bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Cognitive Decline in the Elderly by Informant Interview
Authors: Jorm A. F. , Korten A. E.
Published: August 2008

Cognitive decline in a sample of 64 elderly people was assessed by a standardised informant interview dealing with changes in memory and intelligence which had taken place in the previous 10 years. Scores from the interview were found to correlate (r=0.74) with the Mini-Mental State Examination. Moreover, the informant interview was found to be less affected by pre-morbid ability than the MMSE. Direct assessment of decline by informants may be a solution to the problem of contamination by pre-morbid ability which affects traditional cognitive screening instruments.
Therapist Contact and Outcome of Self-exposure Treatment for Phobias
Authors: Ghosh A. , Marks I. M. , Carr A. C.
Published: August 2008

Eighty-four chronic phobic patients were randomly assigned to self-exposurein vivoinstructed by either a psychiatrist, a computer or a book; mean therapy time per patient was respectively 3.1, 3.2 and 0 hours. Seventy-one patients completed treatment. All three groups improved substantially and similarly to 6 months follow-up, with no significant difference between them; self-exposure treatment was effective even without therapist contact. Among the three groups, initial expectation of help and positive attitude to the psychiatrist were equally high and related to subsequent rating of help received. All three groups rated the psychiatrist as more tolerant, reliable, and understanding than the computer or book, but these attitudes did not relate to outcome, were initially similar among all three groups, and changed minimally at 6 months follow-up.
Polydipsia in Chronic Psychiatric Patients
Authors: Delva Nicholas J. , Crammer John L.
Published: August 2008

Eight chronic psychiatric in-patients with polydipsia, and polyuria, up to 22 litres per 24 hours, were studied by frequent timed body weight and urine volume measurements, and episodic plasma electrolyte estimations. During the day they all showed irregular water retention, with hyponatremia in proportion to the weight gain. During the night they always lost water and weight, returning to their individual lowest weights and to normal plasma sodium. Measurement of weight in chronic psychiatric patients can be used to identify patients with significant polydipsia, to monitor those with the disorder and permit targeted fluid restriction, and to assess the efficacy of treatment procedures such as medication.
Heterogeneity of Tardive Dyskinesia
Authors: Glazer William M. , Morgenstern Hal , Niedzwiecki Donna , Hughes Jeffrey
Published: August 2008

To determine whether tardive dyskinesia (TD) is a single abnormal movement syndrome or multiple syndromes involving different anatomical areas, we examined 228 out-patients diagnosed with TD at the Connecticut Mental Health Center in New Haven. Application of factor analysis to the seven anatomical severity scores of the Abnormal Involuntary Movement Scale yielded three statistically independent factors involving abnormal movements primarily of the jaw-tongue, face-lips, and extremities-trunk. Using logistic regression to predict the severity of these factors, we found that the severity of the orofacial scores was positively associated with age, schizoaffective or affective disorder, and living alone, while severity of non-orofacial movement was positively associated with current neuroleptic dose, non-use of psychiatric medication, and living alone. Our findings suggest that orofacial and non-orofacial dyskinetic movements may involve distinct clinical syndromes of TD, each having a different set of prognostic and, possibly, aetiological determinants.
Psychotherapy and Dysmorphophobia: A Case Report
Authors: Bloch Sidney , Glue Paul
Published: August 2008

The treatment of patients with dysmorphophobia remains a confused matter, probably because of clinical heterogeneity. Our experience with the case reported in this paper suggests that psychodynamic psychotherapy is indicated for certain carefully selected patients.
Another Calendar Savant
Authors: Hurst Lindsay C. , Mulhall David J.
Published: August 2008

A 38-year-old patient, who can give the day of the week of any day this century, is described. He is believed to have been autistic in early childhood. The relationship of the autistic child and the adolescent idiot savant is discussed and brief reference made to the patient's method.
An Outcome Study of Gamblers Anonymous
Authors: Stewart Ruth M. , Brown R. Iain F.
Published: August 2008

Retrospective and prospective studies of a total sample of 232 attenders at groups of Gamblers Anonymous suggest that total abstinence from gambling was maintained by 8% of all comers at one year from first attendance and by 7% at two years.
Schizophrenic Thought Disorder
Authors: Cutting J. , Murphy D.
Published: August 2008

It is suggested that schizophrenic thought disorder comprises four relatively independent components: delusion; intrinsic thinking disturbance; formal thought disorder; and deficient real-world knowledge – a new concept. Schizophrenic and neurotic control subjects were given tests of thinking, perception, appreciation of conversational discourse, and social and practical knowledge. Not all deluded schizophrenics had intrinsic thinking disturbance. Those that did tended to have overinclusive categorisation as the most apparent deficit. Formal thought disorder was associated with a poor performance on the test of conversational discourse. The most striking result was that 75% of schizophrenic patients were markedly deficient, relative to neurotic patients, on their knowledge of everyday social issues.
The Significance of Depression in the Prediction of Relapse in Chronic Schizophrenia
Authors: Johnson D. A. W.
Published: August 2008

