bluuebunny/crossref_metadata_2025 huggingface dataset:
Stressful Life Events and Graves' Disease
Authors: Harris Tirril , Creed Francis , Brugha Traolach S.
Published: October 2008

“The role of stressful life events in the onset of Graves' disease (toxic diffuse goitre) is controversial. However, the numerous early clinical reports that supported such an association were not adequately controlled and specificity of the diagnosis could be questioned. Later studies have not shown a causal relation, but these studies were small, did not have proper controls, or epidemiological methods were inappropriate. To assess possible associations between life events, heredity, social support, and Graves' disease, we have done a population-based case-control study in a defined area with about 1 million inhabitants. Over 2 years, 208 (95%) of 219 eligible patients with newly-diagnosed Graves' disease and 372 (80%) of all selected matched controls answered an identical mailed questionnaire about marital status, occupation, drinking and smoking habits, physical activity, familial occurrence of thyroid disease, life events, social support, and personality. Compared with controls, patients claimed to have had more negative life events in the 12 months preceding the diagnosis, and negative life-event scores were also significantly higher (odds ratio 6.3, 95% confidence interval 2 · 7–14 · 7, for the category with the highest negative score). Individuals who had relatives with thyroid disease (especially first-degree and second-degree relatives) were more likely to have Graves' disease (3 · 6, 2 · 2–5 · 9). Slightly more patients than controls were divorced (1 · 8, 1 · 0–3 · 3) and reported a less frequent intake of alcohol (0 · 4, 0 · 2–0 · 8). When results were adjusted for possible confounding factors in multivariate analyses, risk estimates were almost unchanged. These findings indicate that negative life events and hereditary factors may be risk factors for Graves' disease.”
Mental Health Services in Transition: the United States and the United Kingdom
Authors: Raftery James
Published: October 2008

Mental health services are of interest not only because of the large burden they impose, but also because they have been subject to more change than virtually any other type of health service over the past four decades. Although both the US and UK have taken to ‘deinstitutionalisation’ with enthusiasm, the US has so far proceeded somewhat further down that road than the UK. While both countries face similar problems, the NHS and Community Care Act 1990 may now lead to considerable further changes in the UK.
Sociology in the Context of Social Psychiatry
Authors: Cooper Brian
Published: October 2008

As part of its concern with the environmental causes of disease, medical research tries to comprehend the nature of social processes and their implications for human health: an endeavour calling for sociological concepts and methods (Susseret al, 1985). Medical needs are mirrored within sociology, which has never been confined to study of the workings of society, but has always concerned itself also with their impact on individuals and on public health. The importance of cooperation between the two disciplines is thus indisputable. Nevertheless, interprofessional relationships have never been easy, and Pflanz's dictum, that “the history of the relationship between sociology and medicine is … mainly a history of unsuccessful encounters” (Pflanz, 1976), remains substantially true today. The difficulties have been ascribed to interdisciplinary tensions of the kind that arise when a relatively young academic profession seeks to assert its autonomy in a relationship with an older-established and more powerful one. Martin (1976), stressing the dangers that can result from mutually false expectations, invoked the analogy of a marriage in which:
The Assessment of Insight in Psychosis
Authors: David Anthony , Buchanan Alec , Reed Alison , Almeida Osvaldo
Published: October 2008

An assessment schedule was used to determine the nature of insight in 91 mixed psychotic patients, and to examine its distribution and associations. While all the components of the schedule intercorrelated significantly, scores for compliance were only weakly related to those for ability to label psychotic phenomena as abnormal. Compliance and illness recognition were related to IQ. Total insight score was inversely correlated, moderately, with a global measure of psychopathology derived from the PSE, and was less in patients involuntarily committed. Age, sex, diagnosis, and the number of previous hospital admissions had little effect. The results support the notion that insight is not a unitary concept.
Can We Predict the Persistence of Depression?
Authors: Scott Jan , Eccleston Donald , Boys Richard
Published: October 2008

Fifty-five patients with primary major depression were followed up prospectively from time of onset of the index illness episode until recovery. The course of depression in hospital-treated patients was protracted, with a median length of episode of one year. Two factors significantly predicted persistence of symptoms: interval between onset and receipt of treatment, and premorbid neuroticism, which accounted for 55% of the variance in length of episode.
Homogamy: the Relationships and Sexual Partners of Normal-Weight Bulimic Women
Authors: Lacey J. Hubert
Published: October 2008

This study reports the demography, weight, and alcohol and psychiatric histories of the sexual partners of 112 consecutive patients with bulimia nervosa, all from an urban catchment area. Seventy-three patients (65%) had a current sexual partner. The partners were of similar social background, but slightly older. On average, partners were overweight (110% of MMPW) and over 27% reported having an eating or weight problem. A quarter of the partners had been treated for a psychiatric or emotional disorder. Nearly 40% drank more than 36 units of alcohol a week, and 14% had received treatment or consulted a doctor for alcohol-related problems. Heavy-drinking partners and multi-impulsive bulimics sought out each other. A quarter of partners had themselves been raised in a nuclear family in which a member had received psychiatric treatment; 12% had had a mother or sister with an eating disorder. Thirty-seven per cent of patients used a ‘safe man’, their fear of being hurt stemming from low self-esteem and a general sense of ‘failure’, and for 11% the relationship was abusive.
Multiple Self-damaging Behaviour among Alcoholic Women
Authors: Evans Chris , Lacey J. Hubert
Published: October 2008

