bluuebunny/crossref_metadata_2025 huggingface dataset:
Somatisation disorder in primary care
Authors: Escobar Javier I. , Gara Michael , Silver Roxanne Cohen , Waitzkin Howard , Holman Alison , Compton Wilson
Published: October 2008

Background

Somatisation is a common and frustrating clinical problem in primary care.

Method

Using structural diagnoses and functional measures, we examined the prevalence and associated features of somatisation disorder defined by three current nosologies and an abridged construct in subjects using primary care services.

Results

Somatisation disorder, diagnosed according to the standard criteria, was found to have a very low prevalence (range 0.06–5%), while more than one-fifth of the sample (22%) met the criteria for the abridged diagnosis. There was poor agreement between succeeding versions of the DSM system for identifying cases of somatisation disorder, each system ending up with rather disparate sets of individuals as well as variable levels of psychopathology and disability.

Conclusions

According to these data, standard somatisation disorder diagnoses add little to the prediction of disability/psychopathology beyond the contributions of an abridged construct of somatisation.
Typology of common psychiatric syndromes
Authors: Sullivan Patrick F. , Kendler Kenneth S.
Published: October 2008

Background

Diagnostic comorbidity is prevalent in psychiatry and may be inadequately captured by the DSM-III/III-R nosology.

Methods

The lifetime presence of 11 psychiatric diagnoses was determined by structured personal interviews of a population-based sample of 1898 female twins. We used latent class analysis to derive an empirical typology.

Results

Six classes provided the best fit to the data. Their mnemonics were: minimal disorder (60% of the sample), major depression -generalised anxiety disorder (19%), alcohol–nicotine (7%), highly comorbid major depression (5%) and eating disorders (3%). The validity of this typology was strongly supported by demographic, health, personality and attitudinal validators along with the significant monozygotic twin concordance for class membership. The typology superficially resembled DSM-III-R, but contained many differences. Major depression appeared in three forms (alone, with generalised anxiety disorder and with considerable comorbidity). Alcoholism-nicotine dependence and the various anxiety disorders formed discrete classes, but were also prominent in other classes. Bulimia and anorexia were exceptional in their appearance in a single class.

Conclusions

The DSM-III-R and closely related DSM-IV nosology did not capture the natural tendency of these disorders to co-occur. Fundamental assumptions of the dominant diagnostic schemata may be incorrect.
Effects of community services on disability and symptoms
Authors: Wykes Til , Leese Morven , Taylor Ruth , Phelan Michael
Published: October 2008

Background

Community care for people with psychosis can be provided via several different service models. The study compared two models: standard community treatment with high patient:staff ratios, and intensive community treatment in which there was more of an emphasis on community involvement and lower patient:staff ratios.

Method

All people fulfilling diagnostic criteria for psychosis and living in two defined geographical areas in south London were identified. These people were provided with either an intensive or standard service depending on their address. Their social behaviour and symptoms were measured at the beginning of the study and after two years.

Results

There is little evidence of any effects of the two service models on levels of symptoms. However, the standard service did seem to be advantageous in reducing social disability for those with medium or low levels of disability.

Conclusions

The effect of intensive community services was the opposite to that predicted. Despite improvements in outcomes (e.g. hospital admission), there were no advantages for this type of service in the measures of disability or symptoms. In fact, the standard service was effective in reducing disability, whereas in the intensive service there was no change.
Social roles and gender difference in the prevalence of common mental disorders
Authors: Weich Scott , Sloggett Andrew , Lewis Glyn
Published: October 2008

Background

It is not known why the most common mental disorders, anxiety and depression, are more prevalent among women than men. The aim was to test the hypothesis that this gender difference could be explained by differences between men and women in social role occupancy, after adjusting for age and socio-economic status.

Method

A cross-sectional survey of 8979 adults aged 16–74 years living in private households in England. Wales and Scotland was carried out. Prevalence of common mental disorders was assessed using the General Health Questionnaire.

Results

The gender difference in the prevalence of the common mental disorders (unlike social role occupancy) did not vary with age to a statistically significant degree (unadjusted odds ratio 1.35, 95% C11.23–1.48) (P < 0.0001). Although those of either gender occupying the fewest, and women occupying the most social roles (after adjusting for age) had the highest prevalence of common mental disorders, neither number of social roles, occupancy of traditional ‘female’ caring and domestic roles, nor socio-economic status explained the gender difference in these conditions (adjusted OR 1.26, 95% C11.14–1.41) (P < 0.001).

Conclusions

The gender difference in the prevalence of the common mental disorders is not explained by differences between men and women in the number or type of social roles occupied.
Age at onset and outcome in schizophrenia are related to the degree of familial loading
Authors: Suvisaari Jaana M. , Haukka Jari , Tanskanen Antti , Lönnqvist Jouko K.
Published: October 2008

Background

Recent research suggests that high familial loading is associated with early onset of schizophrenia. Results concerning outcome have been controversial.

