bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictive factors of post‐discharge follow‐up care among adolescent suicide attempters
Authors: Granboulan V. , Roudot‐Thoraval F. , Lemerle S. , Alvin P.
Published: March 2003

Objective:  To study short‐term compliance with follow‐up care in a sample of adolescent suicide attempters.

Method:  One hundred and sixty‐seven adolescents, aged from 13–18 years and hospitalized after a suicide attempt, completed a questionnaire that included the CES‐Depression Scale and Zung Anxiety Scale. Physicians assessed the hospital care immediately after the attempt, and post‐discharge care plans. Three months later, adolescents were contacted by telephone and asked about follow‐up care.

Results:  After 3 months, 91.6% of the adolescents could be contacted: 25.5% never attended any follow‐up; 11.1% went only once; 31.4% missed some appointments; and 32.0% went to all their scheduled appointments. Adolescents who complied with follow‐up care differed significantly from those who did not: they showed more depression, anxiety and illicit drug use at the time of the attempt; they had more often planned the attempt; they were hospitalized longer; and they met with a psychiatrist more often while hospitalized. Compliance was also better when the follow‐up appointment was scheduled before discharge.

Conclusion:  Compliance with post‐discharge follow‐up care depends upon the adolescent's psychopathology but may also be improved by the type of hospital care and post‐discharge plans.
CYP2D6 and CYP2C19 genotype‐based dose recommendations for antidepressants: a first step towards subpopulation‐specific dosages
Authors: Kirchheiner J. , Brøsen K. , Dahl M. L. , Gram L. F. , Kasper S. , Roots I. , Sjöqvist F. , Spina E. , Brockmöller J.
Published: March 2003

Objective: This review aimed to provide distinct dose recommendations for antidepressants based on the genotypes of cytochrome P450 enzymes CYP2D6 and CYP2C19. This approach may be a useful complementation to clinical monitoring and therapeutic drug monitoring.

Method: Our literature search covered 32 antidepressants marketed in Europe, Canada, and the United States. We evaluated studies which had compared pharmacokinetic parameters of antidepressants among poor, intermediate, extensive and ultrarapid metabolizers.

Results: For 14 antidepressants, distinct dose recommendations for extensive, intermediate and poor metabolizers of either CYP2D6 or CYP2C19 were given. For the tricyclic antidepressants, dose reductions around 50% were generally recommended for poor metabolizers of substrates of CYP2D6 or CYP2C19, whereas differences were smaller for the selective serotonin reuptake inhibitors.

Conclusion: We have provided preliminary average dose suggestions based on the phenotype or genotype. This is a first attempt to apply the new pharmacogenetics to suggest dose‐regimens that take the differences in drug metabolic capacity into account.
Structural brain abnormalities in unselected in‐patients with major depression
Authors: Videbech Poul , Ravnkilde Barbara , Fiirgaard Bente , Clemmensen Karin , Egander Annette , Rasmussen Niels Anton , Christensen Thorkil , Sangill Ryan , Rosenberg Raben
Published: March 2003

Objective: Several studies have indicated an increased frequency of cerebral atrophy and white matter lesions in patients with major depression, especially in older age groups.

Method: Forty‐four representative in‐patients with major depression in which neurological disorders were clinically excluded, and 49 age‐ and gender‐matched controls were MR scanned.

Results: Unexpectedly, two of the patients had severe brain pathology which could account for their psychiatric symptoms. Analysis of the remaining patients (mean age 42 years) did not reveal an increased frequency of cerebral atrophy. The number of white matter lesions increased with age to an odds ratio greater than 3 for patients aged 50, but this was not statistically significant.

Conclusion: Brain atrophy and white matter lesions did not occur with significantly increased frequency in these relatively young unselected depressives, but the finding of severe brain pathology stresses the importance of brain imaging in late‐onset psychiatric disorders.
Maastricht Assessment of Coping Strategies (MACS‐I): a brief instrument to assess coping with psychotic symptoms
Authors: Bak Maarten , Van Der Spil Farida , Gunther Nicole , Radstake Steven , Delespaul Philippe , Van Os Jim
Published: March 2003

Objective: To examine the reliability of a brief instrument to assess coping with symptoms by patients with psychotic illness.

Method: A semi‐structured interview (MACS) was developed to assess the amounts of distress, control and coping in relation to psychotic symptoms. Two raters interviewed 23 symptomatic but stable patients with a diagnosis of chronic schizophrenia on two separate occasions. Case managers were also interviewed.

Results: Both the number of coping strategies used for different groups of symptoms, and the amount of coping used in different domains of coping strategies could be assessed reliably between interviewers (intraclass correlation coefficients range: 0.90–0.97) and between interview sessions (ICCs range: 0.75–0.80). Reliability with case managers, however, was low.

Conclusion: The MACS may be a reliable and useful instrument to assess coping in relation to subjective experience of distress by and control over psychotic symptoms.
Care utilization and outcome of DSM‐III‐R major depression in the general population. Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS)
Authors: Spijker J. , Bijl R. V. , De Graaf R. , Nolen W. A.
Published: March 2003

Objective: To assess care utilization, individual characteristics and clinical and functional outcomes for various modalities of professional care in people with DSM‐III‐R major depression.

