bluuebunny/crossref_metadata_2025 huggingface dataset:
Intensive case management for the severely mentally ill
Authors: Holloway Frank , Carson Jerome
Published: October 2008

Background

The aim was to compare the efficacy of intensive clinical case management (ICM) with standard community care in the management of ‘hard to treat’ patients with a severe mental illness.

Method

A randomised controlled trial was carried out in East Lambeth, a deprived area of inner London. Seventy people with psychosis designated as ‘hard to treat’ by referring teams were included; 35 were randomised to ICM (case load eight patients per worker), and 35 to standard care, which offered follow-up by a community psychiatric nursing service (30 patients per worker). Outcome measures were admissions and hospital bed utilisation; contact with services; symptomatology; social behaviour; social functioning; quality of life; patients' satisfaction with care at 9 and 18 months.

Results

There were no differences in patients' symptoms, social behaviour or social functioning. Quality of life was significantly improved in patients receiving ICM at 9 months. Satisfaction with care was significantly greater among case-managed patients. All ICM patients remained in contact with services throughout the study, while six control patients were refusing all contact with services at 18 months.

Conclusions

ICM failed to improve the clinical outcome of ‘hard to treat’ patients. The service was successful in maintaining contact with patients, was greatly appreciated and had a positive effect on their perceived quality of life.
Informing patients about tardive dyskinesia
Authors: Chaplin Robert , Kent Andrew
Published: October 2008

Background

This paper evaluates the effects on knowledge and clinical stability of an educational intervention about tardive dyskinesia.

Method

Fifty-six patients receiving antipsychotic maintenance completed a questionnaire assessing their knowledge about tardive dyskinesia. After random allocation to either an educational intervention or a control group, their knowledge was reassessed at six months.

Results

Ninety-five per cent of patients completed the study. The study patients gained significantly more knowledge than the controls, who made modest gains. There were no significant differences in clinical outcome between the groups.

Conclusion

Patients can learn about serious toxic effects of antipsychotic treatment with a low risk of non-compliance. Discussion about tardive dyskinesia is necessary in the process of obtaining informed consent to treatment.
‘Cloze’ procedure refined and modified
Authors: Newby David
Published: October 2008

Background

‘Cloze procedure assesses the predictability of text by deleting words at set intervals and having a panel of raters fill the blanks. Two refinements to the procedure are described: ‘modified Cloze and ’ ‘reverse Cloze’, the latter examining the subject's ability to interpret a partial transcript.

Method

Samples of speech were obtained from patients with schizophrenia, manic-depression and orthopaedic disorders using a standard prompt, and the output analysed using modified Cloze. In addition, subjects completed a reverse Cloze passage.

Results

Both modified Cloze and reverse Cloze discriminated the performance of patient groups, with patients with schizophrenia performing worst.

Conclusions

These techniques extend earlier findings suggesting reduced predictability in psychotic speech, particularly for patients with schizophrenia. The reverse Cloze procedure suggests a ‘mirror-image’ deficit and is a potential objective index of psychopathology that is much simpler to apply than traditional Cloze.
First episodes of psychosis in Afro-Caribbean and White people
Authors: Takei Noriyoshi , Persaud Rajendra , Woodruff Peter , Brockington Ian F. , Murray Robin M.
Published: October 2008

Background

There have been few prospective studies of the long-term outcome of psychosis in people of Afro-Caribbean origin in the UK.

Method

We followed-up a population-based, consecutive series of 34 Afro-Caribbean and 54 White people with psychosis who had been extensively investigated during their first admission in 1973/74. Diagnoses were made by direct interview using the Present State Examination at both first admission and follow-up.

Results

Ninety-seven per cent of the original sample were traced. A slightly greater proportion of the Afro-Caribbean people were assigned to the S+ Catego class (schizophrenia), both on first assessment and at follow-up. No difference was found between the two groups in the consistency of diagnosis over the 18 years or in the proportion of patients considered psychotic but Afro-Caribbean people tended to have fewer negative symptoms at follow-up. There were striking differences between the two groups in their experience of psychiatric care; Afro-Caribbean people were more likely to have been readmitted, to have experienced longer hospitalisations, and to have undergone more involuntary admissions than their White counterparts.

Conclusions

Afro-Caribbean people who met clinical and research criteria for schizophrenia had a less satisfactory experience of, and response to, psychiatric care over 18 years than their White counterparts.
Longitudinal study of interpersonal dependency in female twins
Authors: O'Neill F. Anthony , Kendler Kenneth S.
Published: October 2008

Background

Interpersonal dependence is thought to be important in a number of physical and psychological disorders. There are several developmental theories that suggest environmental influences in childhood are important.

Method

A twin study methodology was used to look at the genetic and environmental influences on interpersonal dependence as measured by a sub-scale of the Interpersonal Dependency Inventory with a population-based sample of 2230 twins.

Results

Psychometric analysis revealed that this was a stable measure and that there was a substantial degree of construct validity Both univariate and longitudinal twin analysis suggested that there was a modest genetic influence and a large, specific environment influence on interpersonal dependency as measured by this scale. The longitudinal analysis revealed that the genetic influence was stable over the time-scale sampled and the environmental influence was moderately stable.

