bluuebunny/crossref_metadata_2025 huggingface dataset:
Cosegregation of Christmas Disease and Major Affective Disorder in a Pedigree
Authors: Gill Michael , Castle David , Duggan Conor
Published: October 2008

Three males with factor-IX deficiency (Christmas disease) in one pedigree all had severe affective disorder. This apparent cosegregation, if true, would support the hypothesis that in some pedigrees, a gene for major affective disorder is located on the X chromosome.
Sodium Valproate as an Antidepressant
Authors: Kemp L. I.
Published: October 2008

A patient with chronic depression responded to treatment for her major depressive episodes, but was left with a dysthymia which was eventually relieved by anticonvulsants. Sodium valproate may be of use in a range of affective disorders.
Chronic Depersonalisation NeurosisauShorvon – A Successful Intervention
Authors: Ballard C. G. , Mohan R. N. C. , Handy S.
Published: October 2008

A patient with chronic primary depersonalisation responded well to a combination of psychotherapy and abreaction.
Ethical Issues in Genetic Linkage Studies of Psychiatric Disorders
Authors: Alexander Joyce Rachel , Lerer Bernard , Baron Miron
Published: October 2008

Recent advances in molecular genetics have radically altered the prospects for determining the role of heredity in the transmission of major psychiatric disorders. Identification of the actual gene(s) involved, elucidation of their structure, and determination of their products are the steps which theoretically follow successful demonstration of linkage (Gurling, 1985; Baron & Rainer, 1988). Consideration of the ethical issues raised by genetic linkage studies is therefore now of paramount importance. This article focuses on the problems raised by the research process, and not on the ethical implications of the results eventually obtained.
Institutionalism and Schizophrenia 30 Years on
Authors: Curson David A. , Pantelis Christos , Ward Jan , Barnes Thomas R. E.
Published: October 2008

In their comparison of chronic schizophrenic patients in three British mental hospitals in 1960, Wing and Brown found a strong association between the poverty of the social environment and the severity of ‘clinical poverty’ (blunted affect, poverty of speech, and social withdrawal). Between 1960 and 1968 the social environments of all three hospitals improved and a weak causal relationship between social poverty and clinical poverty was reported in a proportion of patients. Using the same assessment instruments as Wing and Brown, the present study re-examined the relationship between social and clinical poverty in the long-stay schizophrenic population of a fourth British mental hospital in 1990. The association found between social and clinical poverty was much weaker than in 1960. Reluctance on the part of patients to be discharged from the institution was unrelated to length of stay. There was no significant difference in severity of illness between the patients in the present study and those in the earlier study. However, patients in the former group spent more time doing nothing than those in the hospital with the most understimulating environment three decades before, with four-fifths doing nothing for over five hours a day, despite a greatly increased ratio of nurses to patients.
Seeing is Believing: The Role of ‘Preconscious' Perceptual Processing in Delusional Misidentification
Authors: Fleminger Simon
Published: October 2008

We have no introspective knowledge of the effects of preconscious processing on our perceptions. We are, therefore, not aware that our expectancies may have prejudiced our perceptions. Expectancies tend to foster perceptions with which they are consonant. Therefore false expectations, driven by false beliefs, may result in misperceptions which reinforce those false beliefs. This morbid cycle is central to the delusional misidentification syndromes. This cycle, with positive feedback, is intrinsically unstable, which helps to explain brief episodes of delusional misidentification. Good sensory data, strong links between sense data and memory, and good judgement will all help to prevent misperceptions. The less these constraints are disrupted, the stronger will be the psychological forces needed to generate a delusional misidentification. It is likely that suspiciousness generates particularly assertive effects on preconscious processing of perceptions. Abnormalities of perceptual processing in patients with schizophrenia explain their proclivity to delusional misidentification.
Schizophrenics and Social Judgement
Authors: Cramer P. , Bowen J. , O'Neill M.
Published: October 2008

Videotaped social interactions were shown to a population of schizophrenics and controls who were asked to comment on the emotional state of the principal protagonist. Their free responses were subjected to a content analysis to examine which of three possible explanations of known schizophrenic inaccuracies on this task were responsible: formal thought disorder, selective avoidance of psychological factors, or perceptual/attentional deficits. Neither selective avoidance nor marked thought disorder were found to explain these errors. The schizophrenics as a group rated much the same, irrespective of clinical profile. Their judgements of personality were less clear-cut than the controls.
The Association Between Triple X and Psychosis
Authors: Woodhouse Wendy J. , Holland Anthony J. , McLean Greg , Reveley Adrianne M.
Published: October 2008

Two cases of psychotic illness in association with the karyotype triple X showed specific diagnostic and management problems as well as obstetric complications, EEG abnormalities, and lack of a family history of psychiatric disorder. Routine karyotyping during the investigation of psychosis is becoming relevant to psychiatric practice as research reports increasingly feature genetic and chromosome anomalies in association with schizophrenic psychoses.

