bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychological consequences of the 1998 landslide in Sarno, Italy: a community study
Authors: Catapano F. , Malafronte R. , Lepre F. , Cozzolino P. , Arnone R. , Lorenzo E. , Tartaglia G. , Starace F. , Magliano L. , Maj M.
Published: March 2003

Objective: This community study assessed the prevalence of post‐traumatic stress disorder (PTSD) and the psychosocial consequences of the landslide which occurred in Sarno, Southern Italy, in May 1998.

Method: A random sample (n=272) of the population living in the highest risk area of Sarno, and a control group recruited in a small town situated near the disaster area, but not affected by the event, were assessed 1 year after the disaster by standardized instruments.

Results: Of the subjects recruited in Sarno, 27.6% met DSM‐IV criteria for PTSD; 59% subjects recruited in Sarno and 35% of the control group were identified as ‘probable cases’ by the GHQ‐30 (P<0.0001). Subjects recruited in Sarno had significantly higher scores on the four GHQ‐30 subscales identified by factor analysis.

Conclusion: This study emphasizes the negative impact of a natural catastrophic event on mental health, and the need for preventive interventions.
Determinants of poor 1‐year outcome of DSM‐III‐R major depression in the general population: results of the Netherlands Mental Health Survey and Incidence Study (NEMESIS)
Authors: Spijker J. , Bijl R. V. , De Graaf R. , Nolen W. A.
Published: March 2003

Objective:  To investigate risk factors of poor 1‐year outcome of major depression in the general population and to compare the results with data from clinical populations.

Method:
 Psychiatric diagnoses were determined in a representative sample (N=7076) of the Dutch general population, using the Composite International Diagnostic Interview (CIDI) at baseline and 12 months later. A broad range of potential risk factors were evaluated.

Results:  Of the depressed people at baseline, 28.3% were depressed 12 months later. Younger age, severity of depression, longer duration of previous episodes, the presence of anhedonia and early awakening, external locus of control and multiple negative life events appear to be risk factors.

Conclusion:  Poor outcome of major depression is frequent in the general population. Largely the same risk factors are involved as in clinical populations.
The European perspective of psychiatric reform
Authors: Becker T. , Vázquez‐Barquero J. L.
Published: March 2003

Objective: To provide a framework of mental health care reform across Europe.

Method: On the basis of summary quantitative indices and expert ratings of broad aspects of mental health care structure, the process and outcome of psychiatric reform common trends and differences are outlined.

Results: There has been a broad trend away from an institutional model of care with the mental hospital as the dominant institution, and community‐ and general hospital‐based mental health services of varying comprehensiveness are in place in most countries. The social and broad community aspects of psychiatric reform have generally been somewhat less successful than changes in service set‐up. Assessment of reform outcomes proves particularly difficult.

Conclusion: Psychiatric reform processes have achieved some of their aims, and there are broadly similar trends. Regional variation is substantial and may be as important as cross‐national differences. Mental health care reform is ongoing across the European region.
Italian psychiatric reform 20 plus years after
Authors: Burti L.
Published: March 2003

Objective: To describe the current situation of mental health care in Italy and implementation of mental health reform legislation.

Method: The current mental health care system and studies of the implementation of psychiatric reform are described.

Results: The 1978 reform law inaugurated fundamental changes in the care system (prohibiting admissions to state mental hospitals, stipulating community‐based services, allowing hospitalization only in small general‐hospital units). Uneven reform implementation was reported initially. However, in 1984 in‐ and out‐patient services in the community were available to >80% of the population. There is a comprehensive network of in‐ and out‐patient, residential and semi‐residential facilities. Recently, services have been jeopardized by the managed‐care revolution, and non‐profit organizations supplement the public system (especially residential care, employment and self/mutual help).

Conclusion: Implementation of the psychiatric reform law has been accomplished, and the year 1998 marked the very end of the state mental hospital system in Italy.
Psychiatric reform in Russia
Authors: Poloshij B. , Saposhnikova I.
Published: March 2003

Objective: To describe the mental health care system in Russia against the background of rapid social, economic and political change since the late 1980s.

Method: Indicators of social stress and deteriorating population mental health and official data on service provision are presented.

Results: In the current system of psychiatric care dispensaries take a central position. Key issues of the discussion on mental health care include ways of coping with social stress disorders, strategies to redefine psychiatric rehabilitation in a changed social–economic context and steps towards strengthening social support networks for people with mental illness. Following political abuse of psychiatry, professionals have had to face justified and unjustified accusations, and been faced with a general challenge to their role.

Conclusion: Tackling problems of social stress, the integration of mental health care in the general medical care system and the building‐up of general hospital in‐patient psychiatric units are of strategic importance.
Evolution of the mental health care system in Poland
Authors: Puzynski S. , Moskalewicz J.
Published: March 2003

Objective: The aim of this paper is to trace evolution of mental health system in Poland.

Method: Available Polish literature and fundamental policy documents including mental health legislation are reviewed and major milestones in this evolution identified and then discussed against the background of political and social developments.

