bluuebunny/crossref_metadata_2025 huggingface dataset:
Testing the stress‐vulnerability hypothesis in ICD‐10‐diagnosed acute and transient psychotic disorders
Authors: Das S. K. , Malhotra S. , Basu D. , Malhotra R.
Published: March 2003

Objective:
 To examine if family‐history‐positive (FHP) vis‐à‐vis family‐history‐negative (FHN) probands with ICD‐10‐diagnosed acute and transient psychotic disorders (ATPD) differ significantly with respect to number of life events and cumulative stress score prior to the onset of ATPD.

Method:
 Forty probands with ICD‐10‐based clinical diagnosis of acute and transient psychotic disorders were studied with respect to: (a) history of psychiatric disorders in first‐degree relatives, and (b) antecedent life events and cumulative stress. The FHP and FHN probands were compared on the latter variables using Mann–Whitney U‐test.

Results:
 FHP probands reported significantly less number of total life events compared to FHN probands (P=0.006). Similarly, FHP probands had significantly less stress score than FHN probands (P=0.002). There were no significant demographic or clinical differences between the two groups.

Conclusion:  The findings support the stress‐vulnerability hypothesis in the aetiology of ATPD.
A prospective study of 86 new patients with social anxiety disorder
Authors: Allgulander Christer , Nilsson Bo
Published: March 2003

Objective: To determine the prognosis in 86 new patients with social anxiety disorder.

Method: Untreated subjects with social anxiety were recruited by advertising in Stockholm, randomized to 3 months treatment with paroxetine or placebo, and then offered continued specialist care. Metabolizing capacity was determined by genotyping CYP2D6 in the subjects on paroxetine. After a mean 32 months all were contacted for a personal interview.

Results: Of the 92 evaluable subjects, 86 (93%) were interviewed. A favourable prognosis was seen in the subjects randomized to paroxetine who chose to continue with serotonergic medication. The least favourable prognosis was in those given placebo who chose not to be treated after the trial. Twenty‐four subjects were still symptomatic and dysfunctional and had not sought treatment. Drug‐induced adverse effects caused treatment termination in six subjects, one of whom had a poor metabolizing genotype.

Conclusion: Due to their condition, some subjects with social anxiety refrain from effective treatments. The efficacy of serotonergic medication was maintained and augmented after a mean period of 32 months.
MACS‐II: does coping enhance subjective control over psychotic symptoms?
Authors: Bak Maarten , Van Der Spil Farida , Gunther Nicole , Radstake Steven , Delespaul Philippe , Van Os Jim
Published: March 2003

Objective: Associations between subjective experience of control and the use of self‐initiated coping strategies were examined in patients with psychotic symptoms.

Method: Twenty‐three patients were interviewed to assess (i) the subjective experience of distress with and control over symptoms and (ii) the coping strategies used.

Results: There was a positive association between coping type and control (OR=1.07, 95% CI: 1.03–1.12). Active coping strategies had the strongest association with experience of control (active problem‐solving: OR=1.41 95% CI: 1.18–1.68; active problem‐avoiding: OR=1.45 95% CI: 1.18–1.68). Symptomatic coping was negatively associated with control (OR=0.40, 95% CI: 0.30–0.55), but was the most frequently used strategy. Depressive symptoms were associated with the highest number of coping strategies.

Conclusion: Coping strategies differ in the degree and direction of associated subjective control, and symptoms differ in the degree with which coping is mobilized. Assessment of coping strategies may be useful as a prelude to psychological therapy.
Lithium and suicidal behavior in major affective disorder: a case–control study
Authors: Coryell William , Arndt Stephan , Turvey Carolyn , Endicott Jean , Solomon David , Mueller Tim , Leon Andrew C. , Keller Martin
Published: March 2003

Objective: A number of studies have suggested that lithium may be particularly effective in reducing suicide risks among patients with major affective disorders. The design of many of these studies left them open to biases associated with treatment compliance, however.

Method: Subjects were drawn from a naturalistic, long‐term follow‐up of patients with major affective disorders. Fifteen who committed suicide while receiving somatotherapy where matched to non‐suicidal patients who were similarly receiving somatotherapy at the same point in follow‐up. The same procedure was followed for 41 patients who made a serious suicide attempt during follow‐up.

Results: Six (40.0%) of the patients who committed suicide, and eight (53.3%) of their controls, were thought to have been taking lithium in the preceding week. Among attempters and their controls, nine (22.0%) and eight (19.5%), respectively, were taking lithium.

Conclusion: These results do not support previous suggestions that lithium has uniquely antisuicidal properties. Other existing datasets should be explored with this design to establish whether lithium does, or does not, offer special protection against suicide.
Association of personal and familial suicide risk with low serum cholesterol concentration in male lithium patients
Authors: Bocchetta Alberto , Chillotti Caterina , Carboni Gianfranco , Oi Antonio , Ponti Marco , Del Zompo Maria
Published: March 2003

Objective:  We sought to establish whether low cholesterol concentration may be associated with a personal history of attempted suicide or a family history of completed suicide in psychiatric out‐patients on maintenance lithium treatment, who represent a population at risk for suicide.