British Journal of Psychiatry (1992), 160, 554–557
Blunted Prolactin Responses to d-Fenfluramine in Sociopathy
Authors: O'Keane Veronica , Moloney Eamonn , O'Neill Helen , O'Connor Art , Smith Charles , Dinan Timothy G.
Published: October 2008

Using a neuroendocrine probe we studied nine male’ offenders in a forensic hospital, convicted of murder, with a diagnosis of antisocial personality disorder, who had been behaviourally ‘quiescent’ for varying periods and who had not recently been abusing drugs. Nine healthy age-matched men also participated. All subjects received 30 mg d-fenfluramine (d-FEN), a 5–HT releasing agent, orally, after an overnight fast, and serial samples for prolactin estimation were taken hourly for five hours. Responses were significantly impaired in the patients, suggesting a subsensitivity of certain 5–HT systems in antisocial personality disorder, regardless of recent or ongoing behavioural disturbance.
Central Conduction Time in Childhood Autism
Authors: McClelland R. J. , Eyre D. G. , Watson D. , Calvert G. J. , Sherrard Eileen
Published: October 2008

To investigate the integrity of the brain-stem in 20 mentally handicapped children who met the Rutter criteria for autism, brain-stem auditory evoked potentials were obtained for a range of stimulus intensities. Central conduction times (CCTs) were calculated for the Wave l–Wave V interval of the brain-stem potentials. In children under 14 years of age CCTs were normal. In children 14 years of age and over, three of four girls and eight of nine boys had CCTs exceeding normal limits when compared with a group of controls of normal intelligence, matched for age and sex. CCTs recorded from a group of non-autistic mentally handicapped children were within normal limits. The age distributions are consistent with a maturational defect in myelination within the brain-stem in autism, a defect which may have a much wider anatomical distribution throughout cortical and subcortical structures.
Ventricular Enlargement in Schizophrenia
Authors: Van Horn J. D. , McManus I. C.
Published: October 2008

Multivariate meta-analysis was performed on 39 studies of ventricular size in schizophrenia which used the ventricle:brain ratio (VBR). The size of the VBR was dependent both upon the date when studies were carried out (more recent studies showing a reduction in the difference between schizophrenics and controls), and upon the diagnostic criterion used in the studies. Methodological factors in study design seemed more important than the characteristics of the schizophrenic subjects, in determining the VBR. Our analysis suggests that there is a difference in VBR between schizophrenics and controls which would seem to be an indisputable characteristic of schizophrenia. However, the difference is smaller than has previously been thought, so that, although of undoubted theoretical interest in accounting for the aetiology of schizophrenia, it is probably too small to be of practical significance in diagnosis, or in the differentiation of subtypes.
A Survey of Practice at a Regional Forensic Service: What Do Forensic Psychiatrists Do?
Authors: Mendelson Eric F.
Published: October 2008

During a six-month period, 306 psychiatric assessments were recorded prospectively on specifically designed schedules. There was a skewed distribution towards younger patients, and 78% were male. Just over half were seen for a court report, one-third of cases came from solicitors, and in two-thirds the request was merely for advice. Secure care was only sought in 15%. In nearly two-thirds an offence had precipitated the referral. Half were seen in prison. The majority had a history of dangerous behaviour and one-fifth were regarded as a sexual risk to others. Only one-third had not previously seen a psychiatrist. A personality disorder was diagnosed in 41%, but only 6% were considered to be psychopaths. These and other findings are discussed to help give an insight into the service.
The Relationship of Environmental Temperature to the Incidence and Outcome of Schizophrenia
Authors: Gupta Sunjai , Murray Robin M.
Published: October 2008

This paper presents new analyses of data from two multicentre studies carried out by the WHO. The morbid risk of developing schizophrenia, as broadly defined by the Determinants of Outcome Study, was positively related to the mean daily range of temperature. The outcome of schizophrenia, as determined by the International Pilot Study of Schizophrenia, was found to be positively related to mean environmental temperature. Further studies are needed to examine the relationship of geographical and climatic variables to schizophrenia in order to complement what is already known about the role of sociocultural factors.
The Nithsdale Schizophrenia Surveys. IX: Akathisia, Parkinsonism, Tardive Dyskinesia and Plasma Neuroleptic Levels
Authors: McCreadie Robin G. , Robertson Lesley J. , Wiles David H.
Published: October 2008

Of all known schizophrenics living in Nithsdale, south-west Scotland, 146 (88%) were examined for the presence of the three principal movement disorders secondary to antipsychotic medication, namely akathisia, tardive dyskinesia and Parkinsonism. Of these, 18% had akathisia, 5% pseudoakathisia, 29% tardive dyskinesia, 8% persistent tardive dyskinesia, and 27% Parkinsonism. No movement disorder was seen in 44%, 36% had one and 20% had more than one movement disorder. Plasma neuroleptic levels at the time of clinical assessment were measured by the radioreceptor technique. Correlations between dose and plasma level were low; the ratio of mean plasma concentration to mean dose was greatest with fluphenazine decanoate and lowest for sulpiride. The concentration:dose ratio was higher in the elderly. There was no relationship between neuroleptic levels and akathisia, Parkinsonism or tardive dyskinesia. Additional psychotropic medication influenced neuroleptic levels. In 9% of patients receiving oral antipsychotic medication, no drug was detected in plasma.
Deliberate Self-poisoning in Asian and Caucasian 12–15–Year-Olds
Authors: Mcgibben L. , Ballard C. G. , Handy S. , Mohan R. N. C. , Silveira W. R.
Published: October 2008

