bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of forced‐air warming systems with lower body blankets using a copper manikin of the human body
Authors: Bräuer A. , English M. J. M. , Lorenz N. , Steinmetz N. , Perl T. , Braun U. , Weyland W.
Published: March 2003

Background: Forced‐air warming has gained high acceptance as a measure for the prevention of intraoperative hypothermia. However, data on heat transfer with lower body blankets are not yet available. This study was conducted to determine the heat transfer efficacy of six complete lower body warming systems.

Methods: Heat transfer of forced‐air warmers can be described as follows:

Q˙=h·ΔT·A

where Q˙ = heat transfer [W], h = heat exchange coefficient [W m−2 °C−1], ΔT = temperature gradient between blanket and surface [°C], A = covered area [m2].

We tested the following forced‐air warmers in a previously validated copper manikin of the human body: (1) Bair Hugger® and lower body blanket (Augustine Medical Inc., Eden Prairie, MN); (2) Thermacare® and lower body blanket (Gaymar Industries, Orchard Park, NY); (3) WarmAir® and lower body blanket (Cincinnati Sub‐Zero Products, Cincinnati, OH); (4) Warm‐Gard® and lower body blanket (Luis Gibeck AB, Upplands Väsby, Sweden); (5) Warm‐Gard® and reusable lower body blanket (Luis Gibeck AB); and (6) WarmTouch® and lower body blanket (Mallinckrodt Medical Inc., St. Luis, MO).

Heat flux and surface temperature were measured with 16 calibrated heat flux transducers. Blanket temperature was measured using 16 thermocouples. ΔT was varied between −10 and +10 °C and h was determined by a linear regression analysis as the slope of ΔT vs. heat flux. Mean ΔT was determined for surface temperatures between 36 and 38 °C, because similar mean skin temperatures have been found in volunteers. The area covered by the blankets was estimated to be 0.54 m2.

Results: Heat transfer from the blanket to the manikin was different for surface temperatures between 36 °C and 38 °C. At a surface temperature of 36 °C the heat transfer was higher (between 13.4 W to 18.3 W) than at surface temperatures of 38 °C (8–11.5 W). The highest heat transfer was delivered by the Thermacare® system (8.3–18.3 W), the lowest heat transfer was delivered by the Warm‐Gard® system with the single use blanket (8–13.4 W).

The heat exchange coefficient varied between 12.5 W m−2°C−1 and 30.8 W m−2°C−1, mean ΔT varied between 1.04 °C and 2.48 °C for surface temperatures of 36 °C and between 0.50 °C and 1.63 °C for surface temperatures of 38 °C.

Conclusion: No relevant differences in heat transfer of lower body blankets were found between the different forced‐air warming systems tested. Heat transfer was lower than heat transfer by upper body blankets tested in a previous study. However, forced‐air warming systems with lower body blankets are still more effective than forced‐air warming systems with upper body blankets in the prevention of perioperative hypothermia, because they cover a larger area of the body surface.
Clinical trial of esmolol‐induced controlled hypotension with or without acute normovolemic hemodilution in spinal surgery*
Authors: Lim Y. J. , Kim C. S. , Bahk J. H. , Ham B. M. , Do S. H.
Published: March 2003

Background: Drug‐induced controlled hypotension (CH) combined with acute normovolemic hemodilution (ANH) is being widely used for blood conservation in surgical patients. The purpose of this study was to investigate the efficacy and safety of esmolol‐induced CH combined with ANH (hematocrit down to 28%).

Methods: Thirty patients who were scheduled to receive spinal surgery were randomly divided into two groups: an esmolol‐induced CH alone group (esmolol group, n=15) and a CH‐ANH combined group (E‐ANH group, n=15). Controlled hypotension was induced with esmolol 500 µg/kg, followed by a continuous infusion of 0–300 µg/kg/min to maintain mean arterial pressure at 55–65 mmHg.

Results: The mean infusion rate of esmolol in the esmolol‐ANH group was 46±6 µg/kg/min (mean±SD), which was significantly lower than the 77±9 µg/kg/min used in the esmolol group (P<0.05). The number of units of homologous blood (packed RBC) transfused perioperatively was 2.2±0.6 units in the esmolol‐ANH group, which was significantly less than 4.3±0.4 units used in the esmolol group (P<0.01). While O2 delivery decreased significantly during CH, O2 consumption remained unchanged in both groups. No complications resulted from CH or ANH in any of the groups.

Conclusion: Our data suggest that ANH of moderate degree can be combined with esmolol‐induced CH to improve blood conservation in surgical patients.
Oral clonidine premedication does not reduce postoperative vomiting in children undergoing strabismus surgery
Authors: Gulhas N. , Turkoz A. , Durmus M. , Togal T. , Gedik E. , Ersoy M. O.
Published: March 2003

Background: We evaluated the effect of oral clonidine on postoperative vomiting (POV) in children undergoing strabismus surgery.

Methods: Eighty ASA physical status I children aged 3–12 years were randomly assigned to one of two groups in a double‐blinded manner. One hour before surgery, each patient in the clonidine group (n=40) received clonidine 4 µg kg−1 in apple juice 0.2 ml kg−1, and each of the controls (n=40) received apple juice 0.2 ml kg−1 only. The protocol for general anesthesia was propofol‐sevoflurane in N2O/O2. A paracetamol suppository was administered in each case to prevent postoperative pain. Patient responses during 0–48 h after anesthesia were recorded as complete (no POV, no antiemetic rescue required), retching, vomiting, or rescue antiemetic.

