bluuebunny/crossref_metadata_2025 huggingface dataset:
The Prevalence of Bulimia Nervosa
Authors: Cooper Peter J. , Charnock Deborah J. , Taylor Melanie J.
Published: August 2008

There have been reports of a high prevalence of bulimic episodes and the syndromes of bulimia nervosa and DSM-III bulimia in community samples. A group of American authors recently compared the findings of a contemporary survey with those of a survey they had conducted previously and reported a three-fold increase in the prevalence of DSM-III bulimia. The present study replicates a community survey conducted four years ago in Britain. The prevalence of bulimic episodes, self-induced vomiting and bulimia nervosa found in the present survey was very similar to that found in the earlier study.
A Possible Variant of the Neuroleptic Malignant Syndrome
Authors: Sullivan Caroline F.
Published: August 2008

A 20-year-old man developed generalised rigidity and signs of autonomic instability following the introduction of therapy with zuclopenthixol decanoate. A diagnosis of NMS was made, despite the absence of hyperthermia. He recovered on treatment with thiamine, dantrolene, and bromocriptine.
Self-Inflicted Eye-Injuries
Authors: Rogers Tim , Pullen Ian
Published: August 2008

Three cases of self-inflicted eye injuries are described and discussed. A review of the literature shows that several psychiatric diagnoses have been assigned to those who mutilate their eyes, and various unconscious mechanisms proposed to explain this unusual phenomenon.
Ganser Syndrome and Its Management
Authors: Carney M. W. P. , Chary T. K. N. , Robotis P. , Childs A.
Published: August 2008

The literature on the Ganser syndrome is reviewed, and a case history is described. A brief hospital admission is worthwhile for patients with this syndrome, but planning and persuasion are needed.
Explaining and Understanding in Psychopathology
Authors: Ebmeier Klaus P.
Published: August 2008

Psychoanalytical methodology has been described as causal explanation or hermeneutic understanding. This methodological dichotomy has been introduced into psychopathology by Karl Jaspers. Contemporary authors' contributions in the area are discussed. Although these authors accept a role for both methods, they agree with Jaspers that psychoanalysis should be subjected to the logical limitations of hermeneutic analysis. A logical framework for the interaction of explaining with understanding is presented and discussed in relation to psychiatric research.
Midsagittal Magnetic Resonance Imaging of Autism
Authors: Gaffney Gary R. , Kuperman Samuel , Tsai Luke Y. , Minchin Susan , Hassanein Khatab M.
Published: August 2008

Since recent reports suggest structural brain abnormalities in autistic patients, we analysed magnetic resonance imaging (MAI) scans of autistic children. Planimetric measurements were done on midsagittal MRI scans, produced with a 0.5 T superconducting magnet. Scans of 13 ‘high-level’ austic subjects were compared with 35 control MRI scans, read as anatomically normal by a neuroradiologist. Corpus callosal, fourth ventricular, cerebellar, cerebral, and cranial areas were measured. The fourth ventricle was found to be significantly larger in the autistic group. No other areas in the midsagittal scans differed statistically between groups. Results suggest that structures defining the fourth ventricle are anatomically altered in autistic patients.
The Aetiology of Post-traumatic Stress Disorders Following a Natural Disaster
Authors: McFarlane Alexander Cowell
Published: August 2008

The onset of post-traumatic stress disorders in a group of firefighters who had an intense exposure to a bushfire disaster was investigated using a longitudinal research design. Contrary to expectation, the intensity of exposure, the perceived threat, and the losses sustained in the disaster, when considered independently, were not predictors of post traumatic stress disorder. By contrast, introversion, neuroticism, and a past history and family history of psychiatric disorder were premorbid factors significantly associated with the development of chronic post-traumatic stress disorders.
Urinary Catecholamine Metabolite and Tribulin Output During Lactate Infusion
Authors: Clow Angela , Glover Vivette , Weg M. W. , Walker P. L. , Sheehan D. V. , Carr D. B. , Sandler M.
Published: August 2008

Urinary output of homovanillic acid and 4-hydroxy-3-methoxymandelic acid was decreased both in patients with panic attacks and in normal controls during lactate infusion, whereas that of tribulin (an endogenous monoamine oxidase inhibitor and benzodiazepine receptor binding inhibitor) was increased. There was no change in urinary excretion of any of these compounds during saline infusion. These findings provide further evidence of a link between tribulin output and stress and anxiety in man and point to its possible in vivo action as a monoamine oxidase inhibitor.
Mephentermine Dependence with Psychosis
Authors: Joshi Uday G. , Bhat Shripathy M.
Published: August 2008

Dependence on mephentermine, a widely used sympathomimetic pressor agent, is so far unreported, although misuse of inhalers is recognised. A case of mephentermine dependence associated with chronic psychosis is reported here. Psychosis initially surfaced with chronic dexamphetamine abuse, but was sustained for 3 years by mephentermine. After a period of remission lasting for 4 years, the patient again developed psychosis on restarting abuse of mephentermine, which lasted for 5 years.
Benign Hereditary Chorea a Case Report
Authors: Loosmore S. J. , Wood K.
Published: August 2008