Method: Psychiatric diagnoses were determined at baseline and 12‐month follow‐up in a representative sample (N=7076) of the Dutch population, using the Composite International Diagnostic Interview (CIDI).

Results: A total of 45.3% of the 223 individuals with major depression received professional care in the 12 months between baseline and follow‐up, and 42.6% of these were treated with antidepressant medication. Higher level of care was associated with clinical factors and functional limitations. Clinical outcomes were poorly correlated with functional outcomes. Mild to moderate effects in functional outcome were found for all care modalities.

Conclusion: Outcome of antidepressant treatment can be improved and such treatment should focus on the more severe forms of depression. Functional outcome assessment is recommended in addition to clinical assessment.
Is any female preponderance in depression secondary to a primary female preponderance in anxiety disorders?
Authors: Parker G. , Hadzi‐Pavlovic D.
Published: March 2003

Objective: National community studies consistently identify higher rates of both depressive and anxiety disorders in women. The female preponderance in depression could be primary or, alternatively, a sex difference in anxiety could determine the differential depression rates. We therefore pursue whether the female preponderance in depression is secondary to a female preponderance in anxiety disorders in a community sample.

Method: We analyse relevant data from the National Comorbidity Study (NCS) database, examining in particular whether sex differences in anxiety (here those meeting criteria for panic disorder, agoraphobia without panic disorder, generalized anxiety and social phobia) influenced sex differences in the prevalence of both major depression and dysthymia.

Results: Survival analyses indicated that, for both major depression and dysthymia, and within subsamples of those with early onset and late onset depression, both female sex and a preceding anxiety disorder made significant contributions, with preceding anxiety making the consistently stronger contribution of the two.

Conclusion: A proportion of the female preponderance in major depression and dysthymia in the general community appears determined by a primary sex difference in anxiety.
Dose–response relationship of selective serotonin reuptake inhibitors treatment‐emergent hypomania in depressive disorders
Authors: Ramasubbu R.
Published: March 2003

Objective: The notion that antidepressant treatment‐associated hypomania or mania being pharmacologically induced has been challenged. To determine whether selective serotonin reuptake inhibitors (SSRI) induced hypomania is secondary to medication effects, we examined the dose–response relationship of SSRI‐induced hypomania in two patients with depressive disorder.

Method: Case study.

Result: Hypomanic symptoms emerged during treatment with sertraline at the dose of 300 mg per day in a 45‐year‐old male with major depression. Paroxetine treatment at the dose of 80 mg per day induced hypomania in a 37‐year‐old female with dysthymia and trichitillomania. These patients have no family or personal history of bipolar disorder. Hypomania resolved when sertraline was decreased to 200 mg per day and paroxetine to 40 mg per day. No hypomanic switch was observed during 18–24 months follow‐up.

Conclusion: In the absence of risk factors for manic switch, SSRI‐induced hypomania may be dose‐dependent medication effects.
Lower suicide risk with long‐term lithium treatment in major affective illness: a meta‐analysis
Authors: Tondo Leonardo , Hennen John , Baldessarini Ross J.
Published: March 2003

Objective: To compare suicide rates with vs. without long‐term lithium treatment in major affective disorders.

Method: Broad searching yielded 22 studies providing suicide rates during lithium maintenance; 13 also provide rates without such treatment. Study quality was scored, between‐study variance tested, and suicide rates on vs. off lithium examined by meta‐analyses using random‐effects regression methods to model risk ratios.

Results: Among 5647 patients (33 473 patient‐years of risk) in 22 studies, suicide was 82% less frequent during lithium‐treatment (0.159 vs. 0.875 deaths/100 patient‐years). The computed risk‐ratio in studies with rates on/off lithium was 8.85 (95% CI, 4.12–19.1; P<0.0001). Higher rates off‐lithium were not accounted for by treatment‐discontinuation.

Conclusion: Suicide risk was consistently lower during long‐term treatment of major affective illnesses with lithium in all studies in the meta‐analysis, including the few involving treatment‐randomization.
Quality of life in schizophrenia in India: comparison of three approaches
Authors: Lobana Aprajita , Mattoo Surendra K. , Basu Debasish , Gupta Nitin
Published: March 2003

Objective: To compare ratings of quality of life in patients with established schizophrenia in Chandigarh, India, in both subjective and objective view points and between patients' and relatives' ratings.

Method: Subjective and objective quality of life was assessed in 38 patients with schizophrenia using the Quality of Life Interview – Brief Version and WHO Quality of Life – Bref scale. Key family members were also interviewed using the same scales.

Results: Subjective and objective quality of life are moderately well correlated (r=0.43) and similar agreement was found between patients and relatives (r=0.46).

Conclusion: Although quality of life is characteristically measured with subjects, the use of objective measures of quality of life and key informants of patients provide useful proxy measures.
Mental health in Europe: problems, advances and challenges
Authors: Rutz W.
Published: March 2003

Objective: To describe mental health care needs and challenges across the WHO European region of 51 nations.

Method: Based on morbidity and mortality data from HFA Statistical Database and Health21, the policy framework of WHO Europe, major trends in mental health care needs, psychiatric reform and mental health promotion are discussed.