Method

We assessed the relationship between familial loading, age at onset and outcome in all Finnish patients with schizophrenia born between 1950 and 1969. Patients and their first-degree relatives were identified using nationwide registers. Familial loading scores were calculated for schizophrenia and for combined psychotic disorders, and patients were accordingly classified into three groups: high (n = 761), intermediate (n = 14 247), and low familial loading (n = 725). Linear mixed models and the Cox proportional hazard model were used in the analyses.

Results

Onset was earliest, hospitalisation longest and risk of retirement in receipt of a disability pension highest in the group with high familial loading, with opposite extremes found in the group with low familial loading.

Conclusions

High familial loading for schizophrenia is associated with early onset and poor outcome of schizophrenia.
Changes in public attitudes to depression during the Defeat Depression Campaign
Authors: Paykel E. S. , Hart Deborah , Priest R. G.
Published: October 2008

Background

Aims of the Defeat Depression Campaign between 1991 and 1996 included the reduction of stigma associated with depression, education of the public about the disorder and its treatment and encouragement of earlier treatment-seeking. Newspaper and magazine articles, radio and television programmes and other media activities were employed.

Method

Surveys of public attitudes were conducted by MORI in late 1991, early 1995 and mid-1997. Each covered approximately 2000 subjects, sampled to be representative of the population of Great Britain. Structured interviews covered views on depression, treatment and general practitioners (GPs).

Results

There were significant positive changes regarding attitudes to depression, reported experience of it, attitudes to antidepressants, and less consistently, to treatment from GPs. Changes were of the order of 5–10%. Throughout, attitudes to depression and to treatment by counselling were very favourable, whereas antidepressants were regarded as addictive and less effective.

Conclusions

Positive attitude change was achieved during the Campaign, although there is still room for improvement in some aspects.
Genetic and non-genetic subtypes of major depressive disorder
Authors: Andrew Martin , McGuffin Peter , Katz Randy
Published: October 2008

Background

We aimed to examine the hypotheses that major depression is aetiologically heterogeneous consisting of a mixture of ‘genetic’ and ‘non-genetic’ forms or, alternatively, a mixture of one form that is ‘pure’ depression and another that has a familial relationship with alcohol dependency or other disorders.

Method

One hundred and eleven twin pairs (44 monozygotic, 67 dizygotic) where the proband had received treatment for DSM–IV major depression were ascertained via a hospital register. Family history information on parents and siblings was obtained from the proband, co-twin or both. Diagnoses on parents and siblings were made blind to twin zygosity or concordance and compared in the relatives of concordant versus discordant twins.

Results

The lifetime prevalence and age-corrected risk of depression were no different in the relatives of concordant and discordant twin pairs. There was a marginally significant increase in the rate of alcohol abuse or dependence among the relatives of concordant twins but no difference between concordant and discordant pairs in respect of other axis I diagnosis among family members.

Conclusions

The results argue against genetic heterogeneity and suggest that major depression cannot usefully be divided into genetic and non-genetic forms or into ‘pure’ depression and depression associated with other disorders such as alcohol dependency.
Family history as a predictor of poor long-term outcome in depression
Authors: Duggan Conor , Sham Pak , Minne Carine , Lee Alan , Murray Robin
Published: October 2008

Background

We investigated whether family history had prognostic significance in depression in a study which addressed some of the methodological shortcomings of previous studies.

Method

We collected family history data on a consecutive series of 89 patients admitted with RDC major depression, blind to the outcome of the proband. This comprised 116, 283 and 120 first-degree relatives examined with the SADS–L, FH–RDC and case note data, respectively. The outcome of 74 of these probands (83%), previously categorised into four operationally defined groups, was then examined.

Results

A positive family history of severe psychiatric illness (i.e. a relative with a history of either a psychosis, hospitalised depression or suicide) was associated with poor outcome in the proband. This association persisted after controlling for variable family size, age structure and gender. As family history was correlated with neither Kendell's neurotic/psychotic index nor the probands neuroticism score, an individual with high scores an all three would have a greatly increased chance of having a poor outcome.

Conclusions

A family history of severe psychiatric illness in a first-degree relative may be useful as one of the vulnerability factors for predicting poor long-term outcome in depression.
Randomised double-blind comparison of the incidence of tardive dyskinesia in patients with schizophrenia during long-term treatment with olanzapine or haloperidol
Authors: Beasley Charles M. , Dellva Mary Anne , Tamura Roy N. , Morgenstern Hal , Glazer William M. , Ferguson Kevin , Tollefson Gary D.
Published: October 2008

Background

Tardive dyskinesia is important in the side-effect profile of antipsychotic medication.

Aims

The development of tardive dyskinesia was evaluated in patients treated with double-blind, randomly assigned olanzapine or haloperidol for up to 2.6 years.

Methods

Tardive dyskinesia was assessed by the Abnormal Involuntary Movement Scale (AIMS) and Research Diagnostic Criteria for Tardive Dyskinesia (RD-TD); it was defined as meeting RD-TD criteria at two consecutive assessments. The risk of tardive dyskinesia, the relative risk, incidence rate, and incidence rate ratio were estimated.

