bluuebunny/crossref_metadata_2025 huggingface dataset:
One and Two Year Outcomes for Adults with Learning Disabilities Discharged to the Community
Authors: Donnelly Michael , McGilloway Sinead , Mays Nicholas , Knapp Martin , Kavanagh Shane , Beecham Jennifer , Fenyo Andrew
Published: October 2008

Background

Long-stay patients with learning disabilities (n=214) were assessed in hospital and 12 and 24 months after discharge in order to examine the effects of relocation.

Method

Each resident acted as his/her own control in a prospective repeated-measures design. Skills and behavioural problems were assessed by keyworkers. Self-perceived quality of life was obtained during interviews with researchers who also completed an environmental checklist of the residents' accommodation.

Results

There was little or no change in peoples low pre-discharge skill levels. Certain aspects of problem behaviour improved after 12 months, although socially unacceptable behaviour increased slightly. People were less depressed (P⩽ 0.01) 12 months after discharge (n=119) and were more satisfied (P⩽ 0.05) with their new ‘homes’ (n=108). There were few changes in the pattern of activities or the social networks of people 12 months later. Little or no further change in outcomes was reported 24 months after discharge.

Conclusions

The implementation of the deinstitutionalisation policy in Northern Ireland has been limited by the predominance of residential and nursing homes and the lack of ‘ordinary’ accommodation. There is a need for purchasers and providers to give more attention to ways in which the principles of normalisation could be incorporated in the process of contracting and delivering services.
Mass Hysteria: One Syndrome or Two?
Authors: Ali-Gombe Abubakar , Guthrie Elspeth , McDermott Niall
Published: October 2008

Background

It has been suggested that mass hysteria can be divided into two syndromes; one with predominant features of anxiety and the other with predominant abnormalities of motor behaviour. In the former condition, prior tension is absent and spread is by visual contact In the latter, prior tension is present, initial cases can be identified and spread is gradual.

Method

The development and resolution of neurological symptoms in 156 Nigerian school girls were studied and a diagnosis of ‘mass hysteria’ made.

Results

The signs and symptoms manifested by the school girls during the outbreak of illness had features of both ‘anxiety’ and ‘motor’ predominant forms of mass hysteria.

Conclusions

Although there may be two patterns of symptom presentation in mass hysteria, other supposedly discrete features overlap. This weakens the argument that there are two separate syndromes.
Bipolar Affective Disorder Minus Left Prefrontal Cortex Equals Schizophrenia
Authors: Pang Alfred , Lewis Shôn W.
Published: October 2008

Background

An investigation of the relationship between bipolar affective disorder and schizophrenia, following a severe head injury and removal of the left prefrontal cortex.

Method

A single case report.

Results

An individual with past history of bipolar affective disorder suffered traumatic damages to the left prefrontal cortex with a second lesion in the left temporal lobe. The patient developed typical schizophrenia nine months later. The relevance of his brain lesions in determining the schizophrenic symptoms is discussed.

Conclusion

We propose that the specific pattern of brain injury in this patient was sufficient to change the phenotype from bipolar affective disorder to schizophrenia.
Tardive Dyskinesia and Positive and Negative Symptoms of Schizophrenia
Authors: Yuen Owen , Caligiuri Michael P. , Williams Richard , Dickson Ruth A.
Published: October 2008

Background

Controversy surrounds the relationship between tardive dyskinesia (TD) and symptoms of schizophrenia. While some studies reported that negative symptoms of schizophrenia may be a risk factor for TD, others reported a relationship between TD and positive symptoms.

Method

Eighty-four patients were studied, of whom 47 met criteria for TD. Clinical and instrumental procedures were used to increase the sensitivity of our assessments of the presence and severity of TD. Stepwise logistic and linear regression procedures were used to identify demographic variables, psychopathology, and motor parameters associated with the presence and severity of TD.

Results

A 3-factor model consisting of age, clinical tremor, and negative symptoms explained 25% of the variance in clinical TD severity. A 6-factor model consisting of female gender, instrumental and clinical measures of parkinsonism, positive, and negative symptoms explained 49% of the variance in severity of instrumentally derived dyskinesia.

Conclusions

These results suggest that the presence of TD may be associated with positive symptoms; that the severity of TD may be related to negative symptoms; and that the relationship between negative symptoms and TD severity may be influenced by the presence of parkinsonism.
Clinical Usefulness of an Aftercare Worker for Psychotic Patients Discharged from Half-way Houses in Hong Kong
Authors: Mak Ki-Yan , Gow Lyn
Published: October 2008

Background

The aim was to assess the clinical usefulness and economic viability of an aftercare worker for psychotic patients discharged from half-way houses in Hong Kong.

Method

A sample of 32 chronic psychotic patients was provided with a full-time aftercare worker. A matched control group received no such service.

Results

The experimental group was found to have greater and better employment prospects, better mental status with less hospitalisation and less law-breaking behaviour than the control group. Some of these benefits were converted into economic terms and the tangible costs incurred in the project were calculated.