A case of benign hereditary chorea is reported, along with a brief review of the condition. It is a rare and little known autosomal dominant disorder which may be confused with Huntington's chorea, which has a more serious prognosis. The case described shows some characteristic features. It is difficult to decide how many of the patient's psychiatric difficulties are a reaction to his disabilities and how many have an organic substrate.
Depression and Perceptions of Early Parenting: a Longitudinal Investigation
Authors: Gotlib Ian H. , Mount John H. , Cordy Nikkie I. , Whiffen Valerie E.
Published: August 2008

It has been suggested that the quality of early parenting received by depressed adults is more negative than that received by non-depressed people. Since perceptions of parenting are usually examined only when subjects are depressed, depressed subjects' negative reports may be distortions due to their depression, rather than accurate recollections. In the present study, both depressed and remitted women reported experiencing greater parental overprotection than did non-depressed women, but only depressed subjects also reported less parental caring. The results are discussed with respect to the early experiences of depressed individuals, the distinction between parental caring and over protection, and the importance of interpersonal factors associated with depression.
The Current Age of Youthful Melancholia
Authors: Klerman Gerald L.
Published: August 2008

The possibility of a rise in rates of depression among adolescents and young adults was first reported in the 1970s. Particular note was taken of the emergence of childhood depression and the increase in suicide attempts and death among adolescents and young adults. Data from large-sample family studies and community epidemiological surveys have been reviewed and reanalysed, using life-table statistical methodology. Evidence for secular trends are presented, and the problems of disentangling period and cohort effect are discussed. It appears that the ‘baby boomers' -those born in the years after World War II- have had increased rates of depression and other related illnesses, including drug abuse and alcoholism. The theoretical aspects of this are discussed, particularly for gene-environment interactions.
The Effect of Electroconvulsive Therapy on CSF Amine Metabolites in Schizophrenic Patients
Authors: Cooper S. J. , Leahey W. , Green D. F. , King D. J.
Published: August 2008

The effects of a series of six ECT treatments were observed on the CSF concentrations of HVA, MHPG, and 5-HIAA in 12 patients suffering from schizophrenia. Four patients were previously neuroleptic drug-free, and eight had received only oral neuroleptic drugs at the same dose for more than 4 weeks. A significant increase in the concentration of HVA was observed after the first ECT treatment but not after the final treatment. No significant changes were observed in the concentrations of MHPG and 5-HIAA. The patients improved clinically, and the results suggest that ECT has important effects on dopaminergic systems.
Psychiatric Interviewing Techniques
Authors: Cox A. , Rutter M. , Holbrook D.
Published: August 2008

The effects of two experimental interview styles, designed to differ in the extent of their use of active feeling-oriented techniques but similar in their use of active fact-oriented techniques, were compared in initial diagnostic interviews with the mothers of children referred to a psychiatric clinic. The style that employed a higher level of actively responsive feeling-oriented techniques elicited more emotional expression and more often obtained certain feelings of potential diagnostic significance. The actively responsive style was more effective in increasing the amount of feeling expressed if mothers' spontaneous rate of expression was relatively low.
Social and Parenting Factors Affecting Criminal-Offence Rates
Authors: Kolvin I. , Miller F. J. W. , Fleeting M. , Kolvin P. A.
Published: August 2008

A rare opportunity to study deprivation and criminality across generations arose from the follow-up of the families who participated in the Newcastle Thousand Family Survey. The data on these families had been preserved and it was possible, using criminal records, to examine longitudinally whether children who grew up in ‘deprived’ rather than ‘non-deprived’ families were more at risk of offending during later childhood and beyond. The results of this study suggest that this is indeed so.
Goal-oriented Group Treatment for Sexually Abused Adolescent Girls
Authors: Furniss Tilman , Bingley-Miller Liza , van Elburg Annemarie
Published: August 2008

This paper reports on goal-oriented group treatment for adolescent girls who have been sexually abused within the family. The treatment approach on which the therapeutic work was based and the treatment programme are described briefly. The group treatment was seen as part of a family approach to child sexual abuse in the family. The membership and structure of the group and the aims of treatment are described. Some characteristics of the specific group processes are detailed and illustrated by clinical examples. Clinical results on outcome and results from an independent follow-up study are described, and some relevant clinical issues are discussed.
Assaults on Staff by Psychiatric In-patients
Authors: Haller Robin M. , Deluty Robert H.
Published: August 2008

Recent surveys indicate that the frequency of assaults on psychiatric staff by in-patients has increased substantially over the past decade. With patient assaultiveness becoming of greater concern, the need to predict, anticipate, and avoid confrontations with potentially assaultive patients has grown. Regrettably, the vast majority of studies examining the nature, correlates, and predictors of in-patient assaultiveness suffer from methodological problems that limit the validity of their findings.
Psychometric Correlates of Episodic Violent Behaviour
Authors: Mungas Dan
Published: August 2008

