bluuebunny/crossref_metadata_2025 huggingface dataset:
Coping strategies in relatives of people with schizophrenia before and after psychiatric admission
Authors: Scazufca Marcia , Kuipers Elizabeth
Published: October 2008

Background

Most research on expressed emotion (EE) has used an empirical approach to describe relatives' ways of coping with people with schizophrenia.

Aims

To use the stress and coping model proposed by Lazarus and Folkman to examine how relatives coped with patients.

Method

Patients with DSM–III–R schizophrenia and their relatives were assessed just after hospitalisation of the patients and nine months after discharge. Both assessments included the symptoms of the patients and the coping strategies, burden, distress and levels of EE of the relatives.

Results

Fifty patients and 50 relatives were assessed at inclusion, and 31 patients and 36 relatives at follow-up. Coping strategies were used more frequently at inclusion than at follow-up. Problem-focused coping was the strategy used more often at both assessments. Avoidance coping was strongly associated with burden, distress and high EE at both assessments.

Conclusions

Ways of coping are influenced by relatives' perceptions of the situation with patients. Avoidance strategies seem to be less effective in regulating the distress of care-givers than problem-focused strategies.
Limits to the value of mental health review tribunals for offender patients
Authors: Taylor Pamela J. , Goldberg Emma , Leese Morven , Butwell Martin , Reed Alison
Published: October 2008

Background

Reform of mental health legislation for England and Wales is due. MHRTs offer an important check in the balance between patient and public rights.

Aims

To study the quantity and outcome of MHRTs in special (high-security) hospitals.

Method

Data were extracted from the records of 1670 patients detained under mental illness or psychopathic disorder classifications in special hospitals during 1992.

Results

There were 661 MHRT hearings, mostly requested by patients. Forty-three (7%) discharges were ordered, often without key data about continuing care in the written evidence. There were 56 recommendations for transfer to lesser security. Correlates of MHRT discharge were: female gender, younger age (in women), a legal classification of psychopathic disorder and shorter length of stay. Conditional discharge did not necessarily mean departure from special hospital.

Conclusions

Special hospital MHRTs result in few changes in patient status. A probable need for improvement in the evidence put before an MHRT was found. Legislation reformers should consider an extension of MHRT powers to order transfer between levels of security.
Efficacy of bupropion for smoking cessation in smokers with a former history of major depression or alcoholism∗
Authors: Hayford Kara E. , Patten Christi A. , Rummans Teresa A. , Schroeder Darrell R. , Offord Kenneth P. , Croghan Ivana T. , Glover Elbert D. , Sachs David P. L. , Hurt Richard D.
Published: October 2008

Background

A past history of major depression or alcoholism has been associated with poorer smoking treatment outcomes.

Aim

To evaluate the efficacy of bupropion for smoking cessation in smokers with a former history of major depression or alcoholism, and changes in depressive symptoms during smoking abstinence.

Method

Data were drawn from a multicentre trial of bupropion for smoking cessation. Smokers (n=615) received placebo or bupropion sustained-release at 100, 150, or 300 mg/day for six weeks after target quit date (TQD). The primary outcome was the point prevalence smoking abstinence at the end of treatment and at one year. The Beck Depression Inventory (BDI) was used to assess depressive symptoms.

Results

A significant dose – response effect of bupropion for smoking cessation was found. This was independent of history of major depression or alcoholism. Among those continuously abstinent from smoking for two weeks following TQD, an increase in BDI score was associated with a return to smoking at end of treatment.

Conclusions

Bupropion is efficacious for smoking cessation independently of a former history of major depression or alcoholism. Increases in depressive symptoms during an initial period of abstinence are associated with a return to smoking.
Randomised placebo-controlled trial of moclobemide, cognitive–behavioural therapy and their combination in panic disorder with agoraphobia
Authors: Loerch Bernd , Graf-Morgenstern Mechthild , Hautzinger Martin , Schlegel Sabine , Hain Christoph , Sandmann Juergen , Benkert Otto
Published: October 2008

Background

In the treatment of panic disorder with agoraphobia, the efficacy of pharmacological, psychological and combined treatments has been established. Unanswered questions concern the relative efficacy of such treatments.