Conclusions

The provision of an aftercare service is clinically useful and economically viable.
Prediction of ECT Response: Validation of a Refined Sign-Based (CORE) System for Defining Melancholia
Authors: Hickie Ian , Mason Catherine , Parker Gordon , Brodaty Henry
Published: October 2008

Background

The clinical validity of melancholia has been argued on the basis of its capacity to predict response to electroconvulsive therapy (ECT). We have argued that a sign-based (CORE) rating system of psychomotor disturbance can identify patients with melancholia. Therefore, the clinical validity of the CORE system was tested here in terms of its capacity to predict response to ECT.

Method

The response of 81 patients with primary affective disorders to an individualised course of ECT was investigated. CORE scores and other clinical predictors were evaluated in terms of their capacity to predict effect size changes in symptoms and disability.

Results

CORE scores predicted ECT response, as did the presence of psychotic features. The combination of marked psychomotor change (high CORE scores) and psychotic features predicted the best response to ECT.

Conclusion

This study supports the clinical validity of the CORE system for diagnosing melancholia.
The Bereavement Response: A Cluster Analysis
Authors: Middleton Warwick , Burnett Paul , Raphael Beverley , Martinek Nada
Published: October 2008

Background

Literature and clinical experience suggest that some people experience atypical, complicated or pathological bereavement reactions in response to a major loss.

Method

Three groups of community-based bereaved subjects – spouses (n=44), adult children (n=40), and parents (n=36) – were followed up four times in the 13 months after a loss. A 17-item scale of core bereavement times was developed and used to investigate the intensity of the bereavement response over time.

Results

Cluster analysis revealed a pattern of bereavement-related symptoms approximating a syndrome of chronic grief in 11 (9.2%) of the 120 subjects. None of the respondents displayed a pattern consistent with delayed or absent grief.

Conclusions

In a non-clinical community sample of bereaved people, delayed or absent grief is infrequently seen, unlike chronic grief, which is demonstrated in a minority.
A Genetic Linkage Study of the D2Dopamine Receptor Locus in Heavy Drinking and Alcoholism
Authors: Cook C. C. H. , Palsson G. , Turner A. , Holmes D. , Brett P. , Curtis D. , Petursson H. , Gurling H. M. D.
Published: October 2008

Background

Reports of an association between restriction fragment length polymorphisms (RFLPs) at the dopamine D2receptor (DRD2) locus and alcoholism have suggested involvement of that locus in the aetiology of alcoholism.

Method

Sib pair linkage analyses were conducted in families multiply affected by alcoholism, using both the Taql ‘A’ RFLP and a microsatellite repeat polymorphism at the DRD2 locus.

Results

The ‘Identical By Descent’ analysis provided significant evidence of an effect of the DRD2 locus on the liability to develop heavy drinking (P<0.0016) and Research Diagnostic Criteria alcoholism (P<0.0003) in the first sample of families studied. However, this result was explicable by the segregation of alleles in a single large sibship, and it was not replicated in a second sample of families.

Conclusions

The results do not support linkage between the DRD2 locus and alcoholism in most of the families studied. It remains possible that this locus influences the predisposition to alcoholism in some families.
Impulsivity in Disordered Eating, Affective Disorder and Substance use Disorder
Authors: Bushnell J. A. , Wells J. E. , Oakley-Browne M. A.
Published: October 2008

Background

Failure to control impulsive behaviour has been postulated as an underlying mechanism common to substance use disorder, sociopathy and to a substantial subgroup of women with bulimia nervosa.

Method

Three hundred and one women recruited to a general population study were selected either at random or because they had lifetime substance use disorder, affective disorder or symptoms of bulimia. A subsequent interview determined the existence of problems with impulsivity. Behaviour that is an integral part of a DSM–III axis 1 disorder was excluded from the impulsivity measure.

Results

Similar rates of impulsivity were found in all three of these types of disorder, and this was little different from the rate found in the women selected randomly from the general population. However, among those with comorbid disorder there was more impulsivity, and the more comorbid disorders found, the higher the proportion with problems of impulsivity.

Conclusions

Because those in treatment facilities are more likely to have other comorbid disorders (Berkson's bias), findings derived from observations of women with bulimia who are in treatment may be compromised by selection bias and may have limited applicability to those with the disorder who are not in treatment.
Psychological Predictors of Insight and Compliance in Psychotic Patients
Authors: Kemp Róisín , David Anthony
Published: October 2008

Background

A possible neuropsychological basis for poor insight in psychosis has been proposed Consistent supporting evidence for this is lacking.

Method

Seventy-four consecutive acutely psychotic in-patients who were recruited for a randomised controlled trial of compliance therapy were given a battery of neuropsychological tests, along with a comprehensive clinical assessment before and after the intervention.

Results

Performance on neuropsychological tests improved during the patients' admission and treatment in hospital as did symptoms and levels of insight Cognitive function showed no relationship to insight and compliance initially, and very little after the intervention. Factors related to insight and compliance prior to discharge included: diagnosis, attitudes to medication, side-effects, being a detained patient and whether or not compliance therapy was given.