Method:  We retrospectively reviewed charts regarding 783 out‐patients consecutively admitted to a lithium clinic from 1976 to 1999. Individual age‐ and gender‐specific quartile of serum cholesterol concentration were correlated against personal lifetime suicide attempts and completed suicide in first‐degree relatives.

Results:  The proportion of men with a personal lifetime history of attempted suicide, especially if violent, and that of men with history of completed suicide in a first‐degree relative were significantly higher among the group with cholesterol concentration in the lowest quartile compared to the group with cholesterol levels above the 25th percentile.

Conclusion:  Low cholesterol concentration should be studied further as a potential biological/genetic marker of suicide risk.
The validity of proxy‐based data in suicide research: a study of patients 50 years of age and older who attempted suicide. I. Psychiatric diagnoses
Authors: Conner Kenneth R. , Duberstein Paul R. , Conwell Yeates
Published: March 2003

Objective: To investigate the validity of best‐estimate methodology for making psychiatric diagnoses among individuals who attempted suicide.

Method: Subjects were 80 patients admitted for treatment following a suicide attempt. Psychiatric diagnoses based on structured interviews with subjects were compared with diagnoses made based on interviews with proxy respondents. In both cases, interview information was supplemented with pre‐admission psychiatric and medical records to inform diagnoses.

Results: Diagnostic agreement, based on kappa coefficients, was substantial for major depression and bipolar disorders, and moderate for non‐affective psychoses, organic mood and anxiety disorders. Agreement was substantial for substance dependence but poor for substance abuse disorders.

Conclusion: Results support best‐estimate methodology for making mood and substance dependence diagnoses in research of suicidal behavior in this age group, with potential implications for interpreting postmortem research of completed suicide.
Increasing rates of suicide in Western Australian psychiatric patients: a record linkage study
Authors: Lawrence David , D'Arcy C. , Holman J. , Jablensky Assen V. , Fuller Stuart A. , Stoney Alexia J.
Published: March 2003

Objective: To investigate the risk of suicide following contact with mental health services and whether it has changed over time.

Method: Record linkage was used to obtain the records of previous hospital admissions and mental health service contacts for deaths due to suicide in the period 1980–98. Standardized incidence rates were calculated for the general population and for users of mental health services. Proportional hazards regression was used to assess risk factors within the cohort of people with mental health service contact.

Results: Suicide risk was significantly increased in users of mental health services (rate ratio 6.66 in males and 7.52 in females). Suicide risk was highest in the first 7 days after discharge from in‐patient care, and decreased exponentially with time since discharge. Suicide risk in users of mental health services has increased over the study period.

Conclusion: These results highlight the importance of adequate follow‐up of patients discharged from in‐patient services, and the need for adequate resources for community‐based services.
Mental abilities of male relatives of psychotic patients
Authors: Karlsson Jon L.
Published: March 2003

Objective: Exploration of academic and creative potentials of first‐degree relatives of hospital‐treated psychotic patients in Iceland.

Method: Relatives identified in a previously published family study of psychosis are evaluated, using records available at the National Archives and National Library in Reykjavik. Performance of groups of relatives is compared to that of the general population.

Results: Healthy relatives of patients are found to excel over others in authorship of books of fiction or poetry, in general school performance at age 20 years and in mathematics. These findings apply to both schizophrenia and affective illness.

Conclusion: Relatives of psychotic patients often exhibit good mental abilities
What to do about mental disorder — help‐seeking recommendations of the lay public
Authors: Angermeyer M.C. , Matschinger H. , Riedel‐Heller S.G.
Published: March 2003

Objective: Sociocultural factors have been recognized as an important predictor in shaping help‐seeking behaviour.

Method: We investigated attitudes of the lay public toward help‐seeking for mental disorders in a population survey (n=1564) conducted in the new Laender of Germany. After presenting a vignette depicting a person either with major depression or with schizophrenia (DSM‐III‐R), we inquired about help‐seeking recommendations. employing a qualitative approach.

Results: The lay support system plays an significant role in initially dealing with mental disorders. However, help‐seeking recommendation differed for depression and schizophrenia. In depression, support from the lay system was more often considered. In schizophrenia, public opinion favoured the expert system. If primary suggestions fail the expert system is clearly favoured regardless of the disorder in question.

Conclusion: Lay public's opinion has to be taken into account of in mental health care planning to make services more acceptable to the consumer and their social network.
Depression in stroke patients 7 years following stroke
Authors: Dam Henrik
Published: March 2003

Objective: To study the frequency of depression in stroke patients many years following stroke, most previous studies having concentrated on the first few years.

Method: Participants of a previous study of post‐stroke depression (99 stroke patients and 28 control subjects) were re‐examined 7 years later. Depression was diagnosed using research diagnostic criteria. The test battery comprised the Mini Mental State Examination, the Raven Matrices A+B and Word Pair Learning. Subjective experience of changes in memory, concentration, mood, irritability and fatigue during the 7‐year period was also examined.

Results: Twenty per cent of the stroke patients fulfilled the criteria for major or minor depression compared with 11% of the control subjects. No differences in cognitive function were found between depressed and non‐depressed stroke patients. The stroke patients reported experiencing more lability of mood and irritability during the 7‐year period following stroke than the control subjects. Depressed stroke patients experienced more impairment of concentration and memory function than non‐depressed stroke patients.