Conclusions

This finding is at odds with theories that suggest shared environment is important in the aetiology of interpersonal dependency.
Meta-analysis of trials comparing antidepressants with active placebos
Authors: Moncrieff Joanna , Wessely Simon , Hardy Rebecca
Published: October 2008

Background

Unblinding effects may-introduce bias into clinical trials. The use of active placebos to mimic side-effects of medication may therefore produce more rigorous evidence on the efficacy of antidepressants.

Method

Trials comparing antidepressants with active placebos were located. A standard measure of effect was calculated for each trial and weighted pooled estimates obtained. Heterogeneity was examined and sensitivity analyses performed. A subgroup analysis of in-patient and out-patient trials was conducted.

Results

Only two of the nine studies examined produced effect sizes which showed a consistent significant difference in favour of the active drug. Combining all studies produced pooled effect size estimates of between 0.41 (0.27–0.56) and 0.46 (0.31–0.60) with high heterogeneity due to one strongly positive trial. Sensitivity analyses excluding this and one other trial reduced the pooled effect to between 0.21 (0.03–0.38) and 0.27 (0.10–0.45).

Conclusions

Meta-analysis is very sensitive to decisions about exclusions. Previous general meta-analyses have found combined effect sizes in the range 0.4–0.8. The more conservative estimates produced here suggest that unblinding effects may inflate the efficacy of antidepressants in trials using inert placebos.
Reduced latent inhibition in people with schizophrenia: an effect of psychosis or of its treatment
Authors: Williams Jonathan H. , Wellman Nigel A. , Geaney David P. , Cowen Philip J. , Feldon Joram , Rawlins J. N. P.
Published: October 2008

Background

People with schizophrenia show impaired attention. This could result from reduced latent inhibition (a measure of ability to filter out irrelevant stimuli). Previous studies have found reduced auditory latent inhibition in people with acute schizophrenia: we tested whether this results from psychosis or from drug treatment.

Method

We measured auditory latent inhibition in two studies. One compared antipsychotic-naive people with acute schizophrenia with patients within two weeks of starting antipsychotic treatment. The second compared healthy volunteers given either saline or 1.0 mg haloperidol, intravenously.

Results

Latent inhibition was absent in treated patients, but was clearly present in patients who were naive to antipsychotics. Latent inhibition was absent in volunteers given haloperidol, but was clearly present in those given saline.

Conclusions

The reduced auditory latent inhibition seen in acute schizophrenia is more plausibly due to antipsychotic treatment than to the disorder. Unless neuropsychological models of schizophrenia incorporate evidence from drug-free patients and drug-treated healthy controls, they may be invalid.
Psychiatric disorders as a factor in sick-leave due to other diagnoses
Authors: Hensing Gunnel , Spak Fredrik
Published: October 2008

Background

The aim was to analyse the role of psychiatric disorders in sick-leave in different sick-leave diagnoses.

Method

A stratified population-based sample of women (n=292) in Göteborg were interviewed, and diagnoses were made according to DSM–III–R. Sick-leave data, including diagnoses, were obtained for two years.

Results

Women with psychiatric disorders had an increased number of sick-leave spells and sick-leave days in all the sick-leave diagnostic groups. The largest differences between the two groups of women were found in mental disorders, diseases of the locomotor system and gastro-intestinal diseases. The association between psychiatric disorders and sick-leave was strongest in older age groups.

Conclusions

Unrecognised psychiatric disorders associated with an increased number of medical complaints and visits can be an important factor in the increase in sick-leave.
Recovered memories of childhood sexual abuse
Authors: Brandon Sydney , Boakes Janet , Glaser Danya , Green Richard
Published: October 2008

Background

The growth in the USA of ‘recovered memory therapy’ for past sexual abuse has caused great public and professional concern. It became apparent that the polarisation of views and fierce controversy within the American psychiatric community was in danger of bringing psychotherapy into disrepute and it seemed important to examine objectively the scientific evidence before such polarisation developed in the UK.

Method

A small working group reviewed their own experience, visited meetings and centres with expertise in this field, interviewed ‘retractors' and accused parents, and then began a comprehensive review of the literature.

Results

There is a vast literature but little acceptable research. Opinions are expressed with great conviction but often unsupported by evidence.

Conclusions

The issue of false or recovered memories should not be allowed to confuse the recognition and treatment of sexually abused children. We concluded that when memories are ‘recovered’ after long periods of amnesia, particularly when extraordinary means were used to secure the recovery of memory, there is a high probability that the memories are false, i.e. of incidents that had not occurred. Some guidelines which should enable practitioners to avoid the pitfalls of memory recovery are offered.
Early signs of psychotic relapse in schizophrenia
Authors: J⊘rgensen Per
Published: October 2008

Background

People with schizophrenia are at high risk of psychotic relapse. The purpose of this study was to evaluate the predictive validity and temporal link of early signs to this.