Among patients being treated for specific behaviour-control problems, there exists an important subgroup of ‘multi-impulsive’ patients whose treatment might be facilitated if the full range of their problems were recognised and dealt with as one general issue of impulse control. In women in particular, loss of control of eating may be prevalent and easily concealed from staff, and may thwart treatment. This survey of 50 women attending an alcoholic-treatment unit explored the prevalence of behavioural-control problems other than those of alcohol. Three-quarters of the women also had other behavioural problems. Over half the sample had thought of taking an overdose and just under half had actually taken one; about a quarter had cut themselves deliberately; half described impulsive physical violence; half acknowledged a period of ‘promiscuity’; and at least 16% had had a clinically diagnosable eating disorder. More research is needed but we believe that all self-damaging behaviour should be addressed simultaneously to prevent ‘revolving door’ relapses as emotional distress is transferred from one behaviour to another.
Hyperkinetic Syndrome and Disruptive Early Experiences
Authors: Haddad P. M. , Garralda M. E.
Published: October 2008

Five children aged 8–10 years presenting to child psychiatric clinics with hyperkinetic syndrome and severe disruptive early experiences are described. At referral all had been living in stable families for a minimum of four years. Biological risk factors were absent. It is proposed that the disruption of early attachments resulted in ill-regulated search and exploratory behaviour and that this had a continuing effect on the children's ability to focus and control attention skills and motor behaviour.
Verbally Mediated Childhood Post-traumatic Stress Disorder
Authors: Saigh Philip A.
Published: October 2008

This report chronicles the verbally mediated traumatisation and subsequent PTSD in an 11-year-old girl. Information obtained from parental interviews, academic transcripts, anecdotal teacher comments, structured and unstructured interviews, and standardised anxiety, depression, and misconduct scales was used to highlight the unique distress of the patient.
The Clinical Efficacy of Maintenance Electroconvulsive Therapy in a Patient with a Mild Mental Handicap
Authors: Puri B. K. , Langa A. , Coleman R. M. , Singh I.
Published: October 2008

A 32-year-old chronically relapsing depressed male patient with a mild mental handicap had tried different forms of pharmacotherapy which were either not tolerated or failed to prevent recurrences of episodes of psychotic depression. The use of maintenance ECT as the mainstay of the therapeutic regime led to a marked consistent clinical improvement.
A Selective Review of Child Psychiatric Syndromes with a Somatic Presentation
Authors: Garralda M. E.
Published: October 2008

This review focuses on ‘aches and pains' and conversion syndromes as a basis for the description of psychological factors and mechanisms of relevance for the somatisation of distress in childhood and which may contribute to medical help-seeking for children. The characteristic pattern of associated psychological factors includes child personality features; academic concerns; family health problems; and styles of family interaction. Further research is required to explore in more depth the nature of these factors, the mechanisms that mediate the development of severe handicapping problems, and effective interventions.
Cardiac Vagal Tone in Generalised Anxiety Disorder
Authors: Kollai Mark , Kollai Balazs
Published: October 2008

The aim of the present study was twofold: firstly, to determine cardiac vagal tone in subjects with generalised anxiety disorder directly, using an invasive pharmacological method; and secondly, to test whether the non-invasive method of measuring the amplitude of respiratory sinus arrhythmia (RSA) gives a reliable estimate of cardiac vagal tone in this form of anxiety disorder. Comparison of baseline physiological measures of anxious and control subjects revealed that cardiac vagal tone and heart rate were not different in the two groups of subjects, whereas length of the respiratory cycle and amplitude of respiratory sinus arrhythmia were reduced in the former group. Because of the higher respiratory rates of anxious subjects, the RSA method was found to underestimate cardiac vagal tone in generalised anxiety disorder.
Can Autism be Detected at 18 Months?
Authors: Baron-Cohen Simon , Allen Jane , Gillberg Christopher
Published: October 2008

Autism is currently detected only at about three years of age. This study aimed to establish if detection of autism was possible at 18 months of age. We screened 41 18–month-old toddlers who were at high genetic risk for developing autism, and 50 randomly selected 18–month-olds, using a new instrument, the CHAT, administered by GPs or health visitors. More than 80% of the randomly selected 18–month-old toddlers passed on all items, and none failed on more than one of pretend play, protodeclarative pointing, joint-attention, social interest, and social play. Four children in the high-risk group failed on two or more of these five key types of behaviour. At follow-up at 30 months of age, the 87 children who had passed four or more of these key types of behaviour at 18 months of age had continued to develop normally. The four toddlers who had failed on two or more of these key types of behaviour at 18 months received a diagnosis of autism by 30 months.
The Psychopathology of Gilles de la Tourette's Syndrome
Authors: Robertson Mary M. , Channon Shelley , Baker Jane , Flynn Deborah
Published: October 2008