Results: The mental health system evolved since the beginning of the 1970s from large hospitals towards community‐based care. It was found that the changes were rather slow due to financial shortages and lack of clear demand from users. Recent transitions offer opportunities to increase impact of users and their families. On the other hand, however, introduction of health insurance system reduces prospects for well co‐ordinated mental health policy and may lead to inequalities in access to services.

Conclusion: It can be concluded that evolution of mental health services has been influenced by prevailing ideologies as much as by technical and professional considerations.
Mental health care reform in the Netherlands
Authors: Schene A. H. , Faber A. M. E.
Published: March 2003

Objective: To describe the major changes in mental health care for adults in the Netherlands during the past 25 years.

Method: Scientific literature and official documents.

Results: Phases of the reform process are the integration of ambulatory services in the early 1980s and the following implementation of community mental health centres (RIAGGs); the differentiation and extramuralization of mental hospitals; the differentiation within the field of living accommodations; and the final fusion process between these three into integrated regional mental health care organizations. Current issues in the development of services are, e.g. the ever growing demand for mental health care, special programmes for defined target populations, legislation and patient rights, rehabilitation and empowerment.

Conclusion: The Dutch mental health care system has a low threshold and a comparatively good quality. There is a long‐lasting and strong influence of user and family organizations on the content and quality of services. Recently important organizational changes are taking place.
Schizophrenia — progressive and massive decline in response readiness by episodes
Authors: Levander S. , Jensen J. , Gråwe R. , Tuninger E.
Published: March 2003

Objective: To relate the pattern of neuropsychological impairments among schizophrenic patients to case history data and disease characteristics in a cross‐sectional study of unselected patients, and to integrate these data with two previous longitudinal studies of neuropsychological impairments among schizophrenic patients.

Method: One hundred consecutive schizophrenic patients were studied with respect to clinical case history and current symptoms, medication and neuropsychological impairment using a comprehensive computerized test battery.

Results: The most salient finding was a marked slowing of response readiness, linearly related to the number of previous acute episodes. The resulting deficit was far beyond what has been obtained in any other group of subjects (average −6 SD for >five episode patients). The impairments in many of the other neuropsychological parameters could to some extent be explained with reference to response slowing, with one exception — verbal short‐term memory. Adjustment for important confounding factors (age, duration of illness, medication) did not change the strong negative association between response readiness and number of previous episodes.

Conclusion: These findings, together with findings of our two previous longitudinal studies and a recent replication, prompted us to suggest that each acute schizophrenic episode inflicts damage to a set of hypothetical structures, cognitive pattern generators. We assume that these structures translate intentions to logistic programs. When damaged, delays are introduced into executive functions and corollary discharge processes will run out of phase with intentions. This model implicates new ways of looking at the generative mechanisms of the illness, and on treatment strategies.
Genetic epidemiology: bringing genetics to the population – the NAPE Lecture 2001
Authors: Merikangas K.
Published: March 2003

Objective: To present an overview of the status of genetics of mental disorders and to describe the role of genetic epidemiology in the future of the implementation of the human genome initiative.

Method: Reviews evidence on familial recurrence risk for major mental disorders and approaches to identify genes for complex disorders.

Results: The next decade will witness shifts in approaches of both epidemiology and genetics to address sources of complexity of the mental disorders. Descriptive genetic epidemiology will evolve into analytic genetic epidemiology by shifting the key questions from estimation of the magnitude of mental disorders to identification of risk and protective environmental factors that may be informative for both etiology and prevention. Genetics research will expand to population‐based studies for complex disorders and will employ designs and methods that incorporate sources of complexity.

Conclusion: In summary, the next era of human genetics will witness major shifts in approaches to identify the genes underlying mental disorders. The contributions of genetic epidemiology to translate advances in molecular genetics to public health are discussed.
Identifying crime victims who are at high risk for post traumatic stress disorder: developing a practical referral instrument
Authors: Wohlfarth T. , Winkel F. W. , Van Den Brink W.
Published: March 2003

Objective To construct a practical instrument for the identification and referral of crime victims who are at high risk for post traumatic stress disorder (PTSD).

Method: Crime victims filing a complaint at a police station were asked to fill out a questionnaire probing risk factors for PTSD (n=126). One and 3 months later, these victims filled out a self‐report version of the PTSD Symptom Scale (PSS‐SR).

Results: The combination of four items predicted persistent PTSD with a sensitivity of 1.00 and a specificity of 0.62. The items were: being victims of a violent crime, knowing the perpetrator, experiencing the results of the crime as worse than was expected, and blaming oneself for the event. Only 25% of PTSD cases received emotional support from a victim assistance organization.

Conclusion: This study demonstrates that early detection of high‐risk victims and their referral to treatment is both necessary and possible.
Bias in computerized neuropsychological assessment of depressive disorders caused by computer attitude
Authors: Weber B. , Fritze J. , Schneider B. , Kühner T. , Maurer K.
Published: March 2003

Objective: Psychiatric patients are increasingly confronted to computerized psychological and psychopathological assessment. Patients' attitude to computers was reported to affect acceptance of computerized assessment.

Method: In 78 psychiatric in‐patients neuropsychological impairment was examined following admission on an open ward by conventional as well as computerized memory and attention tasks. Besides psychopathological assessment, self ratings of computer attitude and acceptance of the computerized assessment were completed.

