bluuebunny/crossref_metadata_2025 huggingface dataset:
Fragile States of Mind: Neuroticism, Vulnerability and the Long-Term Outcome of Depression
Authors: Surtees P. G. , Wainwright N. W. J.
Published: October 2008

Background

This paper considers the extent to which vulnerability to the outcome of major affective disorder is conferred through personality deviance. Results are based upon a 12 year longitudinal follow-up study of 80 patients with a primary depressive disorder, originally selected from a consecutive series seeking care at a hospital in Scotland.

Methods

The study included detailed clinical course assessments in association with the formal application of diagnostic criteria. Assessments on recovery from the index episode included measures of self-confidence and of neuroticism. Experience of selected severe loss events over the study period was also determined.

Results

Limited self-confidence was strongly related, unlike neuroticism, to the subsequent first recurrence of affective disorder. Relationships between psychosocial, clinical and demographic factors and long-term outcome revealed psychosocial factors, in particular neuroticism and a lack of self-confidence, to have the greatest prognostic significance.

Conclusions

These results reveal the heightened risk over the long-term of a poor outcome for depressive disorder consequent upon measures of personality deviance and of exposure to adversity. While giving only limited support to narrowly defined psychosocial models of depression, they clarify the risk gradients involved and through this may provide a firmer basis than hitherto for relapse prevention.
Long-Term Stability of Diagnosis and Symptom Dimensions in a Systematic Sample of Patients with Onset of Schizophrenia in Childhood and Early Adolescence. II: Positive/Negative Distinction and Childhood Predictors of Adult Outcome
Authors: Maziade Michel , Bouchard Stéphane , Gingras Nathalie , Charron Liliane , Cardinal Andrée , Roy Marc-André , Gauthier Benoît , Tremblay Guy , Côté Serge , Fournier Christiane , Boutin Pierrette , Hamel Martin , Mérette Chantal , Martinez Maria
Published: October 2008

Background

The aim of this study was to verify the presence and stability across life of the positive/negative distinction in early-onset schizophrenia (EO-SZ) through a longitudinal factor analysis of the schizophrenic dimensions, and to identify the factors predicting several indices of long-term outcome for EO-SZ.

Method

Forty children consecutively referred for DSM–III–R schizophrenia (SZ) in a specific catchment area comprised the sample.

Results

Across a 14.8-year follow-up, longitudinal factor analysis identified two separate factors corresponding to the positive and negative symptom dimensions. We also observed that: the GAS rated over the last three years of adult illness and the severity of negative symptoms during the stabilised interepisode intervals in adulthood were the indices of adult outcome that were most easily predicted; and the best childhood predictors of adult outcome were premorbid functioning and severity of positive and negative symptoms during acute episodes.

Conclusions

The presence of premorbid non-psychotic behaviour disturbances (NPBD) and premorbid developmental problems was not related to severity of outcome, in contrast to the former variables.
Performance on Neuropsychological Tests Related to Single Photon Emission Computerised Tomography Findings in Frontotemporal Dementia
Authors: Elfgren Christina I. , Ryding Erik , Passant Ulla
Published: October 2008

Background

This study examines relations between regional cerebral blood flow (rCBF) and neuropsychological test results, age at onset and duration of disease in patients with frontotemporal-type dementia (FTD).

Method

Sixteen patients with a diagnosis of probable FTD were examined using single photon emission computerised tomography (SPECT) with 99mTc-HMPAO as the tracer. The rCBF of 14 regions of interest relative to cerebellar blood flow was calculated. Psychological tests assessing language, verbal fluency, memory and visuospatial constructive ability were given.

Results

Correlations were demonstrated between a global impairment score and relative blood flow in lateral frontal, medial frontal and left orbital frontal areas. Verbal fluency scores correlated with left lateral frontal medial frontal and left anterior inferior temporal blood flow. No relationships between decrease in CBF and age at onset or duration of disease, or between impaired cognitive function and age at onset or duration of disease, were found.

Conclusions

The present study demonstrates a close coupling between reduced rCBF and specific neuropsychological deficits in FTD.
Early Psychological Reactions in a Group of Individuals with Pre-existing and Enduring Mental Health Difficulties Following a Major Coach Accident
Authors: Chubb Helen L. , Bisson Jonathan I.
Published: October 2008

Background

The impact of major trauma on individuals with pre-existing and enduring mental health difficulties is poorly understood.

Method

Twenty individuals with pre-existing and enduring mental health difficulties were assessed with the Clinician Administered Post Traumatic Stress Disorder Scale, the 28-item version of the GHQ, the Hospital Anxiety and Depression Scale, and the Impact of Event Scale between four and eight weeks after their involvement in a major coach accident.

Results

Ten (50%) individuals satisfied the full DSM–IV criteria for a diagnosis of PTSD. The questionnaire scores indicated a high level of psychological suffering among the group. On dividing the sample into those individuals with previous diagnoses of anxiety or depressive disorders and those with a previous diagnosis of chronic schizophrenia, the schizophrenia group displayed less marked psychological sequelae on all measures.