Results: There were no significant differences between the clonidine and control groups regarding the number of patients with complete response (21 vs. 18, respectively) retching (10 vs. 14, respectively), vomiting (19 vs. 22, respectively), or rescue antiemetic (9 vs. 12, respectively) during the first 48 h.

Conclusion: Oral premedication with clonidine 4 µg kg−1 did not reduce the rate of POV in the children undergoing strabismus surgery.
Cardiac arrest in an infant with congenital adrenal hyperplasia
Authors: Ruppen W. , Hagenbuch N. , Jöhr M. , Christen P.
Published: March 2003

We report a 3‐month‐old boy who suffered an out‐of‐hospital cardiac arrest. During resuscitation, the medical team was informed that he was receiving hydrocortisone treatment. The possibility of adrenal insufficiency with hyperkalemic cardiac arrest prompted the administration of calcium, which resulted in the return of spontaneous circulation. The infant's diagnosis of congenital adrenal hyperplasia was not spontaneously mentioned by the parents. This case illustrates the importance of obtaining adequate parental information and considering hyperkalemia as a possible cause of cardiac arrest.
Maternal mortality in West Africa
Authors: Bouvier‐Colle Marie‐Hélène , Ouedraogo Charlemagne , Dumont Alexandre , Vangeenderhuysen Charles , Salanave Benoît , Decam Christophe ,   the MOMA group
Published: March 2003

Background. According to estimates of maternal mortality rates from WHO/UNICEF, the West African rates appear to be among the world’s highest. The precision of these estimates from general mortality models is far from ideal and no information on the distribution of causes of death is provided. The principal objective of our study is to describe the maternal mortality, estimation of the rates and distribution of obstetric causes, from a population based survey of pregnant women carried out in West Africa. We also present the main characteristics of the deaths that occurred, including avoidable aspects.

Methods. The survey included all the pregnant women living in seven defined areas, from December 1994 through June 1996, depending on the area. Twenty thousand three hundred and twenty‐six pregnant women (94.3% of all those identified) agreed to participate and 19,545 were followed throughout the second trimester of pregnancy, delivery and the puerperium. Physicians from the survey team made special enquiries about all maternal deaths. But the deaths occurring during the first months of pregnancy could not be estimated. A subcommittee analyzed all the deaths, assigned the underlying cause and discussed the avoidable aspects of the death.

Results. Sixty‐six deaths were reported. Fifty‐five (three late) were deaths due to obstetric causes; six were fortuitous deaths, and no cause could be defined for five. As a mean and for pregnancy after week 25, the maternal mortality rate was estimated at 311 (95% CI 234–404) per 100,000 live births and 852 (95% CI 456–1457) in rural areas. Hemorrhages accounted for 29% of obstetric deaths, uterine rupture 13%, eclampsia and infectious diseases 11% each. Seventy‐four percent of the direct obstetric causes were considered avoidable.

Conclusion. Confidential enquiries into maternal deaths in West Africa are not just a concern of the others. They are urgently requested to promote the improvement of health services.
Growth factors in corneal wound healing following refractive surgery: A review
Authors: Baldwin Heather C. , Marshall John
Published: March 2003

The first part of this review article aims to provide important basic definitions of growth factor terminology, and to put forward a model for understanding the role of growth factors in a wound healing context. In the second part of the paper, we review the literature on growth factors in the cornea, including that on changes associated with wound healing following refractive surgery in the epithelial, stromal, and endothelial layers. The role of growth factors in stromal removal, corneal neovascularization, corneal innervation and wound healing is considered. The importance of the epithelial–stromal interaction is discussed, including the role of growth factors in keratocyte apoptosis. In the final section, we review the current literature on endogenous and exogenous modulation of growth factors in corneal wound healing. This includes importantin vitrowork but aims to emphasize clinically relevant results. Photorefractive keratectomy(PRK) may have short‐term complications such as pain and haze, whereas laserin situkeratomilieusis (LASIK) may have longer‐term adverse effects on corneal biomechanics. The emerging technique of laser epithelial keratomilieusis (LASEK) provides an interesting alternative wound which may be less susceptible to the inherent complications of PRK and LASIK. At present, the phenomenon of iatrogenic keratectasia following LASIK is not fully understood, but these features of wound healing following PRK may be amenable to growth factor modulation.
On the operationalization of psychopathy: further support for a three‐faceted personality oriented model
Authors: Johansson P. , Andershed H. , Kerr M. , Levander S.
Published: March 2003

Objective: This study is an attempt to compare two alternative models of psychopathy (PCL‐R); (i) the traditional 17‐item two‐factor model where the first factor describes a deceitful, manipulative and callous, unemotional dimension and the second factor describes the impulsive, irresponsible and antisocial behavioral lifestyle dimension; and (ii) a recently proposed 13‐item three‐factor model involving an interpersonal facet, an affective facet and a behavioral facet.

Method:  Exploratory and confirmatory factor analyses of PCL‐R scores on a sample of 293 adult male violent offenders were conducted.