Results

The relative risk of tardive dyskinesia for the overall follow-up period for haloperidol (n=522) v. olanzapine (n=1192) was 2.66 (95% CI=1.50–4.70). Based on data following the initial six weeks of observation (during which patients underwent medication change and AIMS assessments as frequently as every three days), the one-year risk was 0.52% with olanzapine (n=513) and 7.45% with haloperidol (n=114). The relative risk throughout this follow-up period was 11.37 (95% Cl=2.21–58.60).

Conclusion

Our results indicated a significantly lower risk of tardive dyskinesia with olanzapine than with haloperidol.
Natural history of behavioural changes and psychiatric symptoms in Alzheimer's disease
Authors: Hope Tony , Keene Janet , Fairburn Christopher G. , Jacoby Robin , McShane Rupert
Published: October 2008

Background

Alzheimer's disease and other types of dementia are characterised by numerous psychiatric and behavioural changes. Little is known of their natural history.

Aims

To investigate the sequence and pattern of these changes throughout the course of dementia.

Method

One hundred people, initially living at home with carers, entered a prospective, longitudinal study. At four-monthly intervals, behavioural and psychiatric symptoms were assessed using the Present Behavioural Examination and Mini-Mental State Examination. Follow-up continued for up to nine years (mean 3.3 years; s.d. 2.4). Patterns of onset and disappearance of these symptoms, their sequence and association with time of death and cognitive decline were analysed. Autopsy confirmed a diagnosis of pure Alzheimer's disease in 48 subjects. Data for this subgroup are presented.

Results

Some changes tend to occur earlier than others but changes can occur at almost any time in the course of dementia.

Conclusions

The natural history of behaviour changes in Alzheimer's disease shows great individual variation although some changes tend to follow a recognisable sequence.
Validity of current clinical criteria for Alzheimer's disease, vascular dementia and dementia with Lewy bodies
Authors: Holmes Clive , Cairns Nigel , Lantos Peter L. , Mann Anthony
Published: October 2008

Background

Following the success of the NINCDS–ADRDA criteria for Alzheimer's disease, groups interested in vascular dementia and dementia with Lewy bodies have now adopted similar criteria.

Aims

To assess whether the validity of these criteria are influenced by the prevalence of mixed pathologies or by the prevalence rate.

Method

A community based postmortem study.

Results

Mixed pathologies were common (33.8%). The high specificities obtained for the CDLB and NINDS–AIREN criteria (1.00 and 0.95, respectively) were associated with low sensitivities (0.22 and 0.43, respectively). Low prevalence and the presence of mixed pathologies had a deleterious effect on positive predictive values.

Conclusions

Current clinical diagnostic criteria are good at detecting pathology per se but not at detecting pure pathology. A large proportion of subjects from the general population fulfilling probable CDLB, probable NINCDS–ADRDA or probable NINDS–AIREN will have mixed pathologies.
Comparison of intensive and standard case management for patients with psychosis
Authors: Creed Francis , Burns Tom , Butler Tom , Byford Sarah , Murray Robin , Thompson Simon , Tyrer Peter
Published: October 2008

Background

Case management, particularly in intensive form, has been widely introduced for the treatment of severe mental illness. However, the optimal intensity of case management has not been determined.

Aims

We aimed to assess whether intensive case management (small case load) reduces hospitalisation and costs compared with standard case management.

Method

Development and rationale of a large randomised controlled trial comparing intensive case management (case load per worker? 15 patients) with standard case management (case load 30–35 patients)

Results

Two-year outcome data will be obtained on patients representative of the seriously mentally ill in inner-city mental health services.

Conclusions

The study planned with 700 patients should be sufficient to detect small differences in the readmission of patients to hospital (10%), the number of days spent in hospital over a two-year period (10 days) and the average weekly cost of care per patient. The sample is large enough to compare the cost-effectiveness of intensive and standard case management in mild and severe disability and in people of African–Caribbean origin and White Caucasians.
Homicides by people with mental illness: myth and reality
Authors: Taylor Pamela J. , Gunn John
Published: October 2008

Background

Tragic and high-profile killings by people with mental illness have been used to suggest that the community care model for mental health services has failed.

Aims

To consider whether such homicides have become more frequent as psychiatric services have changed.

Method

Data were extracted from Home Office-generated criminal statistics for England and Wales between 1957 and 1995 and subjected to trends analysis.

Results

There was little fluctuation in numbers of people with a mental illness committing criminal homicide over the 38 years studied, and a 3% annual decline in their contribution to the official statistics.

Conclusions

There are many reasons for improving the resources and quality of care for people with a mental disorder, but there is no evidence that it is anything but stigmatising to claim that their living in the community is a dangerous experiment that should be reversed. There appears to be some case for specially focused improvement of services for people with a personality disorder and/or substance misuse.
Early life family disadvantages and major depression in adulthood
Authors: Sadowski Hartwin S. , Ugarte Blanca , Kolvin Israel , Kaplan Carole E. , Barnes Jacqueline
Published: October 2008

Background

There is evidence that exposure to social and family disadvantages in childhood are a risk factor for adult depression.