Results: There is a mortality crisis related to mental ill health in Eastern European populations of transition. Destigmatization is required to improve early intervention and humanization of services, and national mental health audits are needed to create the basis for national mental health planning, implementation and monitoring. There are both problems and advances in service restructuring, and comprehensive mental health promotion programmes, preventive and monitoring strategies are required.

Conclusion: Partnerships between national and international organizations, especially WHO and the European Union, have to be strengthened to make progress on the way to integrated community mental health services.
Mental health reforms in Eastern Europe
Authors: Tomov T.
Published: March 2003

Objective: To describe the background in general culture, public and professional discourse against which mental health care reform initiatives in Eastern Europe need to be seen.

Method: An account of some key aspects of sociopolitical and cultural transition in Eastern European countries is given, and core results of a research project on attitudes and needs assessment in psychiatry in six Eastern European countries are reported.

Results: In post‐totalitarian cultures mental health reforms impinge on imagination in ways which are not easy to predict. Some of the reasons for this are traced to the psychiatric practices under the system of total control, e.g. dispensary care, political abuse, reification of classificatory terms. Data on a study of attitudes suggest that institutions had replaced community life in those parts of Europe.

Conclusion: It is predicted that with time trust in the capacity of community to contain mental illness will be regained.
Psychiatric reform in Germany
Authors: Bauer M. , Kunze H. , Von Cranach M. , Fritze J. , Becker T.
Published: March 2003

Objective: To describe the ongoing process of German psychiatric reform and the structure and functioning of mental health services.

Method: Information sources used include official reports describing mental health services, relevant publications related to organization and functioning of services.

Results: There has been far‐reaching change in mental health care since the late 1960s: psychiatric hospitals have lost about 50% of their beds and one psychiatric hospital has been closed. One hundred and sixty‐five general hospital psychiatric units have been built up. Out‐patient, community and residential services have been developed. There is a lack of diversified residential and rehabilitation services, particularly for the most severely ill. Co‐ordination of care is not always ensured, transfer of patients to remote nursing homes has occurred in some places. Carers and service users articulate their views to an increasing degree.

Conclusion: Political and professional enthusiasm have been important in implementation of the German reform. Evolving it further will require major efforts.
Mental health care in Germany: carers’ perspectives
Authors: Brand U.
Published: March 2003

Objective: To assess the mental health care system in Germany from the point of view of the federal association of family carers of people with mental illness.

Method: Family carer involvement and perspective are discussed on the basis of available literature, questionnaire surveys and documents of carer organizations.

Results: At the beginning of the reform movement the views of informal carers were not discussed. Since 1985 family carers have joined forces to express their views on needs of the severely mentally ill and their carers. Their aim is to point out deficits of the care system and to work towards improved care for their relatives with mental illness and changes in the mental health care system.

Conclusion: In the reform process informal carers should receive support and be respected as experts and partners.
Mental health service provision in England
Authors: Johnson S. , Zinkler M. , Priebe S.
Published: March 2003

Objective: To describe mental health service provision for adults of working age in England.

Method: Services in an inner London area are described so as to illustrate current patterns of service organization in England. National trends are then discussed.

Results: Despite relatively low public expenditure, substantial progress has been made in deinstitutionalization and development of comprehensive community‐based services. Persisting difficulties include high staff turnover, a minority of patients who do not engage with community services, user and carer dissatisfaction with emergency services, and social exclusion because of stigma. Recent government policy advocates resolving some of these problems using new service models such as assertive outreach and crisis teams.

Conclusion: Closure of the large asylums has largely been accomplished. England is now entering a new phase in community service development, with a range of innovative developments aimed at resolving problems still encountered after the initial phases of integrated community service development.
Trends and developments in public psychiatry in France since 1975
Authors: Provost Dominique , Bauer Andrée
Published: March 2003

Objective: The authors present an account of the current state of sectorization in France and its development over the last decade.

Method: The paper is based on statistics collected by the French Health Ministry and on relevant laws and regulations. Comments by patients, families and professionals are presented.

Results: The supply of mental health care is usually satisfactory, and there is a tendency for in‐patient units to be converted into day hospitals. There is a large disparity between regions, especially in child and adolescent psychiatry. The 1838 law governing compulsory admissions was revised in 1990, and this revision was the object of a commission of inquiry in 1995. Psychiatric units work on the borders between health and social services and are forging new links between the two.

Conclusion: Psychiatric care requires an integrated health and social perspective. In the field of mental health legislation European recommendations are called for.
Mental health care reform in Sweden, 1995
Authors: Stefansson C.‐G. , Hansson L.
Published: March 2003

Objective: To describe the content of the Community Mental Health Care reform in Sweden, in effect from 1995 and directed to severely mentally ill people (SMI).

Method: Evaluating changes, at local and national level, in living conditions among SMI and resources of services directed to them, by using registers, questionnaires, interviews and case studies.

Results: A survey, covering 93% of the population, identified 43 000 SMI (prevalence of 0.63%); 4000 long‐stay patients and 400 rehabilitation programmes were transferred from psychiatric services to social services (15% of the budget of psychiatric services). Employment and rehabilitation projects, family support and user programmes and educational projects for social services staff, were launched (funded by state subsidies).