Conclusions

Clinical variables and attitudes to treatment appear to be more relevant to compliance and the development of insight in acute psychosis than neuropsychological impairment.
Measuring the Mental Health Status of a Population: a Comparison of the GHQ–12 and the SF–36 (MHI–5)
Authors: McCabe C. J. , Thomas K. J. , Brazier J. E. , Coleman P.
Published: October 2008

Background

A comparison of the performance of the 5-item mental health dimension of SF–36 (MHI–5) with that of the 12-item General Health Questionnaire (GHQ–12) in a defined, non-patient population, using standard statistical tests.

Methods

A postal survey of 3000 patients aged 16–64 years was conducted. Patients were randomly selected from the practice lists of two general practices chosen to represent populations with different socio-economic characteristics.

Results

Considerable evidence was found for the internal consistency of both instruments (Cronbach's α 0.91 and 0.84 for GHQ–12 and the MHI–5 respectively) and for their construct validity in terms of distinguishing between groups with measured health differences. Both instruments showed a significant difference in the mean scores for men and women. In contrast to the GHQ–12, no correlation was found between age and score for the MHI–5. Both instruments were equally sensitive to socio-economic characteristics and to levels of social support The scores on the two instruments were highly correlated (Spearman rank correlation – 0.73).

Conclusion

The MHI–5 has comparable psychometric performance to the GHQ–12, and can be used to measure and compare mental health in defined populations. Operational advantages of the MHI–5 over the GHQ–12 are that it is in the public domain, is part of a general health measure (SF–36) and is shorter.
Aspects of Perinatal Psychiatric Illness
Authors: Pritchard Dewi B. , Harris Brian
Published: October 2008

Background

In view of the current changes in the National Health Service, it was considered an opportune time to review the literature on perinatal psychiatric illness.

Method

A systematic review was undertaken of relevant articles on medline, ClinPsych and Excerpta Medica Psychiatry.

Results

Sixty-eight articles were used in the review.

Conclusions

Developments in the field of perinatal psychiatry include a greater understanding of the nosology and aetiology of the conditions, the effect of maternal illness on the child as well as transcultural factors. The perspective of the individual sufferer has been somewhat ignored. New treatments with both pharmacotherapy and hormones are emerging, but perhaps the greatest current challenge is to adapt our management strategies to community care.
Large Variations of Plasma Levels During Maintenance Treatment with Depot Neuroleptics
Authors: Tuninger Eva , Levander Sten
Published: October 2008

Background

Stability of neuroleptic medication has been associated with optimal clinical effect and minimal side-effects. Depot administration is assumed to yield better stability.

Method

Thirty patients on depot neuroleptic treatment were followed during three years with repeated measurements of plasma level and concurrent ratings of clinical symptoms and side-effects.

Results

Of 120 blood samples 35 (29%) measurements were outside ± 2 s.d. measurement error (expected 5%). Perphenazine levels were more variable (46%) than haloperidol (25%) and flupenthixol (12.5%). No relationship was found between side-effect ratings and fluctuations of plasma levels.

Conclusion

Depot neuroleptic medication does not eliminate a clinically unwanted and sometimes marked variation in plasma level.
Behavioural Vigilance in Schizophrenia
Authors: Mar Corinne M. , Smith David A. , Sarter Martin
Published: October 2008

Background

Despite 30 years of research, some surprisingly fundamental gaps remain in our understanding of schizophrenic input dysfunctions.

Method

In a provisional test of a ‘hyperattention’ hypothesis, schizophrenic patients and control subjects performed a behavioural test that was adapted from a paradigm originally developed for characterising vigilance or sustained attention in animals. On this computerised operant testing procedure, subjects discriminated between signals of various salience and non-signal presentations. Hits and correct rejections resulted in monetary rewards while misses and false alarms entailed monetary costs.

Results

Data from in-patients with schizophrenia and age, education and gender-matched controls support hypotheses not only about hyperattentional dysfunctions in schizophrenia with respect to overall signal detectability but also in terms of resistance to the vigilance decrement that normally occurs over trials.

Conclusions

The theoretical importance of impairments of this sort are discussed with respect to the cognitive and perceptual consequences of hypervigilance and ‘input dysfunction’.
Antipsychotic drug-induced movement disorders in schizophrenics in relation to CYP2D6 genotype
Authors: Armstrong Martin , Daly Ann K. , Blennerhassett Richard , Ferrier Nicol , Idle Jeffrey R.
Published: October 2008

Background

Approximately 5–10% of Caucasians (poor metabolisers) show impaired metabolism of at least 20 therapeutically important drugs, including a number of commonly used antipsychotic agents, because they lack the cytochrome p450 enzyme CYP2D6. The molecular basis of this defect is now well understood and simple genotyping tests using the polymerase chain reaction (PCR) have been developed.

Method

To determine whether poor metabolisers are more susceptible to acute dystonic reactions and chronic movement disorders associated with the administration of antipsychotic drugs, we determined CYP2D6 genotypes in a group of 76 schizophrenics using previously described methods involving PCR and restriction fragment length polymorphism analysis.