Aims

To demonstrate that moclobemide and cognitive–behavioural therapy (CBT) are effective singly and more effective in combination.

Method

Fifty-five patients were randomly assigned to an eight-week treatment of: moclobemide plus CBT; moclobemide plus clinical management (‘psychological placebo’); placebo plus CBT; or placebo plus clinical management.

Results

Comparisons between treatments revealed strong effects for CBT. Moclobemide with clinical management was not superior to placebo. The combination of moclobemide with CBT did not yield significantly better short-term results than CBT with placebo. The CBT results remained stable during a six-month follow-up, although a substantial proportion of patients treated with placebo plus CBT needed additional treatment.

Conclusions

CBT was highly effective in the treatment of panic disorder with agoraphobia and reduced agoraphobia to levels that were comparable to those of non-clinical controls.
Family intervention for intellectually disabled children
Authors: Russell Paul Swamidhas Sudhakar , John Jacob Kochukaleekal , Lakshmanan Jeyaseelan L.
Published: October 2008

Background

Resources to address the needs of parents of intellectually disabled children in developing countries are limited.

Aims

The efficacy of interactive group psychoeducation on measures of parental attitude towards intellectual disability was assessed in southern India.

Method

Fifty-seven parents randomised to 10 weeks of experimental and control therapy were assessed using the Parental Attitude Scale towards the Management of Intellectual Disability. The pre- and post-intervention measurements were done by a single-blinded rater and compared.

Results

The intervention group had a statistically significant increase in the outcome scores and clinical improvement in the total parental attitude score, orientation towards child-rearing, knowledge towards intellectual disability and attitude towards management of intellectual disability, but no change in attitude towards the intellectual disability subscale.

Conclusions

Interactive group psychoeducation is effective for changing the attitude of parents with intellectually disabled children, and is a viable option to be developed in situations where resources are limited.
Psychotropics and suicide prevention
Authors: Isacsson Göran , Holmgren Per , Druid Henrik , Bergman Ulf
Published: October 2008

Background

Systematic clinical investigations of consecutive suicides have found psychiatric disorders in 90–95% of subjects (depressive disorder 30–87%).

Aims

To investigate use of psychotropics in men and women of different ages who commit suicide.

Method

Results of toxicological screening in 5281 suicides in Sweden 1992–94 were studied.

Results

Psychotropics were detected in 45.3% of the suicides. Antidepressants were detected in 12.4% of the men and 26.2% of the women (7.2% and 14.2%, respectively, of those under 30 years of age). Neuroleptics or antiepileptics (in the absence of antidepressants) were detected in 8.3%, and anxiolytics/hypnotics alone in 20.5% of the subjects. Overdose by an antidepressant was the probable cause of death in 2.1% of the men and 7.9% of the women.

Conclusions

The pattern of psychotropics detected in toxicology was incongruent with the pattern of diagnoses found in the clinical investigations of suicides mentioned above. Depression appears to be undertreated in individuals committing suicide, especially in men and in subjects under 30 years of age.
Quick rating of depressed mood in patients with anxiety disorders
Authors: McKenzie Nigel , Marks Isaac
Published: October 2008

Background

Regular assessment of mood is often important for treatment but traditional measures can be time-consuming. A quick ‘litmus test’ is needed.

Aims

To test the reliability and validity of a single-item scale for mood.

Method

Mood was measured repeatedly in 812 patients (258 in-patients, 554 out-patients) being treated in an anxiety disorders unit. Patients had self- and clinician ratings of a single-item depression scale and also rated the 21-item Beck Depression Inventory (BDI–21). Their single-item scores were compared with BDI–21 scores and with outcome measures.