Conclusion: SMI still have difficulties in obtaining adequate support on the basis of disability laws and there continue to be barriers between social services and psychiatric services.
Spanish psychiatric reform: what can be learned from two decades of experience?
Authors: Vázquez‐Barquero José Luis , García José , Torres‐González Francisco
Published: March 2003

Objective: The objective of the paper is to describe the impact of Spanish psychiatric reform on the organization and functioning of mental health services.

Method: This paper is based on official administrative reports and on relevant related publications.

Results: The most significant achievements of Spanish psychiatric reform have been: (i) the development of a new organization of mental health care, decentralized in character and territorially based; (ii) the integration of psychiatric patients in general health care; (iii) the creation of an extensive community network of health centres; and (iv) the development of more positive attitudes towards mental illness. However, our analysis also reveals the existence of significant deficiencies.

Conclusion: Analysis of the Spanish experience shows that the process of psychiatric reform depends basically on long‐term commitments, which in a system such as Spain’s must come from central administration and also from the autonomous communities.
A novel pharmacological concept in an animal model of psychosis
Authors: Dawirs R. R. , Teuchert‐Noodt G.
Published: March 2003

Objective: We have analysed pharmacologically induced perturbation of functional and structural neurogenesis in the prefrontal cortex (PFC) and hippocampus.

Method: Juvenile gerbils received a single dose of methamphetamine (METH, 50 mg/kg, i.p.). In adults the following parameters were quantitatively investigated: prefrontal dopaminergic and GABAergic innervation densities (immunocytochemistry), morphogenesis of pyramidal cells (Golgi), dentate granule cell proliferation (BrdU‐labelling), working memory and behavioural inhibition (delayed response, open‐field).

Results: A single challenge of METH continuously suppresses granule cell proliferation in adult gerbils and initiates rewiring of neuronal networks in the PFC which run concurrently with the development of severe deficits in PFC‐related behaviours.

Conclusion: It appears that a continuous remodelling of neuronal circuits is an inherent property of the brain, the biological significance of which seems to be to ascertain adaptive interaction between brain and environment. Learning more about drug‐induced neuronal reorganization might be basic for understanding the genesis of psychotic conditions in the brain. This presentation is based both on own research and on a review of the literature.
Cognitive subprocesses and schizophrenia. A. Reaction‐time decomposition
Authors: Krieger S. , Lis S. , Gallhofer B.
Published: March 2003

Objective: The aim of the study is to demonstrate that deficits of information processing in schizophrenic patients can be isolated with reaction‐time (RT) decomposition paradigms.

Method: Three types of visually presented tasks were applied: simple, disjunctive and choice RT‐tasks. RT were split into movement latency and time necessary to execute movements. Comparisons of three samples of schizophrenic patients (295.3) with individually matched (age, sex, education and handedness) healthy controls are presented: Sample 1: 10 drug‐naive first‐onset patients, Sample 2: 10 neuroleptically treated first‐onset patients, Sample 3: 10 neuroleptically treated chronically ill patients.

Results: Findings indicate that schizophrenia affects primarily subprocesses in which percepts are translated into appropriate actions (response‐selection). Neuroleptic treatment improves processing at this stage but is accompanied by slowing of movement execution.

Conclusion: Response‐selection is selectively impaired in first‐onset patients. This disturbance, which might be specific for schizophrenia, can be regarded as indication of a disconnection between frontal and posterior areas.
Cognitive subprocesses and schizophrenia. B. Maze tasks
Authors: Krieger S. , Lis S. , Gallhofer B.
Published: March 2003

Objective: In a companion paper we demonstrated that in reaction‐time tasks the response selection stage is selectively disturbed in schizophrenia. The aim of the present study is the investigation of subprocesses, which are incorporated into repeatedly activated loops of cognitive processes and need additional information from working memory.

Method: Maze tasks of varying complexity (with and without bifurcations) were presented to drug‐naive and treated first‐onset schizophrenic patients. The tasks had to be solved under easy and difficult motor‐conditions. Both patient samples were compared with healthy control groups matched by age, sex, education and experience with the experimental setting.

Results: In mazes with alternative routes patients exhibited the expected decrease of performance. However, untreated patients improved under difficult motor conditions. This improvement is smaller after neuroleptic treatment.

Conclusion: Under difficult motor conditions attention is focused on the execution of movements and thus withdrawn from perceiving irrelevant response alternatives, i.e. the effects of disturbed response selection are reduced.
Neuropsychological impairments in patients with schizophrenia: stability and prediction of outcome
Authors: Gråwe R. W. , Levander S.
Published: March 2003

Objective: To assess neuropsychological impairments among fairly young schizophrenic patients over time, and relations between impairment and symptoms, drug type and dose.

Method: Clinical and neuropsychological data for 29 schizophrenic patients have been published earlier. Twenty of these patients were retested after 3 years using the same methods.

Results: The patients displayed stable impairments in most neuropsychological tests. Vocabulary and focused attention improved over time, whereas response slowness became more pronounced. Symptoms varied considerably over time. A specific pattern of neuropsychological impairments, but not measures of psychopathology, predicted clinical outcome. Patients were unable to judge their test performance.