Results

There was no difference in genotype frequencies between the schizophrenics and a normal control population, suggesting that CYP2D6 genotype was not a factor in determining susceptibility to the disease. However, four of the five poor metabolisers compared with 44% of the remaining subjects were suffering from a movement disorder at the time of the study, although because of the small number of poor metabolisers in the group the difference was not statistically significant. Poor metabolisers were not more likely to suffer an acute dystonic reaction.

Conclusions

CYP2D6 genotype is not a determinant of susceptibility to acute dystonic reactions but may be a contributory factor in antipsychotic drug-induced movement disorders including tardive dyskinesia.
The mental health residential care study: Predicting costs from resident characteristics
Authors: Chisholm D. , Knapp M. R. J. , Astin J. , Lelliott P. , Audini B.
Published: October 2008

Background

Little information is available on the costs of residential care for people with mental health problems, and there are very few research data on how or why the costs of provision vary.

Method

As part of a broader study based on data collected from across the residential care sectors in eight districts and using multiple regression analysis, research has examined whether and which resident characteristics are associated with higher or lower costs.

Results

Resident characteristics account for approximately 21% of the observed variation in inter-resident costs. Separate analyses were conducted for people in the London and non-London districts. The resident characteristics that were found to be significant predictors of cost include: age, gender, ethnic group, history of psychiatric admissions, diagnosis, emotional lability, daily living skills, social interaction and network, aggression, suicidal tendencies, drug abuse and legal status. Examination of the residual ('unexplained') costs found significant differences between facility types, sectors (private and voluntary being less costly than public, other things being equal) and districts.

Conclusions

The associations uncovered by these analyses can inform commissioners' planning and purchasing activities, at both the macro and micro levels, by revealing those resident needs and circumstances that are associated with higher costs.
Long-term mortality after first psychiatric admission
Authors: Naik Prakash C. , Davies Steffan , Buckley Ann M. , Lee Alan S.
Published: October 2008

Background

Little is known about the long-term mortality and causes of death after first psychiatric admission.

Method

A consecutive series of 87 patients admitted for the first time from a strictly defined catchment area to Saxondale Hospital, Nottinghamshire, who were discharged in 1974 and 1975, were traced in 1992 to either their general practitioner or death. The causes of their deaths were ascertained and the observed mortality was compared with expected mortality.

Results

Twelve subjects had died. None had committed suicide, and there were no open verdicts or accidental deaths. Although the observed mortality was higher than expected, there was no significant excess.

Conclusions

There may be little scope for reducing suicide rates by targeting patients for careful follow-up after discharge from their first psychiatric admission. More research is required before large investments are made in potentially fruitless interventions to achieve the objectives ofThe Health of the Nation.
Relatives' expressed emotion and non-verbal signs of subclinical psychopathology in schizophrenic patients
Authors: Woo Stephanie M. , Goldstein Michael J. , Nuechterlein Keith H.
Published: October 2008

Background

Previous research has generally found that variations in relatives' affective attitudes (expressed emotion; EE) towards a schizophrenic family member could not be accounted for by differences in the severity or form of the patient's symptomatology. These findings have been based on clinicians' ratings of psychopathology in patients.

Method

To approach the question from a different perspective, videotaped interactions between a patient and family members, obtained four to five weeks after hospital discharge, were coded for subclinical signs of psychopathology expressed by the patient. The Behavioral Subclinical Rating Scale (BSRS) was developed to compare subclinical levels of non-verbal and paralinguistic symptoms expressed by patients from both high- and low-EE families.

Results

Highly significant differences were found in the BSRS data. Patients from high-EE families showed more hostile and unusual behaviour with relatives than those from low-EE homes, who, in contrast, showed more anxious behaviour.

Conclusion

These data suggest that a complex transactional model is necessary to understand how family attitudes evolve during the course of a relatives' schizophrenic disorder.
The structure and development of borderline personality disorder: A proposed model
Authors: Ryle Anthony
Published: October 2008

Background

The theory of cognitive analytic therapy is extended to offer an understanding of borderline personality disorder (BPD).

Method

A structural model (the multiple self states model) and a classification of different levels of developmental damage are proposed.

Results

The model offers an explanation of the phenomenology of BPD.

Conclusions

The multiple self states model provides insights that will be useful for clinicians involved in the psychotherapy and management of BPD patients.
Patterns of hypnotic drug prescription in Italy
Authors: Balestrieri M. , Bortolomasi M. , Galletta M. , Bellantuono C.
Published: October 2008

Background

In Italy a number of studies have been published on psychotropic drug use in general practice and community settings. However, the present study is the first Italian study to focus on hypnotic drug prescriptions in a large community sample.

Method

Data were collected from 145 of the total of 404 pharmacies of five large cities in north-eastern Italy. All consecutive patients presenting a prescription for a hypnotic drug were interviewed by the pharmacists during a two-week period.

Results

The pharmacists interviewed 7/44 consecutive patients. The highest prevalence of prescriptions for hypnotic drugs was found in the elderly and in women. The majority (96%) of prescriptions were for benzodiazepines, with lorazepam and triazolam accounting for 50%. Short-acting and ultra-short-acting benzodiazepines were more frequently prescribed for sleep induction by general practitioners (GPs) than by psychiatrists and other physicians. Frequently the benzodiazepine used as a hypnotic was also prescribed for day time sedation. Approximately 72% of subjects reported they had been taking the prescribed drug for one year or more.