The present study compares adults with Gilles de la Tourette's syndrome (GTS) with depressed adults and normal controls on questionnaires measuring obsessionality, depression, and anxiety. The GTS and depressed groups scored significantly higher than the normal controls on all measures. The GTS subjects had similar scores on measures of obsessionality to those of the depressed subjects, but significantly lower scores on measures of depression and anxiety. This suggests that obsessionality is a prominent feature of GTS, and that the psychopathological profile is different to that of patients with major depressive disorder.
Premorbid Social Underachievement in Schizophrenia
Authors: Jones P. B. , Bebbington P. , Foerster A. , Lewis S. W. , Murray R. M. , Russell A. , Sham P. C. , Toone B. K. , Wilkins S.
Published: October 2008

In an investigation of the timing and precursors of social decline in schizophrenia and affective psychosis, 195 subjects from the Camberwell Collaborative Psychosis Study were currently of lower social class than were their fathers. A comparison between father's occupation and proband's best premorbid occupational level indicated underachievement confined to DSM–III schizophrenia, there being no such effect in affective psychosis. Decline in social status following onset of psychosis, analysed by comparing best premorbid occupation with current occupation, was marked in both schizophrenia and affective psychosis, indicating a non-specific effect. Schizophrenic patients who failed to achieve their fathers' social status had poorer educational qualifications than those who equalled or bettered their paternal social class, despite similar premorbid IQ (NART) scores and age at onset of psychosis. These results indicate that schizophrenia may be manifest before the onset of psychosis, and lend weight to the notion of a developmental origin to this disorder.
Life Events and Psychosis
Authors: Bebbington Paul , Wilkins Soraya , Jones Peter , Foerster Alice , Murray Robin , Toone Brian , Lewis Shôn
Published: October 2008

Data from the Camberwell Collaborative Psychosis Study were used to examine the proposition that there is an excess of life events preceding the onset of psychoses of all types. Of 97 patients from the study who had episodes within the past year that were datable, 51 had developed psychotic symptoms from an essentially symptom-free state, 29 had been suffering only from neurotic symptoms, and 17 had experienced a marked exacerbation of psychotic symptoms. DSM–III diagnoses were collapsed into three major groups: 51 cases of schizophrenia; 31 cases of mania; and 14 cases of depressive psychosis. Life-event histories were taken for the six months before onset, and when these were compared with equivalent histories from a psychiatrically healthy sample from the local general population, there was a significant excess of life events, particularly in the three months before onset of psychosis. This was apparent in all groups, and remained even when events were restricted to the independent category. The excess of events began rather earlier than has been found in previous studies. In our view, this study provides some of the strongest evidence for a link between life events and the emergence of psychotic symptoms.
The Community's Tolerance of the Mentally Ill
Authors: Brockington Ian F. , Hall Peter , Levings Jenny , Murphy Christopher
Published: October 2008

A survey of attitudes to mental illness was conducted in a quota sample of about 2000 subjects in Malvern and Bromsgrove. Factor analysis showed three main components – benevolence, authoritarianism, and fear of the mentally ill. Residents of Bromsgrove, which is served by a traditional mental hospital, were slightly more tolerant than those living in Malvern, which has a community-based service, and has seen the closure of two mental hospitals in its vicinity during the last 10 years. The main demographic determinants of tolerance are age, education, occupation, and acquaintance with the mentally ill.
Stressful Life Events and Schizophrenia II: Conceptual and Methodological Issues
Authors: Norman Ross M. G. , Malla Ashok K.
Published: October 2008

Research on the relationship between stress and schizophrenia is fraught with conceptual and methodological problems. These problems include issues related to the nature and measurement of stress, the likelihood of reciprocal influences between stress and symptoms, and the adequate assessment of symptoms. Several recommendations are made regarding future research in this area. These include using multiple and broadly based measures of different types of stressors and symptoms, greater use of truly prospective research designs, and the evaluation of the effects of interventions specifically designed to reduce stress in patients who suffer from schizophrenia.
Home-Based Care and Standard Hospital Care for Patients with Severe Mental Illness: A Randomised Controlled Trial
Authors: Simpson C. J. , Seager C. P. , Robertson J. A.
Published: October 2008

Objective

To compare the efficacy of home based care with standard hospital care in treating serious mental illness.

Design

Randomised controlled trial.

Setting

South Southwark, London.

Patients

189 patients aged 18–64 living in catchment area. 92 were randomised to home based care (daily living programme) and 97 to standard hospital care. At three months' follow up 68 home care and 60 hospital patients were evaluated.

Main outcome measures

Use of hospital beds, psychiatric diagnosis, social functioning, patients' and relatives' satisfaction, and activity of daily living programme staff.

Results

Home care reduced hospital stay by 80% (median stay 6 days in home care group, 53 days in hospital group) and did not increase the number of admissions compared with hospital care. On clinical and social outcome there was a non–significant trend in favour of home care, but both groups showed big improvements. On the global adjustment scale home care patients improved by 26.8 points and the hospital group by 21.6 points (difference 5.2; 95% confidence interval -1.5 to 12). Other rating scales showed similar trends. Home care patients required a wide range of support in areas such as housing, finance, and work. Only three patients dropped out from the programme.