Three groups of neuropsychiatric out-patients, homogeneous according to parameters of violent behaviour, were identified in a previous study using a cluster analysis procedure and compared in this study on psychometric variables. These groups were (a) a group manifesting frequent, impulsive violence (n= 35), (b) a non-violent group (n= 57), and (c) a group whose violent behaviour was much less frequent and severe than in the first group, and more provoked (n= 31). Impulsively violent patients showed language and visual-perceptual deficits, but no other neuropsychological or intellectual deficits. The MMPI F, K and Ma and MacAndrews Alcoholism scales and a perceptual organisation factor derived from the Holtzman Inkblot Test significantly discriminated groups. Results of this and the initial study have implications regarding psychological aspects of aggression and underlying biological mechanisms.
Patterns of Care in a District General Hospital Psychiatric Department
Authors: Lawrence R. E. , Cumella S. , Robertson J. A.
Published: August 2008

A survey of all admissions of patients under the age of 65 during the first 6 years of a District General Psychiatric Department without mental-hospital support is reported. Three high-uptake groups of in-patients were defined; the long-stay (12 months or more), the medium-stay (6–12 months), and the revolving-door group (more than three admissions in any period of 12 months). Identifying characteristics which distinguish between these groups were examined. During a 7-year period there was no accumulation of long-stay patients, and a striking lack of schizophrenic patients who remained in hospital for more than 6 months or who had more than three admissions in any twelve-month period. This was not accounted for by drift of the high-uptake groups out of contact with the service, but may be related both to the style of service provision and to the socially cohesive nature of the area under study. Local variation should be given due importance when community services are being developed.
Some Influences on Regional Variation in Frequency of Prescription of Electroconvulsive Therapy
Authors: Latey R. H. , Fahy T. J.
Published: August 2008

A Republic of Ireland national survey of electroconvulsive therapy (ECT) showed wide inter-hospital variation in ECT rates. Psychiatric admission rates, professional attitudes, and patient turnover were found to predict these rates. No significant association was found between ECT rates and public/private care or other socio-economic factors. A limited examination of British admission data revealed a similar set of correlations, suggesting that the findings may apply in non-profit health-care systems outside the Republic of Ireland.
The Geriatric Mental State Examination As a Case-finding Instrument in the Community
Authors: Mcwilliam C. , Copeland J. R. M. , Dewey M. E. , Wood N.
Published: August 2008

The Geriatric Mental State Examination (GMS), a standardised psychiatric interview, and its computerised diagnostic system, AGECAT, have been applied to a large (1070) sample of subjects aged over 65 in Liverpool. In a split-half study of this sample, diagnostic scales within the GMS and a diagnostic index derived from them were tested for efficacy in cases of organic and early organic illness (mostly various stages of dementia) and depressive illness. Results demonstrated high levels of sensitivity and specificity, and positive predictive values were within the expected range when applied to these disorders, given their low prevalence in the community. The GMS, when used in this way, is a flexible and effective case-finding instrument.
Which Neurotic Patients Do Psychiatrists Treat?
Authors: Eagles John M. , Alexander David A.
Published: August 2008

Of 336 newly referred neurotic patients, 80 were not offered continuing psychiatric treatment. The factors associated with patients' not being offered continuing treatment were: short duration of illness; history of alcohol abuse and/or deliberate self-harm; age over 50 years; being widowed; and living more than 20 miles from the main hospital complex. The implications of these findings are discussed.
Behavioural Treatment of Illness Phobia and Hypochondriasis
Authors: Warwick Hilary M. C. , Marks Isaac M.
Published: August 2008

Illness phobia and hypochondriasis can be associated with severe disability and requests for reassurance. Exposure to illness cues and prevention of reassurance produced rapid improvement in both health anxiety and in social functioning. Our uncontrolled results warrant a controlled prospective trial with follow-up.
Post-Ictal Psychoses
Authors: Logsdail S. J. , Toone B. K.
Published: August 2008

Post-ictal psychoses have so far received little attention. The clinical details of 14 cases, diagnosed according to newly formulated criteria, were examined. Psychoses were usually precipitated by a run of seizures and occurred after a lucid interval. The seizures were partial complex with secondary generalisation in 11 cases. Catego analysis of the Present State Examination confirmed pleomorphic phenomenology. Follow-up details were available in all cases, for up to eight years. Psychoses tended to recur. Similarities with chronic epileptic psychosis are discussed, and a possible organic aetiology for post-ictal psychosis is proposed.
Supportive Psychotherapy: A Contradiction in Terms?
Authors: Crown Sydney
Published: August 2008

My title points to the basic paradox: if it is psychotherapy, can it be supportive? If it is supportive, can it be psychotherapy?
Addiction and After
Authors: Gossop Michael
Published: August 2008

The development of the British response to ‘the drugs problem’ since the 1960s does not lend itself readily to any optimistic interpretation. The initial wave of enthusiasm for clinics during the latter years of the 1960s soon faded. The clinic system was deprived of sufficient support, and many staff became disillusioned and burnt out. Treatment and responses gradually changed, not as the result of any clearly thought-out policy, but as the result of a vague drift of views.
Psychological Reactions of Women Who Have Been Raped
Authors: Mezey Gillian C. , Taylor Pamela J.
Published: August 2008