The mean annual rates of hospital admission for deliberate self-poisoning were calculated for Caucasian and Asian 12–15–year-olds between 1982 and 1990 as 2.31 and 2.47 per 1000 respectively. There was an excess of girls in each group.
Dementia Presenting with Sore Eyes
Authors: Kisely Stephen , Tweddle Deborah , Pugh Elizabeth Wyn
Published: October 2008

A patient who presented with soreness of her eyes was given a diagnosis of dementia of the frontal type (DFT) complicated by a major depressive illness. The report illustrates the multiplicity of presenting symptoms in patients with dementia. Resistance to treatment is often an indication that a depressive disorder is symptomatic of underlying organic brain disease.
Social Factors and Recovery from Anxiety and Depressive Disorders
Authors: Brown G. W. , Lemyre L. , Bifulco A.
Published: October 2008

Analysis of 33 instances of recovery or improvement among 92 women with anxiety, and 49 instances of recovery and improvement among 67 episodes of depression, showed that recovery and improvement, when compared with conditions not changing, were associated with a prior positive event. Such events were characterised by one or more of three dimensions: the ‘anchoring’ dimension involved increased security; ‘fresh-start’, increased hope arising from a lessening of a difficulty or deprivation; and ‘relief’, the amelioration of a difficulty not involving any sense of a fresh start. Events characterised by anchoring were more often associated with recovery or improvement in anxiety, and those characterised as fresh-start were associated with recovery or improvement in depression. Recovery or improvement in both disorders was more likely to be associated with both anchoring and fresh-start events. The study involved the reworking of some social and clinical material, and although done blind should be seen as exploratory.
The Effects of Electroconvulsive Therapy on Plasma Insulin and Glucose in Depression
Authors: Williams Karen , Smith Jeanette , Glue Paul , Nutt David
Published: October 2008

The effects of ECT on plasma insulin and glucose were assessed in 20 depressed patients, during the first, third and fifth session of ECT. After each administration of ECT there was a significant rise in blood glucose and plasma insulin levels, both of which peaked at 15 minutes. Insulin responses tended to attenuate over the course of ECT, whereas the glucose responses were similar for all three treatments. ECT was effective in all patients, although two months after the last treatment nine patients had partially relapsed (Hamilton score > 15). Those who relapsed had a more attenuated insulin response at the fifth treatment than those who had remained well, which suggests that insulin response to ECT may be predictive of clinical outcome.
Abnormal Subjective Time Experience in Depression
Authors: Blewett A. E.
Published: October 2008

Abnormality of subjective time experience is well recognised in psychiatric illness. Earlier authors suggested that slowed time experience in depression is an aspect of psychomotor retardation, while more recently it has been argued that this disturbance is non-specifically linked to the global severity of the depressive syndrome. This study offers evidence that both views can be justified: slowed time awareness is a common symptom of depression, related particularly to retardation, and to the severity of the mood disturbance. Some of the experimental difficulties in this kind of research are illustrated.
Alzheimer's Disease, Other Dementias, Depression and Pseudo-dementia: Prevalence, Incidence and Three-Year Outcome in Liverpool
Authors: Copeland J. R. M. , Davidson I. A. , Dewey M. E. , Gilmore C. , Larkin B. A. , Mcwilliam C. , Saunders P. A. , Scott A. , Sharma V. , Sullivan C.
Published: October 2008

A group of 1070 community-living persons aged 65 and over was assessed using the GMS–agecat package and other interviews at years 0 and 3. Year 3 interviewers were ‘blind’ to the findings at year 0, and the prevalence of organic disorders and depression was very similar in both years. According to the results at year 3, minimum and maximum prevalence figures for dementia at year 0 were 2.4% and 3.8% for moderate to severe and 0.4% and 2.4% for mild or early cases, with a best estimate of 3.5% and 0.8%, or 4.3% overall, divided into: senile, Alzheimer's type 3.3%; vascular 0.7%; and alcohol-related 0.3%. The overall incidence of dementia, clinically confirmed by six-year follow-up, was 9.2/1000 per year (Alzheimer type 6.3, vascular 1.9, alcohol related 1.0). Three years later, 72.0% of those with depressive psychosis and 62.3% of those with depressive neurosis were either dead or had some kind of psychiatric illness. Nearly 60% of milder depressive cases (7.2% of the total sample) had either died or developed a chronic mental illness. The outcome of depressive pseudodementias is equivocal so far. Findings at year 3 provide validation of agecat computer diagnosis against outcome; organic and depression diagnoses are seen to have important implications for prognosis.
Alexithymia in Women with Anorexia Nervosa
Authors: Bourke Michael P. , Taylor Graeme J. , Parker James D. A. , Bagby R. Michael
Published: October 2008

The prevalence of alexithymia in 48 female anorexia nervosa patients was 77.1% compared with a prevalence of 6.7% in 30 normal female subjects, matched by age and education. Alexithymia correlated negatively with education in the anorexic patient group, but was unrelated to duration of illness, amount of weight loss, and levels of depression and of general psychoneurotic pathology.
Frontal Lobology – Psychiatry's New Pseudoscience
Authors: David Anthony S.
Published: October 2008