Results

The single-item depression scores correlated 0.71 to 0.78 with the BDI–21 scores. Clinically useful cut-off points were identified. Depression scores at discharge, but not pre-treatment, correlated significantly with improvement in the main problem.

Conclusions

The quick single-item depression scale, whether rated by patient or by clinician, is a reasonable rough guide to mood in anxiety disorders and saves time for the patient and the clinician compared to longer measures.
Depression of older age
Authors: Copeland John
Published: October 2008

Background

The EURODEP collaboration was formed to take advantage of existing studies of random community samples of older people in Europe, using GMS–AGECAT for case identification and diagnosis. Later, other centres joined, and the EURO–D scale was developed to harmonise the different methods used with the GMS. Previous studies had revealed different levels of depression in Europe but had been confounded by the use of unreconcilable methods. These studies attempt to overcome this problem.

Aims

To introduce the first set of publications from the EURODEP collaboration.

Method results and conclusions

Presented in five accompanying papers (pp. 307–345, this issue)
Predictors of chronic post-traumatic stress disorder
Authors: Freedman Sara A. , Brandes Dalia , Peri Tuvia , Shalev Arieh Y.
Published: October 2008

Background

Most individuals who, shortly after trauma, express symptoms of post-traumatic stress disorder (PTSD) recover within one year of their traumatic experiences. In contrast, those who remain ill for one year rarely recover completely. The early identification of the latter is, therefore, very important.

Aims

To prospectively evaluate predictors of PTSD at four months and one year.

Method

We followed 236 trauma survivors recruited from admissions to a general hospital's emergency room for four months, at which point 41 (17.4%) met diagnostic criteria for PTSD. Twenty-three of these individuals, and 39 individuals without PTSD at four months, were assessed again at one year.

Results

Depressive symptoms were the best predictors of PTSD at both time points. Intrusive symptoms and peri-traumatic dissociation were better at predicting four-month PTSD than one-year PTSD.

Conclusions

The occurrence of depression during the months that follow a traumatic event is an important mediator of chronicity in PTSD.
Validation of the Health of the Nation Outcome Scales
Authors: Bebbington Paul , Brugha Terry , Hill Trevor , Marsden Lucy , Window Suzanne
Published: October 2008

Background

The Health of the Nation Outcome Scales (HoNOS) were developed to assess the outcome of severe mental disorders in relation to the Health of the Nation Strategy for England.

Aims

To validate the HoNOS.

Method

One hundred and fifteen patients were assessed by key workers using HoNOS, and by research workers using SCAN, SBS, and SRPS, and completing HoNOS in the light of this additional material. These assessments were repeated after 6 weeks.

Results

The performance of HoNOS in the hands of key workers was generally poor, in relation both to the research workers' rating of HoNOS and to the criterion instruments. Performance was particularly poor when the change in scores was used as a measure of outcome.

Conclusions

There are serious problems in using HoNOS as a routine measure of clinical status in busy psychiatric services. Its performance is probably related to the training and experience of key workers. Sequential ratings are not a good method for assessing outcome. Managers and planners should be cautious in adopting HoNOS, but it is worthy of consideration in developing a suite of locally agreed outcome measures.
Brief scale for measuring the outcomes of emotional and behavioural disorders in children
Authors: Gowers Simon G. , Harrington Richard C. , Whitton Anna , Lelliott Paul , Beevor Anne , Wing John , Jezzard Robert
Published: October 2008

Background

Following the development of a child and adolescent version of the Health of the Nation Outcome Scales (HoNOSCA), field trials were conducted to assess their feasibility and acceptability in routine outcome measurement.

Aims

To evaluate the reliability, validity and acceptability of HoNOSCA in routine outcome measurement.

Method

Following training, 36 field sites provided ratings on 1276 cases at one time point and outcome data on 906. Acceptability was assessed by way of written feedback and at a debriefing meeting.