Twelve women, reporting rape to the police, were interviewed on three occasions over a 4-month period. Their psychological and behavioural experiences, during that time, were compared with those of 12 controls: women who were attending a Family Planning Clinic and without a history of such trauma, and small numbers of victims of non-sexual assault. All victims showed, initially, high levels of distress or some psychopathology but only the rape victims were reliable in attending follow-up appointments. In all but one case the acute, intense symptoms of distress resolved, but other substantial changes in lifestyle had taken place. The particular difficulties in counselling and research in this area were highlighted by this pilot work. Would-be counsellors should be cautious about taking on this kind of work unless considerable practical and emotional support is available to them.
Resistant Bipolar Affective Disorder Treated by Stereotactic Subcaudate Tractotomy
Authors: Poynton A. , Bridges P. K. , Bartlett J. R.
Published: August 2008

The results of stereotactic subcaudate tractotomy in nine patients with resistant bipolar affective disorder are presented in the form of a single case study with a summary of the other eight cases. Follow-up studies at 2–4 years showed substantial improvement in five patients and amelioration of symptoms in a further four patients, with a tendency for a greater improvement in the manic than in the depressive episodes. These preliminary results suggest that there is a place for this operation in the management of severe bipolar affective disorders which are not responding to any other treatment, although decisive recovery occurs less often than with unipolar depression.
The Psychopathology of the Gilles de la Tourette Syndrome
Authors: Robertson Mary M. , Trimble Michael R. , Lees A. J.
Published: August 2008

Ninety patients with the Gilles de la Tourette syndrome were studied. A high incidence of depression, hostility, and obsessionality was found. Depression was not related to administered medication, while aggression, hostility, and obsessionality were significantly associated with some important features of the syndrome, namely copro- and echo-phenomena and a family history of tics or the Gilles de la Tourette syndrome. Links between psychopathology and neurological and electroencephalographic abnormalities were minimal.
Kleine-Levin Syndrome: Report of Two Cases with Onset of Symptoms Precipitated by Head Trauma
Authors: Will R. G. , Young J. P. R. , Thomas D. J.
Published: August 2008

Two cases of Kleine-Levin syndrome are described in which the onset of symptoms was temporally related to head injury. The possible aetiological role of trauma and an apparent response to treatment with lithium carbonate are discussed.
Writer's Cramp in a Deaf 12-year-old Girl
Authors: Georgui M. M.
Published: August 2008

An unusual case of writer's cramp in a 12-year-old deaf girl is reported. Possible aetiological and contributing factors in her environment are discussed, with particular relevance to a hysterical conversion reaction.
Prescribing for the Long-term Mentally Ill
Authors: Holloway F.
Published: August 2008

A survey of the drug treatment of long-term mentally ill users of a district psychiatric service is described. The appropriateness of prescriptions was assessed against standard criteria after a detailed clinical review of each patient. Overprescribing, particularly of sedative/hypnotic and of anticholinergic and antipsychotic drugs, was common. Junior psychiatrists and general practitioners are in need of improved training in the management of chronic psychiatric illness: a review of treatment practices might be an appropriate medium for this training.
Supervising Lithium a Comparison of a Lithium Clinic, Psychiatric Out-patient Clinics, and General Practice
Authors: Masterton George , Warner Mary , Roxburgh Brian
Published: August 2008

Supervision of lithium treatment among three groups of patients treated in different settings – at a lithium clinic, as hospital out-patients, and by a GP – was studied. The lithium clinic maintained lower levels and checked these more frequently. Elevated lithium levels were most frequent in the GP-supervised group, which also included the 13 patients with the most impaired glomerular filtration. In hospital settings GFR-impaired patients received a lower daily dose of lithium; in general practice, affected patients had a higher mean serum lithium level and were more frequently prescribed lithium once daily. We conclude that patients with glomerular impairment who require lithium should be supervised by a specialist, or at least prescribed lithium in divided daily doses.
Anorexia Nervosa and Bulimia Nervosa in British Blacks
Authors: Holden Neil L. , Robinson Paul H.
Published: August 2008

Thirteen black patients were referred over 5 years to the eating-disorders unit at the Maudsley Hospital. Two suffered from anorexia nervosa and 11 from bulimia nervosa. This group was compared with a matched white control group from the total clinic population during that period. The Blacks had more commonly experienced parental divorce or separation, and premorbid obesity, and were more likely to be referred by the emergency services. Their lower educational achievements, and fathers of lower socio-economic status, reflected variation among the general black and white populations in this country, but their educational levels and social statuses were higher than in the general black population.
Aspects of Psychiatric Symptoms at Different Stages in the Treatment of Transsexualism
Authors: Mate-Kole Charles , Freschi Maurizio , Robin Ashley
Published: August 2008

Three groups of male transsexuals at different stages of the treatment process were examined and shown to match retrospectively in actuarial and psychiatric data. Transsexuals who were on a waiting list for surgery showed lower neurotic scores on the Crown–Crisp Experiential Index than those at the assessment stage of clinic attendance, while post-operative transsexuals obtained scores lower than either of the other groups. Transsexuals during the assessment stage of treatment obtained the lowest scores on items in the Bern Sex Role Inventory that define stereotypical masculine characteristics and the highest scores on items that define stereotypical feminine characteristics, in relation to the other two groups.
Performance of the Dexamethasone Suppression Test in Depressive Illness According to ICD and DSM-III Classification Systems
Authors: Watkins Sarah , Harris Brian , Cook Nigel , Thomas Roger , Riad-Fahmy Diana
Published: August 2008