The prospective monitoring of two separate groups of chronically schizophrenic patients on regular depot maintenance therapy suggests that depression developing after an interval of 1 year from recovery from an acute relapse indicates a significant increase in the risk of a further relapse within 2 years, compared with depression within the first year, or no depression. Patients with such depression were more prone to relapses than other patients, despite regular medication within normal dose ranges. The results suggest that the aetiology of depression occurring in patients after 1 year in a stable mental state is different from that of depression within the first year, and in many patients, the former represents underlying schizophrenic activity prior to an early relapse.
Partly Dominant Transmission of Schizophrenia in Iceland
Authors: Karlsson Jon L.
Published: August 2008

Voluminous data on the familial distribution of schizophrenia in Iceland were evaluated in terms of a partly dominant genetic mechanism. The risks were found in most instances to be proportional to the probability of harbouring the proposed gene, but penetrance rates, which generally are around 25%, appear to be elevated when additional risk factors are present. This occurs in individuals with multiple ill relatives, in offspring of two schizophrenic people, or in monozygotic co-twins. Excessive risks also occur in families with unusually severe disease.
Elderly Offenders
Authors: Taylor Pamela J. , Parrott Janet M.
Published: August 2008

Among custodially remanded male prisoners from Greater London and its surrounds, in 1979–1980, nearly 3% (63 men) were aged 55 or over, about one-third of these being over 65. More than 40% were detained on theft charges and few for more serious offences, although serious violence was not unknown and nearly one-fifth of those 65 or over were subsequently convicted of non-violent sexual assaults. Like their younger counterparts, less than one-fifth of those aged 55 or over appeared to be first-time offenders. About half of the men of 55 or over had active symptoms of psychiatric disorder on entering the prison and about half had some form of physical disorder, twice the rates for those under 55. Psychosis and alcoholism were the major psychiatric problems; 27% were alcoholics, to the extent of showing withdrawal symptoms on or soon after entering prison. Schizophrenia was less common than the younger age groups, but affective psychosis more so; 37% of the older men had a major functional psychosis. Two-thirds of the 55–64 age group and over three-quarters of the over 65s were without an address; most of both groups were personally isolated.
Increased Mortality Rates in Late-life Depression
Authors: Murphy Elaine , Smith Rae , Lindesay James , Slattery Jim
Published: August 2008

Physical illness at referral and subsequent mortality were studied in a group of elderly patients with depression, and compared with age/sex-matched controls. The depressed group was significantly less well at first interview, and had a significantly higher 4–year mortality. When the effect of physical illness was controlled, the depressed patients (particularly the men) still had a significantly higher 4–year mortality, suggesting that the greater mortality in the depressed group was not due to differences in physical health alone.
Suicide, and Other Causes of Death, Following Attempted Suicide
Authors: Hawton Keith , Fagg Joan
Published: August 2008

The number of deaths in a large series of suicide attempters followed up after their attempts was 3.3 times greater than expected. Suicide or probable suicide occurred in 2.8% by the end of the eighth year of follow-up, the rate of suicidal deaths being 26.9 times the expected rate. The highest risk of suicide was during the first 3 years, especially in the first 6 months, following an attempt. Factors identified at the time of the attempts which were associated with suicide risk included: being male, advancing age (females only), psychiatric disorder (especially schizophrenia), long-term use of hypnotics, poor physical health, and repeat attempts. Recent disruption of a relationship with a partner and major rows rarely preceded the attempts of those who later killed themselves. Factors predicting long-term risk of suicide also predicted short-term risk. There were more than double the expected number of deaths from natural causes, the excess being greatest in females. Markedly high death rates were found for endocrine, circulatory and respiratory diseases, and accidents.
Clinical Assessment of Anorexia Nervosa
Authors: Morgan H. G. , Hayward A. E.
Published: August 2008

The Morgan-Russell outcome assessment schedule is described and statistically analysed with reference to two independent series of patients suffering from anorexia nervosa. The value of check lists and simple scaling of data is emphasised as one way of improving the standards of routine case-note documentation in clinical psychiatric practice.
Asperger's Syndrome and Autism: The Case for a Connection
Authors: Bowman Eimer Philbin
Published: August 2008

There is considerable disagreement on the classification of Asperger's syndrome and its relationship to autism. Unlike autism, Asperger's is not usually recognised before 30 months of age, and speech delay is not typical. However, if a child exhibits all the symptoms of autism apart from these two features, are these sufficient grounds for withholding a diagnosis of autism? This paper describes four boys and their father who, by presenting at various points on the autistic/Asperger spectrum, embody this dilemma for the diagnostician. The implications for research and clinical practice are discussed.
Twin Birth and Adult Psychiatric Disorder
Authors: Chitkara Bina , MacDonald Alison , Reveley Adrianne M.
Published: August 2008

We compared the general distribution of diagnoses in 20 895 patients at the Maudsley Hospital with that of 504 patients born twins, including 117 twins where the co-twin had died before the age of 15. Significant differences in diagnostic distribution were found in the co-twin-dead compared with the co-twin-alive group; the former received diagnoses of schizophrenia, personality disorder, or substance abuse more often than the latter. While there were no overall differences between twins and non-twins, there were relatively more twins in the above three diagnostic groups. We suggest that the factors leading to the death of one twin are implicated in the later psychiatric morbidity of the survivor.
Munchausen Syndrome
Authors: Humphries S. R.
Published: August 2008