Conclusions

In Italy benzodiazepines are the most frequently prescribed drugs for sleep induction; as they are widely prescribed for elderly people by GPs often for long periods of time, educational programmes and guidelines on the rational use of benzodiazepines in general practice are needed.
Cytogenetic abnormalities on chromosome 18 associated with bipolar affective disorder or schizophrenia
Authors: Mors Ole , Ewald Henrik , Blackwood Douglas , Muir Walter
Published: October 2008

Background

A few recent linkage studies have shown a possible locus for bipolar disorder on chromosome 18. Cytogenetic studies may assist in the further localisation of susceptibility loci on this chromosome.

Method

A search was made for abnormalities of chromosome 18 in two separate large cytogenetic databases. In Denmark detection of mental illness in subjects with chromosome abnormalities was done by cross-linking the two separate register of psychiatric and chromosome disorders. In Scotland the Cytogenetic Registry of the MRC Human Genetics Unit undertakes long-term clinical follow-up of all cases with chromosome abnormalities.

Results

Cross-linking the two Danish register's revealed a family with the rare karyotype abnormality inv(18) (p11.3;q21.1) with one inversion carrier who also suffered from bipolar disorder. In this family there were two other cases of bipolar disorder, but the karyotype of these cases could not be established. One family in Scotland showed a case of schizophrenia in a carrier of inv(18) with the same breakpoints as the Danish family.

Conclusions

We suggest further studies of the 18p11.3 and 18q21.1 regions in order to identify genes involved in bipolar affective disorder and schizophrenia.
Maintenance electroconvulsive therapy and cognitive function
Authors: Barnes Richard C. , Hussein Ali , Anderson David N. , Powell David
Published: October 2008

Background

ECT is rarely used as a prophylactic treatment. A 74-year-old woman with unstable bipolar affective disorder receiving maintenance ECT presented a unique opportunity to measure the cognitive effects of continuing ECT.

Method

A single case report with serial psychometric testing during over 400 ECT treatments as a single maintenance treatment.

Results

Serial testing did not demonstrate progressive cognitive deterioration, but consistent cognitive deficits typical of acute treatment were evident. The degree of cognitive difficulty may be related to the frequency of treatment.

Conclusions

Maintenance ECT can be an effective prophylactic treatment for selected patients. Cognitive effects would appear to be no greater than with acute treatment and seem to be non-progressive.
The Hampstead Schizophrenia Survey 1991
Authors: Jeffreys Siobhan E. , Harvey Carol A. , McNaught Alan S. , Quayle Anthony S. , King Michael B. , Bird Anne S.
Published: October 2008

Background

A point prevalence study al schizophrenia was carried out in 1986 in the former Hampstead Health District using a key informant method to identify cases. The point prevalence al broadly defined schizophrenia was 4.7 per 1000.

Method

A repeat census al people with schizophrenia, using the same method, was carried out in 1991 and the point prevalence calculated. The accuracy al the census method was estimated. Contact with services, social and occupational activity, and medication usage in the 1986 and 1991 samples were compared.

Results

The point prevalence rate al broadly defined schizophrenia in 1991 was 5.1 per 1000. The results al both censuses showed we underestimated the number of individuals with DSM-III-R positive schizophrenia by about 14%. The level of contact with specialist services was greater in 1991 than 1986. Patients in 1991 were discharged on higher doses of medication, and their most recent admission was more likely to be due to non-compliance, than the 1986 group.

Conclusion

The point prevalence confirmed the high rate reported in 1986. The accuracy of the census was within acceptable limits for service planning. Contact with specialist services increased between 1986 and 1991.
Symptom severity and cognitive impairment in chronically hospitalised geriatric patients with affective disorders
Authors: Powchik Philip D. Harvey. Peter , Parrella Michael , White Leonard , Davidson Michael
Published: October 2008

Background

Affective disorders typically have a better outcome than schizophrenia, although recent evidence suggests that some patients with affective disorder have a relatively poor outcome, with cognitive impairments and persistent symptomatology.

Method

Fifty chronically hospitalised geriatric patients with mood disorders (major depression or bipolar disorder) were compared on the clinical symptoms and aspects of cognitive impairment with 308 geriatric schizophrenic patients who were hospitalised at the same institution. The two samples did not differ in current age or in premorbid education level, but the affective patients had a later age of onset and more females in the sample.

Results

There were no overall differences in cognitive functioning between the groups, although the clinical symptom profiles resembled those seen in better outcome patients.

Conclusions

Cognitive impairment is present in poor-outcome patients with affective disorders as well as schizophrenia, suggesting that cognitive impairments predict poor outcome across psychiatric disorders and not just in schizophrenia.
A neuropsychological perspective on three schizophrenic patients with midline structural defects
Authors: Edelstyn N. M. J. , Oyebode F. , Riddoch M. J. , Soppitt R. , Moselhy H. , George M.
Published: October 2008

Background

The relationship between midline structural defects and schizophrenia remains unclear, although a number of neuroradiological studies have reported an association between schizophrenia and a range of anomalies.