Results

HoNOSCA demonstrated satisfactory reliability and validity characteristics. It was sensitive to change and its ability to measure change accorded with the clinicians' independent rating. HoNOSCA was reasonably acceptable to clinicians' from a range of disciplines and services.

Conclusions

Provided that training needs can be met, HoNOSCA represents a satisfactory brief outcome measure which could be used routinely in child and adolescent mental health services.
Changes in personality traits during treatment with sertraline or Citalopram
Authors: Ekselius Lisa , Von Knorring Lars
Published: October 2008

Background

Recent studies indicate that selective serotonin re-uptake inhibitors (SSRIs) reduce the symptoms accompanying personality disorders and modulate a normal personality.

Aims

To examine the effect of two SSRIs, sertraline and Citalopram, on personality traits in major depressed patients.

Method

Personality traits were evaluated at baseline and after six months using the Karolinska Scales of Personality (KSP).

Results

After treatment, significant changes in the direction of normalisation were seen in all scales. To determine whether the observed changes could be explained by improved depressive symptoms, multiple stepwise regressions with the separate KSP as dependent variables were performed. Improvements in depressive symptoms only accounted for 0–8.4% of the observed variance.

Conclusions

In depressed patients treated with SSRIs significant effects are seen on personality traits measured by the KSP.
Brain mechanisms associated with depressive relapse and associated cognitive impairment following acute tryptophan depletion
Authors: Smith Katharine A. , Morris John S. , Fristdn Karl J. , Cowen Philip J. , Dolan Raymond J.
Published: October 2008

Background

Acute tryptophan depletion lowers brain serotonin synthesis and results in a transient, but striking, clinical relapse in recovered depressed patients.

Aims

To identify brain regions which change their activity as an acute depressive relapse evolves and to determine how pathological mood might modulate neural activity during a cognitive task.

Method

We used H215O positron-emission tomography (PET) to study eight recovered depressed men after tryptophan depletion and after a control procedure. During both PET scan sessions, subjects performed a paced verbal fluency task which alternated with a control verbal repetition task.

Results

Increasing levels of depression after tryptophan depletion were associated with diminished neural activity in the ventral anterior cingulate, orbitofrontal cortex and caudate nucleus regions. In addition, depressive relapse attenuated cognitive task-related activation in the anterior cingulate cortex.

Conclusions

Our data indicate that changes in neural activity in distinct brain regions mediate the clinical phenomena of depression and depression-related cognitive impairment following acute tryptophan depletion. These changes could be associated with the widespread distribution of serotonin neurons in brain pathways associated with the expression of affect and cognitive performance.
Fluoxetine in post-traumatic stress disorder
Authors: Connor Kathryn M. , Sutherland Suzanne M. , Tupler Larry A. , Malik Mary L. , Jonathan R. , Davidson T.
Published: October 2008

Background

Most pharmacotherapy trials in post-traumatic stress disorder (PTSD) have been conducted upon male combat veterans. Outcome studies relating to civilians are therefore needed.

Aims

To demonstrate that fluoxetine is more effective than placebo in treating PTSD.

Method

Civilians with PTSD (n=53) were treated for 12 weeks with fluoxetine (up to 60 mg/day) or placebo. Assessments of PTSD severity, disability, stress vulnerability, and high end-state function were obtained.

Results

Fluoxetine was more effective than placebo on most measures at week 12, including global improvement (much or very much improved: fluoxetine 85%, placebo 62%, difference 0.24, 95% CI 0.01–0.47; very much improved: fluoxetine 59%, placebo 19%, difference 0.40, 95% CI 0.16–0.64), and high end-state function (fluoxetine 41%, placebo 4%, difference 0.37, 95% CI 0.17–0.57)

Conclusions

Fluoxetine was superior for measures of PTSD severity, disability, stress vulnerability, and high end-state function. The placebo-group response was low when viewed as a broad outcome based on a portfolio of ratings, but was higher with a traditional global rating criterion.
First-contact incidence rate of schizophrenia on Barbados
Authors: Mahy George E. , Mallett Rosemarie , Leff Julian , Bhugra Dinesh
Published: October 2008

Background

The incidence rate for broad schizophrenia among second-generation African–Caribbean people in the United Kingdom has been reported as high. Ethnicity, migration and psychosocial stressors have been suggested as causal factors.