A case report of a 37-year-old woman with Munchausen syndrome which differs in many respects from the classical picture is described. Attempts are made to examine the motives behind the syndrome and to make a link with the common pattern of deliberate self-harm.
Fatal Deliberate Self-Harm seen in a Sri Lankan Hospital
Authors: Ganesvaran T. , Rajarajeswaran R.
Published: August 2008

A total of 328 patients were admitted for deliberate self harm (DSH) to the General Hospital Jaffna, Sri Lanka, during the year 1984. Twenty-two of these patients succumbed to their injuries. Information about these patients collected before death, and their methods of suicide, are reported.
The Scottish First Episode Schizophrenia Study V. One-year Follow-up
Authors: McCreadie Robin G. , Wiles David H. , Grant Stewart M. , Moore John W. , Crocket George T. , Mahmood Zahid , Livingston Martin G. , Watt James A. G. , Greene J. G. , Kershaw Peter W. , Todd Norman A. , Scott Angus M. , Loudon John , Dyer James A. T. , Philip Alistair E. , Batchelor David
Published: August 2008

Of 49 schizophrenic patients followed up 12 months after their first admission to hospital, only about 45% had experienced no relapse and had no schizophrenic symptoms; a poorer outcome was more often found in Feighner positive than Feighner negative schizophrenic patients. The patients' overall level of unemployment had more than doubled to 51%. In patients whose acute episodes responded to treatment, pimozide taken once weekly as maintenance therapy was as effective as intramuscular flupenthixol decanoate, but tardive dyskinesia appeared in two patients receiving weekly pimozide; the repeat psychometric assessment at 12 months found modest improvements, i.e. no evidence of intellectual decline, in Matrices, Block Design, and Digit Copying tests. Forty per cent of relatives still showed significant psychological distress, which correlated with patients' schizophrenic symptoms, and the relatives' social functioning remained poorer than that of a normal community sample.
The Nithsdale Schizophrenia Survey VII. Does Relatives' High Expressed Emotion Predict Relapse?
Authors: McCreadie R. G. , Phillips K.
Published: August 2008

A review of all known schizophrenic people living in Nithsdale in South-West Scotland identified long-stay in-patients, patients living on their own and those living with relatives showing low or high expressed emotion (EE). A prospective 12-month follow-up identified relapsing patients, defined as those readmitted to hospital with exacerbation of schizophrenic symptoms or a fresh episode of illness, or, if not readmitted, with a significant increase in antipsychotic medication. There was no difference in relapse rates in patients living on their own, with low-EE, or with high-EE relatives. Amount of contact with high-EE relatives did not affect relapse rates. The different results obtained from the Nithsdale group compared with one from Camberwell are discussed.
Hospital-treated and General-population Morbidity from Affective Disorders
Authors: Sashidharan S. P. , Surtees P. G. , Kreitman N. B. , Ingham J. G. , Miller P. McC.
Published: August 2008

In this study, we compare the rates of psychiatric disorders found among women in a random sample of the general population with those of patients referred to specialist services. Both these groups were drawn from the same geographical area. The ratio of prevalence rates is less than the ratio between inception rates in the two groups. When only those with affective disorders were considered, the results revealed that the point prevalence in the treated-disorders group was only 1% of the community-group prevalence, while the inception into care in the former group was nearly 6% of that in the latter. Single women and older women were over-represented in the hospital sample.
Clomipramine, Self-exposure and Therapist-aided Exposure for Obsessive–Compulsive Rituals
Authors: Marks I. M. , Lelliott P. , Basoglu M. , Noshirvani H. , Monteiro W. , Cohen D. , Kasvikis Y.
Published: August 2008

A randomised treatment design for 49 chronically obsessive–compulsive ritualising patients was devised and three controlled comparisons were made. 1. During 7 weeks of self-exposure instructions, clomipramine treatment improved some measures of rituals and depression significantly more than did placebo medication; this effect was transient and disappeared as drug treatment and exposure were continued for a further 15 weeks. 2. During 11–16 weeks of clomipramine treatment, self-exposure instructions yielded highly significantly more patient improvement than did anti-exposure instructions on nearly all measures of rituals and some of social adjustment. 3. Adding therapist-aided exposure (1.3 hours) to self-exposure instructions (3 hours) after 8 weeks had a barely significant transient effect of dubious clinical value, which was lost by the end of exposure (at week 23) and during follow-up assessments to week 52. We conclude that of the three therapeutic factors tested, self-exposure was the most potent; clomipramine played a limited adjuvant role, and therapist-aided exposure a marginal one.
Pseudocyesis Preceding Psychosis
Authors: Mortimer Ann , Banbery Jo
Published: August 2008

Pseudocyesis is an uncommon condition in which the psychological and somatic phenomena are usually thought to arise with neurotic rather than psychotic illness. We report a patient whose pseudocyesis took a course not previously described, culminating in an acute schizophrenic episode. Despite this she demonstrated many similarities with neurotic patients previously described in the literature. A phenomenological explanation, the belief of pregnancy as an overvalued idea, is discussed.
Community Psychiatry
Authors: Forster D. P.
Published: August 2008