Results: A more negative attitude to computers was found to be significantly correlated to higher nervousness in patients' self report (R=0.38, P=0.0005) as well as to poorer results of computerized attention tasks (R=0.39, P=0.0007). Particularly in patients with depressive disorders computer attitude could be shown to explain 39% of the variance of attention performance.

Conclusion: Results indicate a significant effect of negative computer attitude on acceptance and thus reliability of computerized examination, resulting in a bias in computerized attention‐related assessment in patients with depressive disorders.
Validity of the Hopkins Symptom Checklist‐25 amongst HIV‐positive pregnant women in Tanzania
Authors: Kaaya S. F. , Fawzi M. C. S. , Mbwambo J. K. , Lee B. , Msamanga G. I. , Fawzi W.
Published: March 2003

Objective: To validate the Hopkins Symptom Checklist‐25 (HSCL‐25) for use as a depression screen amongst human immuno‐deficiency virus (HIV) positive pregnant women.

Method: Amongst 903 (mean age 24.8 years) HIV‐positive pregnant women, a two‐phased design included measures for health‐related quality of life, perceived social support, and the HSCL‐25 screen for depressive (HSCL‐15 subscale) and anxiety symptoms. The Structured Clinical Interview for DSM‐IV (SCID) was independently administered on a stratified random subsample.

Results: Internal consistency of the HSCL‐25 (alpha 0.93) and HSCL‐15 (alpha 0.9) was adequate, with expected findings demonstrated in discriminant validity analysis. A depression‐anxiety construct explained nearly 40% of the variance. Eight individual HSCL‐25 items demonstrated an area under the curve (AUC) greater than 0.6 for DSM‐IV major depression and the HSCL‐25 and HSCL‐revised had an optimal depression cut‐off score of 1.06 and 1.03 for the HSCL‐15.

Conclusion: The HSCL‐25 demonstrated utility as a screen for depression; its inability to gauge severity of symptoms in this cultural context is discussed.
Addition of cognitive‐behaviour therapy for obsessive‐compulsive disorder patients non‐responding to fluoxetine
Authors: Kampman M. , Keijsers G. P. J. , Hoogduin C. A. L. , Verbraak M. J. P. M.
Published: March 2003

Kampman M, Keijsers GPJ, Hoogduin CAL, Verbraak MJPM. Addition of cognitive‐behaviour therapy for obsessive‐compulsive disorder patients non‐responding to fluoxetine. Acta Psychiatr Scand 2002: 106: 314–319. © Blackwell Munksgaard 2002.

Objective: Selective serotonin re‐uptake inhibitors (SSRIs) and cognitive behaviour therapy (CBT) have both proven to be effective in the treatment of obsessive compulsive disorder (OCD). It is generally recommended that adequate but unsuccessful SSRI treatment is supplemented with CBT, although only one empirical study was conducted to verify this recommendation. The present study examined the effects of supplemental CBT to continued fluoxetine treatment in OCD patients non‐responding to fluoxetine alone.

Method: After 12 weeks of fluoxetine, 14 of 56 out‐patients had a reduction rate less than 25% on the Yale‐Brown Obsessive Compulsive Scale (Y‐BOCS) and were classified as non‐responders. They subsequently received 12 sessions CBT additional to the continued fluoxetine treatment.

Results: The mean symptom reduction as rated by the Y‐BOCS, for the patients who completed both treatment phases, was 8.5% in the first phase and 41% in the second phase.

Conclusion: Supplemental CBT for OCD patients, after initial, unsuccessful fluoxetine treatment is shown to be effective.
Relative increase in choline in the occipital cortex in chronic fatigue syndrome
Authors: Puri B. K. , Counsell S. J. , Zaman R. , Main J. , Collins A. G. , Hajnal J. V. , Davey N. J.
Published: March 2003

Puri BK, Counsell SJ, Zaman R, Main J, Collins AG, Hajnal JV, Davey NJ. Relative increase in choline in the occipital cortex in chronic fatigue syndrome. Acta Psychiatr Scand 2002: 106: 224–226. © Blackwell Munksgaard 2002.

Objective: To test the hypothesis that chronic fatigue syndrome (CFS) is associated with altered cerebral metabolites in the frontal and occipital cortices.

Method: Cerebral proton magnetic resonance spectroscopy (1H MRS) was carried out in eight CFS patients and eight age‐ and sex‐matched healthy control subjects. Spectra were obtained from 20 × 20 × 20 mm3 voxels in the dominant motor and occipital cortices using a point‐resolved spectroscopy pulse sequence.

Results: The mean ratio of choline (Cho) to creatine (Cr) in the occipital cortex in CFS (0.97) was significantly higher than in the controls (0.76; P=0.008). No other metabolite ratios were significantly different between the two groups in either the frontal or occipital cortex. In addition, there was a loss of the normal spatial variation of Cho in CFS.

Conclusion: Our results suggest that there may be an abnormality of phospholipid metabolism in the brain in CFS.
Personality features of patients with mixed and pure manic episodes
Authors: Brieger P. , Ehrt U. , Roettig S. , Marneros A.
Published: March 2003

Brieger P, Ehrt U, Roettig S, Marneros A. Personality features of patients with mixed and pure manic episodes. Acta Psychiatr Scand 2002: 106: 179–182. © Blackwell Munksgaard 2002.