Methods

A study sample of 60 out-patients with schizophrenia was examined every second week over a period of six months. The study design included self-reporting (Early Signs Scale) and objective assessment (General Psychopathology of Positive and Negative Symptom Scale) of behavioural and phenomenological changes (early signs). Criterion cut-off points were based on a comparison to the subjects' individual baseline scores.

Results

Twenty-seven subjects (45%) experienced a relapse. Composite increased score ($ 10 points) of self-reported/objectively assessed early signs predicted the relapse with a sensitivity of 81% and a specificity of 79%. Thus the predictive validity of early signs of relapse was considerable, particularly self-reporting of early signs of relapse: sensitivity 74% and specificity 79%. The inclusion of objective assessment added only marginally to the prediction. Early signs were detected most often (70%) within the four weeks immediately before the individuals' relapse.

Conclusion

Psychotic relapse is most often preceded by early signs. Clinical practice should integrate this knowledge by an ongoing monitoring including self-reporting.
Psychopharmacology of severe self-injury associated with learning disabilities
Authors: Clarke David J.
Published: October 2008

Background

Many sedative and antipsychotic agents have been used in the management of severe self-injury associated with learning disabilities. Their efficacy has been questioned. Recent research has identified some biological abnormalities associated with severe self-injury and allowed a more rational selection of treatment.

Method

Review of published literature, including trials, previous reviews and case reports.

Reports

There is evidence for the efficacy of opiate antagonists in the management of severe self-injury, and recent research has identified potential methods of predicting treatment response. Dopamine D1 antagonists and some agents affecting serotonin turnover may also be of benefit.

Conclusions

More rational psychopharmacological treatments for severe self-injurious behaviour may become available. Such treatments are difficult to evaluate for methodological and ethical reasons. They usually involve the clinical use of compounds for unlicensed indications, rather than trials of agents developed specifically to treat severe self-injurious behaviour. Combining psychopharmacological and psychological interventions may provide additional benefits.
Auditing electroconvulsive therapy
Authors: Duffet Richard , Lelliott Paul
Published: October 2008

Background

This is the third large-scale audit in the past 20 years and compares the practice of electroconvulsive therapy (ECT) in England and Wales with the standards derived from the Royal College of Psychiatrists' 2nd ECT handbook.

Method

Facilities, equipment, practice, personnel and training were systematically evaluated during visits to all ECT clinics in the former North East Thames and East Anglia regions and Wales. All other English ECT clinics were surveyed with a postal questionnaire. Information was obtained for 184 (84%) of the 220 ECT clinics identified.

Results

Although some aspects of ECT administration had improved since the last audit in 1991, overall only one-third of clinics were rated as meeting College standards. Only 16% of responsible consultants attended their ECT clinic weekly and only 6% had sessional time for ECT duties. Fifty-nine per cent of all clinics had machines of the type recommended by the College and 7% were still using machines considered outdated in 1989. Only about one-third of clinics had clear policies to help guide junior doctors to administer ECT effectively.

Conclusions

Twenty years of activity by the Royal College of Psychiatrists and three large-scale audits have been associated with only modest improvement in local practice.
Epidemiology of paranoid symptoms in an elderly population
Authors: Forsell Yvonne , Henderson A. Scott
Published: October 2008

Background

Elderly people with paranoid symptoms are a taxing group for medical and social services, but studies of the prevalence of these symptoms in the general elderly population are rare. This study aimed to estimate the community prevalence and to identify some associated variables.

Method

A community sample of 1420 elderly people, was extensively examined by nurses and physicians.

Results

Paranoid ideation was found in 6.3% of the sample. The prevalence in people with cognitive dysfunction (n=381, 12.1%) was higher than in those without (n=1039, 2.6%). Once cognitive impairment had been controlled the associated variables were: being divorced, being female, having depressive symptoms, using psychotropic drugs, having no friends or visitors, using community care and being an immigrant.

Conclusion

Paranoid symptoms in this elderly population were associated most strongly with cognitive impairment. Other associated variables pointed to a higher level of social isolation than others in the community.
Detecting postnatal depression in Chinese women
Authors: Lee Dominic T. S. , Yip S. K. , Chiu Helen F. K. , Leung Tony Y. S. , Chan Kathy P. M. , Chau Irene O. L. , Leung Henry C. M. , Chung Tony K. H.
Published: October 2008

Background

We evaluated the utility of the Chinese version of the Edinburgh Postnatal Depression Scale (EPDS) and measured the prevalence of major depression six weeks after confinement among Chinese women in Hong Kong.

Method

A prospective cohort of 145 women completed the EPDS, the 12-item General Health Questionnaire (GHQ) and the Beck Depression Inventory (BDI) six weeks after giving birth. They were then assessed with the Structured Clinical Interview for DSM–III–R, non-patient version (SCID–NP) to establish psychiatric diagnosis. The criterion validity of EPDS was tested against this clinical diagnosis, and the concurrent validity against the GHQ and BDI scores was also evaluated. The internal consistency of the scales was measured by Cronbach's α coefficient.

Results

The Chinese EPDS had satisfactory psychometric properties and a cut-off score of 9/10 is recommended for screening depressive illness in a general postnatal population. At six weeks postpartum, 5.5% of the study population suffered from major depression.