Conclusion

There was a high incidence of early psychological sequelae among the group as a whole. Some diagnoses (e.g. depression and anxiety) may predispose to psychological sequelae while others (e.g. chronic schizophrenia) may not.
Neutropenia and Agranulocytosis in Patients Receiving Clozapine in the UK and Ireland
Authors: Atkin Karen , Kendall Francis , Gould Duncan , Freeman Hugh , Lieberman Jeffrey , O'Sullivan Desmond
Published: October 2008

Background

Clozapine can cause reversible agranulocytosis and neutropenia. This study documents the occurrence of blood dyscrasias and identifies predisposing risk factors.

Method

An analysis was made of the haematological, demographic, and dosage data from a central database on 6316 patients receiving clozapine over four and a half years in the UK and Ireland.

Results

During the study period 2.9% of the patients developed neutropenia and 0.8% developed agranulocytosis. The peak incidence of both disorders was in the first 6–18 weeks of treatment. Fatal agranulocytosis occurred in 0.03% of patients. After the first year of treatment the incidence of agranulocytosis significantly decreased to the order noted with some phenothiazines.

Conclusions

The use of a patient monitoring service kept the haematological risks associated with using clozapine within acceptable limits, particularly in view of the benefits of this medication in treatment-resistant schizophrenia.
Erotomanic Symptoms in 42 Chinese Schizophrenic Patients
Authors: Phillips Michael R. , West Charles L. , Wang Ruiwen
Published: October 2008

Background

Reports on erotomania frequently include schizophrenic patients with secondary erotomania, but there are no reports on the prevalence and characteristics of erotomanic symptoms in schizophrenic patients.

Method

A structured item on erotomanic delusions was added to the Chinese version of the Scale for Assessment of Positive Symptoms and administered to 448 randomly selected schizophrenic patients on admission to four psychiatric hospitals in China.

Results

Erotomanic symptoms were identified in 9.4% of the patients (42/448; 95% CI 6.9–12.4%); 4.5% (20/448; CI 2.8–6.8%) had erotomanic ideation and 4.9% (22/448; CI 3.1–7.4%) had fixed erotomanic delusions. Compared with patients without erotomanic symptoms, erotomanic patients were more likely to be male and unmarried, and they had a higher level of education, more severe grandiose delusions, more prominent hostility, and less severe negative symptoms.

Conclusion

The relatively common occurrence of erotomanic symptoms in Chinese schizophrenic patients may be related to the indirect manner of expressing sexual interest in Chinese culture and, thus, be an example of the cultural moulding of psychiatric symptoms.
Psychotherapy Integration: Its Implications for Psychiatry
Authors: Albeniz Alberto , Holmes Jeremy
Published: October 2008

Background

The proliferation of psychotherapies has been balanced by an equal and opposite tendency towards integration. Integrative approaches are particularly relevant to psychotherapy in psychiatric settings.

Method

Medline and manual literature searches yielded over 250 articles on psychotherapy integration, which are reviewed in the light of the authors' experience in a district psychotherapy service.

Results

Psychotherapy integration is an umbrella term covering a wide range of meanings: rapprochement between different theoretical positions; convergence of ideas and techniques; eclectic selection from many different methods; and integration proper in specifically integrative therapies. Many effective psychotherapeutic treatments for psychiatric disorders are integrative, including those for depression, schizophrenia, bulimia nervosa and borderline personality disorder.

Conclusions

Integration at the level of practice is common and desirable. At the level of theory, clarification and creative conflict are essential. Different therapeutic approaches should work closely together but retain their separate identities.
Eye Movement Desensitisation Treatment Utilises the Positive Visceral Element of the Investigatory Reflex to Inhibit the Memories of Post-Traumatic Stress Disorder: A Theoretical Analysis
Authors: MacCulloch Malcolm J. , Feldman Philip
Published: October 2008

Background

Eye movement desensitisation and reprocessing (EMDR) has attracted controversy and has led to publications covering a wide range of psychological problems treated by EMDR, in particular, post-traumatic stress disorder (PTSD). There is growing clinical evidence of the effectiveness of EMDR, but a lack of a convincing theoretical basis to explain its rapid effect.

Method

This paper argues that a combination of Pavlovian and Darwinian theory provide a theoretical explanation for the therapeutic effectiveness of EMDR.

Results

We suggest that the investigatory component of the orienting reflex is an evolutionary development enabling organisms to assess their environment for both opportunities and threats. We propose that EMDR is rapidly effective because it is a clinical method of Pavlovian conditioning by which the positive visceral element of the investigatory reflex can be paired with clinically-induced noxious memories to remove their negative affect.

Conclusion

Compared with established forms of treatment for PTSD, EMDR is rapid, with resulting clinical and economic benefits. Our suggested theoretical basis for EMDR has implications for further explanatory research and for developments in EMDR treatment.
Caudate Nucleus Morphology in Tardive Dyskinesia
Authors: Brown Keith W. , White Thomas , Wardlaw J. M. , Walker Nicholas , Foley D.
Published: October 2008

Objective

The objective of this project was to test whether there are differences in the size of the caudate nucleus in schizophrenic in-patients with and without tardive dyskinesia.