Conclusion: A few years after the first episode, our patients displayed a specific pattern of neuropsychological impairment, which predicted clinical outcome. One aspect of the impairment appears to be failure at self‐monitoring.
Randomized controlled trials in schizophrenia: a critical perspective on the literature
Authors: Gilbody S. , Wahlbeck K. , Adams C.
Published: March 2003

Objective: The randomized trial provides an opportunity to minimize the inclusion of biases in the evaluation of interventions in psychiatry. Difficulties arise, however, when applying their results to `real world' clinical practice and decision‐making. We, therefore, examined the real world applicability of schizophrenia trials.

Method: A narrative overview of the content and quality of the randomized trials relevant to the care of those with schizophrenia is provided.

Results: Complex, explanatory, under‐powered randomized drug trials dominate evaluative research in schizophrenia.

Conclusion: Explanatory designs are a necessary but insufficient step in establishing the true worth of interventions in schizophrenia. Research from other spheres of mental health and wider health care suggest that pragmatic trials are feasible. This design allows large scale trials to be conducted which include patients which we would recognize from routine practice and which record outcomes which are of genuine interest to decision‐makers.
Referrals to a liaison psychiatry out‐patient clinic in a UK general hospital: a report on 900 cases
Authors: Bass C. , Bolton J. , Wilkinson P.
Published: March 2003

Objective: To describe the demographic and clinical characteristics of consecutive referrals to an out‐patient liaison psychiatry clinic in a large university hospital in the UK.

Method: We studied 900 patients using a standardized proforma. Assessments of functional capacity were made using the Global Assessment of Functioning (GAF) scale, and each patient was assigned a psychiatric diagnosis using ICD‐10 criteria.

Results: Four of five of all referrals presented with somatic complaints, and 41% had a concurrent physical illness. The most common psychiatric diagnoses were somatoform disorders (55%) and neurasthenia (11%). Although more than half (59%) had no previous psychiatric history, a surprisingly high number (35%) had significant functional impairment (scores of < 50 on the GAF scale). The lack of adequate psychological treatment services often provided a barrier to optimal management of some of the more disabled patients.

Conclusion: The general hospital liaison psychiatry clinic provides an acceptable setting in which to assess and manage patients referred from non‐psychiatric colleagues.
Personality profile among primary care patients: experimenting with the Arabic IPDE ICD‐10
Authors: El‐Rufaie O. E. F. , Al‐Sabosy M. , Abuzeid M. S. O. , Ghubash R.
Published: March 2003

Objective: To estimate the prevalence of personality disorder (PD) among primary health care (PHC) patients, and to investigate the characteristic features of the International Personality Disorder Examination, the ICD‐10 module (IPDE ICD‐10).

Method: A sample (n=158) PHC patients in Al Ain, United Arab Emirates (UAE) were interviewed by general practitioners (GPs) using the Arabic version of the IPDE ICD‐10.

Results: Patients interviewed were 82 males and 76 females. Definite PD was identified in 12.7%. Prevalence rates among males and females were 9.8 and 15.8% consecutively. Commonest personality disorders were the schizoid (5.1%), anankastic (4.4%) and the emotionally unstable, borderline type (3.8%). Comorbidity of PD was manifested by 30% of definite PD patients. The mean dimensional scores of definite and probable PD patients were 5.6 and 4.3 consecutively.

Conclusion: The IPDE‐ICD‐10 is useful but relatively time consuming with repetition and need of rephrasing in some items. Dimensional measurement proved essential.
Serum cholesterol and psychological distress in hospitalized depressed patients
Authors: Borgherini G. , Dorz S. , Conforti D. , Scarso C. , Magni G.
Published: March 2003

Objective: To assess the relationship between total serum cholesterol and various psychosocial variables in depressed in‐patients.

Method: One hundred and eighty‐six patients had their total fasting serum cholesterol assessed following admission; psychiatric diagnoses were obtained with the structured clinical interview for DSM‐IV (SCID) interview. Psychopathology was measured with a clinician rated scale [Montgomery and Asberg Depressive Rating Scale (MADRS)] and a self‐rating scale [Symptom checklist‐90 (SCL‐90)].

Results: Univariate analyses showed lower total serum cholesterol levels being correlated with higher scores in several psychopathological areas. Multivariate analyses indicated that male gender, lower age and higher MADRS scores were the most predictive variables for lower cholesterol levels.

Conclusion: The data suggest, in this depressed population, an association between serum cholesterol and depressive symptoms. What is the cause and what is its effect is not possible to say from this cross‐sectional study.
Risk factors in the early family life of patients suffering from dissociative disorders
Authors: Pasquini P. , Liotti G. , Mazzotti E. , Fassone G. , Picardi A. ,   The Italian Group for the Study of Dissociation
Published: March 2003

Objective: To test the hypothesis that not only intrafamiliar childhood abuses inflicted to the patient, but also major losses or other severe life events suffered by the mother within 2 years of patient's birth, are risk factors for the development of dissociative disorders (DDs).

Method: A multicentric case–control study of 52 cases and 146 controls.