Conclusions

The Chinese EPDS will be useful for screening for postnatal depression.
Prolactin response to d-fenfluramine is blunted in people with anorexia nervosa
Authors: Monteleone Palmiero , Brambilla Francesca , Bortolotti Francesca , La Rocca Antonietta , Maj Mario
Published: October 2008

Background

Several studies have explored serotonin (5-HT) transmission in people with anorexia nervosa, but their results have been inconsistent.

Method

According to a double-blind placebo-controlled design, plasma prolactin response to the specific serotonergic probe d-fenfluramine was investigated in 10 underweight and two normal-weight women with anorexia, and in 12 age-matched healthy females. Eating-related psychopathology, depressive and obsessive-compulsive symptoms, and aggressiveness were measured by appropriate rating scales.

Results

Compared with healthy control subjects, the women with anorexia showed reduced baseline prolactin and oestrogen levels and increased basal Cortisol concentrations. The prolactin response to d-fenfluramine was blunted and did not correlate with psychopathological measures.

Conclusions

These results support a dysfunction of 5-HT transmission in anorexia nervosa. This dysfunction does not seem to be related to concomitant depressive or obsessive-compulsive symptoms or to the level of aggressiveness of the patients.
Critique of the DSM–IV operational diagnostic criteria for schizophrenia
Authors: Maj Mario
Published: October 2008

The DSM–IV operational diagnostic criteria for schizophrenia (American Psychiatric Association, 1994) are being used extensively in several countries for clinical, research and educational purposes.
Serotonin and panic
Authors: Bell C. J. , Nutt D. J.
Published: October 2008

Background

Tricyclic (TCA) and monoamine oxidase inhibitor (MAOI) antidepressants are effective in the treatment of panic disorder. Two selective serotonin reuptake inhibitors (SSRIs) have also been licensed in the UK for this indication and studies with three other SSRIs have recently been completed. These provide further evidence for the role of serotonin in panic.

Method

Review of clinical, animal and laboratory studies.

Results

SSRIs have been shown to be effective in the treatment of panic disorder. The reported rates of improvement of 60–70% of patients taking SSRIs are similar to those seen withTCAs and greater than placebo. Other serotonergic agents do not appear to be effective. Animal work and human studies including measures of 5-HT in plasma, cerebrospinal fluid and platelets, challenge paradigms and tryptophan depletion show that the relationship between 5-HT and anxiety is complex.

Conclusion

Clinical trials have shown that of all the serotonergic agents only the SSRIs are effective in panic disorder. They are as beneficial as the TCAs and seem to be better tolerated which may be particularly significant in view of the chronic nature of the condition. Serotonin plays a role in panic disorder and serotonergic dysfunction, however the results and evidence do not fit one theory alone. It is also likely that different brain regions and 5-HTreceptors are involved in specific ways.
Cortical grey matter reductions associated with treatment-resistant chronic unipolar depression
Authors: Shah Premal J. , Ebmeier Klaus P. , Glabus Michael F. , Goodwin Guy M.
Published: October 2008

Background

The aetiology of treatment-resistant major depression is little understood; its apparent intractability may reflect brain abnormality.

Method

Magnetic resonance images of the brains of 20 subjects with major depression lasting for two years or more were compared with 20 healthy control subjects and 20 other subjects who had completely recovered from depression. Subjects were individually matched for age, gender, years of education and premorbid IQ. Grey matter was segmented from the images, and compared between groups on a voxel-by-voxel basis.

Results

Subjects with chronic depression showed reduced grey matter density in the left temporal cortex including the hippocampus. There was also a trend for reduction in the right hippocampus. Left hippocampal grey matter density was correlated with measures of verbal memory, supporting the functional significance of the observed magnetic resonance imaging changes.

Conclusions

Our results potentially challenge the accepted view of depression as a functional and fully reversible illness, implying instead that more permanent brain changes may be associated with chronicity. Confirmatory longitudinal and prospective studies are required to determine whether these differences pre-date the onset of depression or are the result of the chronic illness process or its treatment.
Poverty, psychological disorder and disability in primary care attenders in Goa, India
Authors: Patel Vikram , Pereira Jerson , Countinho Livia , Fernandes Romaldina , Fernandes John , Mann Antony
Published: October 2008

Background

This study examined the association of common mental disorders in primary health clinic attenders with indicators of poverty and disability in Goa, India.

Method

Adult attenders (n=303) in two primary health clinics were recruited.

Results

There were 141 (46.5%) cases of common mental disorder. The following were associated with common mental disorder: female gender; inability to buy food due to lack of money; and being in debt. Cases scored significantly higher on all measures of disability. Primary health clinic staff recognised a third of the morbidity but used multiple oral drugs, injectable vitamins and benzodiazepines to treat common mental disorders.