Aims

To determine the incidence of schizophrenia for the whole population of Barbados using an identical methodology to two previous studies in Trinidad (Bhugra et al, 1996) and London (Bhugra et al, 1997)

Method

A12-month study of all persons in the 18–54-year age group presenting with a psychosis for the first time was carried out on the population of Barbados. Information was collected using World Health Organization screening and measurement instruments.

Results

On an island of just over a quarter of a million, 40 out of the 53 patients that met the inclusion criteria were categorised as S+ (narrow) schizophrenia, giving an incidence rate of 2.8/10 000 (95% CI 1.97–3.7). The incidence rate for broad schizophrenia was calculated at 3.2/10 000 (95% CI 2.3–4.1), which is significantly lower than the comparable rate for London's African–Caribbeans of 6.6/10000 (95% CI 4.5–8.7)

Conclusions

The very high rate for broad schizophrenia among African–Caribbean people in the UK is probably due to environmental factors.
North Staffordshire Community Beds Study: Longitudinal evaluation of psychiatric in-patient units attached to community mental health centres
Authors: Boardman Anthony P. , Hodgson Richard E. , Lewis Martyn , Allen Keith
Published: October 2008

Background

This study evaluates two in-patient units attached to community mental health centres (CMHCs) that were designed to supplement acute in-patient care and to integrate with community-based after-care services.

Aim

To examine the comparative outcome of patients with severe mental illness (SMI) admitted to the two units.

Method

All patients with SMI admitted to the acute psychiatric wards serving the two CMHCs, those transferred to the community in-patient units and those admitted directly to these units (n=110) were compared with patients (n=67) admitted to acute wards serving two similar catchment areas without associated community beds. Baseline clinical and social measures were made and repeated at six and 12 months. Satisfaction with services was assessed at 12 months.

Results

The experimental group showed significantly better outcomes, significant reduction in unmet need and better satisfaction with services.

Conclusions

The use of the community beds appears to have significant benefits for patients with SMI.
Schizophrenia and temporal lobe asymmetry
Authors: Highley J. Robin , McDonald Brendan , Walker Mary A. , Esiri Margaret M. , Crow Timothy J.
Published: October 2008

Background

A previous report by Crow of a left-sided increase in temporal horn volume in schizophrenia implies a left-sided loss of tissue.

Aims

To elucidate the structural nature of schizophrenia.

Method

The volume of grey matter in the temporal pole and inferior, middle and superior temporal gyri was measured, in addition to the total volume of grey and white matter, in the temporal lobes of the brains of 29 patients with schizophrenia and 27 controls.

Results

We found a significant left-sided reduction in the superior temporal gyrus in both males and females with schizophrenia, which was related to increasing age of onset in the males. The total volume of temporal lobe grey and white matter was also significantly reduced. Although being more marked on the left than the right, the lateralisation for these total grey and white measures (by contrast with the superior temporal gyrus alone) did not attain formal statistical significance.

Conclusions

Confirmation of a lateralised reduction in the superior temporal gyrus, which is differentially related to age of onset according to gender, adds to evidence that the changes in schizophrenia are in systems that are lateralised. The findings implicate language as the relevant function.
Ecstasy – long-term effects on the human central nervous system revealed by positron emission tomography
Authors: Obrocki Jost , Buchert Ralph , Väterlein Ole , Thomasius Rainer , Beyer Wolfgang , Schiemann Thomas
Published: October 2008

Background

The main psychotropic agent of the popular illicit drug ecstasy is 3,4-methylenedioxymethamphetamine (MDMA). In the light of animal studies and examinations of human cerebrospinal fluid, MDMA is suspected of causing neurotoxic lesions to the serotonergic system.