Conclusion: Affective symptoms are common among stroke patients 7 years following stroke.
Mental disorders among elderly people in primary care: the Linköping study
Authors: Ólafsdóttir María , Marcusson Jan , Skoog Ingmar
Published: March 2003

Objective: The aims of this study were to describe the prevalence of mental disorders among elderly patients in primary care and to compare diagnoses from psychiatric interview with diagnoses in medical records.

Method: Patients aged 70 years and above attending a primary care centre (N=350) were studied using a psychiatric and medical record examination.

Results: The prevalence of mental disorder according to the psychiatric interview was 33% (16% dementia, 17% other mental disorders). Only 49% of these had any psychiatric diagnosis in case records and 17–38% received specific treatments. The frequency of psychiatric symptoms among those with no mental disorder was between 1% and 66%. Patients with mental disorders were more often females, had more visits to a doctor, more diagnoses in medical records, and were prescribed more drugs.

Conclusion: Mental disorders and symptoms are common among the elderly in primary care. More effort should be made to increase the recognition rate.
European perspectives: a carer’s view
Authors: Brand Ursula
Published: March 2003

Objective: To present the work of the European Federation of Associations of Families of Mentally Ill People (EUFAMI) and discuss issues of concern to family carers.

Method: The problem areas identified and discussed by family carers are presented on the basis of questionnaire surveys organized by EUFAMI. Addresses of national organisations of family carers are included.

Results: A range of problem areas are identified; they include subsistence and welfare payments for the severely mentally ill, some shortage of general hospital units, problems of care co‐ordination, issues of respect for family carers and family involvement.

Conclusion: The aim of best practice in mental health care throughout Europe has not yet been reached. Key activities of EUFAMI are aimed at empowerment of families and best practice in psychiatry in Europe.
About the impossibility of a single (ex‐)user and survivor of psychiatry position
Authors: Hölling Iris
Published: March 2003

Objective: To present the European Network of (ex‐)users and survivors of psychiatry and discuss issues of concern among (ex‐)users and survivors.

Method: Material from papers and documents published by and discussed among (ex‐)users and survivors of psychiatry is used to outline topics of interest.

Results: The European Network of (ex‐)Users and Survivors of Psychiatry (ENUSP) was founded in 1991 as an association of national/regional organizations of (ex‐)users and survivors of psychiatry. The network organizes biennial conferences, all delegates are (ex‐)users and survivors of psychiatry. ENUSP aims include the fight against discrimination of people with experience of the psychiatric system, support for (ex‐)user/survivor organizations, influence on policy‐making, legislation and human rights debates, demedicalizing psychiatry, and opposition to unidimensional approaches to mental and emotional distress.

Conclusion: (Ex‐)users and survivors should be involved in monitoring psychiatric services, education and examination of mental health professionals. User/survivor‐controlled services constitute an important innovative service.
Reaction‐times and bioelectrical brain signals of drug‐naive schizophrenic first‐onset patients in identification and classification tasks
Authors: Krieger S. , Lis S. , Gallhofer B.
Published: March 2003

Objective:The question of the present study is whether disturbances of response‐selection in schizophrenic patients are discernible only if overt motor‐actions are required, or also if covert cognitive actions are necessary.

Method:Visual identification (digits) and classification (dot‐enumeration) tasks were presented to 18 drug‐naive, first‐onset schizophrenic patients and healthy controls. It is assumed that enumeration of more than three dots requires additional cognitive processes as buffering and re‐focusing of attention. Reaction‐times and 21‐channel‐EEG were measured. For eye‐movement artefact‐elimination a new non‐parametric regression approach was applied.

Results:Reaction‐times revealed that in the patient group response selection is lengthened in both tasks. Perception of dot numbers is not affected. Bioelectrical data depicted a left‐lateralization of posterior P100 and N100 in the patient group as well as an enhanced fronto‐central P200.

Conclusion:Whereas in reaction‐times of patients only a disturbance of response selection is discernible, bioelectrical measurements also point to an altered organization of perceptive processes.
Longitudinal course of salivary cortisol in post‐traumatic stress disorder
Authors: Kellner Michael , Yehuda Rachel , Arlt Josef , Wiedemann Klaus
Published: March 2003

Objective: In chronic post‐traumatic stress disorder (PTSD) lowered cortisol secretion and hypersuppression to dexamethasone has been described repeatedly. However, so far no longitudinal data on the natural course or on the effect of therapy are available.

Method: We measured basal and post‐dexamethasone morning salivary cortisol in a drug‐free patient with chronic PTSD (DSM‐IV) monthly for nearly 2 years and assessed PTSD and depressive symptoms.

Results: Salivary cortisol decreased dramatically 3 months after the traumatic event and in the further course showed an inverse relation to fluctuating but gradually improving PTSD symptoms. Post‐dexamethasone cortisol was suppressed below the detection limit early after trauma and rose again more than 1 year post‐trauma.

Conclusion: Both the potential renormalization of low cortisol levels in improving chronic PTSD and the putative vulnerability to develop PTSD in subjects with increased dexamethasone suppression need further research.
Acute polymorphic psychotic disorder: diagnostic stability over 3 years
Authors: Sajith S. G. , Chandrasekaran R. , Sadanandan Unni K. E. , Sahai A.
Published: March 2003

Objective: Acute polymorphic psychotic disorder without symptoms of schizophrenia (APPD) in ICD‐10 is unique in many characteristics. This study aimed at investigating the diagnostic stability of APPD over 3 years.