Conclusions

Poverty is closely associated with common mental disorder which in turn is associated with deprivation and despair. Primary mental health care priorities in low-income countries need to shift from psychotic disorders which often need specialist care to common mental disorders. Health policy and development agencies need to acknowledge the intimate association of female gender and poverty with these disorders.
British psychiatric morbidity survey
Authors: Jenkins Rachel , Bebbington Paul , Brugha Traolach S. , Farrell Mike , Lewis Glyn , Meltzer Howard
Published: October 2008

There is mounting evidence of the massive global health burden of mental illness (Murray & Lopez, 1996; Jenkins, 1997). Within Great Britain, the Department of Health's overall objectives for mental illness were summarised as follows (Department of Health, 1993):

(a) To reduce the incidence and prevalence of mental disorders.

(b) To reduce the mortality associated with mental disorders.

(c) To reduce the extent and severity of other problems associated with mental disorders, for example:

(i) poor physical health;

(ii) impaired social functioning;

(iii) poor social circumstances;

(iv) family burden.

(d) To ensure appropriate services and interventions are provided.

(e) To reverse the public's negative perception of mental illness, for example:

(i) counter fear, ignorance and stigma;

(ii) create a more positive social climate in which to seek help;

(iii) improve quality of life for people with mental health problems.

(f) To research causes, consequences and care of specific mental disorders.
Sertraline in the treatment of panic disorder
Authors: Londborg Peter D. , Wolkow Robert , Smith Ward T. , Duboff Eugene , England Donald , Ferguson James , Rosenthal Murray , Weise Charles
Published: October 2008

Background

This study compared the efficacy and safety of sertraline to placebo in treating panic disorder.

Method

178 out-patients with panic disorder who exhibited at least four panic attacks during the four weeks prior to screening and three during the two weeks of lead-in were randomly assigned to 12 weeks of double-blind treatment with sertraline (50, 100 or 200 mg) or placebo.

Results

Sertraline was superior to placebo in reducing the number of panic attacks, situational attacks, unexpected attacks, limited symptom attacks, and time spent worrying (all P < 0.01) and the Hamilton Anxiety Scale (P < 0.05), although Clinical Global Impression (Improvement) did not significantly differentiate groups at 12 weeks and at end-point. No serious adverse events were associated with sertraline. No dose relationship was found for adverse events; overall drop-out rates were not different for sertraline or placebo, although more sertraline-treated subjects discontinued for adverse events, typically early in the study. Only dry mouth and ejaculation failure (primarily ejaculation delay) were associated significantly with sertraline. Conclusions Sertraline was effective and safe in reducing panic attacks. Higher doses were no more effective than the 50 mg dose.
SPET study of verbal fluency in schizophrenia and epilepsy
Authors: Mellers John D. C. , Adachi Naoto , Takei Noriyoshi , Cluckie Alice , Toone Brian K. , Lishman W. Alwyn
Published: October 2008

Background

The association between temporal lobe epilepsy and schizophrenia suggests that the critical abnormality may be pathology within the temporal lobes. People with schizophrenia-like psychosis of epilepsy (SLPE) provide a useful group in which to examine the importance of temporal and frontal lobe dysfunction in schizophrenia.

Method

A verbal fluency activation paradigm and a 99mTc HMPAO SPET were used to study frontotemporal function in people with SLPE (n = 12), schizophrenia (n = 11) and epilepsy (n = 16).

Results

People with SLPE differed from both other groups by showing lower blood flow in the left superior temporal gyrus during performance of a verbal fluency task compared with a word repetition task (F=5.4, P=0.01). During the verbal fluency task people with primary schizophrenia showed a greater increase in blood flow in anterior cingulate (F=4.5, P=0.02) than the other two groups. There were no between-group differences in frontal brain regions.

Conclusion

Our findings support an association between left temporal lobe abnormality and SLPE. The different patterns of activation observed in people with primary schizophrenia and SLPE suggests that different pathophysiological mechanisms may operate in these two groups. In SLPE the pathophysiology may be relatively confined to the dominant temporal lobe.
Predictors of a healthy workplace for Swedish and English psychiatrists
Authors: Thomsen Sarah , Dallender Janie , Soares Joaquim , Nolan Peter , Arnetz Bengt
Published: October 2008

Background

Few studies have attempted to analyse the organisational aspects of the workplace that may affect the well-being of psychiatrists and even fewer have offered insights into what a positive workplace might look like. This study provides an outline of such a workplace, with reference to individual and organisational factors. In addition, a comparison is made between two European cities to check for cultural differences.

Method

Three hundred and eighty psychiatrists from Stockholm and Birmingham responded to a previously tested questionnaire on their work environment.

Results

Predictors of a positive workplace for psychiatrists were: high self-esteem, satisfactory support with work-related problems, lower perceived workload, positive view of leadership, low work-related exhaustion and having a sense of participation in the organisation. There were few cultural differences.

Conclusions

Measures should be taken to improve leadership skills for managers, to offer more support for work-related problems, and to allow psychiatrists to participate more in the organisation.
Reduced levels of GABA-benzodiazepine receptor in alcohol dependency in the absence of grey matter atrophy
Authors: Lingford-Hughes Anne R. , Acton P. , Gacinovic S. , Suckling J. , Busatto G. F. , Boddington S. J. A. , Bullmore E. , Woodruff P. W. , Costa D. C. , Pilowsky L. S. , Ell P. J. , Marshall E. J. , Kerwin R. W.
Published: October 2008

Background

We tested the hypothesis that reduced levels of the GABA-benzodiazepine receptor occur in alcohol dependency using single photon emission tomography (SPET) and the specific GABA-benzodiazepine ligand, 123l-iomazenil.