The frontal lobes are the most evolutionarily advanced organ of the body. Here lies the seat of the highest human functions of thought, intellect, creativity, self-control and social interaction (Milner & Petrides, 1984; Lishman, 1987; Russell & Roxanas, 1990; Kolb & Wishaw, 1990). As one recent reviewer notes (Reading, 1991), it is hard to avoid ‘sounding metaphysical’ when going through such a list. It seems that, in accordance with psychiatry's own late phylogenesis, the frontal lobes have only just been discovered.
Successful Treatment of Episodic Dyscontrol with Carbamazepine
Authors: Lewin Jona , Sumners David
Published: October 2008

Following a road-traffic accident, an 18–year-old man developed episodic dyscontrol which brought him into conflict with the law. Two years after the accident, treatment with carbamazepine was initiated and further aggressive outbursts subsided. The efficacy and mode of action of carbamazepine is discussed and the literature reviewed.
Chromosomal Aberrations and Schizophrenia
Authors: Bassett Anne S.
Published: October 2008

Chromosomal aberrations associated with schizophrenic disorders may suggest regions in which to focus a search for genes predisposing to schizophrenia by a linkage strategy. As for other genetic illnesses, chromosomal abnormalities may also provide useful tools for subsequent physical mapping, fine localisation, and isolation of important susceptibility genes. Identification of several chromosomal aberrations may be especially important, given the unknown pathophysiology, the paucity of known brain genes, and the probable genetic heterogeneity of schizophrenia and manic-depression. However, because psychiatric disorders are common and inherited in a complex manner, researchers must use caution when drawing inferences about associations with chromosomal aberrations. Reported abnormalities involving autosomes (chromosomes 1–22) associated with psychotic disorders are reviewed. Their relevance to linkage studies localising genes for schizophrenia was estimated by standardised criteria for specificity, diagnosis, family history, and overall weight of evidence. Four ‘possibly relevant’ chromosomal regions were identified: 5q, 11q, 18q, and 19p. This paper outlines strategies for future studies to detect new chromosomal aberrations associated with major psychotic disorders that may be relevant to isolating the genes for schizophrenia.
Hysterical Conversion
Authors: Mace C. J.
Published: October 2008

‘Hysterical conversion’ dates from a century before Freud, from an important attempt to rationalise the nosological status of hysteria. Freud's own concept of ‘conversion’ followed as a quite independent synthesis of 19th-century medical thinking on the subject. Subsequent analytical usage of ‘conversion’ which has influenced the description of hysterical syndromes within mainstream psychiatry, has not been consistent with Freud's own.
Psychotic Illness Following ‘Mabi Bark Tea’ Consumption
Authors: Hassiotis Angela , Taylor Jason
Published: October 2008

A first episode of psychosis occurred in a young woman of West Indian parentage and one of identical twins following a brief period of high consumption of a drink made from Colubrina plant extract (mabi bark). The course of the psychosis is described and possible underlying mechanisms and the relationship to amphetamine psychosis are discussed.
Charles Bonnet Syndrome
Authors: Bhatia M. S. , Khastgir U. , Malik S. C.
Published: October 2008

A rare case of Charles Bonnet syndrome, which presented in a 38-year-old man, responded to carbamazepine.
Severe Deprivation in Childhood: A Case Report from Thailand
Authors: Bartlet L. B. , Limsila P.
Published: October 2008

A 3 ½-year-old girl was incarcerated in a bamboo cage after it was feared she had contracted rabies. Six years later, when she was released, she had lost almost all motor control, displayed a number of stereotypies, was incontinent of both faeces and urine, and was diagnosed as having grand mal epilepsy. After four years of treatment (aged 13) she had shown considerable improvement and her mental age was seven years.
Dangerous Behaviour Preceding First Admissions for Schizophrenia
Authors: Humphreys M. S. , Johnstone E. C. , MacMillan J. F. , Taylor P. J.
Published: October 2008

Of 253 patients in their first schizophrenic episode, 52 behaved in a way threatening to the lives of others before their admission to hospital. These 52 patients were studied from data collected at the time of their initial presentation. Despite a history of illness in excess of 1 year in 24 cases, and evidence that violence was motivated by psychotic symptoms in 23 cases, fewer than half of the patients were admitted to hospital as a direct result of their dangerous behaviour. Life-threatening behaviour was more common where the patient had been ill for longer, and where there were delusions of being poisoned.
Seasonality of Admissions in the Psychoses: Effect of Diagnosis, Sex, and Age at Onset
Authors: Takei Noriyoshi , O'Callaghan Eadbhard , Sham Pak , Glover Gyles , Tamura Atsuko , Murray Robin
Published: October 2008

A summer peak was found in first admissions to hospitals in England and Wales between 1976 and 1986 for both affective psychoses and schizophrenia, but not for neurotic conditions or personality disorders. There was no significant relationship between age at first admission and season of admission. The summer peak was most prominent for mania, where it was present in both sexes; for schizophrenia, it was present only in females. These findings suggest that schizophrenia in females, and mania in both sexes, have some aetiological or precipitating factor in common.
The Influence of Antidepressants in Overdose on the Increased Suicide Rate in Ireland Between 1971 and 1988
Authors: Kelleher M. J. , Daly M. , Kelleher M. J. A.
Published: October 2008