The definition of community psychiatry is, of course, a central issue in any personal choice of books or articles about this field. The topic may be interpreted as the study of the provision of psychiatric and related services for the optimal care of the whole community or population. Alternatively, the concept may be confined to all services except hospital residential care, or even to more restrictive definitions. My preference is to adopt the wider definition on the basis of Gestalt theory applied to organisations. That is to say, non-hospital care may have characteristics of its own, but it will also have characteristics which result from its inclusion in the whole programme of psychiatric and social care available. Hence, community psychiatry is only understandable in the context of all forms of care. The interaction of the clinical and organisational roles in community psychiatry is probably more important for good patient care than in any other clinical specialty. In reading about this topic, therefore, a balance has to be struck between clinical psychology and psychiatry and their related skills on the one hand and an understanding of management and its skills on the other.
The Assessment of Psychophysiological Reactivity to the Expressed Emotion of the Relatives of Schizophrenic Patients
Authors: Tarrier Nicholas , Barrowclough Christine , Porceddu Kathleen , Watts Susan
Published: August 2008

The measure of expressed emotion (EE) of the relative has been found to be an important predictor of schizophrenic relapse. Electrodermal measures were recorded when the schizophrenic patient was talking to an experimenter, and when the patient was talking to a relative. Although there were no differences during the relative-absent period, patients with a high-EE relative present exhibited significantly higher frequencies of non-specific skin-conductance responses (NS-SCRs) than patients with a low-EE relative present. Patients show a significant decrease in NS-SCRs on the entry of low-EE, but not high-EE relatives. Patients with high-EE relatives show overall higher levels of skin-conductance levels (SCLs) than patients with low-EE relatives. Although patients with high-EE relatives rate themselves significantly more tense and anxious on self-rating scales, there are no significant correlations between self-ratings and electrodermal measures. The use of electrodermal reactivity as an assessment measure of relapse risk is discussed.
Prevalence of Transsexualism in the Netherlands
Authors: Eklund P. L. E. , Gooren L. J. G. , Bezemer P. D.
Published: August 2008

On the basis of the records of subjects undergoing cross-gender hormonal treatment at the only gender treatment centre in the Netherlands, the prevalence of transsexualism was assessed over the years 1976–1986. In 1980, the prevalence was 1:45 000 for male-to-female and 1:200 000 for female-to-male transsexuals. In 1986 the prevalence for male-to-female transsexuals was 1:18 000, and for female-to-male transsexuals, 1:54 000. The increased prevalence is apparently due to a lower threshold for applying for medical treatment rather than to a true increase in the prevalence. Nevertheless, the calculated prevalence is higher than hitherto recorded. The ratio of male-to-female compared with female-to-male transsexuals was found to remain constant at 3:1.
Cerebral Blood Flow in Chronic Cocaine Users: A Study with Positron Emission Tomography
Authors: Volkow Nora D. , Mullani Nizar , Gould K. Lance , Adler Stephen , Krajewski Kenneth
Published: August 2008

Occurrence of cerebrovascular accidents has been associated with cocaine abuse. We investigated the relative distribution of cerebral blood flow (CBF) in groups of chronic cocaine users, and of normal controls. Relative CBF was measured using positron emission tomography and 15oxygen-labelled water. The cocaine users showed areas of deranged CBF as evidenced by patchy regions of defective isotope accumulation throughout their brain. The chronic cocaine users showed decreased relative CBF in the prefrontal cortex when compared with normal subjects. The repeated scans of some cocaine users, after 10 days of cocaine withdrawal, continued to show decreased relative CBF of the prefrontal cortex. We hypothesise that some of the widespread defects in CBF in the cocaine users could reflect the effects of vasospasm in cerebral arteries exposed chronically to the sympathomimetic actions of cocaine.
The Dexamethasone Suppression Test in Bulimia Nervosa
Authors: O'Brien G. , Hassanyeh F. , Leake A. , Schapira K. , White M. , Ferrier I. N.
Published: August 2008

In a study of the dexamethasone suppression test (DST) in patients with bulimia nervosa, a non-suppression rate of about 50% was found. The only clinical correlates of DST non-suppression were a previous history of weight loss and/or of anorexia nervosa. These results suggest that DST non-suppression in these subjects may be a trait rather than a state marker of anorexia nervosa.
Predicting the Response of Depressed Patients to Biological Treatment: the Dexamethasone Suppression Test Versus Clinical Judgement
Authors: Myers E. D.
Published: August 2008

A dexamethasone suppression test (DST) was carried out in a heterogeneous sample of 174 depressed patients. In a subsample of 130 patients in whom biological antidepressive treatment had been commenced either because of an initial clinical judgement of ‘endogenicity’ or because of subsequent evidence of DST non-suppression, the response to treatment was globally assessed. The results showed no significant differences between the two groups in the numbers of patients responding favourably to treatment. The positive predictive value of DST non-suppression for a favourable response was no higher than that of clinical judgement, and there was little difference between the sensitivity and specificity of the two predictors.
AIMS Ratings – Repeatability
Authors: Bergen J. A. , Carter N. B. , Craig J. , MacFarlane D. , Smith E. F. , Beumont P. J. V.
Published: August 2008