Method

The study was cross-sectional in design, examining group differences between institutionalised schizophrenic patients with and without tardive dyskinesia, using non-enhanced computerised tomography scans of the brain. The group comprised 15 schizophrenic patients with persistent tardive dyskinesia and 21 in-patient schizophrenic controls who were group-matched for demographic variables.

Results

The dyskinetic subjects had a significantly larger left caudate nucleus and tended to have a larger right caudate nucleus than the controls. There were no differences between the groups on any of the measures of cerebral atrophy.

Conclusions

The findings can be understood within the context of models of neostriatal function. It is possible that a larger caudate nucleus could be used to identify patients at risk of developing tardive dyskinesia.
Unwantedness of a Pregnancy and Schizophrenia in the Child
Authors: Myhrman Antero , Rantakallio Paula , Isohanni Matti , Jones Peter , Partanen Ursula
Published: October 2008

Background

Maternal stress during pregnancy has been suggested as a risk factor for schizophrenia We tested the hypothesis that being the child of an unwanted pregnancy would be associated with later schizophrenia.

Methods

Data were collected prospectively in the Northern Finland 1966 Birth Cohort of 11 017 individuals. In the sixth or seventh month of pregnancy mothers were asked whether the pregnancy was wanted, mistimed but wanted or unwanted. Schizophrenia diagnoses in the cohort members were obtained from the Finnish Hospital Discharge Register.

Results

Seventy-six cases of DSM–III–R schizophrenia were identified in the whole cohort between the ages of 16 and 28 years; a cumulative incidence of 0.7%, compared with 1.5% for those bom from unwanted pregnancies. The risk of later schizophrenia among unwanted children was raised compared with wanted or mistimed children, even after adjustment for confounding by sociodemographic, pregnancy and perinatal variables (OR 2.4; 95% CI 1.2–4.8).

Conclusions

The results suggest that unwantedness may operate either directly as a psychosocial stress during development making children more liable to schizophrenia or it may be a marker for behaviours associated with risk in either the mother or the child.
Cholesterol and Mental Disorder
Authors: Boston Paul F. , Dursun Serdar M. , Reveley Michael A.
Published: October 2008

Background

Cholesterol plays an important part in cellular structure and function and changes in serum levels may affect neurotransmission in the central nervous system.

Method

A medline literature search was made covering the period 1990–95 with systematic searching of citations from the articles identified. Representative articles were selected, focusing on those aspects which had not been thoroughly reviewed elsewhere, namely suicidal ideation, depression, personality and schizophrenia.

Results

Lowering cholesterol levels have been associated with an increase in violent deaths in cardiovascular primary prevention studies. However, altered cholesterol levels have also been reported in relation to other psychiatric disorders.

Conclusion

There is substantial evidence that serum cholesterol levels may be associated with variations in mental state or personality. Further work is needed to clarify this and to elucidate the mechanisms involved.
An Investigation of Motor Function in Schizophrenia using Transcranial Magnetic Stimulation of the Motor Cortex
Authors: Puri B. K. , Davey N. J. , Ellaway P. H. , Lewis S. W.
Published: October 2008

Background

In this first investigation of motor function in schizophrenia using transcranial magnetic stimulation (TMS), the general hypothesis tested was that this methodology could be used to investigate the disruption of corticospinal inhibitory processes suggested by cognitive and psychophysiological paradigms.

Method

Nine drug-free DSM–IV schizophrenic patients were compared with nine age- and sex-matched normal subjects. Electromyographic (EMG) recordings were made from the thenar muscles of the dominant hand during sustained, weak voluntary contraction. TMS over a particular threshold applied to the motor cortex would elicit a compound motor evoked potential (cMEP) followed by a period of suppression of EMG.

Results

The latency of cMEPs following TMS was significantly shorter in the schizophrenic patients. The two groups did not differ significantly with respect to mean latency of suppression of EMG activity, or stimulus thresholds for either cMEPs or EMG suppression.

Conclusion

These findings could be the result of a relative lack of corticospinal inhibition of motor responses; a change in the site of TMS activation; or an abnormality of peripheral nervous function in schizophrenia. Drug effects were unlikely since seven of the patients were drug-naïve.
Early Traumatic Stress Reactions among Swedish Survivors of the m/s Estonia Disaster
Authors: Eriksson Nils-Gustaf , Lundin Tom
Published: October 2008

Background

This study is a three-month follow-up study in order to assess the short-term impact of traumatic stress among 53 Swedish survivors of the Estonia disaster.

Method

A questionnaire consisting of general questions about conditions during and after the disaster and self-assessment by Post Traumatic Symptom Scale (PTSS–10), Impact of Event Scale (IES), Sense of Coherence–short version (SoC–12), and the DSM–IV list of dissociative symptoms of Acute Stress Disorder formulated as questions regarding individual reactions was distributed.

Results

The response rate was 79.2% (n=42). The participants scored an average of 3.9 on PTSS–10, 28.5 on IES (‘intrusion’ and ‘avoidance’ subscales) and 62.8 on SoC–12, which shows elevated levels of post-traumatic stress reactions but a normal level of sense of coherence. The reported occurrence of dissociative symptoms during the disaster was as follows: emotional numbing in 43% of the survivors, reduction of awareness in 55%, derealisation in 67%, depersonalisation in 33%, and dissociative amnesia in 29%. Survivors scoring low in SoC scored significantly higher in both PTSS–10 and IES than those with high scores in SoC. All dissociative symptoms were predictive of post-traumatic reactions.