Method

Neurologically and cognitively unimpaired abstinent alcohol-dependent (n=12) and non-alcohol-dependent male subjects (n=14) underwent a 123l–iomazenil SPET scan. SPET and magnetic resonance images were co-registered and voxel-based statistical tests performed. Subjects' clinical and alcohol history were obtained with standard questionnaires. The relationships between clinical and alcohol variables and the regional level of GABA-benzodiazepine receptors were investigated using multiple regression analysis.

Results

Abstinent alcohol-dependent subjects had decreased levels of GABA-benzodiazepine receptor compared with non-alcohol-dependent subjects within the frontal, parietal and temporal cortices, including regions in which grey matter atrophy was absent.

Conclusions

Alcohol dependency is associated with reduced GABA-benzodiazepine receptor levels in the absence of grey matter atrophy in some cortical regions, such as within the parietal lobe. Regional variability of reduction in GABA-benzodiazepine receptors demonstrates that alcohol does not have a global, toxic effect on the brain.
People with schizophrenia and their families
Authors: Brown Steve , Birtwistle Jon
Published: October 2008

Background

This paper presents 15-year outcome data on place of residence, clinical and social morbidity and carer distress in a cohort of 179 people with schizophrenia who were living with their families in 1981–1982

Method

Data on morbidity and carer distress were derived from replicated patient and informant interviews using standardised research instruments. Details of residence came from patient and informant interviews corroborated by case note information.

Results

Thirty-nine (22%) of the original 179 patients were dead and six (3%) lost to follow-up. Of the remaining 134 patients, 74 (55%) still lived with their families, 31 (23%) lived in institutional accommodation, 26 (19%) lived alone and 3 (2%) were homeless. There was little change in the level of clinical or social morbidity or carer distress.

Conclusions

These findings suggest that most people with schizophrenia who live with their families remain significantly disabled by their illness, while their carers suffer ongoing distress. Mental health services should seek to support families who want to care for relatives with schizophrenia. Appropriate alternative accommodation must be provided when family care is not possible.
Limitations of the symptom-oriented approach to psychiatric research
Authors: Mojtabai Ramin , Rieder Ronald O.
Published: October 2008

Background

We critically reviewed the arguments of the symptom-oriented researchers who propose to replace syndromes and diagnostic categories with symptoms as units of analysis in psychiatric research.

Method

Three central arguments were examined: (a) current diagnostic categories lack reliability and validity; (b) using diagnostic categories leads to misclassification and confounding; and (c) symptom-oriented theories are clearer, easier to test, and more likely to lead to an explanation of psychopathology. These arguments are based on three assumptions respectively: (a) symptoms have higher reliability and validity; (b) underlying pathological processes are symptom-specific; and (c) elucidation of the process of symptom development will lead to (and must precede) the discovery of the causes of syndromes.

Results

We found little evidence supporting these assumptions and arguments based on them.

Conclusion

There are no clear advantages in replacing syndromes with symptoms as units of analysis for psychiatric research.
Pathophysiology of ‘positive’ thought disorder in schizophrenia
Authors: McGuire Philip , Quested Digby , Spence Sean , Murray Robin , Frith Christopher , Liddle Peter
Published: October 2008

Background

Formal thought disorder is a characteristic feature of psychosis, but little is known of its pathophysiology. We have investigated this in schizophrenia using positron emission tomography (PET).

Method

Regional cerebral blood flow was measured using H215O and PET while six people with schizophrenia were describing a series of 12 ambiguous pictures which elicited different degrees of thought-disordered speech. In a within-subject design, the severity of positive thought disorder was correlated with cerebral blood flow across the 12 scans in each subject.

Results

Verbal disorganisation (‘positive’ thought disorder) was inversely correlated with activity in the inferior frontal, cingulate and left superior temporal cortex, and positively correlated with activity in the parahippocampal/anterior fusiform region bilaterally, and in the body of the right caudate (P<0.001). The total amount of speech produced (independent of thought disorder) was positively correlated with activity in the left inferior frontal and left superior temporal cortex.

Conclusions

The severity of positive thought disorder was inversely correlated with activity in areas implicated in the regulation and monitoring of speech production. Reduced activity in these regions may contribute to the articulation of the linguistic anomalies that characterise positive thought disorder. The positive correlations between positive thought disorder and parahippocampal/anterior fusiform activity may reflect this regions role in the processing of linguistic anomalies.
Placebo run-in period in studies of depressive disorders
Authors: Quitkin Frederic M. , McGrath Patrick J. , Stewart Jonathan W. , Ocepek-Welikson Katja , Taylor Bonnie P. , Nunes Edward , Delivannides Deborah , Agosti Vito , Donovan Steven J. , Ross Donald , Petkova Eva , Klein Donald F.
Published: October 2008

Background

In spite of the virtually ubiquitous nature of the initial 10-day placebo run-in period (IPR) in drug trials, there is little empirical data establishing its relevance.