Aims

To postulate a relationship between ecstasy use and lasting alterations to the cerebral glucose metabolic rate.

Method

Positron emission tomography (PET) with 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) was performed on seven ecstasy users and seven subjects without any known history of illicit drug use. Data were compared for a limited number of brain regions.

Results

By comparison with the control group, the glucose metabolic uptake of the ecstasy user group was altered within the amygdala, hippocampus and Brodmann's area 11

Conclusions

The results suggest the possibility that ecstasy use has lasting effects on central neuronal activity in humans.
Preterm birth and intra-uterine growth retardation among children of women with schizophrenia
Authors: Bennedsen B. E. , Mortensen P. B. , Olesen A. V. , Henriksen T. B.
Published: October 2008

Background

There is conflicting evidence about the frequency of adverse pregnancy outcomes among women with schizophrenia.

Aims

To investigate the risk of preterm birth, low birth weight and intra-uterine growth retardation among women with schizophrenia.

Method

A total of 2212 births to 1537 women with schizophrenia in Denmark were compared with a random sample of all deliveries in Denmark in 1973–1993 (122 931 births to 72 742 women)

Results

The children of women with schizophrenia were at increased risk of preterm delivery (relative risk=1.46, 95% CI=1.19–1.79), low birth weight (relative risk=1.57, 95% 0=1.36–1.82) and small for gestational age (relative risk=1.34, 95% CI=1.17–1.53)

Conclusions

Women with schizophrenia are at increased risk of adverse pregnancy outcome. This may be associated with an increased mortality and general morbidity and risk of schizophrenia in their children.
Association of low serum total cholesterol with major depression and suicide
Authors: Partonen T. , Haukka J. , Virtamo J. , Taylor P. R. , Lönnqvist J.
Published: October 2008

Background

It has been suggested that low serum total cholesterol is associated with an increased risk of suicide.

Aims

To study the association between serum total cholesterol, depression and suicide using versatile, prospective data.

Method

A total of 29 133 men aged 50–69 years were followed up for 5–8 years. Baseline blood samples were analysed for serum total and high-density lipoprotein cholesterol concentrations. Self-reported depression was recorded, data on hospital treatments due to depressive disorders were derived from the National Hospital Discharge Register and deaths from suicide were identified from death certificates.

Results

Low serum total cholesterol was associated with low mood and subsequently a heightened risk of hospital treatment due to major depressive disorder and of death from suicide.

Conclusions

Our results suggest that low serum total cholesterol appears to be associated with low mood and thus to predict its serious consequences.
Guiding principles of drug demand reduction: An international response
Authors: Ghodse Hamid
Published: October 2008

Background

The 20th century has seen the globalisation and homogenisation of substance misuse problems, blurring traditional boundaries between producer and consumer countries and forcing the international community to consider new responses to substance misuse.

Aims

To highlight the importance of the principles of illicit drug demand reduction and related activities in tackling global drug problems and to discuss the commitment made by United Nations (UN) Member States at the highest political level towards meeting the objectives set in their Declaration on the Guiding Principles.

Method

A review of international responses to substance misuse.

Results

Traditionally, the focus has been on reducing the supply of controlled drugs, while maintaining adequate supplies of narcotic and psychotropic drugs for clinical and scientific purposes. However, it has become apparent that supply reduction in isolation is insufficient and demand reduction is now receiving greater emphasis – culminating in the UN General Assembly adopting the Declaration on the Guiding Principles of Demand Reduction in 1998.

Conclusions

This declaration offers a genuinely holistic approach to the complexities of substance misuse. To be successful, it requires the commitment of governments at the highest level and the willing participation of small communities.
Outcome of admission to a medium secure psychiatric unit
Authors: Maden A. , Rutter S. , McClintock T. , Friendship C. , Gunn J.
Published: October 2008

Background

This is the first long-term follow-up of patients discharged from a medium secure unit.