Conclusions

This study substantiates the importance of assessing dissociative symptoms during a life-threatening event as a possible predictor for later post-traumatic reactions and possible PTSD. The Sense of Coherence Scale may be useful as an instrument to sort out survivors at risk.
Mental Disorder among Refugees and the Impact of Persecution and Exile: Some Findings from an Out-Patient Population
Authors: Lavik Nils Johan , Hauff Edvard , Skrondal Anders , Solberg Øivind
Published: October 2008

Background

Refugees have long been considered at risk for mental disorder. We sought to characterise this risk in an out-patient refugee sample by analysing the relationship between psychiatric symptoms and dysfunction, and between symptoms and the socio-demographic background and stressors specific to this refugee sample.

Method

A consecutive sample of 231 refugee patients referred to the psychiatric out-patient unit at the Psychosocial Centre for Refugees, University of Oslo, was examined with a semi-structured interview guide, Brief Psychiatric Rating Scale (BPRS), Hopkins Symptom Check-List (HSCL-25) and a check-list for post-traumatic symptoms (PTSS-10). Global Assessment of Function (GAF) scores were obtained; and the data were analysed using nine predictor variables.

Results

It was found that 46.6% of the patients had a post-traumatic stress disorder according to the criteria for DSM–III–R as the main diagnosis, while the mean GAF score for the patients was 57.3. Analysis of the GAF and BPRS data did not reveal any predictor of psychotic behaviour. However, torture emerged as an important predictor of emotional withdrawal/retardation. Also, age, gender and no employment or education predicted for anxiety/depression, while refugee status and no employment or school predicted for hostility/aggression.

Conclusions

The results confirm earlier findings that refugees constitute a population at risk for mental disorder. Past traumatic stressors and current existence in exile constitute independent risk factors. However, stressors other than those discussed here appear to be important also, particularly with regard to psychotic symptoms.
Early Compliance and Other Factors Predicting Outcome of Exposure for Obsessive–Compulsive Disorder
Authors: De Araujo L. A. , Ito L. M. , Marks I. M.
Published: October 2008

Background

Identifying predictors of treatment outcome can suggest ways to improve treatment delivery and understanding of its mechanism of action.

Method

Predictors of treatment outcome were sought among 46 out-patients with obsessive–compulsive disorder who completed a nine-week randomised controlled trial of two forms of exposure therapy with ritual prevention.

Results

In both exposure conditions the best predictor of good outcome at the end of treatment (week 9) and of follow-up (week 32) was early compliance in doing exposure homework within a week of starting treatment. A weaker predictor of good outcome at follow-up was within-session reduction in anxiety from weeks 0 to 4.

Conclusion

The strongest and most consistent predictor of better outcome to weeks 9 and 32 was compliance with exposure and ritual prevention in the first week of treatment.
Aetiology of Secondary Depression in Male Alcoholics
Authors: Roy Alec
Published: October 2008

Background

Secondary depression is common among primary alcoholics. However, its aetiology is poorly understood.

Method

Forty men with primary alcoholism, abstinent for two weeks or more, with a secondary major depressive episode were compared with forty matched never-depressed primary alcoholic controls for risk factors for depression and recent life events.

Results

In the six months before the onset of depression depressed alcoholics had experienced significantly more life events, more life events with negative impact more dependent events caused by alcohol, and more independent events. Significantly more depressed alcoholics than controls had a family history of depression, a family history of suicidal behaviour and had themselves attempted suicide.

Conclusion

Having recent life events, particularly events with negative impact, and a family history of depression are risk factors for secondary depression in alcoholics.
Expanded CAG/CTG Repeats in Schizophrenia
Authors: Cardno Alastair G. , Murphy Kieran C. , Jones Lisa A. , Guy Carol A. , Asherson Philip , De Azevedo Maria H. P. , Da Cruz Coelho Isabel M. O. , De Macedo e Santos Antonio J. F. , Pato Carlos N. , McGuffin Peter , Owen Michael J. , O'Donovan Michael C.
Published: October 2008

Background

Schizophrenia is associated with expanded CAG/CTG trinucleotide repeats. We wished to determine whether the presence of such expansions correlated with specific subsyndromes or other clinical features of schizophrenia.

Method

Seventy patients from England and Wales and 44 patients from Portugal with a DSM–III–R diagnosis of schizophrenia were rated on the opcrit checklist Patients' maximum CAG/CTG repeat length was measured using repeat expansion detection (RED). Significant differences were sought for repeat lengths in subjects categorised according to dimensional and categorical schizophrenia subsyndromes, affective episodes, individual symptoms, and a range of demographic variables.

Results

Maximum CAG/CTG repeat length did not differ significantly for any of the clinical or demographic variables studied.