Results: We estimated a crude odds ratio (OR) of 2.6 (adjusted 1.9) for mothers' losses or other severe life events experienced within 2 years of patient's birth, and a crude OR of 7.6 (adjusted 7.2) for patient's early traumatic experiences.

Conclusion: Mother's losses or other severe life events within 2 years of patient's birth and patient's traumatic experiences during childhood are risk factors for the development of dissociative disorders. A possible explanation of these findings is that disorganized or insecure attachment may increase susceptibility to traumatic experiences and propensity to dissociation in adult life.
Personality dimensions in social phobics with or without depression
Authors: Pélissolo A. , André C. , Pujol H. , Yao S. N. , Servant D. , Braconnier A. , Orain‐Pélissolo S. , Bouchez S. , Lépine J.‐P.
Published: March 2003

Objective: This study investigated the personality traits of social phobics using the Temperament and Character Inventory (TCI).

Method: A sample of 178 social phobics was assessed with the TCI, and compared with controls. The patients were classified into two groups, according to the absence (SP group) or to the presence (SP+D group) of depression.

Results: We found significant elevated scores for harm avoidance (HA) in social phobics when compared with controls (16.2 ± 2.7), in both the SP (26.2 ± 3.5), and the SP+D (28.9 ± 4.7), groups. Lower self‐directedness scores were found in the SP and in the SP+D groups when compared with the controls. Patients with the generalized type of social phobia had higher HA scores as compared with other social phobics.

Conclusion: The personality profile obtained in these social phobics, whatever their depressive symptomatology, reflects a dramatically anxious and avoidant temperament associated to an immature character.
Motivational interviewing among psychiatric in‐patients with substance use disorders
Authors: Baker Amanda , Lewin Terry , Reichler Heidi , Clancy Richard , Carr Vaughan , Garrett Rachel , Sly Ketrina , Devir Holly , Terry Margarett
Published: March 2003

Baker A, Lewin T, Reichler H, Clancy R, Carr V, Garrett R, Sly K, Devir H, Terry M. Motivational interviewing among psychiatric in‐patients with substance use disorders. Acta Psychiatr Scand 2002: 106: 233–240. © Blackwell Munksgaard 2002.

Objective: There were three aims of the present study: 1) to document patterns of substance misuse among psychiatric in‐patients with comorbid alcohol and other drug (AOD) use; 2) to examine associations among psychiatric and substance use diagnoses and readiness to change; and 3) to evaluate the effectiveness of an opportunistic motivational interview on engagement in a Specialist Substance Misuse Service (SSMS).

Method: One hundred and sixty subjects were randomly assigned to receive either a motivational interview or no intervention.

Results: Overall, 66.3% of subjects met intervention threshold for cannabis, 60.6% for alcohol and 22.5% for amphetamines. There was a bimodal distribution of stage of change for cannabis use which was associated with age, with precontemplation being associated with older age and less frequent use. Attendance at the SSMS was low and unrelated to intervention status.

Conclusion: A different approach to treatment is recommended, including early intervention among cannabis users.
Helpseeking and access to mental health treatment for obsessive‐compulsive disorder
Authors: Goodwin Renee , Koenen Karestan C. , Hellman Fred , Guardino Mary , Struening Elmer
Published: March 2003

Objective: To identify predictors of helpseeking and use of mental health treatment for obsessive‐compulsive disorder (OCD) using the behavioral model of health service use.

Method: Data were drawn from the 1996 National Anxiety Disorders Screening Day. Participants (n=14 860) completed screening measures providing information about demographics, mental disorders, helpseeking, and treatment experiences for OCD.

Results: Previous use of mental health treatment was associated with comorbid panic disorder [odds ratio (OR)=1.6 (1.3–1.98)], while minority racial status [OR=0.7 (0.5–0.9)] emerged as a barrier to receiving care among individuals with OCD. Among those who had never received mental health care, comorbid panic disorder [OR=2.0 (1.5–2.8)], post‐traumatic stress disorder [OR=1.7 (1.3–2.4)], and suicidal ideation [OR=1.7 (1.2–2.3)] increased readiness to seek treatment while being employed [OR=0.7 (0.5–0.9)], and feeling one could handle the problem on his/her own [OR=0.5 (0.3–0.7)] decreased readiness to seek help for the first time.

Conclusion: These data suggest that access to treatment for OCD may not be equally accessible to all in need by revealing non‐disease related factors (e.g. race, health beliefs) that have a significant impact on decisions to seek and use mental health treatment.
Cognitive‐based measures screening for depression in the medically ill: the DMI‐10 and the DMI‐18
Authors: Parker G. , Hilton T. , Bains J. , Hadzi‐Pavlovic D.
Published: March 2003

Objective: We suggest that the identification of depression in the medically ill (DMI) might be improved by focussing on cognitive features.

Method: We recruited 302 patients to complete our provisional cognitive‐based measure. Subsets also completed one of two comparator screening measures, either the Hospital and Anxiety Depression Scale (HADS) or the Beck Depression Inventory for Primary Care (BDI‐PC). One hundred and sixty patients were then assessed by a psychiatrist who estimated whether they were `clinically depressed' and who also administered a standardized interview for depression (the CIDI).