The performance of the dexamethasone suppression test was assessed in 90 consecutive admissions with a diagnosis of depression, categorised according to two classification systems (DSM-III and ICD-9). Non-suppression was found in most of the diagnostic categories, but there was a highly significant association with the DSM-III classification ‘major depressive episode with melancholia’ (52%) in comparison with the ICD group ‘manic-depressive illness-depressed’ (29%).
Psychiatric Presentation of Third Ventricular Colloid Cyst
Authors: Upadhyaya A. K. , Sud P. D.
Published: August 2008

A case of colloid cyst of the third ventricle in a patient presenting with delusional depressive syndrome, in clear consciousness and with minimal cognitive impairment, is reported. The possible pathogenesis of the syndrome is discussed in the light of the reported association between aqueduct stenosis, diencephalic dysfunction, hydrocephalus, and psychotic symptoms.
Childhood and Adolescent Depression
Authors: Angold Adrian
Published: August 2008

Depression in childhood and adolescence has become a topic of considerable research interest in the last decade. A number of studies ranging over the last half-century provide information about the prevalence of depressive symptoms and syndromes in non-referred populations. These studies are critically reviewed in the light of an analysis of the various meanings that the term ‘depression’ may carry, and a variety of methodological issues. The sparse evidence for the involvement of a number of potential risk factors for depressive disorders is then considered and suggestions for future work in this area are outlined.
Schizophrenic First-rank Symptoms in Organic Mental Disorders
Authors: Marneros A.
Published: August 2008

The frequency of schizophrenic first-rank symptoms (FRS) were investigated in 1698 patients with an organic mental disorder (OMD) according to Schneider's and DSM-III criteria: 7% of the patients with OMD had FRS, compared with 47% of schizophrenic patients. However, the frequency of FRS depends on the state of consciousness and on the aetiology of the OMD: 20% of the patients with clear consciousness had FRS, but only 1.5% of those with clouded consciousness. In cases of some aetiologically defined groups of OMD, such as post-ictal epileptic psychoses or alcoholic hallucinosis, the frequency of FRS is similar to that in cases of schizophrenia. FRS appear to be psychotic reaction patterns whose substrate-related basis extends across the whole spectrum of endogenous and exogenous psychoses.
Marital Problems and Sexual Dysfunction: How are they Related?
Authors: Rust John , Golombok Susan , Collier John
Published: August 2008

In a study of 28 attenders of a sexual and marital clinic, the relationship between marital distress and both general and specific sexual dysfunctions was investigated. It was found that for men there was a much closer relationship between sexual and marital problems than for women. In particular, it was noted that the specific male sexual dysfunctions of impotence and premature ejaculation played a much larger part in marital discord than did the female dysfunctions of anorgasmia and vaginismus.
HIV Infection Associated with Symptoms Indistinguishable from Functional Psychosis
Authors: Buhrich Neil , Cooper David A. , Freed Edgar
Published: August 2008

Patients with acquired immunodeficiency syndrome (AIDS), who present with or develop psychotic symptoms, almost invariably have evidence of cognitive impairment. Three psychotic patients, one with AIDS, and two with AIDS-related complex (ARC), who showed no evidence of cognitive impairment, are reported. It is suggested that the human immunodeficiency virus (HIV) may produce symptoms indistinguishable from those seen in the functional psychoses.
Cyclic AMP Second-Messenger Signal Amplification in Depression
Authors: Ebstein Richard P. , Lerer Bernard , Shapira Baruch , Shemesh Zecharia , Moscovich Daniel G. , Kindler Seth
Published: August 2008

Beta-adrenergic-mediated cyclic AMP accumulation was reduced in lymphocytes obtained from depressed patients from that observed in an age- and sex-matched group of control subjects. Among the depressed patients, those not responding to treatment showed significantly lower pretreatment responses to isoproterenol compared with patients who exhibited significant clinical improvement during antidepressant treatment. Late-night (terminal) insomnia was significantly associated with the blunted response to beta-adrenergic stimulation. In depressed patients with the lowest isoproterenol response, the effect of forskolin (which acts distal to the receptor and directly stimulates the catalytic subunit) on cyclic AMP accumulation was also significantly decreased. This suggests that post-receptor modulations of signal amplification also play a role in the reduced response to beta-adrenergic stimulation in depression.
Hysterical Behaviour in Patriarchal Communities
Authors: Weller Malcolm P. I.
Published: August 2008

The aspirations, mores, and family structure in Cypriot immigrants, which are illustrated in four cases of hysterical behaviour, have many similarities to nineteenth century Viennese society. Such behaviour may mask more sinister diagnoses; one of the cases remains diagnostically uncertain and another passed through a transient hysterical psychosis with Ganser-like symptoms. The cultural, dynamic, and nosological issues are discussed.
Evaluation of Treatment Effectiveness in Psychiatric Research
Authors: Newcombe R. G.
Published: August 2008