Conclusion

There are no subsyndromes or other clinical features of schizophrenia associated with CAG/CTG repeat expansion. Therefore, the identification of the gene(s) that contain expanded CAG/CTG repeats and which are associated with schizophrenia is unlikely to be facilitated at present by using any subsyndromes of schizophrenia as phenotypes.
Fluctuations in Schizophrenic Births by Year
Authors: Torrey E. Fuller , Rawlings Robert R.
Published: October 2008

Background

It has previously been reported that births of individuals who later develop schizophrenia vary by birth year.

Method

Birth data were analysed on 34 024 individuals diagnosed with DSM–III–R disorganised, catatonic, and undifferentiated schizophrenia using time series analysis.

Results

Minor yearly fluctuations were observed but did not achieve statistical significance. Thus earlier findings reported in the literature could not be replicated using a different statistical approach.

Conclusion

The findings do not support theories which assume major yearly fluctuations in the births of individuals with schizophrenia. Such theories include the perinatal effects of influenza, temperature variation, and the effects of severe weather.
Morbid Risk of Schizophrenia in First-Degree Relatives of White and African–Caribbean Patients with Psychosis
Authors: Hutchinson G. , Takei N. , Fahy T. A. , Bhugra D. , Gilvarry C. , Moran P. , Mallett R. , Sham P. , Leff J. , Murray R. M.
Published: October 2008

Background

The high rate of schizophrenia among the second-generation African–Caribbean population in Britain has prompted much concern and speculation. Sugarman and Craufurd have reported that the morbid risk in the siblings of second-generation African–Caribbean schizophrenic patients was unusually high compared with that of the siblings of White patients.

Method

We sought to replicate these findings by comparing the morbid risk for schizophrenia in the first-degree relatives of 111 White and 73 African–Caribbean psychotic probands. The latter comprised 35 first-generation (bom in the Caribbean) and 38 second-generation (born in Britain) probands.

Results

The morbid risk for schizophrenia was similar for the parents and siblings of White and first-generation African–Caribbean patients, and for the parents of the second-generation African–Caribbean probands. However, the siblings of second-generation African–Caribbean psychotic probands had a morbid risk for schizophrenia that was seven times that of their White counterparts (P=0.007); similarly, the siblings of second-generation African–Caribbean schizophrenic probands had a morbid risk for schizophrenia that was four times that of their White counterparts (P=0.05).

Conclusions

These findings replicate those of the earlier report of Sugarman and Craufurd, and suggest either that the second-generation African–Caribbean population in Britain is particularly vulnerable to some environmental risk factors for schizophrenia, or that some environmental factors act selectively on this population in Britain.
The impact of stalkers on their victims
Authors: Pathé Michele , Mullen Paul E.
Published: October 2008

Background

This paper examines the social and psychological impact on victims of stalking.

Method

A group of 100 victims of stalking completed a 50-item questionnaire on their experiences.

Results

The majority of the victims were subjected to multiple forms of harassment including being followed, repeatedly approached and bombarded with letters and telephone calls for periods varying from a month to 20 years. Threats were received by 58 subjects, and 34 were physically or sexually assaulted. All but six victims made major changes in their social and work lives, with 53% changing or ceasing employment and 39% moving home. Increased levels of anxiety were reported by 83%, intrusive recollections and flashbacks by 55%, with nightmares, appetite disturbances and depressed mood also being commonly reported. Suicidal ruminations were acknowledged by 24% of victims. The criteria for a diagnosis of post-traumatic stress disorder were fulfilled in 37% of subjects, with a further 18% having the clinical features but not qualifying for a stressor involving threatened or actual physical harm.

Conclusions

The study indicates the extent of the social and psychological damage sustained by those subjected to persistent stalking, and underlines the inadequacy of the current legal and medical responses to the needs of these victims.
First-onset psychotic illness: Patients'and relatives' satisfaction with services
Authors: Leavey Gerard , King Michael , Cole Eleanor , Hoar Amanda , Johnson-Sabine Eric
Published: October 2008

Background

Despite the growth in patient satisfaction studies, scant attention has been paid to the satisfaction of patients with a first episode of psychotic illness soon after presentation to services. We were particularly interested in any ethnic differences in satisfaction at this seminal stage in patient care.

Method

Using multi-item questionnaire, face-to-face interviews were conducted with patients and relatives 12 months after first contact with psychiatric services. Relatives were also questioned on support and advice issues related to after-care.

Results

Most patients and relatives were generally satisfied with the treatment, and with the ‘humane’ qualities of psychiatric staff, but were less satisfied with the ‘hotel’ aspects of hospital care. Patients, and particularly relatives, were most concerned about levels of information and advice received. Relatives were dissatisfied with after-care. There were no significant differences between Black and other patients, but some differences between their relatives. Patients born abroad were significantly more satisfied than those born in Britain, irrespective of ethnicity. Compulsory detention under the Mental Health Act was also significant in determining low satisfaction for patients and especially for their relatives.

Conclusions

For improved care in the community patients and their relatives need to be seen as partners in care rather than as passive recipients. The issue of information-giving by psychiatric services demands serious attention. Black patients and their relatives were not especially likely to be dissatisfied.
Psychiatric complications of homozygous sickle cell disease among young adults in the Jamaican Cohort Study
Authors: Hilton Claire , Osborn Madeline , Knight Susan , Singhal Atul , Serjeant Graham
Published: October 2008

Background

This study aimed to determine the prevalence of psychiatric disorder in young adults with homzygous sickle cell (SS) disease and in controls with normal haemoglobin, and to examine factors associated with psychiatric disorder.