Method

Data from 593 subjects were examined retrospectively to determine whether or not the prognosis of subjects minimally improved during the IPR was different to those who were unimproved. The IPR period was single-blind and was followed by a six-week double-blind phase in all studies.

Results

Twenty-six per cent of the subjects were minimally improved and 74% were unimproved. Approximately 10% of the subjects who were much improved were not followed systematically. Across a range of diagnosis, severity and chronicity subjects minimally improved (versus unimproved) after IPR had a more favourable prognosis whether assigned to drug or placebo.

Conclusions

Change during IPR appears to be a meaningful predictor. Stratification should be considered in future antidepressant studies.
Nuclear schizophrenic symptoms as a window on the relationship between thought and speech
Authors: Crow Tim J.
Published: October 2008

Background

Symptoms of schizophrenia known as nuclear’ or ‘first-rank’ are found in all populations. The genetic variation that gives rise to them must be as old as modern Homo sapiens.

Method

The hypothesis was formulated that language evolved, under constraints on callosal transmission, by a process of hemispheric specialisation. One component, the phonological output sequence, became localised to the dominant hemisphere whereas its associations (the signifieds) were lateralised in part to the non-dominant hemisphere. Concepts (‘thoughts’) are translated through a bi-hemispheric interaction into phonemes (‘speech’) by the speaker in frontal association areas, and decoded back into concepts (‘meanings’) by the hearer in occipito-temporo-parietal association areas.

Results

The first-rank symptoms demonstrate that an integral component is a system of ‘indexicality’ that distinguishes those phonemic signals generated by the hearer, from his own thoughts, and from signals that he receives from an interlocutor.

Conclusions

Language, as Buehler proposed, is cast in a coordinate system orientated at its origin, in the dominant hemisphere, to the self of the speaker. Thus conceived, the phenomena of the illness called schizophrenia are key to the neural organisation of the human characteristic of language.
Antecedents of suicide in people with schizophrenia
Authors: Heilä Hannele , Isometsä Erkki T. , Henriksson Markus M. , Heikkinen Marti E. , Marttunen Mauri J. , Lönnqvist Jouko K.
Published: October 2008

Background

Suicides among people with schizophrenia are commonly believed to be impulsive and to occur unexpectedly.

Method

As part of the National Suicide Prevention Project in Finland, a nationwide psychological autopsy study, suicide victims with DSM-III-R schizophrenia (n=86; n=64 in the active illness phase) and others (n=1 109; n=666 without any evidence for psychosis) were compared for communication of suicidal intent (CSI), as well as previous suicide attempts known by the next of kin and/or an attending health care professional during the latest treatment relationship.

Results

More victims with schizophrenia (84%) had a history of previous CSI, and/or had made previous suicide attempt(s) than others (70%). Also, victims with active illness schizophrenia (56%) had more CSI and/or had made suicide attempts during their last three months than victims with no psychosis (41%).

Conclusions

CSI and/or suicide attempts occur at least as often in people with schizophrenia as in those without schizophrenia, even in the active phase of the illness.
Extent and appropriateness of benzodiazepine use
Authors: Taylor S. , McCracken C. F. M. , Wilson K. C M. , Copeland J. R. M.
Published: October 2008

Background

We sought to determine the extent and appropriateness of benzodiazepine use in an elderly community, by measuring prevalence and incidence of benzodiazepines and examining mental health status as a predictor of benzodiazepine use.

Method

Data were collected from two longitudinal studies of people from the same community, sampled in 1982–1983 and again in 1989–1991.

Results

Benzodiazepine prevalence did not decrease during the period under study, but there was a significant reduction in anxiolytic use. Prevalence of benzodiazepines in women is twice that in men, and incidence of hypnotics is slightly higher in women. Prevalence and incidence of hypnotics are strongly associated with increasing age. There were high proportions of long-term users (61 and 70%), and continued use was high (52%) among new users. A large proportion of benzodiazepine use was by those who were concurrently depressed. Similarly, anxiety predicted both current and subsequent use of hypnotics.

Conclusions

Many older people still use benzodiazepines, contrary to official guidelines with regard to their mental health. Our findings add to the weight of opinion that persistent and long-term use should be discouraged.
Suicide and recency of health care contacts
Authors: Pirkis Jane , Burgess Philip
Published: October 2008

Background

Many countries have set targets for suicide reduction, and suggested that mental health care providers and general practitioners have a key role to play.

Method

A systematic review of the literature.

Results

Among those in the general population who commit suicide, up to 41% may have contact with psychiatric inpatient care in the year prior to death and up to 9% may commit suicide within one day of discharge. The corresponding figures are 11 and 4% for community-based psychiatric care and 83 and 20% for general practitioners.

Conclusions

Among those who die by suicide, contact with health services is common before death. This is a necessary but not sufficient condition for clinicians to intervene. More work is needed to determine whether these people show characteristic patterns of care and/or particular risk factors which would enable a targeted approach to be developed to assist clinicians in detecting and managing high-risk patients.
Dose-effect relationships of trauma to symptoms of depression and post-traumatic stress disorder among Cambodian survivors of mass violence
Authors: Mollica Richard F. , McInnes Keith , Pool Charles , Tor Svang
Published: October 2008

Background

The dose – effect relationships of cumulative trauma to the psychiatric symptoms of major depression and post-traumatic stress disorder (PTSD) in a community study of Cambodian survivors of mass violence were evaluated.