A paper referred to me for statistical review has drawn my attention to the issue of appropriate evaluation of the effectiveness of treatments used in psychiatry. It has been suggested that the classical randomised controlled trial (RCT) is inappropriate to many aspects of psychiatry. I feel it is important that this issue should be looked into closely. I believe that the principle that treatment evaluation should be by RCT wherever this is feasible is certainly no less important in psychiatry than in other medical specialties. Discussion of this issue is needed, so that guidelines can be set out which will both be acceptable to researchers in psychiatry and meet scientific standards accepted in other areas of medicine.
Parasuicide and Appendicectomy
Authors: Vassilas Christopher A.
Published: August 2008

A retrospective case-note study of young women admitted for appendicectomy showed that in those patients who had a normal appendix removed, there was a significantly higher rate of admission for parasuicide, before and after the index admission; 27/184 (∼15%) compared with 17/368 (∼5%) for patients who had an inflamed appendix removed.
Subacute Sclerosing Panencephalitis (SSPE) Presenting at the Age of 21 as a Schizophrenia-like State with Bizarre Dysmorphophobic Features
Authors: Salib E. A.
Published: August 2008

A case is described of a 21-year-old man who, after extensive investigations by the general physicians and neurologists, was transferred to a psychiatric hospital with a diagnosis of functional illness. The clinical picture at that stage simulated schizophrenia with prominent dysmorphophobic features. A diagnosis of subacute sclerosing panencephalitis was then made 9 months after the onset.
Down's Syndrome and Eating Disorders
Authors: Holt G. M. , Bouras N. , Watson J. P.
Published: August 2008

We describe the case of a 33-year-old man with Down's syndrome and severe eating disorders. The clinical symptoms, and their difference from those of anorexia nervosa, are discussed. The patient responded well to a strict behavioural programme after long, in-patient treatment and was still well at a 2-year follow-up examination.
Fatigue and Fatigability
Authors: Kennedy H. G.
Published: August 2008

“One spring, towards the end of March, I happened to be in Rome, and, hearing that the migration of the quails had begun, I went down to Palo on the sea coast in order to ascertain whether these birds, after their journey from Africa, showed any of the phenomena of fatigue.”
Writer's Cramp: a Controlled Trial of Habit Reversal Treatment
Authors: Wieck Angelika , Harrington Richard , Marks Isaac , Marsden Colin
Published: August 2008

In uncontrolled studies, several behavioural methods, including habit reversal, were said to be useful in writer's cramp. In this controlled study, 23 subjects with writer's cramp recruited from a neurology clinic were randomly allocated to five sessions over four weeks of either habit reversal training or a control treatment of relaxation training. Three subjects dropped out. Twenty patients (9 habit reversers, 11 controls) completed the trial up to three months follow-up. Outcome measures included observation of writing within the session, assessment of writing tasks completed at home, and blind ratings by an independent assessor. The results showed that habit reversal was no better than relaxation. Taking both treatments together, patients improved to three months follow-up on seven of nine measures, but remained substantially handicapped.
Sex Differences in the Seasonal Distribution of Suicides
Authors: Lester David , Frank Michael L.
Published: August 2008

An attempt was made to replicate in the USA sex differences reported for the seasonal distribution of suicide in the UK, Finland and Australia. No sex differences were found. Spring and late summer peaks were found for suicides by both males and females. The method of suicide was found to be an important factor in the seasonal distribution of the suicides of males and females.
Capgras Syndrome Heralding the Development of Dementia
Authors: Lipkin Bron
Published: August 2008

Delusional misidentification of people otherwise well known, referred to as the Capgras syndrome, has been described in both functional and organic conditions. Evidence is accruing to suggest that it would always be prudent to search vigorously for an organic aetiology.
Personality Disorder: the Patients Psychiatrists Dislike
Authors: Lewis Glyn , Appleby Louis
Published: August 2008

A sample of psychiatrists was asked to read a case vignette and indicate likely management and attitudes to the patient on a number of semantic-differential scales. Patients given a previous diagnosis of personality disorder (PD) were seen as more difficult and less deserving of care compared with control subjects who were not. The PD cases were regarded as manipulative, attention-seeking, annoying, and in control of their suicidal urges and debts. PD therefore appears to be an enduring pejorative judgement rather than a clinical diagnosis. It is proposed that the concept be abandoned.
A Matched-control Follow-up and Family Study of ‘Puerperal Psychoses’
Authors: Platz C. , Kendell R. E.
Published: August 2008

A hundred and ten women admitted to a psychiatric hospital within 90 days of childbirth were individually matched for age, psychiatric syndrome, and year of admission with women admitted to the same hospital with illnesses unrelated to childbirth. Both groups were followed up after a mean interval of nine years, and 72 matched pairs of patients for whom adequate information was obtained were then compared. The previous and subsequent psychiatric morbidity of these two groups, their subsequent obstetric careers, and the psychiatric morbidity of their first-degree relatives were all very similar. However, the puerperal women had significantly fewer relapses in the follow-up period, fewer committed suicide, and the psychiatric morbidity of their relatives tended to be lower. This better outcome was most marked in puerperal subjects with major depressions; those with manic disorders fared no better than controls. These results suggest that puerperal psychoses are basically the same as affective illnesses occurring at other times but, because childbirth is a uniquely potent precipitant of affective illness, some of those who develop puerperal episodes have a lesser genetic predisposition to affective illness than the generality of women with affective disorders.
Factors Affecting the Emotional Wellbeing of the Caregivers of Dementia Sufferers
Authors: Morris Robin G. , Morris Lorna W. , Britton Peter G.
Published: August 2008