Results:  The results of the exploratory factor analysis showed that the 13 items yielded three easily interpretable factors: an interpersonal factor, an affective factor and a behavioral/lifestyle factor. Through confirmatory factor analysis we showed that this model had a significantly closer fit to the data than the classical 17‐item, two‐factor model of the PCL‐R.

Conclusion: The study supports the three‐faceted model of psychopathy.
Psychopathy and violent recidivism among young criminal offenders
Authors: Långström N. , Grann M.
Published: March 2003

Objective: To investigate the predictive validity of psychopathic personality traits (assessed with the revised psychopathy checklist, PCL‐R; Hare, 1991) for violent criminal recidivism among young offenders.

Method:  The relationship between PCL‐R psychopathy and violent re‐offending was studied in 98 young (M=18.40, range 15–20 years) violent and sex offenders subjected to forensic psychiatric evaluation in Sweden during 1988–95. Subjects were followed during detainment and for 24 months in the community to first reconviction for a violent offence.

Results:  We found a modest but significant association between PCL‐R scores and violent recidivism, almost exclusively accounted for by behavioural criteria. Among 13 possible confounders tested, conduct disorder before age 15 and a young age at first conviction eliminated the relationship between psychopathy and violent recidivism in pair‐wise logistic regression models.

Conclusion:  PCL‐R psychopathy may be a less valid predictor for violent criminal recidivism among severe youthful offenders than among adult offenders.
Measuring aggression with the staff observation aggression scale − revised
Authors: Nijman H. , Palmstierna T.
Published: March 2003

Objective:  The staff observation aggression scale (SOAS; Palmstierna & Wistedt, 1987) was developed to measure nature, number, as well as severity of aggressive incidents. In 1999, a revised version of the SOAS (i.e. the SOAS‐R), with a more fine‐grained severity scoring system, was presented. In the current paper, the development and testing of the revised severity scores of the SOAS‐R are addressed.

Method: In two consecutive studies, staff members recorded inpatient aggression on SOAS‐R forms, but also expressed their opinion about the severity of incidents on 100 mm visual analogue scales (VASs). Correlations were calculated between SOAS and SOAS‐R severity scores, on the one hand, and clinical judgements of severity, on the other.

Results:  In both studies, revised SOAS severity scores were more closely related to clinical judgements of aggression severity than the original ones.

Conclusion: The SOAS‐R is a promising tool for research on the prevalence, severity and determinants of inpatient aggression.
Anabolic androgenic steroids and violence
Authors: Thiblin I. , Pärlklo T.
Published: March 2003

Objective:  To scrutinize the criminal career among users of anabolic androgenic steroids (AAS) with focus on a possible relationship between use of AAS and violent offences.

Method:  Prospective longitudinal follow‐up of police records concerning known users of AAS.

Results:  The present study describes five young men who started to use AAS with the primary motive of gaining muscle mass and strength and who subsequently got involved in criminal activities, including violent offences. One person showed deviant behaviour suggestive of conduct disorder at an early age. The other persons appeared to have low self‐confidence, but had not been acting out during early adolescence.

Conclusion:  Use of AAS may constitute an increased risk of developing an antisocial life style with involvement in criminal violence.
Effect of combined treatment with nandrolone and cocaine on the NMDA receptor gene expression in the rat nucleus accumbens and periaqueductal gray
Authors: Le Grevès P. , Zhou Q. , Huang W. , Nyberg F.
Published: March 2003

Objective:  Anabolic androgenic steroids (AAS) have been suggested to sensitize mechanisms involved in drug dependency and aggressive behaviour. Nucleus accumbens and periaqueductal gray (PAG) are believed to be critical in the functional anatomy of these two phenomena, which are partly mediated by the NMDA receptor. This study was undertaken in order to determine the relationship between the effect of AAS and cocaine (given alone or in combination) on the gene expression of the NMDA receptor subtype NR1 in the rat nucleus accumbens and PAG.

Method:  Male rats were subjected to 2 weeks of daily doses of cocaine and the anabolic‐androgenic steroid nandrolone, administrated separately or in combination, and the effect on the mRNA expression for the NMDA receptor NR1 subunit was studied by Northern blot analysis.

Results:  In the nucleus accumbens, injection of cocaine alone and the combination of cocaine and nandrolone caused a significant decrease in the NR1 mRNA level compared with that of control rats. The combined treatment significantly down‐regulated the transcript in the PAG compared with the groups injected with vehicle, nandrolone or cocaine alone.

Conclusion:  It was concluded that AAS combined with cocaine may induce additive increases in glutamatergic activity in these brain areas, supporting the notion that these steroids can sensitize mechanisms involved in the reward and the expression of aggression.
Prediction of inpatient violence
Authors: Steinert T.
Published: March 2003

Objective:  An overview of studies on predictors and on the accuracy of prediction of inpatient violence should be given.

Method:  To date, the published data do not allow a systematic meta‐analysis due to different sample characteristics, different measures and definitions of violence, and different time frames of observation. Published studies were reviewed regarding significant predictors of inpatient violence.

Results:  Predictors of violence in institutional settings are different from predictors of violence in the community: variables such as sex, age, diagnosis and alcohol abuse play a minor role, while clinical and psychopathological variables are prominent. Only history of violence is a robust static predictor. The total level of positive and general psychotic symptoms seems to enhance the violence risk of inpatients, whereas results concerning specific features like delusions or command hallucinations are contradictory due to inevitable problems of sample selection. The accuracy of clinical predictions is better than chance but limited by the effects of therapeutic interventions and research artefacts.