Conclusions

Home based care may offer some slight advantages over hospital based care for patients with serious mental illness and their relatives. The care is intensive, but the low drop out rate suggests appreciation. Changes to traditional training for mental health workers are required.
Sporadic Pick's Disease in a 28-Year-Old Woman
Authors: Mowadat H. Rana , Kerr E. E. , Stclair D.
Published: October 2008

Pick's disease was diagnosed in a 28-year-old woman without a family history of dementia (or other psychiatric disorder), after an initial diagnosis of functional psychosis and management with ECT and neuroleptics. The case illustrates the need for detailed neurological and cognitive testing and consideration of neurodegenerative disorders even in young patients.
Unilateral Auditory Hallucinations
Authors: Almeida Osvaldo P. , Förstl Hans , Howard Robert , David Anthony S.
Published: October 2008

We report a patient with unilateral right auditory hallucinations in association with prominent right-sided hearing impairment and poor performance in neuropsychological tests sensitive to frontal-lobe damage.
Long-Term Outcome in Personality Disorders
Authors: Stone Michael H.
Published: October 2008

Personality disorders meeting DSM or ICD criteria represent the severe end of the broad spectrum of personality configurations involving maladaptive traits. The literature regarding long-term outcome of personality disorders is sparse. Most attention is devoted to formerly institutionalised patients with borderline, antisocial, or schizotypal disorders. Borderline patients at 10–25-year follow-up have a wide range of outcomes, from clinical recovery (50–60%) to suicide (3–9%). Certain factors (e.g. artistic talent) conduce to higher recovery rates, others (e.g. parental cruelty) to lower rates. Schizoid and schizotypal patients tend to remain isolated, and to lead marginal lives. The long-term outcome in antisocial persons is bleak if psychopathic traits are prominent. Personality traits and their corresponding disorders are egosyntonic, harden into habit, and are both slow to change and hard to modify. There is no one treatment of choice. Psychoanalysis and related methods work best within the anxious/inhibited group; cognitive/behavioural techniques are well suited to the disorders requiring limit setting and the amelioration of maladaptive habits.
Homelessness and Mental Illness
Authors: Scott Jan
Published: October 2008

In Great Britain 1–2 million people may be homeless. Most homeless people are men, but about 10–25% are women, of whom about half are accompanied by children. Significant mental illness is present in 30–50% of the homeless: functional psychoses predominate; acute distress and personality dysfunction are also prevalent. Co-morbidity of mental illness and substance abuse occurs in 20%, and physical morbidity rates exceed those of domiciled populations. The homeless mentally ill also have many social needs. Pathways to homelessness are complex; deinstitutionalisation may be only one possible cause of the increase in the number of homeless people. There is much recent research estimating the extent of mental illness and the characteristics of selected subgroups of accessible homeless people. The evaluation of potential service solutions has received less attention. This review outlines the research, highlights current views on the definition and classification of homeless populations, and offers some guidelines on avenues which need to be explored.
Diversion from Custody. II: Effect on Hospital and Prison Resources
Authors: Joseph Philip L. A. , Potter Mark
Published: October 2008

Two hundred and one referrals to a psychiatric assessment scheme based at two inner-London magistrates' courts were followed up to assess the effect of the scheme on hospital and prison resources. Of the 65 hospital admissions, 50 (77%) derived some or marked benefit from psychiatric treatment. Those who did badly were more likely to be of no fixed abode, and had higher rates of criminality and previous compulsory admission to hospital. Absconding was the largest management problem; 30 (46%) of those admitted did so. Twelve months after admission, all patients except one had been discharged; 10 (15%) had been readmitted to hospital. The scheme generated an extra 21 (64%) hospital admissions per annum from the two courts, compared with the three years before its introduction. The saving in remand time to the prison was approximately double the increased admission time to hospital. However, the overall effect of early diversion on hospital and prison resources was small.
Parental Ideas of Normal and Deviant Child Behaviour
Authors: Hackett Latha , Hackett Richard
Published: October 2008

The parents of Gujarati and English children were interviewed and their attitudes to a wide range of child behaviour elicited. Differences in their ideas of normal and deviant behaviour were found in areas such as conduct and bedwetting, but not in self-care.
Stress Incubation and the Onset of Affective Disorders
Authors: Bebbington Paul , Der Geoff , Maccarthy Brigid , Wykes Til , Brugha Terry , Sturt Pip , Potter Jenny
Published: October 2008

Incubation is the process by which life events influence the onset of psychiatric disorder after an appreciable delay. It has long been recognised clinically. In this paper we use data from the Camberwell Collaborative Depression Study to see whether incubation effects can be demonstrated in depressive illness. We used a novel adaptation of survival analysis for this purpose. The results suggest that incubation does occur in depressive disorder, that it is much less important than the effect of life events close to onset, that it is apparent in women but not in men, and that it is no more evident preceding endogenous than neurotic symptom patterns.
Clinicopathological Studies of the Dementias from an Epidemiological Viewpoint
Authors: Brayne Carol
Published: October 2008