Aims

To describe the short– and long-term outcomes of admission for all patients discharged during a 14-year period.

Method

A longitudinal cohort study of all 234 patients discharged from the Denis Hill Unit, Bethlem Royal Hospital, between 1980 and 1994, followed for an average 6.6 years.

Results

Although 48% of admissions were from prison, only 8% returned there, with most being transferred to another psychiatric bed. One-fifth of patients spent none of the follow-up time in the community; 75% of patients had at least one readmission; only 24% were convicted of further offences.

Conclusions

Re-offending rates are comparable with those for patients discharged from high-security hospitals, and much lower than those for released prisoners. The high readmission rates indicate the need for a range of services to maintain former patients in the community.
Twin studies of psychosis and the genetics of cerebral asymmetry
Authors: Crow T. J.
Published: October 2008

Kläning (1999, this issue) reports that dizygotic twins are at increased risk of schizophrenia relative to the general population. Any departure from the first assumption of twin studies that the illness has the same origin in twins as it does in the general population might tell us something about aetiology. Kläning's expectation that monozygotic twins would be at increased risk because such pairs are at increased risk of perinatal complications was not confirmed, adding to the weight of evidence that such complications are unrelated to the origins of psychotic illness. The contrary finding that dizygotic twins are at increased risk draws attention to the nature of dizygotic twinning. Is there something about this process that yields a clue to the origins of psychosis?
Greater occurrence of schizophrenia in dizygotic but not monozygotic twins
Authors: Kläning Ulla
Published: October 2008

Background

A previous study demonstrated a higher rate of first hospitalisation for schizophrenia in twins than in singletons.

Aims

To compare the schizophrenia rates in monozygotic twins, dizygotic twins and the general population.

Method

Through record linkage between the Young Cohort of the Danish Twin Register and the Danish Psychiatric Case Register, the rate of schizophrenia in’ monozygotic and dizygotic twins and the rate in the general population were compared.

Results

The rate of first admission to hospital for schizophrenia in dizygotic twins was 40% greater than that in the general population. The rate in monozygotic twins was not increased. The difference between the rates in mono- and dizygotic twins was statistically significant (P < 0.001)

Conclusions

This result is surprising and is in the direction opposite to that expected, suggesting new possibilities in the study of risk factors.
Operation and organisation of services for people with severe mental illness in the UK
Authors: Schneider Justine , Carpenter John , Brandon Toby
Published: October 2008

Background

Since 1991, English mental health policy guidelines have been explicit in recommending inter-professional working, involvement of patients and carers, harmonisation between health and social services and targeting at people with severe mental illness.

Aims

To explore the structure and operation of mental health services in practice and relate them to measurable data.

Method

A survey of mental health trusts was conducted in 1997–1998. Responses were compared with a concurrent survey of social services departments. Some qualitative data were collected. Harmonisation and targeting scores were devised and tested for association.

Results

The response rate was 79%. The frequency with which different professionals, patients and carers were involved in the care process is described. Reasons for this are discussed briefly. Levels of harmonisation and targeting were found to vary widely and to be positively associated.

Conclusions

This survey portrays mental health services' practice in relation to Government policy. However, adherence to guidelines cannot be taken as a guarantee of service quality or efficiency.
Autism screening questionnaire: Diagnostic validity
Authors: Berument Sibel Kazak , Rutter Michael , Lord Catherine , Pickles Andrew , Bailey Anthony
Published: October 2008

Background

Good interview and diagnostic measures for autism and other pervasive developmental disorders (PDDs) are available but there is a lack of a good screening questionnaire.

Aims

To develop and test a screening questionnaire based on items in the best available diagnostic interview – the Autism Diagnostic Interview – Revised (ADI–R)

Method

A 40 -item scale, the Autism Screening Questionnaire (ASQ), was developed and tested on a sample of 160 individuals with PDD and 40 with non-PDD diagnoses.