In the present study, two raters, a psychologist and a nurse, each made five independent ratings of 30 different video-recorded patient-examinations. Having thus excluded patient fluctuation, individual-rater consistency and between-rater agreement over the 6 weeks of the study are examined. While between-rater agreement was apparently being maintained, mean AIMS scores steadily increased. In the hands of these raters, AIMS items 2 and 4 emerged as very reliable, while items 1, 6, and 7 showed high variability. Some patients appeared to be hard to rate. Differences between the study raters and the author JB highlight the issue: how reproducible is an AIMS rating?
Patterns of Psychiatric Morbidity in a Genito-urinary Clinic
Authors: Barczak P. , Kane N. , Andrews S. , Congdon A. M. , Clay J. C. , Betts T.
Published: August 2008

The prevalence of psychiatric disorder (by DSM–III criteria) in a population attending a genito-urinary clinic was found to be 31%. The performance of the Hospital Anxiety Depression (HAD) scale as a screening questionnaire for psychiatric disorder was assessed. Case definition by a score of 8 or more on either of the anxiety or depressive subscales produced optimal results, giving sensitivities of 82% and 70%, and specificities of 94% and 68%, for depressive and anxiety disorders respectively.
Schizophreniform Psychosis Associated with the Menstrual Cycle
Authors: Gerada Clare , Reveley Adrianne
Published: August 2008

The premenstrual and menstrual periods are associated with increased psychiatric disturbances, both of a psychotic and neurotic nature. Pre-existing psychosis can worsen in the premenstrual period, or, as we describe in the following case report, a psychosis can occur in the premenstrual period with complete remission once the bleeding has ceased. The role of menstruation in the timing and pathogenesis of the major psychoses is largely ignored in present-day psychiatry. In the nineteenth century, however, psychosis coincident with menstruation was thought to merit its own special term (Menstruationpsychose), and Kraepelin himself described the importance of the association (Kraepelin, 1909). In contrast, premenstrual tension has been the subject of continuous interest since the term was first used by Frank (1931), and there have been cases described of premenstrual tension in association with psychosis. Williams & Weeks (1952), for example, reported on 16 cases where the psychosis was characteristic of mania or catatonic schizophrenia, and more recently, Price & DiMarzio (1986) found that 60% of a group of rapidly cycling manic-depressive psychotics suffered from severe premenstrual tension. Psychosis associated with the menstrual cycle without concomitant symptoms of premenstrual tension has also been described. Lingjaerde & Bredland (1954) presented a case of a 24-year-old woman who developed a manic–depressive (manic-type) psychosis synchronous with her menstrual cycle, after childbirth. A Japanese cohort of patients diagnosed as suffering from “periodic psychosis” (Wakoh et al, 1960) showed significant correlation between acute psychosis and the luteal phase of the menstrual cycle. The premenstrual period is also known to exacerbate pre-existing psychosis; Ota et al (1954) and Gregory (1957) have shown a significant increase in psychotic behaviour in the last 10 days of the menstrual cycle. We present a patient with a schizophreniform psychosis occurring irregularly but concomitant with her menstrual cycle, with total remission during the interval stage.
Molecular Genetics and Human Disease Implications for Modern Psychiatric Research and Practice
Authors: Baron Miron , Rainer John D.
Published: August 2008

Techniques of molecular genetics, including recombinant-DNA technology, are likely to have a key role in modern psychiatric research and practice. This article reviews some methods of DNA analysis and their applications to clinical science: specifically, how these methods can be used to localise, identify, isolate, and clone clinically important genes, and how this should enable us to elucidate the molecular pathology of most inherited (psychiatric) disorders. The implications of these developments for prevention and treatment of genetic disease are discussed.
The Camberwell Collaborative Depression Study III. Depression and Adversity in the Relatives of Depressed Probands
Authors: McGuffin P. , Katz R. , Bebbington P.
Published: August 2008

The relationship between life events and depressive disorder was assessed in 83 families ascertained through depressed probands. Contrary to expectation and to previous suggestions, we found no inverse relationship between the presence of familial loading and reactivity to stress. Thus the relatives of probands whose onset of depression followed life events or chronic difficulties had slightly higher lifetime rates of depression than the relatives of probands whose onset was not associated with adversity. There was only a weak and non-significant relationship between recent life events and current disorder among relatives, and no apparent tendency for life-event-associated depression to ‘breed true’ within families. Comparison with a community sample showed that the first-degree relatives of depressives had significantly elevated rates both of current depression and of recent threatening life events. This finding still held when proband-associated life events were discounted, suggesting that both liability to depression and propensity to experience life events are familial.
The Practice of Community Psychiatric Nursing and Mental Health Social Work in Salford Some Implications for Community Care
Authors: Wooff K. , Goldberg D. P. , Fryers T.
Published: August 2008