Objective: To test the hypothesis that patients with a mixed manic episode show different personality features than patients with a pure manic episode.

Method: Sixteen patients with a mixed manic episode (broad criteria) and 26 patients with a pure manic episode were assessed with diagnostic interviews (SCID I/II) as well as instruments for depression, mania and personality.

Results: Even after controlling for age as well as depression and mania score at assessment, no differences between the two groups emerged concerning either personality features as assessed with the NEO‐five‐factor inventory (NEO‐FFI) or personality disorders.

Conclusion: We found no difference between patients with mixed mania and patients with pure mania concerning their personality features. Possible reasons for this are being discussed.
Predictors of first incidence of DSM‐III‐R psychiatric disorders in the general population: findings from the Netherlands Mental Health Survey and Incidence Study
Authors: De Graaf R. , Bijl R. V. , Ravelli A. , Smit F. , Vollebergh W. A. M.
Published: March 2003

de Graaf R, Bijl RV, Ravelli A, Smit F, Vollebergh WAM. Predictors of first incidence of DSM‐III‐R psychiatric disorders in the general population: findings from the Netherlands Mental Health Survey and Incidence Study. Acta Psychiatr Scand 2002: 106: 303–313. © Blackwell Munksgaard 2002.

Objective: To investigate determinants of 12‐month first incidence of DSM‐III‐R mood disorder (MD), anxiety disorder (AD) and substance use disorder (SUD) in the general population.

Method: Data are from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a prospective epidemiologic study in which a representative sample of 7076 adults aged 18–64 years were interviewed with the Composite International Diagnostic Interview. New cases diagnosed 12 months after baseline were compared with never diagnosed controls on sociodemographic and psychosocial variables.

Results: Multivariate, the only demographic variable associated with incidence of MD was female gender. The strongest predictors were negative life events and ongoing difficulties. High level of neuroticism was also associated. Incidence of AD was likewise predicted by female gender. Negative life events and ongoing difficulties were also significant predictors, though weaker than for MD. Incidence of SUD was more common among males, young adults, people not living with a partner and those experiencing positive life events.

Conclusion: Incident MD and AD were predicted more strongly by life events, and SUD more strongly by demographic factors.
Mild cognitive impairment1– a review of prevalence, incidence and outcome according to current approaches
Authors: Bischkopf J. , Busse A. , Angermeyer M. C.
Published: March 2003

Objective:  Mild cognitive impairment is associated with an increased risk of developing dementia. However, agreement needs to be reached on clearly specified diagnostic criteria for mild cognitive impairment. The present paper critically reviews the different constructs of mild cognitive impairment on the basis of the available empirical evidence.

Method:  All published papers on mild cognitive impairment during the last 15 years on Medline and other databases were reviewed.

Results:  Age‐specific prevalence and incidence rates according to the different constructs as well as the prognostic significance of the different constructs concerning the development of dementia are reported. Furthermore, a brief summary of recent research on possible risk factors for a negative course of mild cognitive impairment is provided.

Conclusion:  As there is no construct to date that pools all efforts of defining mild cognitive impairment, the review provides suggestions for an agreement on constructive terminology and research practice.
Cognitive functioning in severe somatization – a pilot study
Authors: Niemi P. M. , Portin R. , Aalto S. , Hakala M. , Karlsson H.
Published: March 2003

Objective:  Somatizing patients often report cognitive complaints but neuropsychological research on somatization is scarce. We investigated somatizing patients for functioning in different cognitive domains.

Method:  Ten female patients with somatization disorder or undifferentiated somatoform disorder and 10 non‐somatizing controls participated in neuropsychological examinations.

Results:  The patients performed at a lower level than the controls in tests involving semantic memory, verbal episodic memory and visuo‐spatial tasks, and were slower in attentional tasks.

Conclusion:  Somatization patients may suffer from substantial problems in cognitive performance.
The man with the purple nostrils: a case of rhinotrichotillomania secondary to body dysmorphic disorder
Authors: Fontenelle L. F. , Mendlowicz M. V. , Mussi T. C. , Marques C. , Versiani M.
Published: March 2003

Objective: To describe a different type of self‐injurious behavior that may be secondary to body dysmorphic disorder (BDD).

Method: Single case report.

Results: We reported a case of an individual who have developed the self‐destructive habit of pulling and severely scraping hairs and debris out of the mucous membrane of his nasal cavities. We have proposed the term rhinotrichotillomania to emphasize the phenomenological overlapping between trichotillomania (TTM) and rhinotillexomania (RTM) exhibited by this case. The main motivation behind the patient's actions was a distressing preoccupation with an imaginary defect in his appearance, which constitutes the core characteristic of BDD. The patient was successfully treated with imipramine.