Method: Forty‐five patients with first episode APPD were followed up and assessed at regular intervals over a period of 3 years.

Results: Thirty‐two patients were females. Average age of the sample was 26.9 years. Thirty‐three cases retained their index diagnosis of APPD, while 12 cases required diagnostic revision: 10 to bipolar affective disorder and the rest to unspecified non‐organic psychosis. Shorter duration of illness (<1 month) and abrupt onset (<48 h) predicted a stable diagnosis of APPD.

Conclusion: APPD is a relatively stable diagnosis and argues for a distinct diagnostic entity.
Previous mood state predicts response and switch rates in patients with bipolar depression
Authors: MacQueen Glenda M. , Trevor Young L. , Marriott Michael , Robb Janine , Begin Helen , Joffe Russell T.
Published: March 2003

Objective: The treatment of bipolar depression is a significant clinical problem that remains understudied. The role for antidepressant (AD) agents vs. mood stabilizers has been particularly problematic to ascertain.

Method: Detailed life charting data from 42 patients with 67 depressive episodes were reviewed. Response rates and rates of switch into mania were compared based on the preceding mood state and on whether an AD or mood stabilizing (MS) agent was added following onset of depression.

Results: Patients who became depressed following a period of euthymia were more likely to respond to treatment (62.5%) than patients who became depressed following a period of mania or hypomania (27.9%). The ratio of response to switch for previously euthymic patients was particularly favorable.

Conclusion: Mood state prior to onset of depression in bipolar disorder appears to be an important clinical variable that may guide both choice of treatment administered and expectation of outcome to treatment.
Use of illicit substances in a psychosis incidence cohort: a comparison among different ethnic groups in the Netherlands
Authors: Veen N. , Selten J.‐P. , Hoek H. W. , Feller W. , Van Der Graaf Y. , Kahn R.
Published: March 2003

Objective: Use of illicit substances has been suggested as an explanation for the increased incidence of psychosis among some immigrant groups. The aim of the present study is to compare the rates of illicit substance use among immigrants with a first psychosis with that among non‐migrants.

Method: A population‐based, first‐contact incidence study in the Netherlands. Patients and key informants were interviewed about drug use in the preceding year.

Results: One hundred and eighty‐one subjects were examined. Proportions of patients who misused any illicit substance were 23% for Dutch, 17% for Moroccans, 27% for Surinamese, 30% for Turkish subjects, and 33% for other immigrants. Logistic regression analysis, controlling for age and sex, showed that ethnicity did not significantly contribute to the prediction of substance misuse.

Conclusion: A higher rate of drug misuse is an unlikely explanation for the increased incidence of psychotic disorders among Moroccan and Surinamese immigrants to the Netherlands.
Determinants of subjective quality of life in patients attending community‐based mental health services. The South‐Verona Outcome Project 5
Authors: Ruggeri M. , Gater R. , Bisoffi G. , Barbui C. , Tansella M.
Published: March 2003

Objective: Investigate the relationship of various domains of quality of life (QoL) with socio‐demographics, clinical and social characteristics, service use and satisfaction in a representative sample of patients in contact with the South‐Verona community mental health service.

Method: Measures included: Lancashire Quality of Life Profile (LQOLP), demographics, diagnosis and service utilization data from the Case Register, Brief Psychiatric Rating Scale (BPRS), Disability Assessment Schedule (DAS), Global Assessment of Functioning (GAF) and Verona Service Satisfaction Scale (VSSS). Analyses were conducted using a block‐stratified multiple regression model.

Results: Demographics, diagnosis, psychopathology, disability, functioning and service use together explained different amounts of variance in each LQOLP domain, but always less than 14%. VSSS explained more variance than any other indicator in health (13.1%), social relations (12.1%), leisure/participation (9.1%), and general wellbeing (9.0%).

Conclusion: Different domains of QoL are predicted by different indicators. In some important domains, self‐perceived satisfactory and effective care might have an impact on the QoL of patients.
Antipsychotic combination therapy in schizophrenia. A review of efficacy and risks of current combinations
Authors: Freudenreich O. , Goff D. C.
Published: March 2003

Objective:  To review the literature on efficacy and risks of combining antipsychotics (atypical with atypical or conventional) and suggest a rationale and strategies for future clinical trials.

Method:  A computerized Medline search supplemented by an examination of cross‐references and reviews was performed.

Results:  Empirical evidence for the efficacy of combining antipsychotics is too limited to draw firm conclusions. The practice of augmenting clozapine with more ‘tightly bound’ D2 receptor antagonists as exemplified by risperidone augmentation of clozapine has some empirical and theoretical support. The risks of augmentation strategies have not been studied systematically. No study has examined the economic impact of combination treatment.