Aims

To explore the effects of multiple adversity in early childhood on adult depression, and the relative effects of the different adversities.

Method

This study utilises data from the Newcastle Thousand Family Study. Information on childhood disadvantages was collected when the participants were 5 years old, and information on mental health was gathered when they were 33 years old. Mental health data were scrutinised blind to the evidence of early disadvantage, and best-estimate diagnoses of major depressive disorder were made according to DSM–III–R criteria.

Results

Multiple family disadvantages in childhood substantially increase the risk of suffering a major depressive disorder in adulthood. Such disadvantages include family or marital relationship instability, a combination of poor mothering and poor physical care, and a combination of dependence on social welfare and overcrowding. For females major depression was linked in particular to the quality of parenting in early life.

Conclusions

Social and family (especially multiple family) disadvantages during childhood predispose individuals to an increased risk of major depression in adulthood.
Stalking: false claims of victimisation
Authors: Pathé Michele , Mullen Paul E. , Purcell Rosemary
Published: October 2008

Background

False allegations of victimisation although uncommon are important to recognise. This paper examines those who falsely claim to have been the victims of stalking.

Aims

To highlight the phenomenon of false victims of stalking.

Method

Twelve individuals who falsely claimed to be victims of stalking were compared with a group of 100 true stalking victims.

Results

False stalking victims presented for help earlier than real victims and were less likely to claim harassment via letters. They reported equivalent levels of violence directed at themselves but seldom claimed others were attacked. Five types of false claimants were recognisable. False victims consumed more medical services than genuine stalking victims and they were more likely to be embroiled in legal action. They reported similar levels of distress with suicidal ruminations in over 40%.

Conclusions

The current interest in stalking is promoting false claims of being stalked. Early identification of these cases and appropriate intervention are essential to both minimising abuses of resources available to true victims and equally to ensure appropriate care for those who express their own disordered state in false claims of victimisation.
Schizophrenia – a disorder of the corollary discharge systems that integrate the motor systems of thought with the sensory systems of consciousness
Authors: Feinberg Irwin , Guazzelli Mario
Published: October 2008

Background

In spite of intensive research, no causal anatomical lesion has been found in schizophrenia. It may instead be caused by malfunctioning circuits in the corollary discharge, feed forward (CD–FF) systems of thought.

Aims

To integrate with the CD–FF hypothesis recent data showing that subcortical motor systems participate in thinking.

Methods

We review CD–FF concepts in relation to recent evidence that ‘motor’ brain structures participate in cognitive processing.

Results

Malfunctioning of CD–FF systems that integrate thinking and consciousness could produce auditory hallucinations, delusions and disorganised thought.

Conclusions

We hypothesise that the pathophysiology of schizophrenia lies in integrative circuits of basal ganglia, thalamus and frontal cortex. Fruitful research directions would include elucidation of CD–FF circuits at even higher brain levels, the behaviour of these circuits during dreaming, and their responses to late maturational events including synaptic elimination.
Continuing treatment of panic disorder after acute response: randomised, placebo-controlled trial with fluoxetine
Authors: Michelson David , Pollack Mark , Lydiard R. Bruce , Tamura Roy , Tepner Rosalinda , Tollefson Gary ,   The Fluoxetine Panic Disorder Study Group
Published: October 2008

Background

Data concerning appropriate treatment in panic disorder following an initial response to acute therapy are limited.

Aims

To assess the safety and efficacy of continued fluoxetine treatment following successful acute therapy of panic disorder.

Method

Patients who responded to acute fluoxetine treatment were randomised to 24 weeks of continued fluoxetine or placebo.

Results

Fluoxetine responders randomised to continue on their acute-phase fluoxetine dose experienced statistically significant improvement in panic attack frequency and phobia rating scale score over 24 weeks of therapy, while those switched to placebo experienced statistically significant worsening in Hamilton Anxiety (HAM–A), Hamilton Depression (HAM–D) and SCL–90–R rating scores.

Conclusions

Fluoxetine was associated with improved clinical outcomes compared with placebo during continuation therapy.
Befriending as an intervention for chronic depression among women in an inner city
Authors: Harris Tirril , Brown George W. , Robinson Ruth
Published: October 2008

Background

Earlier work on the protective role of social support in onset and course of depressive disorder suggested that its provision might be relevant for outcome.

Aims

To evaluate volunteer befriending as an intervention among women with chronic depression in inner London.

Method

A randomised controlled trial, with awaiting list control design, with outcome measured as Present State Examination (PSE)-based full or partial remission after one year.

Results

A statistically significant effect upon remission was found for befriending. Other treatments monitored naturalistically did not relate to remission, nor did initial duration of chronic episode or comorbidity, but there was an association with initial PSE score. The findings are discussed in relation to standard drug-trial results and to another befriending intervention with the elderly.