Studies which examine patients with and without dementia during life and then examine brain tissue after death are extremely difficult to conduct. There are now several such studies published, representing a major contribution to the understanding of the pathologies of the dementias. These studies were not designed to represent population samples and, from an epidemiological viewpoint, they are flawed because none are population-based and none represent the full range of function observed during life. It is therefore important to examine the available studies for their contributions and biases.
The Medical Complications of Anorexia Nervosa
Authors: Sharp C. W. , Freeman C. P. L.
Published: October 2008

The physical complications of anorexia nervosa are common and can be life threatening, but psychiatrists and the increasing number of non-medical therapists involved in treatment programmes often overlook these complications. Cardiovascular complications are the most common, and the most likely to result in fatalities, particularly in those patients who vomit, purge or abuse diuretics, because of the electrolyte abnormalities induced. Osteoporosis is an early and perhaps irreversible consequence of severe weight loss. Further, there are dangers in rapid intravenous hyperalimentation.
The Postconcussional Syndrome: Social Antecedents and Psychological Sequelae
Authors: Fenton George , McClelland Roy , Montgomery Anne , MacFlynn Geraldine , Rutherford William
Published: October 2008

The study consisted of a prospective investigation of 45 consecutively admitted patients who had sustained a mild head injury. In all cases the duration of post-traumatic amnesia was less than 24 hours. Head injury patients had an average of three adverse life events in the year preceding injury compared with 1.5 for controls. Using the PSE, 39% of the group were diagnosed psychiatric cases at six weeks after the injury. For cases the mean level of chronic social difficulties (3.3) was four times that for non-cases (0.8). Six months after injury, 28% of the head injury group had three or more symptoms. These chronic cases were on average ten years older than those whose symptoms had remitted. Chronic cases had, on average, three social difficulties, twice as many as found among those whose symptoms had remitted. The emergence and persistence of the postconcussional syndrome are associated with social adversity before the accident. While young men are most at risk of minor head injury, older women are most at risk of chronic sequelae.
Munchausen's Syndrome and Organic Brain Disorder
Authors: Lawrie Stephen M. , Goodwin Guy , Masterton George
Published: October 2008

A case of Munchausen's syndrome was probably caused by brain damage sustained during a necessary cholecystectomy. Doctors should not be discouraged from seeking treatable disorder because of such patients' behaviour.
Serum Creatine Phosphokinase Elevations in Patients with Tardive Dyskinesia
Authors: Egan Michael F. , Dargham Anissa Abi , Kirch Darrelll G. , Wyatt Richard Jed
Published: October 2008

We describe a case of marked increases in serum creatine phosphokinase (CPK) associated with a dramatic exacerbation of tardive dyskinesia (TD). Chart review of eight additional patients with severe TD revealed three cases with mild CPK elevations. These cases suggest that TD, especially when accompanied by dystonia, may be associated with pathology of striated muscle.
Lessons Learned from Deinstitutionalisation in the US
Authors: Lamb H. Richard
Published: October 2008

Deinstitutionalisation is at an advanced stage in the US, both in duration, and in reduction in state hospital beds. The new generation of chronically and severely mentally ill persons has posed the greatest problems. They no longer receive life-long hospital admission and thus permanent asylum from the demands of the world. Resistance to treatment and substance abuse are problems. Early proponents of deinstitutionalisation believed it would be cheaper, better, and give the mentally ill their freedom. In reality, good community care does not cost less. While a number of community programmes in the US have been impressive, they have served only a small proportion of the total population of severely mentally ill persons. More freedom has been of benefit for many, but has proved difficult for some patients. Some patients have been deinstitutionalised who cannot be effectively treated in the community. The homeless mentally ill epitomise all these problems.
Lithium Augmentation Therapy in Tricyclic-Resistant Depression
Authors: Stein George , Bernadt Morris
Published: October 2008

Thirty-four patients with tricyclic-resistant depressive illness took part in a nine-week, doubleblind, placebo-controlled trial of lithium augmentation. In addition to the maximum tolerated doses of their tricyclic antidepressant, the experimental group (n= 16) received 250 mg lithium daily for three weeks, followed by 750 mg lithium daily for six weeks, while the controls (n= 18) received placebo for three weeks followed by three weeks each of 250 mg lithium daily and 750 mg lithium daily. There was no significant difference between placebo and 250 mg lithium for weeks 0-3 of the trial. However, there was a significantly greater improvement on the MADRS for weeks 3-6 for those subjects on 750 mg lithium than for those on 250 mg lithium. In addition, using a 50% fall in the HRSD as a criterion of drug responsiveness, 22% responded to placebo, 18% to 250 mg lithium, and 44% to 750mg lithium. Thus, lithium in normal, but not in low, dose has a significant antidepressant effect in TCA-resistant depression. Further controlled studies using lithium in normal dose in trials which have a greater duration of placebo exposure are required to confirm the lithium augmentation effect.
An Affective Syndrome in Psychopaths with Borderline Personality Disorder?
Authors: Coid Jeremy W.
Published: October 2008