Method

The study design was cross-sectional. Subjects were aged 18–20 years: 63 with SS disease and 89 controls. The Psychiatric Assessment Schedule was used to determine psychiatric disorder at index of Definition level 5.

Results

Psychiatric disorder was identified in 18 (29%) SS disease patients and in 22 (25%) controls. In SS patients, psychiatric disorder was not related to illness severity but was associated with leaving school early, difficulties in social adjustment, impaired cognitive function and having previous psychiatric difficulties. Male SS patients with psychiatric disorder all had low body mass index (BMI < 17.60). In controls, psychiatric disorder was associated with female gender, unemployment and difficulties in social adjustment.

Conclusions

The prevalence of psychiatric disorder was similar in patients and controls, although associated factors tended to be different. The association with low BMI in SS men merits further study.
Cerebral perfusion correlates of depressed mood
Authors: Ebmeier Klaus P. , Cavanagh Jonathan T. O. , Moffoot Anthony P. R. , Glabus Michael F. , O'Carroll Ronan E. , Goodwin Guy M.
Published: October 2008

Background

The spontaneous diurnal variation of mood and other symptoms provides a substrate for the examination of the relationship between symptoms and regional brain activation in depression.

Method

Twenty unipolar depressed patients with diurnal variation of mood were examined at 8 a.m. and 8 p.m. with neuropsychological measures, clinical ratings and single photon emission tomography (SPET). Brain perfusion maps were spatially transformed into standard stereotactic space and compared pixel-by-pixel. A parametric (correlational) analysis was used to examine the relationship between symptom severity and brain perfusion, both between and within subjects.

Results

Global depression severity and an independent ‘vital’ depression factor were associated in subjects with increased perfusion in cingulate and other paralimbic areas. In addition there was a probable association between an increase in an anxious-depression factor and reduced frontal neocortical perfusion.

Conclusions

Depressive symptom changes are associated with metabolic changes in the cingulate gyrus and associated paralimbic structures.
Impact factors of psychiatric journals
Authors: Howard Louise , Wilkinson Greg
Published: October 2008

Background

We examined citation data for the British Journal of Psychiatry (BJP) and four other general psychiatry journals to assess their impact on the scientific community.

Method

Data on three measures of citations (total number of citations, impact factor and ranking by impact factor) were obtained from Journal Citation Reports for 1985–1994. Rank correlations from year to year were calculated.

Results

The BJP currently ranks sixth of all psychiatry journals when journals are ranked by impact factor. The journal's impact factor fell between 1985 and 1990 and this was followed by a rise in impact factor after 1991. The BJP did not rank in the top 10 psychiatry journals between 1991 and 1993. Archives of General Psychiatry is cited more frequently than any other psychiatry journal, with the American Journal of Psychiatry usually ranking second. Psychopharmacology journals are replacing more general journals in the top rankings. Rankings of most journals have become less stable in recent years.

Conclusions

The BJP would have to change the nature and number of papers published to improve its impact factor. There are a number of limitations to citation data and such data are only one of several factors useful in evaluating the importance of a journal's contribution to scientific and clinical communities.

Conflict of interest

These condauthor is Editor of the British Journal of Psychiatry.
Huntington's disease: Psychiatric practice in molecular genetic prediction and diagnosis
Authors: Scourfield Jane , Soldan Jo , Gray Jonathon , Houlihan Gary , Harper Peter S.
Published: October 2008

Background

Predictive genetic testing for Huntington's disease has been available in Cardiff since 1987 using linked genetic markers, and since 1993 using direct mutation testing, which can also be used as a diagnostic test. During this period there have been numerous referrals that have required liaison with psychiatric services at all stages of the testing programme.

Method

A series of cases was selected to highlight issues from both genetic prediction and diagnosis that are relevant to psychiatric practice and have arisen during the testing programme.

Results

Issues have been raised concerning competence to consent to testing in the context of psychotic illness; depression and suicidal ideation in test candidates; requests for testing from third parties such as psychiatrists, social services and the courts; and testing of children.

Conclusions

As genetic testing becomes possible for more disorders the lessons learned from Huntington's disease will provide valuable guidelines for counselling.
Genetic anticipation and imprinting in bipolar I illness
Authors: Grigoroiu-Serbanescu Maria , Wickramaratne Pryia J. , Hodge Susan E. , Milea Stefan , Mihailescu Radu
Published: October 2008

Background

The study focused on: (1) the existence of genetic anticipation in a randomly selected sample of bipolar I patients using broad and narrow definitions of the affection status in the parental generation; (2) the relationship between anticipation and the age at investigation in probands and in their relatives; (3) the relationship between anticipation and imprinting.

Method

One hundred and fifteen bipolar I patients and their first- to third-degree relatives were diagnosed according to DSM–III–R criteria using the Diagnostic Interview for Genetic Studies and the Family Interview for Genetic Studies.