Method

Three patients are reported, each diagnosed with schizophrenia and neuroradiological evidence of midline structural anomalies. MRI scans are reported in conjunction with performance over a range of neuropsychological tests designed to assess frontal and lateralised cognitive functions.

Results

Evidence of anterior dysfunction was present in all three cases, while on an individual basis patients displayed varying patterns of preserved and dysfunctional cognitive processing.

Conclusion

The reported findings raise a number of interesting issues regarding the nature of hemispheric involvement in schizophrenia.
Suicide in Avon
Authors: Vassilas Christopher A. , Morgan H. G.
Published: October 2008

Background

Suicide rates among young men are rising. Further information about their contacts with services and possible associated stressful life events is necessary.

Method

The sample consisted of all cases where the coroner in the County of Avon had given an inquest verdict of suicide over a 20-month period, together with those who were categorised as suicide by a panel of psychiatrists even though they had received open or accidental inquest verdicts. The coroners dossiers and hospital notes were examined and the relevant general practitioners interviewed.

Results

Interpersonal stress in the last 72 hours was much higher in younger suicides. Young male suicides were also much less likely than others to seek help. Levels of alcohol misuse were no higher in younger than older suicides.

Conclusions

Various subgroups of suicide behave differently in the way they seek and utilise help. The implications of these findings for suicide prevention and service strategy are discussed.
A controlled family study of late-onset non-affective psychosis (late paraphrenia)
Authors: Howard R. J. , Graham C. , Sham P. , Dennehey J. , Castle D. J. , Levy R. , Murray R.
Published: October 2008

Background

The relationship between those schizophrenia-like conditions that have their onset in late life and early-onset schizophrenia is unclear. Very few family history studies of patients with late-onset psychosis have been reported, and it is not known whether their relatives have an increased risk of psychosis.

Method

Information was collected on the psychiatric morbidity of 269 first-degree relatives of patients with schizophrenia or delusional disorder with an onset after the age of 60 (late paraphrenia), and 272 first-degree relatives of healthy elderly control subjects, using a research diagnostic instrument.

Results

With a narrow age range (15–50 years) at risk, the estimated lifetime risk of schizophrenia was 1.3% in the relatives of both cases and controls. With a wider age range (15–90 years) at risk, estimated lifetime risk of schizophrenia was 2.3% for the relatives of cases, and 2.2% for the relatives of controls. However, depression was significantly more common among the relatives of cases than controls.

Conclusion

Those schizophrenia-like psychoses with onset in late life are not genetically associated with schizophrenia.
Brain morphometric comparison of first-episode schizophrenia and temporal lobe epilepsy
Authors: Barr W. B. , Ashtari M. , Bilder R. M. , Degreef G. , Lieberman J. A.
Published: October 2008

Background

Converging evidence has suggested that the abnormalities in brain morphology observed in schizophrenia are similar to those seen in temporal lobe epilepsy (TLE). The purpose ofthis study was to compare the features of these groups directly with measures of the brain using magnetic resonance (MR) morphometry.

Method

Morphometric measures of ventricular and hippocampal volumes obtained from FLASH MR images were studied in 32 patients with first-episode schizophrenia (FES), 39 patients withTLE (21 left, 18 right), and 42 healthy controls.

Results

Ventricular volumes in the FES and TLE groups were both significantly larger than those seen in controls and did not differ from each other. The FES group showed significantly larger temporal horns, while theTLE group had relatively larger frontal horns. Analyses of hippocampal volumes revealed a significant group by hemisphere effect. The FES group showed relative reductions in left hippocampal volume that were comparable only toTLE patients with seizures originating from the left hemisphere.

Conclusion

The results indicate that FES and TLE groups both show evidence of ventricular enlargement. Lateralised morphological abnormalities of the hippocampal formation in FES and left TLE are comparable, and may be specific to temporolimbic regions.
Type of hospital setting and treatment outcome with heroin addicts
Authors: Strang John , Marks Isaac , Dawe Sharon , Powell Jane , Gossop Michael , Richards David , Gray Jeffrey
Published: October 2008

Background

General psychiatrists have recently been encouraged to provide treatment to heroin addicts, including in-patient detoxification. No comparison has previously been made of specialist versus general psychiatric in-patient care.

Method

During a randomised study of cue exposure, 186 opiate addicts were also randomised to either specialist in-patient (DDU; n=115) or general psychiatric (GEN; n=71) wards in the same hospital.

Results

From pre-treatment (post-randomisation) onwards, patient outcomes differed across the two in-patient settings. Of the original randomised sample, significantly more DDU than GEN subjects accepted their randomisation (100 v. 77%), were subsequently admitted (60 v. 42%), and completed in-patient detoxification (45 v. 18%). Of patients admitted, more DDU than GEN patients completed detoxification (75 v. 43%). During seven-month follow-up, of those 43 patients who reached the end of treatment, significantly more ex-DDU than ex-GEN subjects were opiate-free.