Results: Analyses identified items discriminating clinically depressed and non‐depressed individuals, allowing development of brief (10‐item) and extended (18‐item) measures. The two new measures were compared with the HADS and the BDI‐PC in discriminating depressed and non‐depressed medically ill patients.

Conclusion: A cognitive construct‐based approach to assessing depression in the medically ill appears strongly supported. We provide brief (DMI‐10) and extended (DMI‐18) measures that appear to have utility as screening instruments. Consideration of the discriminating items may also assist clinical decision making.
An association between depression, anxiety and thyroid function – a clinical fact or an artefact?
Authors: Engum Anne , Bjøro Trine , Mykletun Arnstein , Dahl Alv A.
Published: March 2003

Objective: The aim of the study was to examine the association between depression, anxiety and thyroid dysfunction.

Method: The study is part of the HUNT‐study. Individuals aged 40–89 years (n=30 589) with thyroid assays, and self‐rating of depression and anxiety – Hospital Anxiety and Depression Scale (HADS) – were divided in six categories according to thyroid function. Relations were investigated with logistic regression analysis.

Results: The group with biochemical hypothyroidism had significantly lower risk for depression and anxiety compared with the reference group with normal thyroid function. Subclinical hypothyroidism, and latent and overt biochemical hyperthyroidism were not risk factors for depression or anxiety. When individuals with former known thyroid disease were excluded from the analyses, the results were essentially identical, but this group had an increased risk of both anxiety and depression, independent of thyroid function.

Conclusion: In this large, unselected population, we found no statistical association between thyroid dysfunction, and the presence of depression or anxiety disorder.
Characteristics of women seeking treatment for premenstrual syndrome in Taiwan
Authors: Hsiao Mei‐Chun , Liu Chia‐Yih , Chen Kuang‐Chao , Hsieh T'sang‐T'ang
Published: March 2003

Objective: To analyze the characteristics of 150 women who visited a premenstrual syndrome (PMS) clinic in a Taiwanese medical center staffed by both psychiatrists and gynecologists.

Method: All subjects were interviewed and assessed for premenstrual dysphoric disorder (PMDD) using DSM‐IV criteria, a PMS questionnaire, and the structured Mini‐International Neuropsychiatric Interview (MINI). Where PMDD was suspected, subjects were followed using a daily symptom record.

Results: A total of 110 subjects (73%) met the ICD‐10 criteria for PMS. The most common PMS symptoms were minor psychological discomfort, muscular tension, and aches or pains. For 129 subjects (86%), other concurrent psychiatric disorders were diagnosed using the MINI. Of these, 48 (37%) reported premenstrual exacerbation (PME) of a previously diagnosed psychiatric condition.

Conclusion: The results of this study indicate that women who complain of PMS may be at a high risk of other psychiatric dysfunction, especially mood disorder. Further, the high proportion of PME cases determined in this study suggests that further investigation is required.
Life dissatisfaction as a predictor of fatal injury in a 20‐year follow‐up
Authors: Koivumaa‐Honkanen H. , Honkanen R. , Koskenvuo M. , Viinamäki H. , Kaprio J.
Published: March 2003

Objective: To investigate the role of life satisfaction (LS) in fatal injuries with special references to unintentional injuries and whether health status modifies this relationship.

Method: A sample of adult Finns unselected for health status (n=29 173) responded in 1975 to a LS scale. Nationwide registry for deaths was used. The dissatisfied were compared with the satisfied by Cox regression.

Results: During 1976–1995, 469 fatal injuries occurred, of which 235 were unintentional. Dissatisfaction predicted fatal unintentional [hazard ratio (HR)=2.83; 95% confidence interval (CI) 1.77–4.51] and intentional injury (HR=3.26; 2.01–5.30). The risk of fatal unintentional injury was 7.8‐fold (women) and 4.0‐fold (men) increased in the sick and dissatisfied compared with the healthy and satisfied. A repeatedly reported dissatisfaction (1975, 1981) provided a HR of 5.17 (1.48–18.0) for unintentional injury death during 1981–1995. The found effect was partly mediated through health behavior and social situation.

Conclusion: Life dissatisfaction predicts both unintentional and intentional injury death.
An interstitial deletion of the long arm of chromosome 21 in a case of a first episode of psychosis
Authors: Takhar J. , Malla Ashok K. , Siu V. , MacPherson Colin , Fan Y. S. , Townsend L.
Published: March 2003

Objective: Case of an interstitial deletion of the long arm of chromosome 21 presenting with first episode of psychosis.

Method: A case report.

Results: A 16‐year‐high school student of Somalian origin presented with a first episode of psychosis, mild mental retardation and dysmorphic features. Chromosome analysis revealed an interstitial deletion in the long arm of chromosome 21, described as 46, XX del (21) (q21q22.1).

Conclusion: First episode of psychosis occurred in combination with neurobiological vulnerability and a complex genetic inheritance. The occurrence of psychosis in our case may be attributable to genes located within the region 21q21q22.1. The possibility that other loci exist on chromosome 21, which predispose to schizophrenia has to be considered. Identification of susceptibility genes will greatly facilitate investigation of factors that contribute to the disease process and may lead to early intervention and prevention.
Influence of gender on social outcome in schizophrenia
Authors: Usall J. , Haro J. M. , Ochoa S. , Márquez M. , Araya S. ,   the NEDES group
Published: March 2003

Objective:  To study the relevance of gender on social functioning in schizophrenia.

