presented with a critical appraisal.

Results

Self-injurious behaviours are associated with some genetic syndromes. However, the causal relationship between the genetic syndromes and the self-injurious behaviour remains far from clear.

Conclusions

Although self-injurious behaviour has been shown to be the part of a broader phenotype in many genetic disorders, the specificity and sensitivity of these behaviours in this context remain unclear.