Results

Age at onset was found to be 6–10 years younger in probands with affected parents or uncles/aunts. Two-thirds of these families showed positive anticipation under both the broad and the narrow definitions of affection status in the parents' generation. The age at investigation was younger in probands showing positive anticipation. Anticipation was found only in probands inheriting the disorder from the paternal side.

Conclusions

In spite of the inevitable association between young current age and young age at onset, which could result in spurious anticipation effects, our findings suggest that this phenomenon is not the sole cause of observed anticipation.
Subjective ratings of emotional health as a risk factor for major depression in a community sample
Authors: Hoff Rani A. , Bruce Martha Livingston , Kasl Stanislav V. , Jacobs Selby C.
Published: October 2008

Background

Although subjective ratings of health have been shown to be accurate predictors of physical health outcomes, there is little research on the association between subjective emotional health (SEH) and psychiatric outcomes.

Method

This paper utilises data from the Epidemiologic Catchment Area study to explore the relationship between baseline SEH and the risk for major depression in the next year. Both recurrent and incident episodes of depression are outcomes of interest.

Results

The age- and gender-adjusted relationship between SEH and depression is quite significant, and remains so after adjusting for other factors associated with major depression. The more positive the SEH rating, the lower the risk of an episode of depression in the next year.

Conclusions

Some possible explanations for this association are explored, including possible confounders that were not accounted for and the possibility that SEH ratings pose an independent risk for major depression.
Outcome in schizophrenia and related disorders compared between developing and developed countries
Authors: Craig Thomas J. , Siegel Carole , Hopper Kim , Lin Shang , Sartorius Norman
Published: October 2008

Background

Data on the two-year pattern of course of illness have been collected in the WHO study of the Determinants of Outcomes of Severe Mental Disorder (DOSMD). These data are reanalysed using recursive partitioning, a method not yet applied to psychiatric data to test the hypothesis that subjects from participating centres in developing countries had better outcomes than those in developed countries.

Method

Subjects were those from the DOSMD study for whom two-year follow-up data were available (n= 1056). The classification and regression trees recursive partitioning technique was used to examine the predictor variables associated with the outcome variable two year pattern of course.

Results

Pattern of course was best predicted by centre, but two developed centres (Prague and Nottingham) grouped with the developing country centres excluding Cali, having better outcomes than in the remaining developed country centres and Cali. Type of onset (insidious v. non-insidious) was the next strongest predictor, but its effect differed across these two centre groupings. Effects for some groups were modified by other predictor variables, including age, child and/or adolescent problems, and gender.

Conclusions

The predominant predictor effects on two-year pattern of course continued to be centre and type of onset, but complex interactions between these variables and other predictor variables are seen in specific centre groupings not strictly defined by ‘developing’ and ‘developed’.
Is the earlier age at onset of schizophrenia in males a confounded finding?
Authors: Jablensky Assen , Cole Steven W.
Published: October 2008

Background

The finding of an earlier age at onset of schizophrenia in males compared with females, replicated across a number of studies, appears to be so robust as to support hypotheses about gender differences in the aetiology of the disorder. However, the possibility that this observed gender effect might reflect other confounding variables has not been adequately explored.

Method

We analysed data on 778 men and 653 women, in three developing countries and in seven developed countries, who had been assessed in the WHO 10-country study of schizophrenia. We applied a generalised linear modelling strategy to estimate the unconfounded contributions of gender, family history, premorbid personality and marital status to age at onset.

Results

The model that explained the highest percentage of the total variance indicated strong main effects (P < 0.001) for marital status and premorbid personality, a weak effect for family history, and an attenuated effect for gender. Two independent verification procedures suggested an independent onset-delaying effect for marital status (married), more marked in males.

Conclusions

The gender difference in the age at onset of schizophrenia is not a robust biological characteristic of the disorder. Failure to control for marital status and premorbid personality in male/ female comparisons of age at onset may explain a large part of the differences reported previously.
The effect of treatment on the two-year course of late-life depression
Authors: Flint Alastair J. , Rifat Sandra L.
Published: October 2008

Background

The purpose of this study was to examine the effect of treatment on the long-term course of geriatric depression.

Method

Eighty-four elderly patients who had responded to treatment of the index episode of major depression were maintained on full-dose antidepressant medication and followed on a monthly basis for two years. Relapse and recurrence were treated in a systematic manner.

Results

The cumulative probability of surviving for two years without relapse or recurrence was 74%. Of the 14 patients who suffered recurrence following recovery from the index episode, all responded to a change of treatment, and 71% remained well for the remainder of the study. The risk of recurrence was significantly increased by a delayed response to treatment of the index episode.

Conclusions

Continuation and maintenance treatment with full-dose antidepressant medication, frequent follow-up, and vigorous treatment of relapses and recurrences, were associated with a good outcome in this group of elderly patients.
The Hampstead Schizophrenia Survey 1991
Authors: McNaught Alan S. , Jeffreys Siobhan E. , Harvey Carol A. , Quayle Anthony S. , King Michael B. , Bird Anne S.
Published: October 2008

Background

The previous paper reports a high prevalence of schizophrenia (broad definition) in an inner London area. In this paper we test hypotheses for this finding and examine the characteristics of people with schizophrenia who move frequently.