Method:  A sample of 200 schizophrenic (DSM‐IV criteria) out‐patients were followed‐up during 2 years and were administered the following instruments: Positive and Negative Symptom Scale (PANSS), Disability Assessment Scale (DAS‐sv), and Global Assessment of Functioning (GAF) Scale. A regression model was created with DAS and GAF as dependent variables, and gender, PANSS, age of onset, duration of illness and marital status as independent variables. Separate regression models were then generated for females and males.

Results:  Gender influenced significantly on DAS and GAF, with men showing worse functioning. In gender specific analyses, we found a significant influence of illness duration and Positive and Negative PANSS on social functioning in men, and of age at onset and Negative PANSS in women.

Conclusion:  Gender had a significant influence on social functioning in schizophrenia, even after adjusting for the other independent variables.
Family history of suicidal behaviour: prevalence and significance in deliberate self‐harm patients
Authors: Hawton Keith , Haw Camilla , Houston Kelly , Townsend Ellen
Published: March 2003

Objective:  To investigate whether there are differences between the characteristics of deliberate self‐harm (DSH) patients with and without a family history of suicidal behaviour.

Method:  In 146 DSH patients, those with and without a positive family history were compared with regard to the nature and repetition of their DSH episodes, and psychological and psychiatric characteristics.

Results:  Fifty‐two (35.6%) patients had a family history of suicidal behaviour. DSH was more frequent in patients' mothers (17.1%) than fathers (2.7%). Patients with a family history of suicidal behaviour, especially females, had higher state anger scores.

Conclusion:  Family history of suicidal behaviour appears to be associated with greater anger. Absence of other associations suggests that family history probably has less implication for individuals who have already engaged in DSH than in contributing to its initiation. Future studies should include patients with violent or life‐threatening DSH acts.
Pathways to care: help seeking behaviour in first episode psychosis
Authors: Addington J. , Van Mastrigt S. , Hutchinson J. , Addington D.
Published: March 2003

Objective:  To determine the number of attempts it took before patients with a first episode of psychosis received adequate help, the signs or symptoms that led them to seek help and the people from whom they attempted to seek help.

Method:  Subjects were 86 individuals with a schizophrenia spectrum disorder, mainly schizophrenia, who were attending a comprehensive program for early psychosis treatment.

Results:  Help‐seeking attempts began in the prodromal phase of the illness and continued into the psychotic phase. Concerning behaviours ranged from more general symptoms to psychotic symptoms. A range of contacts were made early on but emergency services were most often the contact that helped individuals obtain appropriate treatment for psychosis.

Conclusion:  Improved public education and gatekeeper education might reduce the time required for individuals developing a psychosis to receive timely and adequate care.
Markers for depression in Parkinson's disease
Authors: Leentjens A. F. G. , Lousberg R. , Verhey F. R. J.
Published: March 2003

Leentjens AFG, Lousberg R, Verhey FRJ. Markers for depression in Parkinson's disease. Acta Psychiatr Scand 2002: 106: 196–201. © Blackwell Munksgaard 2002.

Objective: To assess whether general risk factors for depression are also markers of depression in patients with Parkinson's disease (PD) and to identify additional disease‐specific markers.

Method: A two‐step logistic regression was performed on data from 161 consecutively referred PD patients, 40 of whom suffered from major depressive disorder. A first logistic model was created with five general risk factors for depression. Next, five potential disease‐specific markers were added to see whether this would improve the model.

Results: The logistic model of general risk factors for depression also predicted depression in PD patients. A family history of depression was the most important marker. `Right‐sided onset' was the only disease‐specific marker that improved the model.

Conclusion: Established risk factors for depression in the general population are also markers of depression in PD. The importance of correcting for general risk factors for depression in the search for disease‐specific risk factors is stressed.
Gender differences in depression risk and coping factors in a clinical sample
Authors: Wilhelm K. , Roy K. , Mitchell P. , Brownhill S. , Parker G.
Published: March 2003

Objective: To examine gender differences in depression risk and coping factors in a clinical sample of patients with a diagnosis of DSM‐IV major depression.

Method: Patients were assessed for substance use and abuse, family history of psychiatric disorder, interpersonal depressogenic factors and lifetime history of anxiety disorders. Trait anxiety, coping styles when depressed, parental bonding, marital features and personality style were also measured. Patients were reassessed at 12‐month follow‐up.

Results: There were few gender differences in experience of depression (either in duration, type or severity prior to treatment) in a group with established episodes of major depression but women reported more emotional arousability when depressed. Women reported higher rates of dysfunctional parenting and childhood sexual abuse, and rated their partners as less caring and as more likely to be a depressogenic stressor. Men were more likely to have a generalized anxiety disorder at assessment, to use recreational drugs prior to presentation. Men were rated as having a more rigid personality style and `Cluster A' personality traits both at assessment and follow‐up.

Conclusion: There were few gender differences in severity or course of established episodes of major depression. Gender differences were related to levels of arousal, anxiety disorders, and repertoires for dealing with depression, rather than depressive symptoms per se.