Conclusion: The case suggests that certain features of TTM, RTM, and BDD may overlap and produce serious clinical consequences. Patients with this condition may benefit from a trial of tricyclics when other effective medications, such as serotonin reuptake inhibitors, are not available for use.
IQ in childhood psychiatric attendees predicts outcome of later schizophrenia at 21 year follow‐up
Authors: Munro J. C. , Russell A. J. , Murray R. M. , Kerwin R. W. , Jones P. B.
Published: March 2003

Objective: Preschizophrenic children who merit psychiatric referral are claimed to have a particularly malevolent illness when the psychosis develops later. The 21 years outcome of a sample of such children was investigated.

Method: Fifty‐one children who attended psychiatric services, and were later diagnosed as having schizophrenia, were followed up a mean of 21 years later. Baseline childhood demographic, clinical and putative aetiological characteristics were identified from the case notes. Follow‐up assessment evaluated clinical symptoms, social functioning and service utilization. The predictive value of baseline factors on outcome was examined.

Results: Outcome was poor, and seven (14%) of the subjects were deceased. Childhood IQ was strongly predictive of social outcome (F=5.1, P=0.01) and service utilization (F=5.2, P=0.01), but not clinical symptoms. No other factors predicted outcome.

Conclusion: Low childhood IQ had an unfavourable impact on social outcome and service utilization once schizophrenia developed.
Temperament, character, and personality disorders: etiologic, diagnostic, treatment issues
Authors: Svrakic D. M. , Draganic S. , Hill K. , Bayon C. , Przybeck T. R. , Cloninger C. R.
Published: March 2003

Svrakic DM, Draganic S, Hill K, Bayon C, Przybeck TR, Cloninger CR. Temperament, character, and personality disorders: etiologic, diagnostic, treatment issues. Acta Psychiatr Scand 2002: 106: 189–195. © Blackwell Munksgaard 2002.

Objective: In this paper, we explore the underlying dimensional structure of personality disorder, propose a novel approach to its diagnosis, and outline our concepts of its etiology and treatment based on the seven factor psychobiological model of temperament and character.

Method: Temperament and character traits were evaluated in a consecutive series of 109 psychiatric out‐patients, with or without personality disorder and varying mood and anxiety states.

Results: Low scores on character dimensions consistently correlated with high symptom counts for personality disorder. Each subtype of personality disorder created a unique combination of correlations with the four temperament traits.

Conclusion: Temperament and Character Inventory (TCI) temperament and character traits efficiently diagnose personality disorder and differentiate its individual subtypes. Character traits are used to diagnose the presence and the severity of personality disorder, whereas temperament traits are used for differential diagnosis. The distinction between temperament and character provides an attractive theoretical basis for etiological postulates and treatment of personality disorder.
Incidental radiological findings on brain magnetic resonance imaging in first‐episode psychosis and chronic schizophrenia
Authors: Lubman D. I. , Velakoulis D. , McGorry P. D. , Smith D. J. , Brewer W. , Stuart G. , Desmond P. , Tress B. , Pantelis C.
Published: March 2003

Objective:  To investigate whether patients with first‐episode psychosis or chronic schizophrenia have an increased incidence of magnetic resonance imaging (MRI) brain abnormalities compared with control subjects.

Method:  Totally 340 clinical MRI reports [Controls (n=98), first‐episode psychoses (n=152), chronic schizophrenia (n=90)] were reported by a neuroradiologist blind to diagnosis and subsequently categorized using referral criteria (immediate, urgent, routine or no referral).

Results:  Thirty percent of all scans were reported by a neuroradiologist as abnormal, but the majority required no referral. Patients with chronic schizophrenia were more likely to have clinically significant abnormal scans than patients with first episode psychosis or control subjects. In four patients the MRI findings led to the discovery of previously unsuspected pathology.

Conclusion:  Patients with chronic schizophrenia have an increased prevalence of incidental brain abnormalities. A small proportion of patients with chronic schizophrenia and first‐episode psychosis benefitted directly from MRI scanning.
Seasonal distribution of suicide in alcoholism
Authors: Brådvik Louise , Berglund Mats
Published: March 2003

Brådvik L, Berglund M. Seasonal distribution of suicide in alcoholism. Acta Psychiatr Scand 2002: 106: 299–302. © Blackwell Munksgaard 2002.

Objective: To investigate the seasonal distribution of suicide in alcohol dependence and to make a comparison with unnatural death in alcoholism and suicide in other diagnostic groups.

Method: Multiaxial ratings of all patients admitted to the Department of Psychiatry in Lund enabled the selection of patients with alcohol dependence (n=1312) during 1949–1969. When followed up to 1997 a total of 102 (99 men) alcoholic patients had taken their own life. Reference groups were patients with severe depression and autopsy cases with other diagnoses.

Results: The alcoholic patients showed a peak during the second quarter of the year (34%, P < 0.05). Other diagnostic groups of suicide and unnatural death in alcoholism did not show any overrepresentation in the spring.

Conclusion: Male alcoholics showed a spring peak of suicide as opposed to other diagnostic groups.
Detention of the mentally ill in Europe – a review
Authors: Zinkler Martin , Priebe Stefan
Published: March 2003

Objective: The frequency of compulsory admission varies widely across Europe. Although there has been some research on a nation‐wide level, no work has been done to compare mental health legislation in different countries in relation to detention rates and to patients' perception of hospital detention.