There has been almost a threefold increase in the incidence of suicide in Ireland during the past 20 years. When each case occurring between 1971 and 1988 was reviewed, the major causes of death were found to be drowning and hanging. Deliberate overdoses with tricyclic antidepressants accounted for less than 4% of all suicides, over the 17 years studied, and during this time, overdose with tricyclics has made a proportionately smaller contribution to the total number of suicides. Greater attention should be paid to identifying and treating the majority of suicidal patients who are at risk by other methods.
Clomipramine versus Phenelzine in Obsessive–Compulsive Disorder
Authors: Vallejo J. , Olivares J. , Marcos T. , Bulbena A. , Menchón J. M.
Published: October 2008

A double-blind clinical trial of clomipramine versus phenelzine was carried out on 30 patients suffering from DSM–III obsessive–compulsive disorder. The study period was 12 weeks, and the maximum doses used (from the fifth week on) were 225 mg/day for clomipramine (14 patients) and 75 mg/day for phenelzine (12 patients); four patients dropped out. Obsessive symptoms improved significantly in both drug groups, but there was no significant difference between groups. Depressive symptoms improved before obsessive ones.
Post-traumatic Stress Disorder: the History of a Recent Concept
Authors: Gersons Berthold P. R. , Carlier Ingrid V. E.
Published: October 2008

This review describes the history of PTSD in relation to military psychiatry, physiology, and crisis theory. It appears that the consequences of psychic trauma are often underestimated and mental health services often fail to provide adequate care. PTSD may be explained as an initially adequate reaction to danger, which becomes pathological if it does not disappear after the danger is gone. The authors argue in favour of better psychiatric intervention after traumatic events and better care for trauma victims.
Relationship Between Iron Status and Chronic Akathisia in an In-patient Population with Chronic Schizophrenia
Authors: Barnes Thomas R. E. , Halstead Simon M. , Little Patrick W. A.
Published: October 2008

Iron status and akathisia were assessed in 105 long-stay in-patients who fulfilled DSM–III–R criteria for schizophrenia, all but three of whom were receiving antipsychotic medication. Chronic akathisia was diagnosed in 23% and pseudoakathisia in 20%. No significant correlation was found between serum iron concentration and the severity of akathisia. There was no significant difference in serum iron concentration between patients with chronic akathisia and those without. However, serum iron and percentage saturation were significantly raised in patients with pseudoakathisia compared with patients with chronic akathisia, and tended to be higher than in patients with akathisia. These findings do not support an association between low serum iron and chronic akathisia.
Mentally Ill Sex Offenders
Authors: Craissati Jackie , Hodes Phil
Published: October 2008

Sex offenders suffering from psychotic illness formed an important small group of a regional secure unit's patients. Ten of the 11 such offenders had a diagnosis of schizophrenia. There was a complex relationship between their mental illness and offending.
Pisa Syndrome Mistaken for Conversion in an Adolescent
Authors: Fichtner Christopher G. , Pechter Bradley M. , Jobe Thomas H.
Published: October 2008

We present a case of acute dystonia in an adolescent, with features that fit the description of the Pisa syndrome. The symptoms developed postoperatively, in a non-psychiatric setting, following administration of antiemetic medication, and the phenomenon was misdiagnosed as a conversion disorder. This case reinforces previous reports cautioning against misinterpretation of dystonic reactions as functional disorders, especially in children and adolescents.
A Female Monozygotic Twin Pair Discordant for Transsexualism
Authors: Garden G. M. F. , Rothery D. J.
Published: October 2008

A 13-year-old girl was referred because of sexual identity problems. There was no mental illness or neurological abnormalities. As her twin sister had no sexual identity problems, it appears that transsexualism is not transmitted by a simple genetic mechanism.
Psychopharmacology and the Ethics of Resource Allocation
Authors: Healy David
Published: October 2008

The introduction of clozapine to current psychiatric practice is considered against a background of potential problems of resource allocation posed by the development of a number of ‘budget-busting’ drugs. It would appear that clinicians may increasingly have to operate within a climate in which the rights of individual patients to expensive treatments will seem to be pitted against the abilities of their communities to afford such treatments. Both clinicians and pharmaceutical companies have roles in the development of such conflicts.
Lymphocyte Response in Depressed Patients and Subjects Anticipating Bereavement
Authors: Spurrell M. T. , Creed F. H.
Published: October 2008

Lymphocyte response to stimulation with phytohaemagglutinin (PHA) was assessed in 11 patients with major depression and 8 subjects anticipating bereavement, in order to examine whether altered immune response (PHA stimulation index) was more closely related to depressed mood than to sleep and weight changes. No significant relationship was found between sleep or weight changes and immune response. Depression, measured using the HRSD (with and without sleep scores) and the BDI, was related differently in the two groups. For the depressed patients, increasing depression was associated with reduction in immune response; among those anticipating bereavement (with low depression scores), increasing depression was associated with enhanced immune response. A regression curve using data from both samples demonstrated an inverted ‘U’-shaped curve relating immune response to mild and severe depressed states. The results of this study suggest a hypothesis that may explain previous discrepant results and which requires testing on more subjects.
Psychiatry is More than a Science
Authors: Cawley R. H.
Published: October 2008