Recent research on the factors that mediate the emotional wellbeing of the caregivers of dementia sufferers is reviewed. The roles of such factors as the caregiver's attributional style and coping strategies, the caregiver's relationship with the dementia sufferer, and levels of formal and informal support are discussed with reference to identifying those caregivers who are particularly vulnerable to emotional disorder or strain.
Scottish Survey of Chronically Ill Day Patients: 3-Year Follow-up
Authors: McCreadie R. G. , Pieri Lorenzo F. , McGuire Ralph J.
Published: August 2008

Chronically ill day patients were followed up 3 years after identification in the catchment areas of 13 psychiatric hospitals serving 54% of the Scottish population. Five per cent had died, 6% were in-patients, 56% remained day patients and 14% were supported by community psychiatric nurses or attended an out-patient clinic; contact had been lost with 19%. Over 3 years, 32% had had at least one admission to in-patient care; a wide range of other services was also used. There was little change in the level of disability; a typical patient in contact at follow-up was single, schizophrenic, and rather disabled.
Estimation of Premorbid Intelligence in Organic Conditions
Authors: Crawford J. R. , Parker D. M. , Besson J. A. O.
Published: August 2008

The validity of premorbid IQ estimates provided by the National Adult Reading Test (NART) and Vocabulary sub-test of the Wechsler Adult Intelligence Scale were evaluated, by comparison with matched, healthy control subjects, in Korsakoff psychosis, alcoholic dementia, dementia Alzheimer type (DAT), multi-infarct dementia (MID), Huntington's disease, and closed head injury (CHI). There was no significant difference in NART performance between control subjects and the alcoholic dementia, DAT, MID, and CHI groups. Although there appeared to be a decline in NART performance in the Korsakoff and Huntington's groups, it did provide a significantly higher IQ estimate than the Vocabulary sub-test. All clinical groups, with the exception of the CHI group, performed at a significantly lower level than the control group on the Vocabulary sub-test.
Lithium Carbonate – a Competitive Aldosterone Antagonist?
Authors: Stewart Paul M. , Atherden Sheila M. , Stewart Susan E. , Whalley Lawrence , Edwards Christopher R. W. , Padfield Paul L.
Published: August 2008

Plasma renin activity (PRA), aldosterone (aldo) levels, electrolyte levels, and blood pressures were measured in 16 patients with affective disorders taking lithium prophylactically, and in 16 age and sex-matched control subjects. PRA and aldo levels were significantly elevated in the lithium-treated group. There was no difference between the groups in plasma electrolytes or erect and supine blood pressures, arguing against secondary aldosteronism. In the lithium-treated group, there was a significant positive correlation between both PRA and plasma aldovsserum lithium. We postulate that lithium inhibits the action of aldosterone on the distal tubule in the kidney. Activation of the renin angiotensin system maintains normal blood pressure and plasma electrolytes.
Marital Violence in the Community
Authors: Andrews Bernice , Brown George W.
Published: August 2008

A study of women in Islington confirms earlier findings of a high rate of reported marital violence (25% experiencing it at some time in their lives). Women who had experienced marital violence tended not to repeat the same pattern in subsequent relationships. Violence was associated with childhood neglect, but not early violence. Premarital pregnancy and teenage marriage were links between early neglect and marital violence, and were also important correlates of later marital violence, irrespective of such earlier lack of care. These early-adult experiences were also related to spending longer in a violent relationship. Women experiencing marital violence were more likely to have been depressed, and to have had low self-esteem, in the 3-year study period.
Psychiatric and Legal Aspects of Persistent Litigation
Authors: Rowlands M. W. D.
Published: August 2008

There is a paucity of literature in English about those people who persistently complain. In Germany and in Scandinavia, a diagnosis of querulent paranoia may be made, although this interesting and uncommon syndrome is rarely recognised in the UK. Five cases of litigiousness or persistent complaining are reported, to illustrate the typical psychopathology and the types of diagnosis that occur. Four of these people are barred from further litigation by the courts (vexatious litigants) and were contacted directly for the purpose of this study.
Opioid Withdrawal and Naltrexone Induction in 48–72 Hours with Minimal Drop-out, Using a Modification of the Naltrexone-Clonidine Technique
Authors: Brewer Colin , Rezae Hussein , Bailey Clayton
Published: August 2008

Using clonidine, naltrexone, and diazepam, 60 withdrawals from heroin and other opioids involving 56 addicts were carried out with only one patient dropping out. In the last 23 cases, we used a modification of the standard technique, giving significantly higher doses of naltrexone and clonidine on the first day. This significantly reduced the average withdrawal time from 3.30 days to 2.32 days, despite lower clonidine dosage and significantly lower diazepam dosage on the second day. The speed, effectiveness, economy, and high acceptability of this withdrawal technique have implications for both private and state-funded treatment programmes.
The Expression of Schizophrenia, Affective Disorder and Vulnerability to Tardive Dyskinesia in an Extensive Pedigree
Authors: Waddington John L. , Youssef Hanafy A.
Published: August 2008