Conclusion:  The author argues that more precise determinations of the violence risk in institutions will fail and that the role of environmental factors has often been underestimated.
Alcohol's role in domestic violence: a contributing cause or an excuse?
Authors: Leonard K. E.
Published: March 2003

Objective: This paper reviews evidence regarding the deviance disavowal approach to alcohol‐related violence. It focuses on whether alcohol intoxication is used to excuse domestic violence, and whether this can explain alcohol/violence association.

Method:Four hypotheses derived from the deviance disavowal approach were identified, including (i) people accept alcohol as a cause of violence; (ii) people attribute less blame and punishment to intoxicated aggressors than to sober aggressors; (iii) the belief that alcohol causes or excuses violence should be associated with and predict the occurrence of alcohol‐related domestic violence; and (iv) the administration of a placebo should increase aggressive behaviour.

Results: The review suggested that some people do accept alcohol as a cause of violence, but that alcohol does not appear to mitigate blame, and this belief is not longitudinally predictive of violence.

Conclusion: The evidence for a deviance disavowal model of alcohol and domestic violence appears quite weak.
Preventing men's violence against women
Authors: Leander K.
Published: March 2003

Objective:  The treatment and prevention of men's violence against women has increasingly been recognized as an issue not only for the criminal justice but also for the health and public health sectors. It is necessary to determine how health care can avoid accelerating women's ‘entrapment’ in a violent situation and to contribute to empowering them to take proactive steps.

Method:  Research and experience reveal how the nature of domestic violence can lead to health care playing a preventive role. The responsible body for health care in Stockholm, the Stockholm County Council, is one of several public authorities involved in a county‐wide initiative called Operation Kvinnofrid, which has focused on internal training programmes as well as public poster campaigns.

Results:  Public awareness campaigns in combination with internal training programmes do have an impact, especially where political and management will is clear.

Conclusion:  Heightened awareness among the public, enhanced skills among health workers, and multiagency coordination of the response to men's violence against women are essential elements of the long‐term prevention of this violence.
Psychological impact of torture: a 3‐month follow‐up of mass‐evacuated Kosovan adults in Sweden. Lessons learnt for prevention
Authors: Ekblad S. , Prochazka H. , Roth G.
Published: March 2003

Objective:  To study the impact of torture on symptomatology among mass displaced adults.

Method: A sample (total 131; 70 females, 61 males) of mass displaced adults from Kosovo, in Sweden, completed 3 months after a baseline study on trauma experiences and perceived symptoms, self‐rated instruments measuring psychiatric symptoms, aggression and coping.

Results:  Torture is associated with poor coping (manageability); depression, anxiety and aggression are associated with post‐traumatic stress disorder. All psychiatric symptoms and poor coping (but not aggression) are associated with being female. Limitations of the study include a relatively small sample. Ongoing trauma and stress before repatriation may also influence the responses. Several lessons learnt for prevention are discussed.

Conclusion: Anger and hostility are important consequences of torture. Further research is necessary to understand the associations among coping strategies, psychiatric symptoms, aggression, torture experience and gender over time after repatriation or applying for asylum.
Reboxetine: tolerability and safety profile in patients with major depression
Authors: Tanum Lars
Published: March 2003

Since reboxetine acts selectively on the reuptake of noradrenaline, it has a different side‐effects profile than drugs acting predominantly on the serotonin reuptake mechanism. Data from patients treated with reboxetine (n=1503) or placebo/comparator drugs (n=1027) show that reboxetine has no significant cardiovascular effects, a low potential for drug interactions, causes no significant impairment of cognitive or motor function and no increase in suicidal ideation. In contrast to certain serotonergic drugs, there is no evidence of any withdrawal syndrome upon abrupt discontinuation or tapering of reboxetine treatment. Sexual dysfunction appears in only a small fraction of the patients and mainly with doses higher than 8 mg daily. The rate of discontinuation due to adverse effects with reboxetine was not significantly different from that observed with placebo in short‐term studies. The level of efficacy and apparently favourable tolerability profile makes reboxetine an important alternative in the medical treatment of depressive illness.
A population study on the influence of depression on neuropsychological functioning in 85‐year‐olds
Authors: Pálsson Sigurður , Johansson Boo , Berg Stig , Skoog Ingmar
Published: March 2003

Objective: To examine cognitive function in very old depressed individuals.

Method: Individuals with major depression (MDS) or dysthymia according to the DSM‐III‐R were compared to mentally healthy regarding tests of verbal ability, inductive logical reasoning, spatial ability, perceptual speed, basic arithmetics, primary memory and secondary memory in a population‐based sample of 85‐year‐olds.

Results: Individuals with MDS performed worse than mentally healthy individuals in tests of verbal ability, inductive logical reasoning, spatial ability, perceptual speed and secondary memory. There were no differences between the groups regarding basic arithmetics and primary memory. The poor test performance was mainly associated with psychomotor retardation and decreased concentration in depressed individuals. Memory complaints were not correlated to poor test performance, neither in the mentally healthy nor in the depressed.