Conclusion:  Further trials of antipsychotic combination therapies are needed before this currently unsupported practice can be recommended. Rationales for combination treatment include a broadening of the range of receptor activity or an increase in D2 receptor occupancy with certain atypical agents. Trial methodology needs to take into account subject characteristics, duration of treatment, optimization of monotherapy comparators, and appropriate outcome measures.
The effects of acute exercise and high lactate levels on 35% CO2 challenge in healthy volunteers
Authors: Esquivel G. , Schruers K. , Kuipers H. , Griez E.
Published: March 2003

Objective:  To test the possible antipanic effects of acute exercise in healthy volunteers exposed to an inhalation of 35% CO2 challenge.

Method:  Twenty healthy subjects in a randomized separate group design, performed exercise in a bicycle ergometer reaching >6 mm of blood lactate and a control condition of minimal activity in the same fashion with no lactate elevation. Immediately afterwards an inhalation of a vital capacity using a mixture of 35% CO2/65% O2 through a mask was given on both conditions.

Results:  Subjects under the exercise condition reported less panic symptoms than controls after a CO2 challenge on the diagnostic statistical manual‐IV (DSM‐IV) Panic Symptom List but no difference on the Visual Analogue Anxiety Scale.

Conclusion:  Subjects under the exertion condition had lactate levels comparable with those of lactate infusions but an inhibitory rather than accumulative effect was seen when combined with a CO2 challenge.
Magnetic motor threshold and response to TMS in major depressive disorder
Authors: Dolberg O. T. , Dannon P. N. , Schreiber S. , Grunhaus L.
Published: March 2003

Dolberg OT, Dannon PN, Schreiber S, Grunhaus L. Magnetic motor threshold and response to TMS in major depressive disorder. Acta Psychiatr Scand 2002: 106: 220–223. © Blackwell Munksgaard 2002.

Objective: The aim of this study was to examine motor threshold (MT) during treatment with transcranial magnetic stimulation (TMS).

Method: The TMS was administered to 46 patients with depression and 13 controls. TMS was performed at 90% power of measured MT. The stimulation frequency was 10 Hz for 6 s, for 20 trains, with 30 s inter‐train intervals. The trial included 20 sessions. Patients and controls were assessed on various outcome measures.

Results: The MT values were comparable between patients and controls. Neither demographic nor clinical variables were factors in determining MT. MT was not shown to have any predictive value regarding outcome of treatment.

Conclusion: In this study, MT at baseline or changes in MT during the treatment period were not able to discriminate between patients and controls and were not found to have any predictive value with regard to treatment outcome.
Nidotherapy: a new approach to the treatment of personality disorder
Authors: Tyrer Peter
Published: March 2003

Objective: To develop a treatment, nidotherapy, or nest therapy, so named because it aims to alter the sufferer's personal environment rather than symptoms or behaviour, in the management of personality disorders.

Method: Case studies, in which analysis of the environmental circumstances associated with the problems of personality disorder is followed by planned adjustment to that environment so that it makes a more appropriate fit for the personality.

Results: Sustained improvement was found in two individuals with personality disorder after nidotherapy. Those with persistent and predictable personality attributes are easier in principle to treat than those with episodic or variable problems.

Conclusion: Nidotherapy deserves further consideration in the management of personality disorders.
The Bech–Rafaelsen Melancholia Scale (MES) in clinical trials of therapies in depressive disorders: a 20‐year review of its use as outcome measure
Authors: Bech P.
Published: March 2003

Bech P. The Bech–Rafaelsen Melancholia Scale (MES) in clinical trials of therapies in depressive disorders A 20‐year review of its use as outcome measure. Acta Psychiatr Scand 2002: 106: 252–264. © Blackwell Munksgaard 2002.

Objective: To evaluate the psychometric properties of the Bech–Rafaelsen Melancholia Scale (MES) by reviewing clinical trials in which it has been used as outcome measure.

Method: The psychometric analysis included internal validity (total scores being a sufficient statistic), interobserver reliability, and external validity (responsiveness in short‐term trials and relapse prevention in long‐term trials).

Results: The results showed that the MES is a unidimensional scale, indicating that the total score is a sufficient statistic. The interobserver reliability of the MES has been found adequate both in unipolar and bipolar depression. External validity including both relapse, response and recurrence indicated that the MES has a high responsiveness and sensitivity.

Conclusion: The MES has been found a valid and reliable scale for the measurement of changes in depressive states during short‐term as well as long‐term treatment.
Inadequate treatment of depression after myocardial infarction
Authors: Luutonen S. , Holm H. , Salminen J. K. , Risla A. , Salokangas R. K. R.
Published: March 2003

Objective: The objective of the study was to investigate the prevalence of depressive symptoms and the self‐reported psychiatric treatment after myocardial infarction.

Method: Depressive symptoms and medication were studied in 85 consecutive acute myocardial infarction patients during 18 months follow‐up. Depressive symptoms were assessed using the Beck Depression Inventory (BDI).

Results: The proportion of patients with depressive symptoms (BDI  10) was 21.2% while in hospital, 30.0% at 6 months and 33.9% at 18 months. At 18 months, none of the patients were receiving adequate antidepressive medication. There were eight patients with BDI scores corresponding to moderate/severe depression (BDI  19). Six of these patients were receiving benzodiazepine medication and two of them had been treated in the mental health care system after the myocardial infarction.