Method

In 1990, a survey of 1000 households was conducted in aThai refugee camp (Site 2) using a multi-stage random sampling design. Trauma history and psychiatric symptoms were assessed for two time periods. Analysis used linear dose – response regression modelling.

Results

993 Cambodian adults reported a mean of 14 Pol Pot era trauma events and 1.3 trauma events during the past year. Symptom categories of depression, PTSD, dissociative and culturally dependent symptoms exhibited strong dose – effect responses with the exception of avoidance. All symptom categories, except avoidant symptoms, were highly correlated.

Conclusions

Cumulative trauma continued to affect psychiatric symptom levels a decade after the original trauma events. The diagnostic validity of PTSD criteria, with the notable exception of avoidance, was supported. Inclusion of dissociative and culturally dependent symptoms increased the cultural sensitivity of PTSD.
Onset and recovery from panic disorder in the Baltimore Epidemiologic Catchment Area follow-up
Authors: Eaton William W. , Anthony James C. , Romanoski Alan , Tien Allen , Gallo Joseph , Cai Guojun , Neufeld Karen , Schlaepfer Thomas , Laugharne Jonathan , Chen Li-Shiun
Published: October 2008

Background

The objective is to estimate parameters of the natural history of panic disorder, including its prodrome, incidence, recovery and recurrence.

Method

In 1981 the Baltimore Epidemiologic Catchment Area Study interviewed 3481 individuals probabilistically selected from the household population. During 1993–1996, 1920 of these individuals (73% of survivors) were interviewed again. Baseline and follow-up interviews included the National Institute of Mental Health Diagnostic Interview Schedule. During the follow-up, a subsample was assessed by psychiatrists using the World Health Organization Schedules for Clinical Assessment in Neuropsychiatry (SCAN).

Results

There were 35 new cases of panic disorder in 24 475 person years of exposure, yielding an annual incidence of 1.43 per 1000 per year. Data from the SCAN assessments suggest the incidence estimate is conservative. Incidence is greater in females and declines with age. About one-third of the new cases arise without agoraphobia, but about half have anxiety of some sort present for many years prior to meeting criteria for diagnosis. People with agoraphobia have less intense onsets but slower recoveries than those without agoraphobia.

Conclusions

Panic is heterogeneous in its pattern of onset and recovery. Some of the heterogeneity is associated with the presence of other anxiety over a long period of the life.
Suicide attempts preceding completed suicide
Authors: Isometsä Erkki T. , Lönnqvist Jouko K.
Published: October 2008

Background

This study investigated three questions with major implications for suicide prevention: the sensitivity of the history of previous suicide attempt(s) as an indicator of suicide risk, the time interval from a preceding suicide attempt to the fatal one, and switching of suicide methods by those eventually completing suicide.

Method

The lifetime history of suicide attempts and the methods the victims (n=1397) used were examined in a nationwide psychological autopsy study comprising all suicides in Finland within a 12-month research period in 1987–1988.

Results

Overall, 56% of suicide victims were found to have died at their first suicide attempt, more males (62%) than females (38%). In 19% of males and 39% of females the victim had made a non-fatal attempt during the final year. Of the victims with previous attempts, 82% had used at least two different methods in their suicide attempts (the fatal included).

Conclusions

Most male and a substantial proportion of female suicides die in their first suicide attempt, a fact that necessitates early recognition of suicide risk, particularly among males. Recognition of periods of high suicide risk on the grounds of recent non-fatal suicide attempts is likely to be important for suicide prevention among females. Subjects completing suicide commonly switch from one suicide method to another, a finding that weakens but does not negate the credibility of restrictions on the availability of lethal methods as a preventive measure.
Medication received by patients with depression following the acute episode: adequacy and relation to outcome
Authors: Ramana Rajini , Paykel Eugene S. , Surtees Paul G. , Melzer David , Mehta Mitul A.
Published: October 2008

Background

The adequacy of pharmacotherapy received in practice by patients after an acute episode of depression has been little studied.

Aims

To describe and assess adequacy of drug continuation and maintenance in patients with depression.

Method

Patients with depression were interviewed 18 months after discharge from hospital. Quantitative assessments of drug treatment doses and compliance were made monthly over this period, and qualitative ratings in continuation and maintenance phases.

Results

About 20% of patients were prescribed low drug doses after discharge and 10% were prescribed no drugs at all. Reported compliance was around 70%. About 30% failed to receive adequate longer-term treatment, mostly due to the continuation phase being too short. Deficiencies of dosage and compliance were greater in patients who never achieved full recovery. Patient refusal was the most common reason for not using antidepressants. Further episodes of depression were not particularly associated with inadequate treatment.

Conclusions

There were deficiencies in drug treatment that did not appear to be the principal cause of further episodes but may be important in non-recovery. Patient fears require discussion.