Conclusion: MDS in elderly individuals is associated with reduced cognitive test performance, especially regarding more complex and time‐demanding tests and in tests of secondary memory.
Psychometric measures of individual change: an empirical comparison with the Brief Psychiatric Rating Scale (BPRS)
Authors: Hafkenscheid A.
Published: March 2003

Objective: An empirical comparison of treatment efficacy estimates as based on psychometric measures of intra‐individual change (Reliable Change methods). Method: All seven different methods of assessing Reliable Change that have been advocated in the past two decades are compared empirically in a large in‐patient sample (n=107). Estimates of treatment efficacy by each of these seven Reliable Change methods are computed, using pre‐/post‐score changes on the Brief Psychiatric Rating Scale (BPRS). Results: It is demonstrated that Reliable Change methods may yield very different estimates of treatment efficacy. The Reliable Change method with the fewest statistical assumptions is one of the least sensitive Reliable Change methods. Conclusions: Disagreement on the proper definition of Reliable Change is not merely of theoretical importance, but also has major practical implications.
Smoking and the risk of suicide
Authors: Tanskanen A. , Tuomilehto J. , Viinamäki H. , Vartiainen E. , Lehtonen J. , Puska P.
Published: March 2003

Objective:To estimate the relationship between cigarette smoking and the risk of suicide.

Method:The mortality of 36 527 adult men and women was monitored for the mean 14.4 years. Information on deaths caused by suicide was obtained from the National Mortality Register. Suicides were subclassified by the level of violence used. Current smokers of 1–20 cigarettes per day were considered light/moderate smokers and heavy smokers were defined as those smoking 21 cigarettes per day.

Results:There were 134 suicides among 17 798 men and 31 suicides among 18 729 women. The most common suicide methods were hanging, firearms and drug overdose. According to the Cox model the adjusted relative risk of both violent and non‐violent suicide was significantly and linearly increased among light/moderate and heavy smokers compared with non‐smokers.

Conclusion:Smoking was associated with an increased risk of suicide irrespective of the level of violence used.
Cognitive impairment and syndromal depression in estimates of active life expectancy: the 13‐year follow‐up of the Baltimore Epidemiologic Catchment Area sample
Authors: Gallo Joseph J. , Schoen Robert , Jones Richard
Published: March 2003

Gallo JJ, Schoen R, Jones R. Cognitive impairment and syndromal depression in estimates of active life expectancy: the 13‐year follow‐up of the Baltimore Epidemiologic Catchment Area sample. Acta Psychiatr Scand 2000: 101: 265–273. © Munksgaard 2000.

Objective: Our hypothesis was that including cognitive status and syndromal depression in specifying functional impairment would result in significant differences in estimates of active life expectancy from specifications that included only standard functional measures (such as|activities of daily living).

Method: The subjects were the 3481 continuing participants of the Baltimore Epidemiologic Catchments Area Program. Interviews included criterion‐based diagnosis of depression, assessment of cognitive status and standard survey questions on function.

Results: Estimates of active life expectancy decreased from 9.8 years to 8.9 years at age 65 years for men, and from 10 years to 8.4 years at age 65 years for women, when the definition of active life expectancy included measures of cognitive impairment and syndromal depression.

Conclusion: Measurements of active life expectancy tend to ignore dependencies related to psychological causes, and should move beyond mere enumeration of activities of daily living and instrumental activities of daily living.
Sex differences in late‐life depression
Authors: Sonnenberg C. M. , Beekman A. T. F. , Deeg D. J. H. , van Tilburg W.
Published: March 2003

Sonnenberg CM, Beekman ATF, Deeg DJH, van Tilburg W. Sex differences in late‐life depression.

Acta Psychiatr Scand 2000: 101: 286–292. © Munksgaard 2000.

Objective: The primary aim of this study was to assess sex differences in depression in later life.

Method: In a random, age and sex‐stratified community sample of 3056 older Dutch people (55–85 years) the prevalence, symptom‐reporting and risk factors associated with depression in later life were studied. Depression was measured with the Center for Epidemiologic Studies Depression scale (CES‐D). Bivariate, multivariate and factor analyses were used.

Results: Prevalence of depression in women was almost twice as high as in men. Controlling for age and competing risk factors reduced the relative risk for females with more than half. Symptom‐patterns in men and women were very much alike. Sex differences in associations with risk factors were small, but exposure to these risk factors was considerably higher in females.

Conclusion: Very little evidence for a typical ‘female depression’ was found. Female preponderance in depression was related to a greater exposure to risk factors.
Quantitative EEG in ‘positive’ and ‘negative’ schizophrenia
Authors: Begić D. , Hotujac Lj. , Jokić‐Begić N.
Published: March 2003

Begić D, Hotujac Lj, Jokić‐Begić N. Quantitative EEG in ‘positive’ and ‘negative’ schizophrenia.

Acta Psychiatr Scand 2000: 101: 307–311. © Munksgaard 2000.

Objective: Quantitative EEG has yielded different results in schizo phrenia. The method of quantitative EEG has been relatively poorly used in the studies of the dichotomy into positive and negative schizophrenia.

Method: Amplitude values of any particular frequency band (after fast Fourier transformation, FFT) were observed in 47 schizophrenic patients (25 patients with positive and 22 patients with negative schizophrenia) and in 50 normal subjects. The frontal, temporal, parietal and occipital regions (F3, F4, C3, C4, T3, T4, P3, P4, 01 and 02) were observed.