Method: Databases and government statistics were searched for regional, national and European data. Legal frameworks were compared and reviewed in relation to patients' and professionals' views.

Results: Nearly 20‐fold variations in detention rates were found in different parts of Europe. Criteria for detention of the mentally ill are broadly similar when it comes to patients at risk to themselves or others. However different rules apply for involuntary treatment in the interest of the patient's health.

Conclusion: Variations in detention rates across Europe appear to be influenced by professionals' ethics and attitudes, sociodemographic variables, the public's preoccupation about risk arising from mental illness and the respective legal framework.
Suicidal behaviour of psychiatric in‐patients
Authors: Spießl H. , Hübner‐Liebermann B. , Cording C.
Published: March 2003

Objective: The study aimed to examine suicidal behaviour before and during in‐patient care in a psychiatric state hospital.

Method: Based upon a psychiatric basic documentation system prevalence and risk factors of in‐patient suicides, suicide attempts and suicidal thoughts were investigated over an 11‐year period from 1989 until 1999.

Results: A total of 30 in‐patient suicides were found among 21 062 patients. According to the multivariate logistic regression analysis the risk of hospital suicide increases for patients with schizophrenia, higher cumulative length of stay, previous suicide attempt, part‐time employment and training/retraining. Predictors of suicide attempt during hospitalization are suicide attempt on admission, personality disorder, suicidal thoughts on admission, schizophrenia and affective disorder.

Conclusion: As Schizophrenics represent the high‐risk group of in‐patient suicide, suicide prevention should be a major goal in their treatment. More frequent suicide risk assessment is recommended particularly before granting a leave or an outing.
Duration of untreated psychosis and its correlates in first‐episode psychosis in Finland and Spain
Authors: Kalla O. , Aaltonen J. , Wahl‐ström J. , Lehtinen V. , Cabeza I. García , De Chávez M. González
Published: March 2003

Kalla O, Aaltonen J, Wahlström J, Lehtinen V, García Cabeza I, González de Chávez M. Duration of untreated psychosis and its correlates in first‐episode psychosis in Finland and Spain. Acta Psychiatr Scand 2002: 106: 265–275. © Blackwell Munksgaard 2002.

Objective: To examine the association of duration of untreated psychosis (DUP) with early course characteristics in first‐episode psychosis in Finland and Spain.

Method: Eighty‐six patients from Finland (49) and Spain (37) were evaluated on various early course characteristics.

Results: The mean value of DUP was 4.0 months (median 2 months) for the Finnish patients and 9.9 months (median 2 months) for the Spanish ones. In both groups, long DUP was associated with insidious onset, poor global functioning, and laboral incapability. Among the Finnish patients exclusively, long DUP correlated with a weak earlier social network, instability of professional identity, long duration of prodromal symptoms, psychological dependency on the family, and criticism by the parents of the patient. Among the Spanish patients only, longer DUP was associated with more severe positive symptoms at admission.

Conclusion: There are universal psychosocial factors influencing DUP, but also cultural differences may have an impact on the treatment delay.
The effect of alcohol consumption on cost of care in severe psychotic illness: a report from the UK700 study
Authors: Laugharne R. , Byford S. , Barber J. A. , Burns T. , Walsh E. , Marshall S. , Tyrer P.
Published: March 2003

Laugharne R, Byford S, Barber JA, Burns T, Walsh E, Marshall S, Tyrer P. The effect of alcohol consumption on cost of care in severe psychotic illness: a report from the UK700 study. Acta Psychiatr Scand 2002: 106: 241–246. © Blackwell Munksgaard 2002.

Objective: Alcohol misuse in psychotic patients is common and leads to poor treatment outcome. This study examines the relationship between alcohol consumption and cost of care in patients with a severe psychotic illness.

Method: Patient care was evaluated over 2 years for 708 patients. Patient reported alcohol consumption was evaluated at initial interview. The outcome measure was cost of care over2 years.

Results: There was no difference in mean cost of care between non‐drinkers, moderate and heavy drinkers. Increased alcohol consumption (measured as a continuous variable, adjusted for baseline characteristics) was associated with lower cost of care.

Conclusion: Heavier alcohol consumers did not incur more treatment costs and may, indeed, cost less than other patients. This may reflect higher levels of drinking being associated with better overall functioning, poorer engagement with services or exclusion from services.
Suicide attempts in women with bulimia nervosa: frequency and characteristics
Authors: Corcos M. , Taïeb O. , Benoit‐Lamy S. , Paterniti S. , Jeammet P. , Flament M. F.
Published: March 2003

Objective:  This study aimed to estimate the lifetime frequency of suicide attempts in a large referred population of women with DSM‐IV bulimia nervosa (BN), and to compare demographic and clinical characteristics of those who had attempted suicide and those who had not.

Method:  A total of 295 women (202 with BN purging type, 68 with BN non‐purging type and 25 with anorexia nervosa binge/eating purging type) were assessed using a semi‐structured interview and self‐rated questionnaires.

Results:  Suicide attempts were frequent (27.8% of women), often serious and/or multiple. Women who had attempted suicide differed significantly from those who had not for earlier onset of psychopathology, higher severity of depressive and general symptoms, and more impulsive disordered conducts, but not for the core symptoms or severity of BN.