The context and content of work undertaken with individual clients by community psychiatric nurses (CPNs) and mental health social workers (MHSWs) in Salford were found to be significantly different. Although there were some areas of overlap, the ways in which the two professions worked were quite distinct. MHSWs discussed a wide range of topics and were as concerned with clients' interactions with family and community networks as they were with symptoms. Their interviews with schizophrenic clients followed a similar pattern to those with other groups, and they worked closely with psychiatrists and other mental health staff. CPNs, on the other hand, focused mainly on psychiatric symptoms, treatment arrangements, and medications, and spent significantly less time with individual psychotic clients than they did with patients suffering from neuroses. They were as likely to be in contact with general practitioners as they were with psychiatrists, and had fewer contacts with other mental health staff than the MHSWs. There was evidence that the long-term care of chronic psychiatric patients living outside hospital required more co-ordinated long-term multidisciplinary input.
Emotional Disturbances in Endocrine Patients
Authors: Lobo Antonio , Pérez-Echeverría Maria-Jesús , Jiménez-Aznárez Antonio , Sancho Maria-Antonia
Published: August 2008

The 28-item General Health Questionnaire (GHQ) has been validated against the criterion of the Clinical Interview Schedule (CIS) in Spanish patients in hospital with several types of endocrinological illnesses. The screening instrument correctly identified 91 of 100 respondents as exhibiting psychiatric disorder. The questionnaire's efficacy was similar at the time of medical discharge, when the rate of disorder was significantly lower. Significant correlations were found between GHQ total scores and endocrine blood measures in Addison's disease, and in Type I diabetes. The four subscales of the GHQ sum to provide additional information concerning somatic symptoms and anxiety.
A Follow-up Study on Alcoholics with and without Co-existing Affective Disorder
Authors: O'Sullivan K. , Rynne C. , Miller J. , O'Sullivan S. , Fitzpatrick V. , Hux M. , Cooney J. , Clare A.
Published: August 2008

Three-hundred male alcoholics were selected from consecutive admissions to hospital. They were divided into three diagnostic sub-groups: primary alcoholics; alcoholics with unipolar affective disorder; and alcoholics with bipolar affective disorder. After three follow-up interviews over a 2-year period after hospital discharge, the three sub-groups reported differences in frequency of mood change, amount of treatment received, and hospital attendance, although there were no clear-cut differences in items associated with their alcoholism. There were, however, some indications that bipolar patients functioned at a better level during the follow-up period, particularly those who were older, had a previous history of longer periods of abstinence, and maintained more frequent contact with Alcoholics Anonymous (AA) and their family doctor.
Influence of Climate on the Prevalence of Mania
Authors: Carney P. A. , Fitzgerald C. T. , Monaghan C. E.
Published: August 2008

Monthly rates of admission of manic patients to the Department of Psychiatry in Galway Regional Hospital were examined for a five-year period. Monthly variation in admission rates was compared with monthly levels of sunshine, temperature and daylength. Results indicated a significant seasonal variation in the prevalence of mania: admission rates were higher in the sunnier months and in months with a greater average daylength. It is suggested that the presentation of mania in this fashion is due to an abnormal response to light in these patients.
The Accident and Emergency Department Management of Deliberate Self-Poisoning
Authors: Owens David W. , Jones Susan J.
Published: August 2008

Consecutive attenders (525) presenting at the Nottingham Accident and Emergency (A & E) department with deliberate self-poisoning were identified retrospectively. Their case-notes were examined for patient characteristics and clinical management. The Nottingham Psychiatric Case Register was examined for previous contact and use of psychiatric services over a 2-year follow-up period. Significant differences were found between those patients admitted to a ward and those who returned home from the A & E Department, in respect of likelihood of psychiatric morbidity and use of psychiatric services. One in three self-poisoning patients returns home directly from the accident department, and there seemed to be appropriate selection.
School Refusal: a 15–20-year Follow-up Study of 35 Swedish Urban Children
Authors: Flakierska Natalia , Lindström Marianne , Gillberg Christopher
Published: August 2008

Results from a 15–20-year follow-up study of 35 7–12–year-old children with school refusal and 35 age- and sex-matched comparison children are reported. The school refusal cases had applied for out-patient adult psychiatric care more often than comparison children. Also they had fewer children of their own. In respect of overall social adjustment and severe psychiatric disorders requiring in-patient treatment, there were no important differences.
Two Cases of Hypomania in AIDS
Authors: Schmidt Ulrike , Miller David
Published: August 2008

HIV disease often leads to neuropsychiatric disturbance, either through direct infection of the brain by the virus or through CNS disease secondary to immunodeficiency. Neuropsychiatric complications of AIDS and AIDS-related disorders may present clinically as acute or chronic organic mental syndromes, or may mimic functional psychiatric illness, in particular depression, anxiety, or psychotic states. Two cases of hypomanic states in homosexual men suffering from AIDS are reported. Neither of the two men had a personal or family history of affective disorder. In one man, hypomanic symptoms were caused by early HIV encephalopathy; he rapidly developed typical HIV dementia with a marked downhill course. In the second case, a clear connection between the hypomanic symptoms and direct HIV brain involvement was not established.
Hypothyroidism in Down's Syndrome
Authors: Mani Chinta
Published: August 2008

Fifty-five adult Down's syndrome subjects resident at Northgate Hospital were screened for the presence of thyroid dysfunction. Approximately 50% of the subjects had clinical features suggestive of hypothyroidism, sufficient to require thyroid-function tests. Twenty-two per cent of the total suffered from some degree of hypothyroidism, and 16% had positive antibodies to thyroid tissue.
Prospective Electroconvulsive Therapy in a Delusional Depressed Patient with a Frontal Meningioma
Authors: Greenberg L. B. , Mofson R. , Fink M.
Published: August 2008