Conclusion: There seems to be considerable problems in the diagnosis and/or treatment of depression after myocardial infarction.
A 3‐year follow‐up study of psychosocial functioning and general symptoms in settled refugees
Authors: Lie B.
Published: March 2003

Objective: Few community studies have addressed the longitudinal course of post‐traumatic stress disorder (PTSD) in traumatized refugees in early resettlement. This longitudinal study investigated changes from the first (T1) to the second interview (T2), 3 years later. The relationship between traumatic exposures and psychosocial factors/psychological symptom load were examined.

Method: Local health professionals performed the interviews, using rating scales and a structured questionnaire. A total of 240 (52%) refugees attended.

Results: Unchanged Hopkins Symptom Checklist‐25 and increase in Harvard Trauma Questionnaire and post‐traumatic stress symptoms‐16 between T1 and T2 were found, indicating the severity and chronicity of problems. Mean post‐traumatic stress score was 15% above cut‐off. Severe life‐threatening trauma and present life in exile with unemployment and unresolved family reunion were risk factors.

Conclusion: Early diagnostic interview should be followed by targeted approach. Pinpointing those in need of specialist services is essential. An interdisciplinary approach is necessary in this work.
2‐COM: an instrument to facilitate patient–professional communication in routine clinical practice
Authors: Van Os J. , Altamura A. C. , Bobes J. , Owens D. C. , Gerlach J. , Hellewell J. S. E. , Kasper S. , Naber D. , Tarrier N. , Robert P.
Published: March 2003

Objective:  A simple patient‐completed self‐report instrument may facilitate patient–professional carer communication.

Method:  A 19‐item self‐report needs schedule was used in a sample of 243 out‐patients with non‐affective psychosis. Patients and professional carers commented on the usefulness of the instrument. In a subgroup of 95 patient–carer dyads, the professional carer was asked to rate the needs in addition to the patient.

Results:  Patients scored their needs reliably and lower than the professionals (OR = 0.9, 95% CI: 0.9, 0.97). Concordance between patients and professional carers on individual needs was very low. More than 50% of the professional carers and more than 80% of the patients found 2‐COM useful. The higher the number of needs indicated by the patient, the greater the discrepancy between patients and professional carers with regard to the usefulness of the schedule.

Conclusion:  2‐COM is a useful instrument to expose, and subsequently bridge, patient–professional carer discordance on patient needs.
Negative symptoms in first episode non‐affective psychosis
Authors: Malla Ashok K. , Takhar Jatinder J. , Norman Ross M. G. , Manchanda Rahul , Cortese Leonard , Haricharan Raj , Verdi Mary , Ahmed Rashid
Published: March 2003

Objective: To determine the prevalence of negative symptoms and to examine secondary sources of influence on negative symptoms and the role of specific negative symptoms in delay associated with seeking treatment in first episode non‐affective psychosis.

Method: One hundred and ten patients who met Diagnostic Statistical Manual‐IV (DSM‐IV) criteria for a first episode of schizophrenia spectrum psychoses were rated for assessment of negative, positive, depressive and extrapyramidal symptoms, the premorbid adjustment scale and assessment of demographic and clinical characteristics including duration of untreated psychosis (DUP).

Results: Alogia/flat affect and avolition/anhedonia were strongly influenced by parkinsonian and depressive symptoms, respectively. A substantial proportion (26.8%) of patients showed at a least moderate level of negative symptoms not confounded by depression and Parkinsonism. DUP was related only to avolition/anhedonia while flat affect/alogia was related to male gender, diagnosis of schizophrenia, age of onset and the length of the prodrome.

Conclusion: Negative symptoms that are independent of the influence of positive symptoms, depression and extra pyramidal symptoms (EPS) are present in a substantial proportion of first episode psychosis patients and delay in seeking treatment is associated mainly with avolition and anhedonia.
Subjective quality of life: validity issues with depressed patients
Authors: Kuehner Christine
Published: March 2003

Objective: To compare depressed patients at different stages of illness and healthy controls on objective and subjective quality of life (QOL) measures and to determine the responsiveness of subjective QOL ratings to change in depression.

Method: A cohort of 56 depressed in‐patients was followed‐up for up to 16 months after discharge and compared with 56 age‐/sex‐matched community controls. Assessment included the SCAN‐PSE‐10 and the Lancashire Quality of Life Profile.

Results: Marked between‐group differences were found on self‐esteem and global and illness‐related QOL ratings. In the patient sample, these measures were also strongly responsive to changes in depression status over time. In contrast, group differences and responsiveness to change for ratings from illness‐farer domains were missing.

Conclusion: This study revealed no evidence for a globally biased negative evaluation of subjective QOL by depressed patients. It is suggested that in depressed samples subjective QOL scores should be interpreted on individual rather than on aggregated life domain levels.
Pain in somatoform disorders: is somatoform pain disorder a valid diagnosis?
Authors: Birket‐Smith M. , Mortensen E. L.
Published: March 2003

Objective: Investigate the validity of DSM‐IIIR somatoform pain disorder (SPD) by comparing subgroups of somatoform disorder patients on several measures of psychopathology.

Method: A total of 144 patients with unexplained physical symptoms were referred from non‐psychiatric departments. Among these, 127 patients with somatoform disorders were identified, classified according to the Structured Clinical Interview for DSM (SCID) diagnostic interview, and rated with scales for somatization, anxiety, depression and personality traits.