A preliminary study of the repetitive mood swings of 72 female psychopaths with a DSM-III diagnosis of borderline personality disorder demonstrated considerable complexity and specificity in what has been previously considered a criterion of personality disorder. A principal-components analysis of the symptom profile for these affective disturbances revealed four factors (anxiety, anger, depression, and tension) which showed individual patterns of association with additional lifetime diagnoses of major mental illness and other personality disorders. The women also had multiple mood-related behavioural disorders, enacted with a feeling of compulsion, which appeared to relieve the original affective symptoms. It is hypothesised that these women could have a distinct affective syndrome that has not previously been described in the literature.
Age of Onset in Schizophrenia: Relations to Psychopathology and Gender
Authors: Mayer C. , Kelterborn G. , Naber D.
Published: October 2008

This retrospective study evaluated differences between patients with first manifestation of schizophrenic psychosis (ICD 295) or paranoid syndrome (ICD 297) between the ages of 18 and 23 or 40 and 63 years. Gender-specific variations in psychopathology were also examined. The numerous analyses of variance gave few significant differences. Patients with a late onset of the disease scored higher on depressive and autonomic syndrome scales at admission, whereas patients with an early onset showed more psychosocial impairment at discharge and their stay in hospital was longer. Among schizophrenic patients only (ICD 297 excluded), only the higher score for autonomic syndrome of the older patients at admission was confirmed. Men were more apathetic at admission and discharge than were women. Excluding patients with a paranoid syndrome, these differences were again significant. Moreover, schizophrenic men had higher depressive and psycho-organic syndrome scores at discharge. The demonstration of only marginal differences between early- and late-onset schizophrenia does not support the assumption that age of onset markedly influences psychopathology.
Compulsory Treatment for Anorexia Nervosa: Compassion or Coercion?
Authors: Tiller Jane , Schmidt Ulrike , Treasure Janet
Published: October 2008

Compulsory treatment for anorexia nervosa was recently once again a topic for discussion following the case of J, a 16-year-old girl who unsuccessfully applied to the Court of Appeal to refuse treatment for her anorexia nervosa. In this instance legal opinion was sought in order to clarify the Children Act 1989. However, much of the media coverage focused on the controversy surrounding the compulsory treatment of anorexia nervosa, under the provisions of the Mental Health Act 1983. There is a lack of research into the compulsory treatment of anorexia nervosa, so debate has to be informed by clinical experience.
Sex Reassignment Surgery
Authors: Snaith Philip , Tarsh Michael J. , Reid Russell
Published: October 2008

“This is an evaluation of the therapeutic effect of sex reassignment surgery on 36 female-to-male transsexuals and 105 male-to-female transsexuals in the Netherlands. Data were collected by means of structured interviews. The evaluation was made on the basis of subjective data only, that is on what the persons themselves reported on their gender identity, gender role, and physical condition. Allowing for the restrictive methodology of the (ex post facto) study, it is concluded that there is no reason to doubt the therapeutic effect of sex reassignment surgery. No specific differences were found between those who were still in medical treatment and those who had completed treatment. The findings obtained in the female-to-male transsexuals compare favourably with those obtained in male-to-female transsexuals. Finally, the conclusion is drawn that more attention ought to be paid to psychosocial guidance in addition to medical guidance.”
Lithium Neurotoxicity at Normal Therapeutic Levels
Authors: Bell A. J. , Cole A. , Eccleston D. , Ferrier I. N.
Published: October 2008

Four cases of lithium-induced neurotoxicity are presented which, taken with evidence from previous reports, indicate that specific risk factors for lithium-induced neurotoxicity at normal serum levels are rapid dosage regimes, concomitant neuroleptic therapy, pre-existing EEG abnormalities, undetected cerebral pathology, organic impairment, and genetic susceptibility.
Capgras' Syndrome Presenting with Violence Following Heavy Drinking
Authors: Thompson Anne E. , Swan Marion
Published: October 2008

Two cases of Capgras' syndrome are described in which patients committed serious acts of violence towards famly members who had become the subject of delusional misidentification. The cases illustrate some typical features of Capgras' syndrome including its potential for dangerousness. Intoxication with alcohol is proposed as a precipitant for violence in these patients.
Munchausen's Syndrome by Proxy
Authors: Fisher Geoffrey C. , Mitchell Ian , Murdoch Douglas
Published: October 2008

We believe the case of a boy whose mother insisted he was psychotic is the first report considering psychiatric illness in a child as part of the Munchausen's syndrome by proxy (MSP) complex.
Mania and Down's Syndrome
Authors: Cooper Sally-Ann , Collacott Richard A.
Published: October 2008

Until recently, it was considered that Down's syndrome precluded a diagnosis of mania, or gave rise to an atypical presentation. There have been seven case reports of mania in people with Down's syndrome and all these cases are reviewed. The clinical features of mania are noted to be similar to those previously described in individuals with learning disabilities due to other causes. However, all reported cases are male and none has a family history of affective disorder. In two of the seven men reported, the illness followed a rapid cycling pattern. Hypothyroidism and monoamine biochemistry in people with Down's syndrome are discussed in the context of these atypical features.
Language Therapy for Schizophrenic Patients with Persistent ‘Voices’
Authors: Hoffman Ralph E. , Satel Sally L.
Published: October 2008