Conclusion:  Interventions targeting depressive and impulsive features associated with BN are essential to reduce the risk of suicide attempt in women with this disorder.
Birth cohort effects in New South Wales suicide, 1865–1998
Authors: Morrell S. , Page A. , Taylor R.
Published: March 2003

Objective:  To examine birth cohort effects in New South Wales (NSW) suicide data (1865–1998).

Method:  Aggregate suicide data were examined after controlling for age and period using descriptive statistics and Poisson regression modelling. Three approaches were applied to address the non‐identification of age, period and cohort in age–period–cohort (APC) models of suicide.

Results:  Apparent cohort effects in male and female suicide using a minimum constraints APC model of age, period and cohort were no longer present in female suicide when a surrogate period APC model was used, and were absent in both male and female suicide when identifiable cohort effects were isolated using a ‘drift’ adjusted approach to APC modelling.

Conclusion:  Increases in youth suicide rates in NSW occurring since the 1960s cannot be attributed to cohort effects, such as family influences on development. The causes of youth suicide are thus effects operating contemporaneously.
Obstetrical complications and the development of postpartum depressive symptoms: a prospective survey of the MATQUID cohort
Authors: Verdoux H. , Sutter A. L. , Glatigny‐Dallay E. , Minisini A.
Published: March 2003

Verdoux H, Sutter AL, Glatigny‐Dallay E, Minisini A. Obstetrical complications and the development of postpartum depressive symptoms: a prospective survey of the MATQUID cohort. Acta Psychiatr Scand 2002: 106: 212–219. © Blackwell Munksgaard 2002.

Objective: To prospectively investigate in a cohort of pregnant women the association between obstetrical complications (OCs) and depressive symptomatology in the early postpartum period.

Method: A total of 441 pregnant women attending the State Maternity Hospital in Bordeaux were interviewed during the third trimester of pregnancy, then at 3 days and 6 weeks after birth. Maternal depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS). Data on a large range of pregnancy, delivery and neonatal somatic adverse events were collected by interviewing the mothers. Data on OCs were rated using the McNeil–Sjöström scale for OCs. A dimensional definition of postnatal depression (EPDS summary score 6 weeks after delivery) was used to explore the relationships between OCs and early postnatal depressive symptoms.

Results: Exposure to severe OCs during pregnancy was associated with more intense depressive symptoms in the early postnatal period, independently from demographic characteristics, marital adjustment, parity, and a history of depressive or anxiety disorder during pregnancy (adjusted B=0.16, 95% CI 0.007, 0.30, P=0.04). No association was found between the severity of postnatal depressive symptoms and labour/delivery or neonatal complications.

Conclusion: Severe pregnancy complications may increase the severity of postnatal depressive symptoms by acting as acute or chronic stressors during pregnancy. The links between OCs, maternal psychopathology, and child development, need to be explored further.
Differential effectiveness of newer and older antidepressants appears mediated by an age effect on the phenotypic expression of depression
Authors: Parker G.
Published: March 2003

Parker G. Differential effectiveness of newer and older antidepressants appears mediated by an age effect on the phenotypic expression of depression. Acta Psychiatr Scand 2002: 106: 168–170. © Blackwell Munksgaard 2002.

Objective: A possible mechanism whereby the serotonin reuptake inhibitor (SSRI) antidepressants may not (overall) be as effective as the tricyclic (TCA) antidepressants is explored.

Method: Clinical psychiatrists rated the effectiveness of past antidepressant medications in a clinical panel study of patients with a major depressive disorder, with 200 having previously received a TCA and 219 an SSRI.

Results: Analyses indicated decreased SSRI effectiveness with age in those with the melancholic subtype. TCA effectiveness appeared uninfluenced by age and depressive subtype.

Conclusion: Findings suggest why the broader‐based TCAs may be more effective than the SSRIs in implicating age and depressive subtype influences.
Medication adherence of individuals with a first episode of psychosis
Authors: Coldham E. L. , Addington J. , Addington D.
Published: March 2003

Objective: To determine rates of adherence to antipsychotic medication in first episode patients and the correlates of adherence in this group.

Method: Subjects were the first 200 admissions to an Early Psychosis Program. Adherence was determined on a three‐point scale. Symptoms, medication side‐effects, quality of life, substance use and family involvement were examined longitudinally.

Results: In their first year in the program 39% were non‐adherent, 20% inadequately adherent, and 41% adherent. Non‐adherent patients demonstrated more positive symptoms, more relapses, more alcohol and cannabis use, reduced insight, and poorer quality of life. They were younger, had an earlier age of onset and less likely to have a family member involved in treatment.

Conclusion: Results for this group are similar to those reported in the literature. Correlates are often the consequence of non‐adherence. Non‐compliance has to be anticipated and relationships maintained with patients and families to intervene as soon as possible to minimize the consequence of non‐compliance.
Age‐related adverse drug reactions to clomipramine
Authors: Stage K. B. , Bech P. , Kragh‐Sørensen P. ,   Danish University Antidepressant Group
Published: March 2003

Objective: The aim of this study was to determine whether age itself is a significant factor in predicting adverse drug reactions in depressed inpatients treated with clomipramine.