Results: Patients presenting pain did not differ significantly from patients presenting non‐pain symptoms on measures of symptoms and personality traits. Correspondingly, patients with SPD did not differ significantly from patients with conversion disorder (CD), while patients with Somatization disorder (SD) had higher scores on most scales for psychopathology and personality disorder.

Conclusion: Significant diagnostic and symptomatic overlap was found between SPD and CD, and although the statistical power of the study was modest, the study questions the validity of the current definition of SPD.
Classification of obsessive‐compulsive disorder in childhood and adolescence
Authors: Steinberger K. , Schuch B.
Published: March 2003

Objective: In child and adolescent psychiatry the validation of the diagnosis must be seen in the context of development. Comparing different diagnostic formulations DSM‐IV and ICD‐10‐DCR in a clinical sample of children and adolescents suffering from obsessive‐compulsive disorder (OCD) and their validation on external criteria represent such a heuristic approach.

Method: We investigated 61 children seen consecutively in a specialized out‐patient clinic for OCD. All of them were assessed by the International Diagnostic Checklists (IDCL). Diagnosis and diagnostic certainty were validated regarding age, age of onset and duration of illness.

Results: The agreement between the two diagnostic systems was low. The diagnostic stability of ICD‐10‐DCR was highly dependent on age, whereas that of the criteria DSM‐IV did not depend on age and almost all subjects could be diagnosed definitely.

Conclusion: This study suggests that the DSM‐IV criteria are superior to that of ICD‐10‐DCR for diagnosing OCD in children and younger adolescents.
The boundary between mixed and manic episodes in the ICD‐10 classification
Authors: Sato T. , Bottlender R. , Kleindienst N. , Tanabe A. , Möller H.‐J.
Published: March 2003

Objective: To investigate the boundary between ICD‐10 mixed and manic episodes, which has apparently remained understudied.

Method: In‐patients with ICD‐10 mixed (n=36) and manic episodes (n=145) were compared in terms of demographic, clinical, therapeutical and outcome variables.

Results: Of in‐patients with manic episode, 26 (18%) had several depressive symptoms at admission. These patients (dysphoric manic patients) were very similar to patients with ICD‐10 mixed episode in terms of current symptomatic presentations and several clinical and therapeutic variables, which were significantly different from those in patients with pure mania.

Conclusion: The ICD‐10 boundary between mixed and manic episodes is unlikely to be effective although experienced clinicians made the diagnoses. The system may have a high probability of diagnosing dysphoric manic patients as having manic episode, despite their great similarities to patients with mixed episode in terms of current psychopathological presentations as well as clinically important variables.
The Danish PET/depression project: clinical symptoms and cerebral blood flow. A regions‐of‐interest analysis
Authors: Videbech P. , Ravnkilde B. , Pedersen T. H. , Hartvig H. , Egander A. , Clemmensen K. , Rasmussen N. A. , Andersen F. , Gjedde A. , Rosenberg R.
Published: March 2003

Objective: We wanted to explore associations between clinical symptoms of depression and the blood flow to specific regions of the brain. Furthermore, we wanted to compare the regions‐of‐interest (ROI) method with the functions‐of‐interest (FOI) approach.

Method: The resting blood flow to 42 ROI in the brain was obtained with positron emission tomography (PET) imaging in 42 representative in‐patients with major depression and 47 matched healthy controls.

Results: The patients had increased blood flow to hippocampus, cerebellum, anterior cingulate gyrus, and the basal ganglia. A strong negative correlation was found between the degree of psychomotor retardation of the patients and the blood flow to the dorsolateral and supraorbital prefrontal cortices. The total Hamilton score was correlated with the blood flow to the hippocampus.

Conclusion: Our findings support the notion that depressed patients have disturbances in the loops connecting the frontal lobes, limbic system, basal ganglia, and cerebellum.
SSRIs vs. TCAs in the treatment of panic disorder: a meta‐analysis
Authors: Bakker A. , Van Balkom A. J. L. M. , Spinhoven P.
Published: March 2003

Bakker A, van Balkom AJLM, Spinhoven P. SSRIs vs. TCAs in the treatment of panic disorder: a meta‐analysis. Acta Psychiatr Scand 2002: 106: 163–167. © Blackwell Munksgaard 2002.

Objective: To compare the short‐term efficacy of selective serotonin reuptake inhibitors (SSRIs) vs. tricyclic antidepressants (TCAs) in the treatment of panic disorder (PD) a meta‐analysis was conducted.

Method: Included were 43 studies (34 randomized, nine open), pertaining to 53 treatment conditions, 2367 patients at pretest and 1804 at post‐test. Outcome was measured with the proportion of patients becoming panic‐free, and with pre/post Cohen's d effect sizes, calculated for four clinical variables: panic, agoraphobia, depression, and general anxiety.

Results: There were no differences between SSRIs and TCAs on any of the effect sizes, indicating that both groups of antidepressants are equally effective in reducing panic symptoms, agoraphobic avoidance, depressive symptomatology and general anxiety. Also the percentage of patients free of panic attacks at post‐test did not differ. The number of drop‐outs, however, was significantly lower in the group of patients treated with SSRIs (18%) vs. TCAs (31%).