The prospective, successful, use of ECT in a patient with a frontal meningioma is described. The authors review the literature on ECT in patients with brain tumours, and suggest factors predictive of a favourable outcome.
Further Observations on the Practice of Community Care in Salford
Authors: Wooff K. , Goldberg D. P.
Published: August 2008

Differences in the clinical characteristics of clients have not been found to account for the interprofessional differences in community psychiatric nurses' and mental health social workers' practice in Salford. We found the consultant-attached mental health social workers, who worked closely with the specialist psychiatric team and who received supportive supervision from their professional managers, maintained stable case-loads, but the primary-care attached community psychiatric nurses, who were isolated from the specialist psychiatric team, and who received little supportive supervision from their professional managers, carried case-loads of increasing size. Failure to improve the way in which services for the mentally ill in the community are co-ordinated is likely to perpetuate the worst characteristics of life in the old back wards into the era of ‘community care’.
Self-Esteem – a Psychiatric View
Authors: Robson P. J.
Published: August 2008

The literature relating to the acquisition, maintenance, and clinical significance of self-esteem reveals theoretical differences between earlier investigators. The nature of self-esteem remains controversial, and attention is drawn to some of the problems of construct validation and measurement. Despite the difficulties, self-esteem is a concept worthy of further pursuit. This will require a measuring instrument that captures the concept more effectively than those currently available.
Blunted Response of Growth Hormone to Clonidine and Apomorphine in Endogenous Depression
Authors: Ansseau M. , Von Frenckell R. , Cerfontaine J. L. , Papart P. , Franck G. , Timsit-Berthier M. , Geenen V. , Legros J. J.
Published: August 2008

We measured the growth hormone (GH) response to clonidine (an alpha-2-adrenergic agonist) and to apomorphine (a dopaminergic agonist) in 15 major endogenous and 15 minor depressive in-patients matched for gender and age. Results showed a significantly smaller GH response in the major depressives to both Clonidine (P<0.01) and apomorphine (P<0.001). No significant difference existed between the two groups with regard to changes in blood pressure and pulse rate during either test. While major depressives showed a trend toward smaller sedative side-effects than minor depressives after Clonidine, they showed significantly smaller sedative and gastro-intestinal side-effects after apomorphine. No significant correlation was present either in the major depressive or in the minor depressive group between the GH responses following Clonidine and apomorphine challenges. These results support the hypothesis of both noradrenergic and dopaminergic neurotransmitter disturbances in major depression, with individual variability with regard to those biochemical anomalies.
Physical Complications in Anorexia Nervosa
Authors: Shur E. , Alloway R. , Obrecht R. , Russell G. F. M.
Published: August 2008

Of twelve patients consecutively admitted to the Maudsley Hospital Eating Disorders Unit, four had neuromuscular abnormality, eight haematological abnormality, and four no abnormality. All those having neuromuscular signs had concomitant haematological dysfunction. Vomiting, and food restriction with vegetarianism, appeared more likely to lead to complications than either food restriction alone or laxative abuse. The physical status of severely underweight patients admitted for refeeding needs to be carefully monitored.
Child and Family Factors Associated with Referral to Child Psychiatrists
Authors: Garralda M. E. , Bailey D.
Published: August 2008

We compared children aged 7–12 years referred to child psychiatrists by general practitioners (GPs) with community control children matched for the presence of psychiatric disorder. Referral status in psychiatrically disturbed children was linked to male sex, severity of the disorder, mental problems in the mothers, high levels of psychosocial stress in the family, and less support from extended families. For the whole group of referred children, the referral was associated with high antisocial scores on parental questionnaires, with parental reports of problems in controlling the children, and of high levels of stress felt in relation to them. In addition, parents of referred children were in disadvantaged socioeconomic groups.
Comprehension and Motivation in Responses to a Psychiatric Screening Instrument Validity of the SRQ in Ethiopia
Authors: Kortmann Frank , Ten Horn Sineke
Published: August 2008

The Self Reporting Questionnaire (SRQ), a psychiatric-case-finding instrument designed by the WHO for developing countries, was tested in Ethiopia. It was submitted to 40 patients attending a psychiatric clinic, 30 at a somatic clinic, and 40 subjects not attending a clinic. Forty per cent of the yes-answers were rated as invalid. The concept-invalidity contributed mainly to the rather poor criterion-validity of the SRQ. In addition, clinic patients seemed to heighten the number of yes-answers to express their need for help. The SRQ measured not only psychiatric complaints but also illness behaviour, even without the presence of any illness. This is a substantial disadvantage if the SRQ is applied to detect the psychiatric cases in the primary-care facilities.
A Comparison of Referrals to Primary-Care and Hospital Out-patient Clinics
Authors: Brown R. M. A. , Strathdee G. , Christie-Brown J. R. W. , Robinson P. H.
Published: August 2008