Method: The study involved 150 hospitalized, depressed patients treated with 150 mg clomipramine per day. Changes in orthostatic blood pressure during treatment as well as the patients' complaint about side‐effects was examined with regard to age. The sample was divided into younger (<56) and older (56–70) groups.

Results: No significant differences between younger and older subjects were found on any of the 44 side‐effects recorded. However, older depressed patients suffer from more pronounced orthostatic hypotension than younger patients.

Conclusion: Older depressed patients who have been treated with clomipramine suffer from more severe orthostatic hypotension than younger patients. However, with the right precautions it is safe to treat older patient up to the age of 70 years with a tricyclic antidepressant.
Involvement of plasma atrial natriuretic peptide in protracted alcohol withdrawal
Authors: Kiefer F. , Andersohn F. , Jahn H. , Wolf K. , Raedler T. J. , Wiedemann K.
Published: March 2003

Objective: Atrial natriuretic peptide (ANP) has been shown to inhibit the effects of corticotrophin releasing hormone, corticotrophin and cortisol, and to influence affective and anxiety symptoms in man. We tested the hypothesis of whether ANP is associated with endocrine and psychopathological disturbances during acute alcohol withdrawal.

Method: ANP and cortisol plasma concentrations were studied in alcoholics during in‐patient detoxification and in healthy controls. Additionally, craving, depressive mood and anxiety were assessed.

Results: Although mean ANP levels increased significantly in alcoholics between days 1 and 14, they remained diminished compared to controls. Separating a subgroup of alcoholics with a decrease of ANP levels during withdrawal, these individuals revealed significantly elevated scores for mean and maximum craving and a trend to an elevated self‐rated anxiety on day 14.

Conclusion: We suggest that a dysregulation of ANP plasma levels during alcohol withdrawal may contribute to symptoms of protracted withdrawal such as craving and anxiety.
Leukocytosis and hypoalbuminemia in mixed bipolar states: evidence for immune activation
Authors: Cassidy Frederick , Wilson William H. , Carroll Bernard J.
Published: March 2003

Objective: Although activation of an immune response during major depressive episodes has been reported, less is known about changes during manic and mixed bipolar episodes.

Method: Albumin and leukocyte levels were compared between subjects in manic and mixed bipolar episodes. Neutrophil, lymphocyte and monocyte levels were compared between the two groups.

Results: Albumin levels were lower in mixed manic subjects as opposed to pure manic subjects and in the combined groups levels were lower in females than in males. Leukocyte levels were higher in mixed manic patients compare with pure manic patients. Both neutrophil and monocyte levels were higher in the mixed manic patients but lymphocyte levels were no different.

Conclusion: Leukocytosis and hypoalbuminemia during mixed manic states suggest immune activation in mixed mania similar to depression. This finding also tends to support the recognition of mixed mania as a distinct bipolar state.
Prediction of aggression on a locked psychiatric admissions ward
Authors: Nijman H. , Merckelbach H. , Evers C. , Palmstierna T. , à Campo J.
Published: March 2003

Objective: The present study evaluates the accuracy of clinical and archival predictors of patients' aggressive behaviour on a locked admissions ward.

Method: Over a 9‐month period, staff members estimated the likelihood that patients would become aggressive during their stay in the ward. These unaided clinical assessments were obtained with Visual Analogue Scales (VASs) administered before the end of the first full day of admission. Archival predictions were based on demographic variables (e.g. gender, number of previous admissions, diagnosis) derived from patients' admission forms. Aggressive behaviour was recorded with the Staff Observation Aggression Scale‐Revised (SOAS‐R).

Results: Clinical predictions of aggression were found to be moderately accurate. On the basis of clinical estimates, 75% of the patients were correctly classified as becoming aggressive or not.

Conclusion: Although a body of evidence indicates that unaided clinical prediction of violent recidivism after hospital discharge does not perform well, it may be quite accurate in estimating short‐term aggression risks during acute psychiatric admission.
Psychiatric symptoms in neurologically asymptomatic Huntington's disease gene carriers: a comparison with gene negative at risk subjects
Authors: Berrios G. E. , Wagle A. C. , Marková I. S. , Wagle S. A. , Rosser A. , Hodges J. R.
Published: March 2003

Objective: Psychiatric profiles of two at‐risk groups [Huntington's disease (HD) gene carriers and non‐carriers] were compared by means of a computerized battery and a structured interview.

Method: To avoid confounding, only subjects who were free from neurological and cognitive deficits (neurologically asymptomatic) were included in the study. To avoid evaluation biases, all subjects were seen before the genetic testing was undertaken.

Results: Gene carriers had significantly worse recognition memory and scored higher in measures of irritability than controls. The groups also differed in terms of the factor structure of their psychiatric symptoms. None of the subjects qualified for a psychiatric diagnosis at the time of assessment.

Conclusion: The groups differed with respect to their profile of psychiatric symptoms. It is hypothesized that these differences are the expression of different mechanisms, i.e. that cognitive deficits relate more to genetic factors and neurotic complaints more to being brought up in a disturbed family background. Issues concerning instrument sensitivity, selection bias and the advantage of seriatim assessments are discussed.