I propose that psychiatry is an applied science and in addition something more. I believe the advances in its scientific content, over the last four decades, may have dazzled us into blindness, or at least made us inarticulate, about the dimension which does not fall within the boundaries of science. If that is true, the future of the subject is threatened by the neglect of one side of its foundations.
Classification and Treatment of Obsessional Slowness
Authors: Veale David
Published: October 2008

Obsessional slowness is regarded as an uncommon but severely disabling variant of obsessive-compulsive disorder. This paper examines the psychopathology, classification, pathophysiology and treatment of obsessional slowness. It argues that primary obsessional slowness does not require classification as a separate syndrome because it can be found to be secondary to recognised phenomena of obsessive-compulsive disorder or anankastic personality disorder. The treatment described in the literature is not thought to be successful in the long term, and controlled trials are required to evaluate new strategies and antidepressant medication.
The Problem of Detecting Changes in the Incidence of Schizophrenia
Authors: Kendell R. E. , Malcolm D. E. , Adams W.
Published: October 2008

Despite reports of falling first-admission rates for schizophrenia in the UK and other Western countries, it would be rash to conclude that the incidence of schizophrenia is falling. An attempt was made to tackle the many methodological problems and sources of bias influencing the relationship between admission rates and incidence in an analysis of inception rates for schizophrenia and other psychoses in Edinburgh between 1971 and 1989. However it was calculated, the inception rate for schizophrenia fell significantly, but because there was evidence that diagnostic criteria for schizophrenia had narrowed between 1971 and 1989, and because a substantial and changing proportion of recorded first admissions were not true first admissions, it was impossible to conclude that the incidence of schizophrenia had fallen. Changes in the incidence of psychiatric syndromes are difficult to establish, particularly in retrospect, and future studies must pay more attention to the many possible confounding influences.
Nosology, Taxonomy and the Classification Conundrum of the Functional Psychoses
Authors: Parshall A. M. , Priest R. G.
Published: October 2008

The theory underlying medical classification is not always given sufficient regard. Here systematic methods developed in biology are summarised and compared with parallel developments in nosology. The classification of the functional psychoses is discussed as an example of a methodological problem in medicine. We consider that cladism could have a useful application in nosology, and could lead to classifications based on the concept of interrelationships of disease.
The Distribution of Adipose Tissue in Female In-patients Receiving Psychotropic Drugs
Authors: Stedman Terry , Welham Joy
Published: October 2008

Of 51 long-term female in-patients receiving psychotropic drugs, 62% were overweight or obese, and 73% were centrally obese to a degree which could be dangerous to their health. The patients also had waist: hip ratios which were significantly higher than expected for their age and obesity (P< 0.01).
Ganser Syndrome Followed by Major Depressive Episode
Authors: Haddad Peter M.
Published: October 2008

A case of complete Ganser syndrome resolved after one week, but was immediately followed by a major depressive episode. The two disorders had a common cause, which is best encapsulated in a psychodynamic formulation.
A Trial of Two Cognitive-Behavioural Methods of Treating Drug-Resistant Residual Psychotic Symptoms in Schizophrenic Patients: I. Outcome
Authors: Tarrier Nicholas , Beckett Richard , Harwood Sue , Baker Amanda , Yusupoff Lawrence , Ugarteburu Itziar
Published: October 2008

Despite neuroleptic medication, many schizophrenic patients continue to experience residual positive psychotic symptoms. These residual symptoms cause distress and disability. We report a controlled trial of two cognitive-behavioural treatments to alleviate residual hallucinations and delusions. Forty-nine patients were recruited into the trial, of whom 27 entered the trial and completed post-treatment assessment, and 23 were reassessed at six-month follow-up. Patients were randomly allocated to either coping strategy enhancement (CSE) or problem solving (PS). Half the patients were allocated to a high-expectancy positive demand condition and half to a counterdemand condition to evaluate expectation of improvement. Patients receiving either cognitive-behavioural treatment showed significant reductions in pyschotic symptoms compared with those in the waiting period, who showed no improvement. There was some evidence, although equivocal, that patients receiving CSE improved more than those receiving PS. There was no evidence that improvements generalised to negative symptoms or social functioning, nor was there evidence that expectancy of treatment benefit contributed to the treatment effect.
Treatment of Persistent Myoclonic Tardive Dystonia with Verapamil
Authors: Abad Vincent , Ovsiew Fred
Published: October 2008

A dramatic improvement in a patient with tardive dystonia was obtained with verapamil after the failure of other medicines. The use of verapamil or other calcium-channel blockers should be considered when treating drug-induced movement disorders.
Mood and Psychiatric Disturbance in HIV and AIDS: Changes Over Time
Authors: Fell Mary , Newman Stanton , Herns Mary , Durrance Pauline , Manji Hadi , Connolly Sean , McAllister Ruth , Weller Ian , Harrison Michael
Published: October 2008

A sample of 26 HIV seronegative, 59 HIV seropositive asymptomatic and 7 HIV seropositive symptomatic homosexual and bisexual men were assessed over two visits, a mean of 11 months apart, using the BDI, STAI, and CIS. Significant differences emerged between the symptomatic group and the other two groups. Past psychiatric history and the somatic items in the assessments accounted for some of these differences. The seropositive asymptomatic and the seronegative groups did not differ on any of the mood or psychiatric assessments, suggesting minimal effect on psychological well-being of seroconversion in the absence of symptoms.
Diagnostic Agreement in Psychiatry
Authors: Okasha A. , Sadek A. , Al-Haddad M. K. , Abdel-Mawgoud M.
Published: October 2008