Conclusions

The results are not unpromising. Additional trials with less restricted intake conditions, and in more naturalistic general practice settings, might confirm volunteer befriending as a useful adjunct to current treatments.
Treatment of neuroleptic-induced akathisia with the 5-HT2antagonist mianserin
Authors: Poyurovsky Michael , Shardorodsky Marina , Fuchs Camil , Schneidman Michael , Weizman Abraham
Published: October 2008

Background

Serotonin (5-HT): dopamine imbalance may underlie neuroleptic-induced akathisia.

Aim

To evaluate the efficacy of the 5-HT2antagonist, mianserin in neuroleptic-induced akathisia.

Methods

Thirty neuroleptic-treated patients with schizophrenia were randomly allocated in a double-blind design to receive either mianserin (15 mg/day) or placebo for five days. Patients were assessed at baseline and on Days 3 and 5 by the Barnes Akathisia Scale (BARS), as well as by other relevant clinical rating scales.

Results

Compared with the placebo group, the mianserin-treated patients showed a significant reduction in all four BARS subscales by Day 5, with mean reductions in the BARS global score of 9.9% and 52.2%, respectively (P=0.006). Response to treatment (a reduction of at least two points on the BARS global subscale), was noted in six patients (40%) in the mianserin group and only one patient (9.1%) in the placebo group (P=0.04, log odds ratio 2.23).

Conclusions

Mianserin at a low dose may be a promising therapeutic option for patients with acute neuroleptic-induced akathisia.
Effectiveness of antidepressants
Authors: Bollini Paola , Pampaliona Sandro , Tibaldi Giuseppe , Kupelnick Bruce , Munizza Carmine
Published: October 2008

Background

Antidepressant drugs are usually prescribed at low doses, possibly to avoid adverse reactions. No comprehensive review has addressed the issue of dose, clinical response and tolerability in a quantitative way.

Aims

To determine whether high doses of antidepressants are more effective than lowdoses, and how safety is affected by dose.

Method

Trials comparing two or more doses of the same antidepressant were located, and all antidepressants administered were converted to the equivalent dose of imipramine. Generalised estimating equations were used to analyse percentage improvement and adverse event rate according to dose level.

Results

Thirty-three studies were identified. The dose level 100-200 mg imipramine equivalents showed an average improvement of 53% by ‘intention-to-treat’. Higher doses were not accompanied by increased efficacy, while lower doses showed reduction in efficacy. Adverse events significantly increased with dose.

Conclusions

With a low dose of antidepressants, clinicians trade off a slightly reduced chance of improvement for a higher chance of avoiding adverse reactions.
Depression in Europe
Authors: Copeland J. R. M. , Beekman A. T. F. , Dewey M. E. , Hooijer C. , Jordan A. , Lawlor B. A. , Lobo A. , Magnusson H. , Mann A. H. , Meller I. , Prince M. J. , Reischies F. , Turrina C. , Devries M. W. , Wilson K. C. M.
Published: October 2008

Background

This is the first report of results from the EURODEP Programme.

Aims

To assess the prevalence of depression judged suitable for intervention in randomised samples of those aged ⩾65 in nine European centres.

Method

The GMS-AGECAT package.

Results

Differences in prevalence are apparent, 8.8% (Iceland) to 23.6% (Munich). When sub-cases and cases are added together, five high- and four low-scoring centres emerge. Women predominated over men. Proportions of sub-cases to cases revealed striking differences but did not explain prevalence. There was no constant association between prevalence and age. A meta-analysis (n=13 808) gave an overall prevalence of 12. 3%, 14.1% for women and 8.6% for men.

Conclusions

Considerable variation occurs in the levels of depression across Europe, the cause for which is not immediately obvious. Case and sub-case levels taken together show greater variability, suggesting that it is not a matter of case/sub-case selection criteria, which were standardised by computer. Substantial levels of depression are shown but 62–82% of persons had no depressive level. Opportunities for treatment exist.
Development of the EURO–D scale – a European Union initiative to compare symptoms of depression in 14 European centres
Authors: Prince M. J. , Reischies F. , Beekman A. T. F. , Fuhrer R. , Jonker C. , Kivela S. -L. , Lawlor B. A. , Lobo A. , Magnusson H. , Fichter M. , Van Oyen H. , Roelands M. , Skoog I. , Turrina C. , Copeland J. R. M.
Published: October 2008

Background

In an 11-country European collaboration, 14 population-based surveys included 21 724 subjects aged ⩾65 years. Most participating centres used the Geriatric Mental State (GMS), but other measures were also used.

Aims

To derive from these instruments a common depression symptoms scale, the EURO–D, to allow comparison of risk factor profiles between centres.

Method

Common items were identified from the instruments. Algorithms for fitting items to GMS were derived by observation of item correspondence or expert opinion. The resulting 12-item scale was checked for internal consistency, criterion validity and uniformity of factor-analytic profile.