The demography, psychiatric morbidity, and motor consequences of long-term neuroleptic treatment in the 14 children born to a father with a family history of chronic psychiatric illness and a mother with a late-onset affective disorder resulting in suicide are documented. Twelve siblings lived to adulthood, nine of whom were admitted to a psychiatric hospital in their second or third decade, and required continuous in-patient care; five remaining in hospital, with long-term exposure to neuroleptics, had chroniC., deteriorating, schizophrenic illness and emergence of movement disorder. Two siblings showed no evidence of psychosis but developed a late-onset affective disorder. The implications for the issues of homotypia, vulnerability to involuntary movements, and interaction with affective disorder are discussed.
Post-Partum Psychosis in Adult GM2 Gangliosidosis
Authors: Lichtenberg P. , Navon R. , Wertman E. , Dasberg H. , Lerer B.
Published: August 2008

Adult hexosaminidase A deficiency is a form of GM2 gangliosidosis with autosomal recessive inheritance. Only 35 cases (mostly among Ashkenazic Jews) have been reported worldwide. Symptoms include, in a third of the cases, psychosis. A 27–year-old sufferer with no prior psychiatric history, developed a post-partum psychosis, with affective and hebephrenic components, 3 days following her first delivery. She responded to lithium within 10 days of initiating treatment; the full episode lasted 1 month. We conclude that lithium is the preferred treatment for psychosis in such adult patients, especially in light of possible long-term neurological deterioration caused by phenothiazines. Ashkenazic Jews with atypical neurological syndromes presenting with psychosis should be tested for hexosaminadase A deficiency.
Towards a Neuropsychology of Schizophrenia
Authors: Frith Christopher D. , Done D. John
Published: August 2008

A viable neuropsychology of schizophrenia requires, first, that signs and symptoms be understood in terms of underlying psychological processes and, second, that these underlying processes be related to brain systems. We propose that the negative signs of schizophrenia reflect a defect in the initiation of spontaneous action, while the positive symptoms reflect a defect in the internal monitoring of action. The spontaneous initiation of action depends upon brain systems linking the prefrontal cortex and the basal ganglia. Internal monitoring, carried out in the hippocampus, of spontaneous action, depends upon links between the prefrontal cortex and the hippocampus via the parahippocampal cortex and the cingulate cortex.
On Moral Judgements and Personality Disorders
Authors: Blackburn Ronald
Published: August 2008

Psychopathic personality has always been a contentious concept, but it continues to be used in clinical practice and research. It also has its contemporary synonyms in the categories of antisocial personality disorder in DSM–III (American Psychiatric Association, 1980) and “personality disorder with predominantly asocial or sociopathic manifestations” in ICD–9 (World Health Organization, 1978), and some overlap between these and the legal category of psychopathic disorder identified in the English Mental Health Act 1983 is commonly assumed. Although the literal meaning of ‘psychopathic’ is nothing more specific than psychologically damaged, the term has long since been transmogrified to mean socially damaging, and as currently used, it implies a specific category of people inherently committed to antisocial behaviour as a consequence of personal abnormalities or deficiencies.
Working with General Practitioners
Authors: Horder John
Published: August 2008

Psychiatrists and general practitioners have found new ways of working together in the last ten years, but there have also been separate activities which could develop into rivalry. These opportunities and dangers are the central theme of this paper. Ways are considered in which the psychiatry of general practice differs from the experience of psychiatrists. Forms of help are suggested which general practitioners need from psychiatrists, whether in clinical practice or education.
The Community Management of Schizophrenia
Authors: Tarrier Nicholas , Barrowclough Christine , Vaughn Christine , Bamrah J. S. , Porceddu Kathleen , Watts Susan , Freeman Hugh
Published: August 2008

Schizophrenic patients were recruited into a trial of a prophylactic behavioural intervention with families. Families with at least one high Expressed Emotion (EE) relative were randomly allocated to one of four intervention groups: Behavioural Intervention Enactive; Behavioural Intervention Symbolic; Education Only; Routine Treatment. Patients from low-EE families were randomly allocated to two groups: Education Only or Routine Treatment. Relapse rates over nine months after discharge were significantly lower for patients in the two Behavioural Intervention, compared with Education Only and Routine Treatment groups. There was little difference between the two low-EE groups. Patients returning to high-EE relatives showed significantly higher relapse rates than those returning to low-EE relatives, in groups not receiving active intervention. Changes from high to low EE occurred in the Behavioural Intervention groups, and similar although less extensive changes occurred in the Education Only and Routine Treatment groups. Changes in criticism and marked emotional over-involvement (EOI) occurred generally in high-EE groups but were larger in magnitude in the Enactive and Symbolic groups. Reduction of hostility only occurred in the Behavioural Intervention groups. These results give partial support for the causal role of EE in relapse. There were no significant differences between the groups with respect to contact with the psychiatric services or medication.