A random sample of 100 new patients referred consecutively to the psychiatric hospital was assessed using the Arabic translation of the PSE. An abstract form was designed to include all PSE scores as well as the necessary extra data to make ICD-9, ICD-10, and DSM-III-R diagnoses. Kappa correlation was calculated for inter-rater and intra-rater reliability. Overall reliability and reliability of each major psychiatric diagnosis were compared between the three systems. The use of the PSE helped in achieving good agreement between Arab psychiatrists for all the three systems, but ICD-10 was found to have the highest reliability figures both for three-digit and four-digit psychiatric diagnoses.
ImpairedIn VivoImmune Responses in Patients with Melancholia
Authors: Hickie Ian , Hickie Catherine , Lloyd Andrew , Silove Derrick , Wakefield Denis
Published: October 2008

Previous attempts to establish a relationship between impaired cell-mediated immunity (CMI) and major mood disorders have been limited by a failure to explore the relevance of depressive subcategories or to assess CMI byin vivomethods. In this case-control study CMI was assessed in 57 patients with major depression (31 with melancholic, 26 with non-melancholic disorders), and in age- and sex-matched controls by bothin vitroandin vivoimmunological techniques. Compared with control subjects and patients with non-melancholic depression, patients with melancholia demonstrated reducedin vivoCMI as assessed by delayed-type hypersensitivity (DTH) skin responses. Although increasing age, severity of depression, hospital admission for treatment, and reported weight loss are correlates of melancholia, none of these factors alone, or in combination, accounted for the differences in DTH responses observed between the two depressive subtypes. These data suggest that impaired CMIin vivomay be limited to those with melancholic disorders. At this stage the factors which account for this effect are unclear.
Bipolar Disorder Associated with Primary Generalised Epilepsy
Authors: Howland Robert H.
Published: October 2008

A patient with bipolar disorder and primary generalised epilepsy, and a family history of psychiatric illness and epilepsy, is described. The episodic psychiatric symptoms were temporally correlated with epileptic discharges and absence seizures observed during repeated EEGs.
Patients' Perceptions of Family Emotional Climate and Outcome in Schizophrenia
Authors: Lebell Malca B. , Marder Stephen R. , Mintz Jim , Mintz Lois I. , Tompson Martha , Wirshing William , Johnston-Cronk Kathleen , McKenzie Joanne
Published: October 2008

Thirty-nine chronic schizophrenic male out-patients and their relatives were interviewed separately to assess their perceptions of their current relationships. Two simple 5-point rating scales predicted the risk of psychotic exacerbation during a one-year follow-up: patients' perceptions of the relatives' attitudes towards them, and patients' own attitudes towards the relatives. Survival analysis of data in a 2 × 2 factorial - combining degree of contact with the key relatives and the patients' perceptions of their relatives - found that patients in frequent contact with a positively perceived relative had significantly better survival rates without psychotic exacerbation. Patients' perceptions of their relatives may help identify patients at risk of exacerbation of their illness.
Down's Syndrome, Dementia, and Superoxide Dismutase
Authors: Dickinson M. J. , Singh I.
Published: October 2008

Mental handicap includes specific behavioural phenotypes apparently caused by single enzyme errors or deletions, for example, compulsive self-mutilation and hypoxanthine-guanine phosphoribosyl transferase deficiency in the Lesch-Nyham syndrome. In Down's syndrome, the possession of additional genetic material is found to be linked to various physical abnormalities (premature cataract formation and hypothyroidism). These close associations between types of behaviour, illnesses, and known genetic abnormalities offer promising avenues for research. In this article we concentrate on the well known link between Down's syndrome and presenile dementia.
Worsening of Pica as a Symptom of Depressive Illness in a Person with Severe Mental Handicap
Authors: Jawed Syed H. , Krishnan Vallepur H. R. , Prasher Verinder P. , Corbett John A.
Published: October 2008

The case of a person with severe mental handicap whose pica became uncontrollable during episodes of depressive illness Is described. Treatment of the depression with lofepramine markedly reduced the pica, and withdrawal of lofepramine led to recurrence. It is suggested that biological symptoms of depression should be monitored in people with severe mental handicap who show significant episodic worsening of long-standing repetitive behaviour.
Familial Cosegregation of Affective Disorder and Hailey-Hailey Disease
Authors: Körner Judith , Rietschel Marcella , Nöthen Markus M. , Wilk Carl M. , Bauer Ralf , Propping Peter , Möller Hans-Jürgen
Published: October 2008

We report on a family with co-occurrence of affective disorder and Hailey-Hailey disease in two brothers and the mother. The putative chromosomal locus of Hailey-Hailey disease, which is a rare dominantly inherited dermatosis, may be a promising candidate region for genetic studies in affective disorder.