All referrals from two general practices to psychiatrists in hospital and primary-care out-patient clinics were examined. Women in all diagnostic groups were preferentially referred to the primary-care clinics, which provided especially for psychotic and chronic illnesses, and at which attendance rates on first and subsequent appointments were substantially higher than at the hospital clinics. The hospital crisis-intervention clinic dealt particularly with acute psychosis and personality disorder. Patients referred to the traditional hospital out-patient service were those with the less common neuroses and personality disorder. These results are reviewed in the context of the criticism that psychiatric clinics in primary care serve only the “worried well”.
Carbamazepine vs Lithium in the Treatment and Prophylaxis of Mania
Authors: Lusznat R. M. , Murphy D. P. , Nunn C. M. H.
Published: August 2008

Fifty-four acutely manic patients were allocated to treatment on a double-blind basis with either carbamazepine or lithium carbonate. The short-term effects of treatment were studied over a period of six weeks and the longer term, prophylactic, effects over a period of up to a year. Additional ‘rescue’ medication was allowed when clinically indicated. There was a high drop-out rate from the trial. Despite this, it appeared that valid comparisons between the two treatments could be made. No statistically significant differences were found, but carbamazepine appeared slightly less effective as a treatment for acute mania and more effective as a prophylactic treatment in this group of patients. Possible predictors of individual responsiveness to each treatment are discussed.
A Clinical Trial of the Efficacy and Acceptability of d-Fenfluramine in the Treatment of Neuroleptic-induced Obesity
Authors: Goodall E. , Oxtoby Christine , Richards Ray , Watkinson Gill , Brown David , Silversonte Trevor
Published: August 2008

Twenty-nine overweight schizophrenic patients maintained on depot neuroleptic injections who wished to lose weight took part in a double-blind, placebo-controlled trial of 30 mg d-fenfluramine. All subjects received dietary advice. Sixteen patients completed the 12-week trial. Rate of weight loss was significantly greater in those taking d-fenfluramine. Side-effects were reported, but no deterioration in mental state was noted.
Prevalence of Obesity in Patients Receiving Depot Antipsychotics
Authors: Silverstone T. , Smith Glenyss , Goodall Elizabeth
Published: August 2008

Antipsychotic drugs have long been noted to cause pronounced weight gain, and drug-induced obesity can assume major clinical importance in long-term medication in the management of chronic schizophrenia. Obesity is associated with increased morbidity and may reduce compliance, leading to a return of psychotic symptoms. In a survey of 226 patients attending depot neuroleptic clinics in one inner London borough, it was found that the prevalence of clinically relevant obesity was four times that in the general population.
Suicide and Parasuicide in a Hill Resort in Malaysia
Authors: Maniam T.
Published: August 2008

Ninety-five cases of suicide and 134 cases of parasuicide that occurred between October 1973 and September 1984 in the hill resort district of Cameron Highlands in Malaysia were analysed. Eighty-one per cent of suicides and 78% of parasuicides were of Indians, although they only form 25% of the population. The average annual suicide rate for Indians (over 10 years of age) was 157 per 100000. About 94% of suicides and 66% of parasuicides were by ingesting agricultural poisons. The age- and sex-specific suicide rates for women were highest in the 20–24-year-old age group. Some possible reasons for high suicide rates among Indians are discussed.
Neuroleptic Malignant Syndrome in Striatonigral Degeneration
Authors: Gibb W. R. G.
Published: August 2008

A case of probable neuroleptic malignant syndrome (NMS) complicating l-dopa withdrawal in striatonigral degeneration is described. This case suggests that the hyperthermia of NMS is due to peripheral heat production associated with severe muscular rigidity secondary to withdrawal of striatal dopamine drive, rather than being centrally mediated by the hypothalamus, which is not involved in striatonigral degeneration.
Did Manic–Depressive Patients Who Committed Suicide Receive Prophylactic or Continuation Treatment at the Time?
Authors: Schou M. , Weeke A.
Published: August 2008

Ninety-two Danish manic–depressive patients with a first psychiatric admission between 1969 and 1983, who committed suicide before 1 July 1986, were considered. Information on any prophylactic or continuation treatment at the time of the suicide was obtained. In 64 of the patients, every precaution seems to have been taken: 28 patients committed suicide during ongoing treatment; 10 while not receiving prophylactic treatment (not indicated); 7 while not in prophylactic treatment because the patients refused or did not tolerate such; and 19 while in prophylactic treatment with antidepressants (10), or lithium (6), or both (3), in usually adequate dosage. In 28 of the patients, suicide might have been obviated. Guidelines for improvement of suicide prevention in manic–depressive illness are presented.
A Study of Mild Dementia in the Community Using a Wide Range of Diagnostic Criteria
Authors: Mowry B. J. , Burvill P. W.
Published: August 2008

The result of, and difficulties in, applying a range of existing criteria for mild dementia to a random sample of community elderly aged 70 years and over is examined. By one or more criteria, 25% had mild dementia, and almost 30% of these had additional psychiatric disorders, mostly depression. Prevalence rates for mild dementia varied widely according to the different criteria. Rates of mild dementia increased with age. Poor specification of diagnostic criteria was a major problem. These criteria should be standardised and detailed, and prospective longitudinal studies conducted to elicit the natural history of this condition.