Conclusions

From pre-treatment onwards, significant differences in process and outcome were found after allocation to treatment on either DDU or GEN. Further randomised studies are required to replicate and explain these findings.
Financial cost of treating out-patients with schizophrenia in Nigeria
Authors: Suleiman Toyin G. , Ohaeri Jude U. , Lawal Rahman A. , Haruna Adam Y. , Orija O. B.
Published: October 2008

Background

An assessment of the monetary costs of treating a group of Nigerian out-patients with schizophrenia, in comparison with insulin-dependent diabetics, was made.

Method

Fifty out-patients with schizophrenia (mean age 42.9) and 40 with diabetes (mean age 41.9), attending government hospitals in Lagos, were assessed at six-monthly intervals, for direct and indirect costs (US$=82 naira; minimum monthly wage=500 naira)

Results

Twenty (40%) of those with schizophrenia and eight (20%) of the diabetics had no income at all. The mean total cost of schizophrenia in six months (2951.4 naira) or US$ 35.9) was significantly less than that of diabetes (11 791 naira or US$ 143). The cost of antipsychotic drugs accounts for 52.8% of the cost of schizophrenia; insulin injections accounted for 92.8% of the total cost of diabetes. Patients with schizophrenia and their relatives suffered significantly more loss of working days. Cost of illness was not significantly correlated with age and duration of illness.

Conclusions

Because of drastic currency devaluation, and lack of disability benefits and nursing homes, the findings contrast with Western reports where cost of drugs constitutes 2–5%, and indirect costs constitute over 50% of the total cost of schizophrenia.
Publication trends of papers on schizophrenia
Authors: Morlino Massimo , Lisanti Felice , Gogliettino Angela , De Girolamo Giovanni
Published: October 2008

Background

We assessed the publication trends of papers on schizophrenia through an analysis of the articles published by three general psychiatric journals (Archives of General Psychiatry (AGP), the British Journal of Psychiatry (BJP), and the Australian and New Zealand Journal of Psychiatry (ANZJP) from three continents.

Method

For each of the journals, we covered the period between 1980 and 1994. We carried out both a quantitative analysis, assessing the trends over time in the publication of papers on schizophrenia, and a qualitative analysis, classifying the articles into eight scientific fields.

Results

During the study period a total of 943 articles dealing with schizophrenia were published in the three journals evaluated; the proportion of papers focusing on schizophrenia was higher in the AGP and in the BJP (18 and 15%) as compared with the ANZJP (5.6%). A substantially higher proportion of basic science articles was published in the AGP as compared with the BJP and the ANZJP, whereby a somewhat larger representation of epidemiological and psychosocial research was found in the latter journals.

Conclusions

Given the importance of schizophrenia in psychiatric research and practice, it will be useful to regularly monitor the research trends in this specific field.
Suicide by age, ethnic group, coroners' verdicts and country of birth
Authors: Neeleman Jan , Mak Vivienne , Wessely Simon
Published: October 2008

Background

Information on suicide in ethnic and immigrant groups in England and Wales is limited.

Method

A three-year (1991–1993) survey was conducted of all unnatural deaths of residents of an urban area. ‘True likely’ and official’ age-adjusted suicide rates were compared by ethnicity and, for Whites, birthplace.

Results

Irrespective of verdict, 329 likely suicides were identified. Relatively few ethnic minority and White immigrant suicides had received a suicide verdict. Afro-Caribbeans had relatively low, and young Indian women relatively high suicide rates. Rates of Scottish- and Irish-born residents were 2.1 to 2.9 times higher than the local base rate. Young White males' rates were higher than those of the elderly.

Conclusions

Classification of suicide is biased with respect to ethnicity and national origin. Rate patterns for ethnic minority groups reflect patterns seen in attempted suicide. In this deprived area, young White male suicide rates have surpassed those among the old.
Family functioning and life events in the outcome of adolescent anorexia nervosa
Authors: North Clive , Gowers Simon , Byram Victoria
Published: October 2008

Background

This study investigates the outcome of anorexia nervosa in adolescents in relation to precipitating life events and changes in family functioning over time.

Method

Thirty-five adolescents with anorexia nervosa and their mothers were administered measures of life events and family functioning at initial assessment and 1 and 2 year follow-up, when outcome was also assessed.

Results

Fifty-five per cent of patients had a good outcome. Patients from initially well-functioning families or those with precipitating life events improved more in the first year, than those with dysfunctional families or without events. Subjects perceived a deterioration in family functioning at 1 year follow-up but an improvement at 2 years. Mothers reported no changes.

Conclusions

Approximately half of a series of early onset cases of anorexia nervosa can be expected to recover by 2 years. Healthy family functioning and presence of a precipitating life event predict good short-term outcome. The relationships between subjects' perceptions of family functioning and their recovery from anorexia nervosa is discussed.
Suicide among psychiatric in-patients in a changing clinical scene
Authors: Morgan H. G. , Stanton Ruth
Published: October 2008

Background

Rapid changes in styles of clinical practice mean that we should carefully monitor the way suicides occur among psychiatric patients both in hospital and in the wider community.