Results

The EURO–D is internally consistent, capturing the essence of its parent instrument. A two-factor solution seemed appropriate: depression, tearfulness and wishing to die loaded on the first factor (affective suffering), and loss of interest, poor concentration and lack of enjoyment on the second (motivation)

Conclusions

The EURO–D scale should permit valid comparison of risk-factor associations between centres, even if between-centre variation remains difficult to attribute.
Cost-effectiveness of assertive community treatment for homeless persons with severe mental illness
Authors: Lehman Anthony F. , Dixon Lisa , Hoch Jeffrey S. , Deforge Bruce , Kernan Eimer , Frank Richard
Published: October 2008

Background

Homelessness is a major public health problem among persons with severe mental illness (SMI). Cost-effective programmes that address this problem are needed.

Aims

To evaluate the cost-effectiveness of an assertive community treatment (ACT) programme for these persons in Baltimore, Maryland.

Methods

A total of 152 homeless persons with SMI were randomly allocated to either ACT or usual services. Direct treatment costs and effectiveness, represented by days of stable housing, were assessed.

Results

Compared with usual care, ACT costs were significantly lower for mental health in-patient days and mental health emergency room care, and significantly higher for mental health out-patient visits and treatment for substance misuse. ACT patients spent 31% more days in stable housing than those receiving usual care. ACT and usual services incurred $242 and $415 respectively in direct treatment costs per day of stable housing, an efficiency ratio of 0. 58 in favour of ACT. Patterns of care and costs varied according to race.

Conclusion

ACT provides a cost-effective approach to reducing homelessness among persons with severe and persistent mental illnesses.
Health of the Nation Outcome Scales
Authors: Trauer Tom , Callaly Tom , Hantz Paul , Little John , Shields Robert B. , Smith Jenny
Published: October 2008

Background

In Victoria, Australia, systematic assessment of outcomes in mental health services are being instituted.

Aims

To carry out a large-scale field trial of the Health of the Nation Outcome Scales (HoNOS).

Method

2137 clients were rated by mental health workers on the HoNOS, and about half were rated again within a few months.

Results

While interrater reliability of the total score was satisfactory, that of some individual items was unacceptable. Significant associations with age and gender were found, and clients with non-psychotic disorders obtained higher (i.e. worse) ratings than those with psychotic disorders. There were relationships between service use and HoNOS total score. For the group as a whole, total scores had not changed at the second rating, but admissions and discharges were associated with increases and decreases in total score. Among clients in the community, there was no relationship between change in HoNOS total score and frequency of contacts.

Conclusions

Certain items, notably 11 and 12, were unreliable. The absence of evidence of sensitivity to change may be due to the short re-rating interval, little real change in the clients, or the characteristics of the scale itself.
Evaluating the Health of the Nation Outcome Scales
Authors: Amin S. , Singh S. P. , Croudace T. , Jones P. , Medley I. , Harrison G.
Published: October 2008

Background

The HoNOS has been developed as a routine measure of outcomes in mental health.

Aims

To explore the validity and interrater reliability of HoNOS in a first-onset psychosis follow-up study.

Method

Between 1992 and 1994 we ascertained a cohort of all persons with first-onset psychosis. We re-assessed these people at 3 years (n=166) with several outcome scales, including HoNOS. Patients' keyworkers also completed the HoNOS. We estimated concurrent validity by calculating correlations between HoNOS and other scales, and interrater reliability.

Results

Researcher HoNOS correlated highly with other scales (0.46 < p < 0.86; P < 0.001). Keyworker HoNOS correlations were lower (0.41 < p < 0.51; P < 0.05), but still significant for all scores except the HoNOS-social subscale (0.12 < p < 0.28). Agreements between researcher and keyworker HoNOS were modest (0.47 < ICC < 0.85).

Conclusions

In this research cohort HoNOS correlates well with established outcome scales. Keyworker ratings show similar, but weaker, relationships; its use in routine settings may require further training for calibration of severity.
Validity and reliability of the Health of the Nation Outcome Scales in psychiatric patients in the community
Authors: Orrell Martin , Yard Paula , Handysides Julia , Schapira Robert
Published: October 2008

Background

The Health of the Nation Outcome Scales (HoNOS) have been developed for assessing the effectiveness of mental health services.

Aims

To investigate the validity and reliability of the HoNOS in patients in contact with mental health services.

Method

Subjects (age range 19–64) came from day hospitals, acute in-patient units and out-patient clinics in general practice. We obtained the opinions of experienced professionals, advocacy groups and patient groups to evaluate consensual and content validity.

Results

One hundred patients were assessed using the package of rating scales. Interrater and test–retest reliability were good for some items and poor for others. The HoNOS had good criterion validity: acute in-patients had higher scores than day patients and out-patients. HoNOS also had good concurrent validity, correlating well with other scales. Comments suggested that the HoNOS was a useful and suitable scale for this population but psychotic symptoms and certain social factors were not sufficiently covered.

Conclusion

The HoNOS had good validity but variable reliability. It may be better than existing scales because of the wide range of areas which it covers.
Paddington Complexity Scale and Health of the Nation Outcome Scales for Children and Adolescents
Authors: Yates P , Garralda M E , Higginson I
Published: October 2008

Background

There is an increasing interest in measuring health care outcomes in mental health services for children as well as adults.