One of us has hypothesised that the ‘voices' of schizophrenic patients reflect altered preconscious planning of discourse that can produce involuntary ‘inner speech’ as well as incoherent overt speech. Some schizophrenic patients reporting voices do not, however, have disorganised speech. We hypothesise that these ‘counterexample’ patients compensate for impairments of discourse planning by reducing language complexity and relying on highly rehearsed topics. A ‘language therapy’ designed to challenge and enhance novel discourse planning was administered to four such patients; three had significant albeit temporary reductions in the severity of their voices. These clinical findings provide further evidence that alterations of discourse planning may underlie hallucinated voices.
Personality Disorder and Treatment Response in Bulimia Nervosa
Authors: Fahy T. A. , Eisler I. , Russell G. F. M.
Published: October 2008

Thirty-nine female out-patients with bulimia nervosa were assessed for personality disorders using the PAS. All subjects then entered a therapeutic trial, comprising eight weeks of cognitive-behavioural therapy with follow-up after eight weeks and at one year. Thirty-nine per cent of the patients were diagnosed as having personality disorders. Patients with personality disorders were more depressed and had a lower BMI than those without. They also had a significantly poorer response to treatment, but the difference between groups did not reach significance when mood and BMI were controlled for. Personality disorder alone does not predict a poor response to treatment, but comorbidity with depression and low weight increases the likelihood of a poor response; these patients are unlikely to respond to brief psychotherapeutic interventions.
Alprazolam and Exposure Alone and Combined in Panic Disorder with Agoraphobia
Authors: Marks Isaac M. , Swinson Richard P. , Başoǧlu Metin , Kuch Klaus , Noshirvani Homa , O'Sullivan Geraldine , Lelliott Paul T. , Kirby Marlene , McNamee Gary , Sengun Seda , Wickwire Kim
Published: October 2008

A cross-national randomised trial of alprazolam for chronic panic disorder with agoraphobia was run. Compared with previous trials it had three new features: an exposure therapy contrast group, a six-month treatment-free follow-up, and a low rate of early placebo drop-outs (‘non-evaluables’). The dose of alprazolam was high (5 mg/day). The 154 patients had eight weeks of: alprazolam and exposure (combined treatment); or alprazolam and relaxation (a psychological placebo); or placebo and exposure; or placebo and relaxation (double placebo). Drug taper was from weeks 8 to 16. Follow-up was to week 43. Results were similar at both sites. Treatment integrity was good. All four treatment groups, including double placebo, improved well on panic throughout. On non-panic measures, by the end of treatment, both alprazolam and exposure were effective, but exposure had twice the effect size of alprazolam. During taper and follow-up, gains after alprazolam were lost, while gains after exposure were maintained. Combining alprazolam with exposure marginally enhanced gains during treatment, but impaired improvement thereafter. The new features put previous trials in a fresh light. By the end of treatment, though gains on alprazolam were largely as in previous studies, on phobias and disability they were half those with exposure. Relapse was usual after alprazolam was stopped, whereas gains persisted to six-month follow-up after exposure ceased. Panic improved as much with placebo as with alprazolam or exposure.
Fluoxetine in Phantom Limb Pain
Authors: Power-Smith Parsley , Turkington Douglas
Published: October 2008

Complete recovery of phantom limb pain of five years' duration occurred in a 71-year-old man following treatment with fluoxetine. There was no coexisting affective disorder. Further research is indicated in view of the postulated role of lowered central 5-hydroxy-tryptamine activity in the genesis and maintenance of chronic pain.

British Journal of Psychiatry (1993), 163, 105–106
Eye-Movement Desensitisation to Overcome Post-traumatic Stress Disorder
Authors: Spector John , Huthwaite Mark
Published: October 2008

A new treatment using a saccadic eye-movement desensitisation (EMD) procedure has recently been introduced to treat post-traumatic stress disorder, a disorder that has been difficult to treat in the past. The treatment is claimed to be very rapid and successful. This paper reports the treatment of a woman with post-traumatic stress disorder following a horrific road traffic accident using the EMD procedure.

British Journal of Psychiatry (1993), 163, 106–108
Thalamo-frontal Psychosis
Authors: McGilchrist Iain , Goldstein Laura H. , Jadresic Danitza , Fenwick Peter
Published: October 2008

A 43-year-old man presented with an 18-month history of acute-onset cyclical behavioural change affecting mood, appetite, sleep, and energy levels. This had followed an initial episode of transient drowsiness which lasted 24 hours. On examination, there was soma evidence of visual memory and frontal lobe deficits. A brain CT scan showed bilateral thalamic infarcts and a brain SPECT scan showed bilateral hypoperfusion of the frontal lobes. To our knowledge, this is the first reported case of thalamic infarction associated with acute-onset cyclical affective psychosis with clinical and neurophysiological features of frontal lobe syndrome. The case also highlights the possible role of thalamofrontal circuits in the pathogenesis of the Kleine-Levin syndrome.