Method

Patients who had died through suicide either while receiving in-patient care or within 2 months of discharge from hospital were compared with a similar series reported 10 years previously. Clinicians' perceptions of patients' behaviour were compared with concurrent controls.

Results

Patients in the more recent study were younger, more often male, and a greater proportion had been discharged from in-patient status. Hazards which complicated risk assessment included short-lasting misleading clinical improvements, variability in degree of distress, and a reluctance to discuss suicidal ideas. Over a range of perceived behaviours it was not possible to distinguish suicides from controls.

Conclusions

In assessing suicide risk paramount importance should be attached to monitoring suicidal ideation and addressing the several hazards which might complicate this procedure.
Altered dopaminergic function and negative symptoms in drug-free patients with schizophrenia
Authors: Knable Michael B. , Egan Michael F. , Heinz Andreas , Gorey Julia , Lee Kan Sam , Coppola Richard , Weinberger Daniel R.
Published: October 2008

Background

Previous in vivo studies of schizophrenia with dopamine D2 receptor radioligands have yielded contradictory results. No prior study has used multiple scans to examine within-subject clinical change.

Method

Twenty-one patients were studied with [1231]-iodobenzamide single photon emission computed tomography about two weeks after neuroleptic withdrawal. Thirteen of the 21 completed a second scan about four weeks after neuroleptic withdrawal. Sixteen controls were scanned for comparison.

Results

There was no significant difference between groups in [1231]-iodobenzamide uptake at either scanning session. No significant correlations with demographic variables (age, illness duration, drug-free period), or clinical ratings (positive and negative symptoms, movement disorder) were observed at either scanning session. There was a significant correlation between change in [1231]-iodobenzamide uptake and change in negative symptom ratings for the subjects who underwent two scans (r=0.72, P < 0.05)

Conclusions

Worsening of negative symptoms may be associated with increased availability of striatal D2 receptors, perhaps because of decreased concentrations of endogenous dopamine.
Recurrence in affective disorder
Authors: Kessing Lars Vedel
Published: October 2008

Background

The risk of recurrence in affective disorder has been found to increase with each new episode. It is unclear whether it is universal without regard to gender, age and type of disorder.

Method

Survival analysis was used to estimate the risk of recurrence in a case-register study including all hospital admissions with primary affective disorder in Denmark from 1971–1993. In this period 20 350 first-admission patients had been discharged with a diagnosis of affective disorder, depressive or manic/cyclic type.

Results

The risk of recurrence increased with the number of previous episodes regardless of the combination of gender, age and type of disorder. Initially in the course of illness, unipolar and bipolar women experienced an equal greater risk of recurrence than men. The risk of recurrence after the first episode was increased for middle-aged and older unipolar women compared with the risk for younger women, while after all other episodes younger age at first episode increased the risk of recurrence.

Conclusions

The course of severe unipolar and bipolar disorder seems to be progressive in nature irrespective of gender, age and type of disorder.
Brain 5-HT neurotransmission during paroxetine treatment
Authors: Sargent P. A. , Williamson D. J. , Cowen P. J.
Published: October 2008

Background

Animal experimental studies suggest that repeated administration of selective serotonin reuptake inhibitors (SSRIs) produces complex adaptive changes in brain serotonin (5-HT) pathways. The effect of these adaptive changes on different aspects of brain 5-HT neurotransmission and their clinical consequences are not well understood.

Method

We studied the effect of repeated administration of the SSRI, paroxetine (20 mg daily), on the Cortisol responses to the 5-HT precursor, 5-hydroxytryptophan (5-HTP), in healthy subjects and depressed patients.

Results

In healthy subjects, following one week of paroxetine treatment there was a large increase in the Cortisol response to 5-HTP. This increase had all but disappeared following 3 weeks treatment. In contrast, in depressed patients treated with paroxetine for 8 weeks, the Cortisol response to 5-HTP was significantly increased.

Conclusions

SSRI treatment in depressed patients produces a persistent increase in the Cortisol response to 5-HTP, a probable measure of neurotransmission at central 5-HT2receptors. Potentiation of 5-HT2neurotransmission is unlikely to account for the efficacy of SSRIs in major depression but might underlie their actions in obsessive–compulsive disorder and also perhaps certain of their adverse effects, notably sexual dysfunction.
Analysis of longitudinal data
Authors: Everitt B. S.
Published: October 2008

Background

Longitudinal data arise frequently in psychiatric investigations, and are most often analysed by multivariate analysis of variance (MANOVA) procedures. However, as routinely applied, the method is not satisfactory, particularly when the data are affected by subjects dropping-out of the study. More suitable methods are now available.

Method

Problems with the MANOVA approach are discussed and the advantages of alternative procedures stressed.

Results

Using MANOVA on complete cases to analyse unbalanced longitudinal data can be seriously misleading. More recently developed methods are far more suitable, but only if the missing values are non-informative.

Conclusions

Routine use of MANOVA for the analysis of longitudinal data, particularly when there is a substantial proportion of drop-outs, is ill advised. Statisticians have considerably enriched the available methodologies during the past decade, and psychiatric researchers dealing with such data should be aware of the advantages of the newer methods.