Aims

We examined the sensitivity of the Paddington Complexity Scale (PCS) and the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) in describing the intakes of child and adolescent mental health clinics.

Method

We carried out a prospective study of two out-patient units and one day patient unit, by means of questionnaires administered to clinicians, parents and children.

Results

Clinician-rated PCS and HoNOSCAs were obtained for 248 new attenders. Both proved sensitive to intake differences between clinics. There were correlations of moderate intensity (r=0.6) between total PCS and HoNOSCA. There were weaker associations between these and parent/child rated measures of behaviour (r=0.4 and 0.3), quality of life and self-esteem (r=0.3 or less).

Conclusions

Both PCS and HoNOSCA are useful for describing clinical profiles of children and adolescents receiving mental health services.
Childhood shyness and maternal social phobia: A community study
Authors: Cooper Peter J. , Eke Marian
Published: October 2008

Background

Family history data suggest the possibility of an association between childhood shyness and parental social phobia.

Aims

To examine the prevalence of maternal affective disorder in a community sample of four-year-old shy and non-shy children.

Method

By screening 867 children, 43 shy children, 59 children with another form of disturbance (i.e. fearfulness, feeding problem or conduct problem) and 26 children with no disturbance were identified. Interviewers who were unaware of child status used a standardised mental state assessment to determine the rate of affective disorder in the mothers of these children.

Results

Compared with the mothers of the children in both comparison groups, the mothers of the children who were purely shy (i.e. shy children with no comorbid condition) had a significantly raised lifetime rate of anxiety disorder in general, and social phobia in particular. The odds ratio of a social phobia in the mothers of the purely shy children was raised over the normal control group by a factor of more than seven.

Conclusions

These findings suggest a specific association between childhood shyness and maternal social phobia.
Unreliable admissions to homicide
Authors: Gudjonsson Gisli H. , Kopelman Michael D. , MacKeith James A. C.
Published: October 2008

Background

The past decade has witnessed a recognition that unsafe criminal convictions may be occasioned by unreliable confessions.

Aims

To present a case which illustrates the dangers of using abreaction interview techniques in a legal context and demonstrate the relevance of the memory distrust syndrome to an unsafe confession to murder.

Method

We undertook a detailed assessment of a person appealing against his original murder conviction/the appellant’, and a careful scrutiny of all the relevant papers in the case.

Results

The appellant served 25 years in prison before his conviction was quashed as ‘unsafe’ on the basis of fresh psychological and psychiatric evidence.

Conclusions

Amnesia for an offence had been misdiagnosed, and the use of repeated abreaction interviews had further confused both the appellant and the original court. At the Appeal Court, the advice was that the man had experienced a form of source amnesia which resulted in an unreliable confession.
Randomised controlled effectiveness trial of a needs-based psychosocial intervention service for carers of people with schizophrenia
Authors: Barrowclough Christine , Tarrier Nicholas , Lewis Shôn , Sellwood William , Mainwaring John , Quinn Joanne , Hamlin Charlotte
Published: October 2008

Background

Family interventions are effective in reducing relapse in patients with schizophrenia, but there is little work demonstrating the effectiveness of the interventions in routine service settings.

Aims

To test the effectiveness of a needs-based family intervention service for patients recruited as out-patients and their carers, including those of low expressed emotion status.

Method

Carers of out-patient schizophrenia sufferers selected only on illness history factors were randomly allocated to receive either family support alone or in combination with systematic psychosocial interventions based on an assessment of need. Delivery of family interventions attempted to involve the clinical team.

Results

Relapse outcomes were superior for family-treated patients at six-month follow-up, although most of the clinical and symptom patient variables assessed remained stable, as did measures of carer burden.

Conclusions

The study demonstrated the effectiveness of family interventions in routine service settings. Problems with staff, patient and carer engagement and participation were identified.
Cognitive disability and direct care costs for elderly people
Authors: Kavanagh Shane , Knapp Martin
Published: October 2008

Background

Population ageing and the high costs of care support for elderly people have concentrated attention on economic issues. Is there an association between costs and cognitive disability?

Aims

To compare service utilisation and direct costs for elderly people with different degrees of cognitive disability, and between people living in households and in communal establishments.

Method

Secondary analysis of Office of Population Censuses and Surveys (OPCS) Disability Surveys data compared service utilisation and costs for 8736 elderly people with cognitive disability. Cost estimates were constructed for all health and social care services.

Results

A much greater proportion of people at higher levels of cognitive disability lived in communal establishments, where their (direct) costs were much higher than when supported in households. Service utilisation patterns and costs varied with cognitive disability.

Conclusions

It is important to look at the full range of living arrangements and support services when examining costs. The potential cost implications of pharmacotherapies, other treatments or new care arrangements cannot be appreciated without such a broad perspective.
Crisis telephone consultation for deliberate self-harm patients: Effects on repetition
Authors: Evans Mark O. , Morgan H. G. , Hayward Alan , Gunnell David J.
Published: October 2008

Background

No interventions have been shown to be effective in reducing deliberate self-harm (DSH) repetition in this group of patients as a whole.