British Journal of Psychiatry (1993), 163, 113–115
A Controlled Study of the Onset, Duration and Prevalence of Postnatal Depression
Authors: Cox John L. , Murray Declan , Chapman Gail
Published: October 2008

In a two-stage screening procedure using the Edinburgh Postnatal Depression Scale and Goldberg's Standardised Psychiatric Interview, 232 women six months after delivery were compared with control women individually matched for age, marital status and number of children, obtained from general practitioner lists, who were not pregnant nor had had a baby in the previous 12 months. No significant difference in the point prevalence of depression at six months was found between the postnatal (9.1%) and control women (8.2%) nor in the six-month period prevalence (13.8% postnatal, 13.4% controls), but a threefold higher rate of onset of depression was found within five weeks of childbirth. The possible explanations relate to the long duration of depression in women with young children, and the stressful effect of childbirth and its psychosocial sequelae.
A Pilot Study of Schizophrenia-Like Psychosis in Epilepsy Using Single-Photon Emission Computerised Tomography
Authors: Marshall E. Jane , Syed G. M. S. , Fenwick P. B. C. , Lishman W. A.
Published: October 2008

In a pilot study, SPECT was used to explore differences in rCBF between a group of patients with schizophrenia-like psychoses of epilepsy (SLPE) and a matched group of epileptic controls. Five patients in each group were investigated and those with SLPE showed significant reductions in the index of rCBF in the left medial temporal region. These differences are being investigated further.
Suicide Notes
Authors: O'Donnell Ian , Farmer Richard , Catalan Jose
Published: October 2008

Detailed case reports of incidents of suicide and attempted suicide on the London Underground railway system between 1985 and 1989 were examined for the presence of suicide notes. The incidence of note-leaving was 15%. Notes provided little insight into the causes of suicide as subjectively perceived, or strategies for suicide prevention.
The Importance of the Role of the Patient in the Outcome of Schizophrenia
Authors: Scott R. D. , Fagin L. , Winter D.
Published: October 2008

The Family Interpersonal Perception Test (FIPT) was used to explore the relationships between schizophrenic patients and their parents, and how these related both to relapse in the year after discharge and to improvement in social functioning. Forty schizophrenic patients and their parents were tested during their first ever admission to hospital and again two years later. Parents' and patient's views of each other were more negative in those with worse outcome, but what most significantly distinguished groups with different outcomes was how patients expected their parents to see them. The FIPT, therefore, reveals patterns of interaction in which the patient's role in outcome is at least as important as that of the parents, and can aid the identification of specific features with which to work in therapy.
Depression in Old Age a Reconsideration of Cerebral Disease in Relation to Outcome
Authors: Baldwin R. C. , Benbow S. M. , Marriott A. , Tomenson B.
Published: October 2008

In a prospective study, 32 patients with depressed mood and cerebral pathology were compared over one year with 66 depressed patients who were cerebrally intact. The hypothesis that the former would have a poorer outcome for depression was not confirmed, although the group with cerebral pathology had a significantly higher than expected death rate. Prognostic factors were identified only for the cerebrally intact group. Those who had major depression were more likely than those with minor depression to be given physical treatments, irrespective of which group they belonged to.
Psychiatric Symptoms in Cannabis Users
Authors: Thomas Huw
Published: October 2008

The usual phenomena of cannabis intoxication include experiences which in a non-intoxicated state would be considered as psychiatric symptoms. These can be distinguished from adverse reactions to cannabis, the commonest of which is an acute anxiety state. Acute psychotic episodes can also follow ingestion of the drug but are infrequent. These can be classified as acute confusional states and episodes occurring in clear consciousness. Neither presentation consistently shows enough specific features to warrant the diagnosis of ‘cannabis psychosis' as a distinct clinical entity. The evidence that cannabis has a causative role in chronic psychotic or affective disorders is not convincing, although the drug may modify the course of an already established illness. Further controlled studies would be required to clarify the aetiological significance of the drug in these conditions.
Post-traumatic Stress Reactions in Children After the 1988 Armenian Earthquake
Authors: Pynoos Robert S. , Goenjian Armen , Tashjian Madeline , Karakashian Meline , Manjikian Raffi , Manoukian Gagik , Steinberg Alan M. , Fairbanks Lynn A.
Published: October 2008

One and a half years after the devastating earthquake in Armenia in 1988, 231 children from three cities at increasing distances from the epicentre were randomly screened in their schools to determine the frequency and severity of post-traumatic stress reactions, using the Children's Post-traumatic Stress Disorder Reaction Index (CPTSD-RI). A systematic clinical assessment of PTSD based on DSM-III-R criteria was also conducted on approximately half of this sample. A high CPTSD-RI score was strongly correlated with a clinical diagnosis of PTSD. A strong positive correlation was found between proximity to the epicentre and overall severity of post-traumatic stress reaction, as well as severity of core component symptoms of PTSD. High rates of chronic, severe post-traumatic stress reactions were found among children in the two most damaged cities, Spitak and Gumri. Analyses controlling for exposure revealed that girls reported more persistent fears than boys. These findings indicate that after catastrophic natural disaster, post-traumatic reactions in children may reach epidemic proportions, remain high for a prolonged period, and jeopardise the well-being of the child population of a large region. Systematic screening of children for PTSD can provide critical information for a rational public mental health programme after such a disaster.