Results: Positive and negative schizophrenia were found to differ only in the delta and theta bands over frontal regions. Positive and negative schizophrenic patients were found to differ from normal subjects in delta, theta, alpha and beta 2 bands.

Conclusion: Delta and theta activity may play a role as a marker in differentiating between positive and negative schizophrenia.
Heterogeneity in schizophrenia; mixture modelling of age‐at‐first‐admission, gender and diagnosis
Authors: Welham J. , Mclachlan G. , Davies G. , McGrath J.
Published: March 2003

Welham J, McLachlan G, Davies G, McGrath J. Heterogeneity in schizophrenia; mixture modelling of age‐at‐first‐admission, gender and diagnosis.

Acta Psychiatr Scand 2000: 101: 312–317. © Munksgaard 2000.

Objective: Identifying and explaining sources of heterogeneity in schizophrenia would help elucidate its aetiology and course. In this paper we examine heterogeneity in terms of age‐at‐first‐admission, diagnosis and gender by decomposing a large dataset using mixture modelling. Method: Using the Queensland Mental Health Statistics System, we first extracted age‐at‐first‐admission data for schizophrenia (ICD8/9 295) to represent a ‘narrow’ definition of schizophrenia (N=7651); we then added paraphrenia (297) and other non‐organic psychoses (298) for a ‘broad’ definition (N=10 199). Mixture models were fitted to these narrowly and broadly defined distributions for both males and females. Results: For narrowly defined schizophrenia a three‐component model best fitted both male and female distributions. While the mean ages of these components were very similar for both males and females, the ratios of males to females crossed from an excess of males in the ‘youngest’ component to an excess of females in the ‘oldest’ component. When using the broad definition, four components best fitted the underlying distributions. While the first three were similar to those found for narrowly defined schizophrenia, the additional fourth component reverted to a male excess; however, the mean age for males was 10 years younger than for females.

Conclusion: Our findings suggest that subtypes based on age‐at‐first‐admission can be identified, although the number identified depends on how inclusively schizophrenia is defined. While there appear to be the same number with similar mean ages for both genders, there are differences in the proportions of males to females. Further work to fully characterize their nature is warranted.
Development, reliability and acceptability of a new version of the DSM‐IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social funtioning
Authors: Morosini P.L. , Magliano L. , Brambilla L. , Ugolini S. , Pioli R.
Published: March 2003

Morosini P‐L, Magliano L, Brambilla L, Ugolini S, Pioli R. Development, reliability and acceptability of a new version of the DSM‐IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social funtioning.

Acta Psychiatr Scand 2000: 101:323–329. © Munksgaard 2000.

Objective: Development of a scale to assess patients' social functioning, the Personal and Social Performance scale (PSP).

Method: PSP has been developed through focus groups and reliability studies on the basis of the social functioning component of the DSM‐TV Social and Occupational Functioning Assessment Scale (SOFAS). The last reliability study was carried out by 39 workers with different professional roles on a sample of 61 psychiatric patients admitted to the rehabilitation unit. Each patient was rated independently on the scale by the two workers who knew them best.

Results: The PSP is a 100–point single‐item rating scale, subdivided into 10 equal intervals. The ratings are based mainly on the assessment of patient's functioning in four main areas: 1) socially useful activities; 2) personal and social relationships; 3) self‐care; and 4) disturbing and aggressive behaviours. Operational criteria to rate the levels of disabilities have been defined for the above‐mentioned areas. Excellent inter‐rater reliability was also obtained in less educated workers.

Conclusion: Compared to SOFAS, PSP has better face validity and psychometric properties. It was found to be an acceptable, quick and valid measure of patients' personal and social functioning.
Lithium monitoring before and after the distribution of clinical practice guidelines
Authors: Eagles John M. , McCann Ian , Neil T. , MacLeod N. , Paterson Neil
Published: March 2003

Objective: To determine whether distribution of clinical practice guidelines improves lithium monitoring and whether standards of monitoring differed between patients in psychiatric contact and those seen only in primary care.

Method: Standards of monitoring were assessed for patients on lithium in northeast Scotland throughout 1995 and/or throughout 1996. Guidelines were circulated in January 1996 to all local general practitioners and psychiatrists. Monitoring was compared between 1995 and 1996 and for patients with and without psychiatric contact.

Results: Both primary care and psychiatric records were scrutinized for 422 and 403 patients prescribed lithium throughout 1995 and 1996, respectively. While monitoring was poor on several parameters during both years, frequency of measurement of both thyroid and renal function improved in 1996. Standards of monitoring were better for patients in psychiatric care.

Conclusion: Standards of lithium monitoring require further improvement. Locally agreed practice guidelines are helpful but patients on lithium should be in continuing contact with an experienced psychiatrist.
Therapeutic drug monitoring of selective serotonin reuptake inhibitors influences clinical dosing strategies and reduces drug costs in depressed elderly patients
Authors: Lundmark J. , Bengtsson F. , Nordin C. , Reis M. , Wålinder J.
Published: March 2003

Objective: This study was initiated in order to describe and evaluate the effects of a therapeutic drug monitoring (TDM) routine of selective serotonin reuptake inhibitors (SSRIs) on treatment strategies and drug costs in depressed elderly patients.