Conclusion: SSRIs and TCAs are equal in efficacy in the treatment of panic disorder, but SSRIs are tolerated better.
Does guilt proneness predict acute and long‐term distress in relatives of patients with schizophrenia?
Authors: Boye B. , Bentsen H. , Malt U. F.
Published: March 2003

Objective:  The aim of the study was to improve our understanding of guilt proneness as predictor of acute and long‐term stress responses in relatives of acutely admitted patients.

Method:  Forty‐nine relatives in close contact with 36 patients suffering from schizophrenia DSM‐III‐R, completed Hostility Guilt (HG) and Guilt Conscience (GC) scales (Revised Mosher Guilt Inventory), and Levenson's Locus of Control Scale (LOC) at the patient's admission to hospital, and the General Health Questionnaire (GHQ) at the patient's admission and at 9 months after discharge.

Results:  Acute distress (GHQ) was positively related to HG, but not when controlling for LOC. GC was positively associated with acute and long‐term distress, GHQ‐depression and coping‐failure, and long‐term GHQ‐anxiety. When controlling for LOC, GC was still positively related to long‐term distress. HG, GC and LOC explained 32% variance of GHQ at 9 months.

Conclusion:  GC seems to be an important predictor of long‐term distress in relatives.
Cognitive and affective disorders associated to HIV infection in the HAART era: findings from the NeuroICONA study
Authors: Starace F. , Bartoli L. , Aloisi M. S. , Antinori A. , Narciso P. , Ippolito G. , Ravasio L. , Moioli M. C. , Vangi D. , Gennero L. , Coronado O. V. , Giacometti A. , Nappa S. , Perulli M. L. , Montesarchio V. , La Gala A. , Ricci F. , Cristiano L. , De Marco M. , Izzo C. , Pezzotti P. , D'Arminio Monforte A. ,   for the NeuroICONA study team
Published: March 2003

Objective: To assess the natural story of HIV‐associated affective and cognitive disorders and the relationship with clinical, pharmacological, immunological and behavioural factors.

Method: A total of 395 HIV‐positive patients, naive to Highly Active Antirectroviral therapy (HAART), with no severe psychiatric disorders have been enrolled in the Neuro‐ICONA Study. All participants were administered a comprehensive data collection instrument including an addiction behaviour survey, a medical problem list, a psychiatric assessment, a validated neuropsychological test battery.

Results: The global prevalence of cognitive impairment and of prominent depressive symptomatology were 17.9 and 15.5%, respectively. A significant difference in the prevalence of prominent depressive symptomatology was observed between patients in HAART and those not taking HAART(14.1 vs. 23.8%; P=0.05).

Conclusion: Depressive and cognitive disorders affect a substantial proportion of HIV‐seropositive subjects. The prevalence of prominent depressive symptomatology appears to significantly vary in relationship to the therapeutic protocol.
Adult antisocial personality traits are associated with experiences of low parental care and maternal overprotection
Authors: Reti I. M. , Samuels J. F. , Eaton W. W. , Bienvenu III O. J. , Costa Jr P. T. , Nestadt G.
Published: March 2003

Objective: To investigate the role of parenting in the development of adult antisocial personality traits.

Method: A total of 742 community‐based subjects were assessed for adult DSM‐IV antisocial personality disorder traits and for measures of parental behavior experienced as children, including by the Parental Bonding Instrument (PBI).

Results: Three fundamental dimensions of parental behavior – care, behavioral restrictiveness and denial of psychological autonomy – were derived by factor analysis from the PBI. These dimensions significantly correlated with measures of parental behavior considered influential in later antisocial behavior. Adult antisocial traits in males were associated with low maternal care and high maternal behavioral restrictiveness, and in females, antisocial traits were associated with low paternal care and high maternal denial of psychological autonomy. These dimensions did not, however, explain all variance parental behavior has on adult antisocial personality traits.

Conclusion: Adult antisocial personality traits are associated with experiences of low parental care and maternal overprotection.
Melatonin response to atenolol administration in depression: indication of β‐adrenoceptor dysfunction in a subtype of depression
Authors: Paparrigopoulos T.
Published: March 2003

Objective: To investigate peripheral β‐adrenoceptor sensitivity in depression by assessing urinary melatonin pre‐ and post‐administration of atenolol.

Method: Overnight urinary melatonin pre‐ and post‐administration of 100 mg oral atenolol was assessed in 36 depressed subjects and 47 controls.

Results: Baseline melatonin was significantly lower in depressed patients than controls (P=0.004). Melatonin following atenolol administration was strongly reduced in both groups (P < 0.0001). This reduction depends on whether the subject is a high or low (cutoff: 0.25 nmol/l) baseline melatonin excretor (P=0.025) and on whether he is depressed being a low excretor (P=0.048). A negative correlation (P=0.007) was found between melatonin decrease after atenolol and the Montgomery‐Asberg Depression Rating Scale score.

Conclusion: Atenolol strongly reduces melatonin in depressed and control subjects; this decrease relates inversely to the severity of depressive symptoms. Furthermore, responsiveness to atenolol differs between low melatonin depressed patients and low excretor controls, alluding to β‐adrenoceptor up‐regulation in a subtype of depression.