Method

People with schizophrenia in the Hampstead area were identified by key informant methodology, at two censuses five years apart. This allowed identification of incident cases during these five years and identification of people who had moved into and out of the area.

Results

The incidence of DSM-III-R schizophrenia in Hampstead between 1986 and 1991 was at least 0.21 per 1000 of the population aged 15 to 54. There was a significant movement of people with schizophrenia to this inner London area from outer London between 1986 and 1991. People with schizophrenia who were relatively mobile were significantly more likely to be male, to suffer with prominent hallucinations, and to have no contact with a GP.

Conclusions

The high prevalence of broad schizophrenia in this inner London area is, in part, due to geographical drift. A significant excess of the people with schizophrenia who move frequently are men with positive symptoms.
The Maudsley Family Study 4. Normal planum temporale asymmetry in familial schizophrenia
Authors: Frangou S. , Sharma T. , Sigmundsson T. , Barta P. , Pearlson G. , Murray R. M.
Published: October 2008

Background

Loss or reversal of the normal asymmetry of the planum temporale (PT) has been reported in schizophrenia, and may be due to aberrations in the gene(s) controlling the development of brain asymmetries. We tested this hypothesis in a sample of schizophrenics and their relatives from families multiply affected with the disorder.

Method

We compared 32 schizophrenics and 55 of their non-schizophrenic first-degree relatives with 39 matched community controls. Volumetric measurements of the cortical volume beneath the PT were obtained using the Cavalieri method from three-dimensionally reconstructed magnetic resonance imaging images.

Results

PT volume asymmetry coefficients from patients and their relatives did not differ significantly from those of the controls. Gender-specific analysis did not reveal any differences.

Conclusions

Abnormalities in PT volume asymmetry are not present in familial schizophrenia, where genetic factors appear to predominate.
The Nithsdale Schizophrenia Surveys 16. Breast-feeding and schizophrenia: Preliminary results and hypotheses
Authors: McCreadie Robin G.
Published: October 2008

Background

Schizophrenia may in some cases be a neurodevelopmental disorder. Breast milk is important to the developing brain. Might a lack of breast milk be an environmental risk factor in schizophrenia?

Method

Mothers of 45 schizophrenic patients in Nithsdale, southwest Scotland, completed a questionnaire about whether or not their offspring had been breast-fed.

Results

The incidence of breast-feeding in patients was 29% and in sibs 38%. Most patients were born in the 1940s and 1950s. The incidence in patients born in these two decades, 33 and 26%, respectively, was significantly lower than in Scottish surveys in 1946 (81%) and 1958 (51%). Those patients who had not been breast-fed had more schizoid and schizotypal personality traits in childhood and a poorer social adjustment than their sibs; breast-fed patients did not differ from their sibs.

Conclusions

Fewer schizophrenic patients than normal were breast-fed. Lack of breast milk may be a risk factor in the neurodevelopmental form of schizophrenia.
Delusion, the overvalued idea and religious beliefs: A comparative analysis of their characteristics
Authors: Jones Edgar , Watson J. P.
Published: October 2008

Background

The study sought to investigate the form of the delusion in schizophrenia and the overvalued idea in anorexia, employing a range of belief characteristics to discover whether differences could be detected between them, and how they stood in general relationship to the religious beliefs of normals.

Method

A belief rating scale was devised with 12 characteristics, and completed by 20 schizophrenics, 20 anorectics, and 20 normal controls. Comparisons were drawn between populations using the Mann-Whitney test, and different types of belief were contrasted within diagnostic groups using each subject as their own control by repeated-measures MANOVA.

Results

The schizophrenic delusion was differentiated from the overvalued idea in anorexia by a number of variables, which also served to distinguish both phenomena from religious beliefs held by normals. The schizophrenic delusion exhibited many of the qualities of an initial (or observational) belief, when its content suggested that it should manifest those of a derived belief. The anorectic overvalued idea, although occasionally an initial belief in terms of its content, was typically held in the form of a derived belief.

Conclusions

A wider range of characteristics is required to define all the differences between delusion and the overvalued idea, and these have implications for belief modification programmes.
Effects of morning phototherapy on circadian markers in seasonal affective disorder
Authors: Thompson C. , Childs P. A. , Martin N. J. , Rodin I. , Smythe P. J.
Published: October 2008

Background

The suppression of melatonin by light at 00.30 hours has been shown to be greater in winter than in summer in patients with seasonal affective disorder (SAD) but not in matched normal controls.

Method

In this study 12 patients with SAD and 12 matched normal controls were exposed to morning light therapy in the winter. Melatonin profiles and sensitivity to light were measured before and after treatment.

Results

The SAD but not the normal group showed a phase advance of melatonin rhythms in response to phototherapy. There was an association between phase position and phase shift in the SAD but not in the normal group.

Conclusions

There may be instability of circadian rhythms in SAD mediated by a high-amplitude phase response curve, rather than a fixed phase abnormality as had been previously suggested. This instability may be secondary to impaired serotoninergic function in the afferent pathways to the suprachiasmatic nuclei.