Method: Blood samples were drawn from elderly depressed patients and analysed for steady‐state trough serum concentrations of citalopram (n=48), paroxetine (n=48) or sertraline (n=39). A global efficacy evaluation was made at baseline and after 6–9 months. Antidepressant drug costs before and after TDM were estimated.

Results: Eight samples were excluded due to technical problems or non‐compliance. In 65 of the 127 (51.2%) remaining cases, the treatment strategy was changed according to the TDM outcome, in most a reduction of the prescribed dose. Bioanalytical TDM costs included the antidepressant drug costs after TDM were reduced by 10.2%.

Conclusion: The results support the utility of TDM in the search for the individual minimum effective SSRI dose in the elderly.
Quantitative and qualitative aspects of obsessive‐compulsive behaviour in children with attention‐deficit hyperactivity disorder compared with tic disorder
Authors: Moll G.H. , Eysenbach K. , Woerner W. , Banaschewski T. , Schmidt M.H. , Rothenberger A.
Published: March 2003

Objective: Within the framework of associated psychopathology in child psychiatric disorders, this study focused on quantitative and qualitative aspects of obsessive‐compulsive behaviour (OCB) in both attention‐deficit hyperactivity disorder (ADHD) and chronic tic disorder/Tourette's disorder (TD).

Method: Forty‐two healthy controls, 41 children with ADHD and 38 children with TD, aged 9–13 years, were investigated using the Leyton Obsessional Inventory — Child Version (LOI‐CV), the Child Behaviour Checklist (CBCL) and an expert‐rated structured parent interview to reflect a cross‐informant view of OCB.

Results: Unexpectedly, self‐reports of children with ADHD rather than children with TD showed the highest OCB scores in the LOI‐CV. Qualitatively, ADHD‐related OCB focused on the item subsets concerning ‘dirt and contamination’, ‘repetition’, ‘overconscientiousness’, and ‘hoarding’. In the parent‐rated CBCL, similar levels of OCB were reported for ADHD and TD patients. In contrast, only children with TD showed clinically relevant OCB according to expert ratings.

Conclusion: Not only young TD patients but also children with ADHD should be investigated and monitored carefully for quantitative and qualitative aspects of OCB comorbidity.
Atypical antipsychotics and weightgain — a systematic review
Authors: Taylor D. M. , McAskill R.
Published: March 2003

Objective: To review systematically data relating to weight changes with atypical antipsychotics.

Method: We conducted a Medline search on October 29 1999 and covered the period 1980–99. All recovered papers were examined for further relevant reports. In addition, we wrote to pharmaceutical manufacturers and 10 practising clinicians to ask them to provide other relevant reports known to them.

Results: Eighty reports mentioning change in body weight were retrieved. Data relating to weight changes were of variable quality. Weight changes were indicated by a variety of measures. The majority of reports related to short‐term changes.

Conclusion: All atypical drugs, with the exception of ziprasidone, have been associated with weight increases. Clozapine seems to have the highest risk of weight gain, followed by olanzapine and quetiapine. There is probably a lower risk with risperidone, sertindole and zotepine and a still lower risk with amisulpride. Ziprasidone appears not to be associated with weight gain. In the absence of more compelling data, these rankings must be considered approximate and preliminary. Longer, more robust trials are needed.
Finnish adoptive family study: sample selection and adoptee DSM‐III‐R diagnoses
Authors: Tienari P. , Wynne L. C. , Moring J. , Läksy K. , Nieminen P. , Sorri A. , Lahti L. , Wahlberg K‐E. , Naarala M. , Kurki‐Suonio K. , Saarento O. , Koistinen P. , Tarvainen T. , Hakko H. , Miettunen J.
Published: March 2003

Objective: To evaluate the genetic contribution to schizophrenia using an adoption design that disentangles genetic and environmental factors.

Method: Finnish hospital diagnoses of schizophrenic/paranoid psychosis in a nationwide sample of adopting‐away women are compared with DSM‐III‐R research diagnoses for these mothers. DSM‐III‐R diagnoses of their index offspring are blindly compared with adopted‐away offspring of epidemiologically unscreened control mothers.

Results: Primary sampling diagnoses of index mothers were confirmed using DSM‐III‐R criteria. Lifetime prevalence of typical schizophrenia in 164 index adoptees was 6.7% (age‐corrected morbid risk 8.1%), significantly different from 2.0% prevalence (2.3% age‐corrected morbid risk) in 197 control adoptees. When adoptees with diagnoses of schizoaffective disorder, schizophreniform disorder, schizotypal disorder and affective psychoses were added, the contrast between the index and control adoptees increased.

Conclusion: The genetic liability to ‘typical’ DSM‐III‐R schizophrenia is decisively confirmed. Additionally, the liability also extends to a broad spectrum of other psychotic and non‐psychotic disorders.
Prevalence estimates of pathological gambling in Switzerland
Authors: Bondolfi G. , Osiek C. , Ferrero F.
Published: March 2003

Objective: The purpose of this study was to evaluate the prevalence of pathological gambling in the Swiss adult population before the introduction of new forms of gambling, and the link between pathological gambling and alcohol abuse.