British Journal of Psychiatry (1993), 163, 109–110
Secondary Prevention of Non-fatal Deliberate Self-harm
Authors: Morgan H. G. , Jones E. M. , Owen J. H.
Published: October 2008

In an attempt to address the low compliance with offers of treatment shown by patients after episodes of non-fatal deliberate self-harm (DSH), patients who had harmed themselves for the first time were offered rapid, easy access to on-call trainee psychiatrists in the event of further difficulties, and they were encouraged to seek help at an early stage should such problems arise. The follow-up data obtained after one year showed a significant reduction of actual or seriously threatened DSH in the experimental group, who also made considerably less demands on medical and psychiatric services, when compared with controls.

British Journal of Psychiatry (1993), 163, 111–112
The Relationship Between Social Dysfunctioning and Psychopathology among Primary Care Attenders
Authors: Wohlfarth Tamar D. , Van Den Brink Wim , Ormel Johan , Koeter Maarten W. J. , Oldehinkel Albertine J.
Published: October 2008

The extent of social dysfunctioning and its relationship to psychological disorders among Dutch primary care patients was examined. Social dysfunctioning in these patients was rather limited, but was more pronounced in patients with a psychological disorder than in those without. Disabilities were largely restricted to the occupational and social roles, with family role functioning and self-care relatively intact. Social dysfunctioning was moderately related to psychopathology, with higher levels of dysfunctioning in more severe and depressed cases. The extent of social dysfunctioning among patients with both anxiety and depression was similar to that of patients with a single diagnosis of depression. Depressed patients had a similar level of dysfunctioning to non-psychotic psychiatric out-patients. Analyses regarding the effects of diagnosis and severity on social dysfunctioning revealed considerable overlap between these two aspects of psychopathology. This study supports the need for a simultaneous but separate assessment of psychopathology and social dysfunctioning. However, future research should incorporate additional predictors of social dysfunctioning (e.g. personality, life events, long-term difficulties, physical disorders), and prospective studies should be conducted to clarify the temporal sequences of symptom severity, diagnosis, and comorbidity on the one hand, and social dysfunctioning on the other.
Coping Strategies of Schizophrenic Patients and their Relationship to Outcome
Authors: Lee Peter W. H. , Lieh-Mak F. , Yu K. K. , Spinks J. A.
Published: October 2008

The experience and perception of effective sources of help of 101 schizophrenic patients were studied. A combination of professional help, social support, and self-coping efforts was listed as helpful. The more experiences patients had with the various sources of help, the better were their outcomes. Premorbid adjustment, exposure to the magnitude and nature of helpful sources, as well as the patients' own ability and motivation to make use of available helpful sources were thought to be important mediating variables for a better outcome. Apart from psychotropic medications, over half of the patients were not using any one of the sources of help mentioned. It remains an important research question whether or not schizophrenic patients may benefit from direct coaching in self-help skills in conjunction with making optimal use of professional and environmental supports.
A Randomised Controlled Trial of Psychotherapy in Patients with Refractory Irritable Bowel Syndrome
Authors: Guthrie Elspeth , Creed Francis , Dawson David , Tomenson Barbara
Published: October 2008

Patients with chronic, refractory irritable bowel syndrome (n =102) were entered into a randomised controlled trial of psychotherapy versus supportive listening. Independent physical and psychological assessments were carried out at the beginning and end of the 12-week trial. For women, psychotherapy was found to be superior to supportive listening, in terms of an improvement in both physical and psychological symptoms. There was a similar trend for men, but this did not reach significance. Following completion of the trial, patients in the control group were offered psychotherapy; 33 accepted and following treatment experienced a marked improvement in their symptoms; ten declined. At follow-up one year later, those patients who had received psychotherapy remained well, patients who had dropped out of the trial were unwell with severe symptoms, and most of the controls who declined psychotherapy had relapsed. This study shows that psychotherapy is feasible and effective in the majority of irritable bowel syndrome patients with chronic symptoms unresponsive to medical treatment.
Psychiatric Morbidity in Older People with Moderate and Severe Learning Disability
Authors: Patel Pradip , Goldberg David , Moss Steve
Published: October 2008

We present a prevalence study of psychiatric morbidity in people over 50 years of age with learning disability (LD), using a new semistructured clinical interview specifically for use with people who have LD (the ‘PAS-ADD’). Assessment involved parallel interviewing of subject and informant, these two sets of information being combined to reach a final diagnosis using ICD-9 and DSM-III-R criteria. Detection of dementia involved interviews with informants, plus investigation of loss of cognitive function over a three-year period. The experimental sample was a mixed community and institutional group (n = 105), including, as far as possible, all people in a single administrative district (Oldham) matching the age and ability criteria. Prevalence of psychiatric disorder excluding dementia was 11.4% (n = 12), most of which were depression and anxiety. Seventy-five per cent of these cases were unknown to mental health services. However, immediate care staff were usually aware of the symptoms, although often unaware of their clinical significance. Prevalence of dementia was also 11.4% (n = 12), with a combined case prevalence of 21.0% (n = 22). The PAS-ADD proved a flexible interview, effective in use with people of varying linguistic level and intellectual ability: 61.9% (n = 65) of the sample were able to be interviewed, fully adequate clinical interviews being obtained with a group of 38 people whose mean IQ was only 39. In the remaining 38.1% (n = 40), diagnosis relied exclusively on informant data. Overall, the combination of subject and informant data was essential for sensitive case detection.