Aims

To investigate the effect on repetition of offering emergency telephone support in a group of hospital-admitted DSH patients.

Method

Atotal of 827 DSH patients admitted to medical wards were randomly allocated to either control or intervention (green card) groups. In addition to treatment as usual, the intervention group was offered telephone support should any further crises occur. The main outcome measure was DSH repetition within six months of the index event.

Results

The intervention had no significant effect on the overall DSH repetition rate (odds ratio 1.20, 95% CI 0.82–1.75). Sub-group analysis suggested that response to the intervention differed according to the past history of DSH – subjects with a previous history repeating more often and first-timers appearing to benefit.

Conclusions

No overall effect of the intervention was shown. Conclusions concerning sub-groups must be regarded as speculative, but they suggest that further assessment of the value of telephone support in first-timer DSH patients is indicated.
Psychiatry in the National Health Service 1948–1998
Authors: Freeman Hugh
Published: October 2008

Background

The 50th anniversary of the inauguration of the NHS provided the occasion to review the evolution of mental health services and of psychiatry itself in Britain during that period.

Aims

The principal themes to be followed were the decline of a mental hospital system that had existed for over a century, the development of an alternative policy of ‘community care’, the emergence of a numerous and well-trained psychiatric profession, and the interaction between political and legal processes and mental health care.

Method

An examination of Ministry of Health and Department of Health and Social Security files in the Public Record Office, interviews with influential figures, examination of the secondary literature, and personal experience of events described.

Results

The material has been analysed, in the light of the expressed aims, and important trends have been described. The current situation is assessed.

Conclusions

The replacement of one system of care and treatment in Britain by another has been a process fraught with overwhelming difficulties. While adhering to the aim of ‘community care’, governments have been reluctant to provide the means for achieving this. The psychiatric profession is now faced with very large but ill-defined responsibilities.
Ethnicity and outcome of psychosis
Authors: Goater Nicky , King Michael , Cole Eleanor , Leavey Gerard , Johnson-Sabine Eric , Blizard Robert , Hoar Amanda
Published: October 2008

Background

An excess of psychotic illness in Black people has been found in cross-sectional studies. Little is known about the outcome of psychosis in different ethnic groups in the UK.

Aims

To compare the incidence, nature and long-term outcome of psychosis in different ethnic groups.

Method

A five-year, prospective study of an epidemiological cohort of people with a first contact for psychosis.

Results

Age-standardised incidence rates for schizophrenia and non-affective psychosis were higher for Black and Asian people than Whites. Stability of diagnosis and course of illness were similar in all ethnic groups. During the fifth year, Black people were more likely than others to be detained, brought to hospital by the police and given emergency injections.

Conclusions

The nature and outcome of psychotic illness is similar in all ethnic groups but Black people experience more adverse contacts with services later in the course of illness.
Suicide in prisons
Authors: Gore Sheila M.
Published: October 2008

Background

A recent review showed that opioid users' deaths from suicide were 10 times as common as expected on the basis of age and gender. Surveys showing prisoners' high prevalence of injecting or opioid dependence have led to a new statistical approach to prison suicides.

Aims

To estimate the expected number of UK prison suicides annually, having taken account of inmates' age, gender and opioid dependence.

Method

By gender, estimate the effective number of individuals (in terms of community-equivalent suicide risk) for whom prisons have a duty of care as 10 times the number of opioid-dependent inmates plus the number of non-opioid user inmates. Apply the gender and age-appropriate national suicide rates to work out the expected number of prison suicides.

Results

The Scottish Prison Service can expect 7.1 suicides per annum, and annual totals up to 12 without exacerbation of suicides due to incarceration. For the Prison Service in England and Wales, 19.3 suicides per annum can be expected in prisons, and annual totals may range up to 28 without indicating incarceration; the total of self-inflicted deaths was 47 in 1993–94

Conclusions

Prisons cannot prevent all suicides. An alert may be warranted if prison suicides exceed 12 per annum in Scotland, or 28 in England and Wales.
Burden experienced by care-givers of persons with bipolar affective disorder
Authors: Perlick Deborah , Rosenheck Robert R. , Clarkin John F. , Sirey Jo Anne , Raue Patrick , Greenfield Susan , Struening Elmer
Published: October 2008

Background

Family members of patients with schizophrenia frequently report burdens associated with caring for their relatives.

Aims

We evaluate the impact of illness beliefs on the burden reported by family care-givers of people with bipolar illness.

Method

The multivariate relationships between patient symptomatology and family illness beliefs and report of burden were examined at baseline among care-givers of 266 patients with Research Diagnostic Criteria-diagnosed bipolar illness who were subsequently followed for 15 months.

Results

At baseline, 93% of care-givers reported moderate or greater distress in at least one burden domain. As a group, care-giver illness beliefs (illness awareness, perception of patient and family control) explained an additional 18–28% of variance in burden experienced beyond the effects of the patients clinical state and history.

Conclusions

Care-givers of patients with bipolar illness report widespread burden that is influenced by beliefs about the illness.