Method: 2526 telephone interviews were completed using standardized assessment instruments for identifying potential and probable pathological gamblers (SOGS) and alcohol abuse (CAGE).

Results: The current prevalence of probable and potential pathological gamblers were estimated to be 0.8% and 2.2%, respectively. The results also show a clear correlation between alcohol abuse and gambling behaviours.

Conclusion: For the first time estimations are available of the Swiss prevalence rates of pathological gambling. Considering the link between gambling availability and increases in the prevalence of pathological gambling and the correlation between alcohol abuse and pathological gambling, the implications of these results for the prevention and treatment of this debilitating disorder are discussed.
Visual perseveration: a new side effect of maprotiline
Authors: Hori H. , Terao T. , Nakamura J.
Published: March 2003

Objective: The aim of this paper is to describe a case of visual perseveration including palinopsia during maprotiline therapy.

Method: A single case report.

Results: The patient, a 56‐year‐old depressive man, suffered from visual perseveration during maprotiline therapy. The visual perseveration was dose‐related and disappeared with reduction and cessation of the therapy.

Conclusion: The present findings suggest that maprotiline can induce visual perseveration including palinopsia in some patients.
The classification of first episode schizophrenia: a cluster‐analytical approach
Authors: Lastra I. , Vázquez‐Barquero J. L. , Herrera Castanedo S. , Cuesta M. J. , Vázquez‐Bourgon M. E. , Dunn G.
Published: March 2003

Objective: This paper examines, using data from the Cantabria First Episode Schizophrenia Study, the usefulness of subdividing, using a cluster analysis technique, this schizophrenia population into subgroups with similar symptoms profiles in terms of SANS and SAPS.

Method: Diagnostic characteristics were determined using the Present State Examination (PSE‐9) and the SANS/SAPS. Premorbid adjustment was assessed using a scale developed combining the Gittelman and Klein's Scales, and the Goldstein's scales. Social Adjustment was evaluated using the WHO‐DAS. In addition clinical histories were used to assess the patients' clinical course.

Results: Our schizophrenic patients could be subtyped into four categories: negative, positive non‐paranoid, simple and disorganized schizophrenia. There is an absence of significant association between the majority of the variables investigated and the four‐cluster model.

Conclusion: Even though our sample could be subtyped into different categories, the model does not show predictive power according to the 3‐year follow‐up data.
The prevalence of personality disorder among UK primary care attenders
Authors: Moran P. , Jenkins R. , Tylee A. , Blizard R. , Mann A.
Published: March 2003

Objective: To determine the prevalence rate of personality disorder among a consecutive sample of UK primary care attenders. Associations between a diagnosis of personality disorder, sociodemographic background and common mental disorder were examined.

Method: Three hundred and three consecutive primary care attenders were examined for the presence of ICD‐10 and DSM‐4 personality disorders using an informant‐based interview.

Results: Personality disorder was diagnosed in 24% (95% CI: 19–29) of the sample. Personality‐disordered subjects were more likely to have psychiatric morbidity as indicated by GHQ‐12, to report previous psychological morbidity, to be single and to attend the surgery on an emergency basis. ‘Cluster B’ personality disorders were particularly associated with psychiatric morbidity.

Conclusion: There is a high prevalence rate of personality disorders among primary care attenders. These disorders are associated with the presence of common mental disorder and unplanned surgery attendance. Personality disorders may represent a significant source of burden in primary care.
Unmet needs in the community:can existing services meet them?
Authors: Lefebvre Johane , Cyr Mireille , Lesage Alain , Fournier Louise , Toupin Jean
Published: March 2003

Objective: This prospective study of community cases examined: (a) needs for care; (b) whether services meet the needs; and (c) personal factors associated with unmet needs.

Method: Two separate ‘Needs for Care Assessment Schedule – Community version’ evaluations identified 38 subjects with No Need (NN), 19 with Met Needs (MN) and 25 with Unmet Needs (UNM). Other instruments included the Diagnostic Interview Schedule – Abridged Version (DISSA) and repeated measures of symptoms and social functioning.

Results: (a) Cases did not equate needs. (b) Services utilization did not equate having met needs. (c) Respondents with UNM were more likely to present high rates of lifetime DSM‐III‐R disorders, no marital relationship ever, no employment, high rates of life events, and physical or sexual abuse in childhood. They have worse outcome in terms of distress and social functioning.

Conclusion: Personnal factors may prevent respondents from seeking, engaging and benefiting from treatment.
Are commonly used self‐report inventories suitable for screening postpartum depression and anxiety disorders?
Authors: Muzik M. , Klier C. M. , Rosenblum K. L. , Holzinger A. , Umek W. , Katschnig H.
Published: March 2003

Objective: The utility of several self‐report symptom inventories were examined for detecting postpartum depression (MDD) and anxiety disorders (AD).

Method: Fifty women (3 or 6 months postpartum), at heightened risk for MDD, completed several depression and anxiety symptom checklists. Psychiatric diagnoses were obtained via SCID interview.

Results: Rates of MDD (n=9) and AD (n=9) were equivalent in this sample, with minimal diagnostic overlap. While all the self‐report depression inventories screened accurately for MDD, none discriminated AD sensitively and reliably.

Conclusion: The frequent occurrence of AD emphasizes the need to identify appropriate screening instruments for postpartum anxiety disorders.