Results

The ASQ has good discriminative validity with respect to the separation of PDD from non-PDD diagnoses at all IQ levels, with a cut-off of 15 proving most effective. The differentiation between autism and other varieties of PDD was weaker.

Conclusions

The ASQ is an effective screening questionnaire for PDD.
Conflict between mothers with eating disorders and their infants during mealtimes
Authors: Stein Alan , Woolley Helen , McPherson Klim
Published: October 2008

Background

In a recent study, 20% of the variance in the weight of infants of mothers with eating disorders was accounted for by mealtime conflict.

Aims

To investigate the antecedents and interactive processes involved in the development of such conflict.

Method

Mothers with eating disorders and their 12-month-old infants (n=34) and a comparison group (n=24) were videotaped during infant mealtimes. Specific classes of antecedents to conflict episodes were identified. An examination was then made of all such antecedents not leading to conflict and the mother–infant responses to each antecedent.

Results

Within the index group, conflict was less likely when mothers acknowledged infants' cues and were able to put aside their own concerns. The relationship between maternal responses and the evolution of conflictual interaction was confirmed in multiple regression analyses including both index and comparison groups.

Conclusions

Mothers' and infants' responses to potential antecedents to conflict had an impact on whether mealtime conflict ensued. Conflict arose because maternal eating disorder psychopathology interfered with aspects of responsive parenting.
Socio-economic deprivation and the prevalence and prediction of depression in older community residents
Authors: Wilson K. C. M. , Taylor S. , Copeland J. R. M. , Chen R. , McCracken C. F. M.
Published: October 2008

Background

The Townsend index is a measure of social deprivation. It can be applied to postal districts and has been employed in studies examining the ecological associations of mental illness.

Aims

We examine the utility of the Townsend index in identifying older populations with a high prevalence and risk of developing depression.

Method

The study was carried out in the context of a cohort study of an age- and gender-stratified sample of 5222 community residents aged 65 years and over. Subjects were interviewed at intervals of two years. The relationships between Townsend score and psychiatric diagnoses (in particular, depression) were examined.

Results

High Townsend scores were associated with increased prevalence and incidence of depression and prevalence of organic psychiatric illness.

Conclusions

The Townsend index can be used to prioritise psychiatric and primary care resources so as to cater for older populations likely to suffer from depression and organic psychiatric conditions.
Active monitoring of 12760 clozapine recipients in the UK and Ireland
Authors: Munro Janet , O'Sullivan Desmond , Andrews Christopher , Arana Alejandro , Mortimer Ann , Kerwin Robert
Published: October 2008

Background

People prescribed clozapine for treatment-resistant schizophrenia have mandatory haematological monitoring through a case register for identifying reversible neutropenia.

Aims

To quantify risk factors for agranulocytosis in subjects receiving clozapine.

Method

Data from 12 760 subjects registered to receive clozapine from January 1990 to April 1997 were analysed. Risk factors for agranulocytosis were quantified using a Cox proportional-hazards regression analysis.

Results

The risk for agranulocytosis in Asian subjects was 2.4 times that in Caucasians (P=0.03). There was an age-related increase in risk of 53% per decade (P=0.0001).

Conclusions

The case register yielded valuable information for guiding research into the causes of the haematological reactions.
Randomisation in clinical trials
Authors: Ogundipe Loafe , Boardman Anthony P. , Masterson Amy
Published: October 2008

Background

Several studies of papers published in non-psychiatric medical journals that report on randomised controlled trials (RCTs) indicate that there is inadequate reporting of the process by which randomisation is carried out.

Aims

To examine the adequacy of the reporting of the procedure of randomisation in clinical trials of parallel design published in the British Journal of Psychiatry (BJP) and the American Journal of Psychiatry (AJP).

Method

All issues of the BJP and the AJP published between January 1990 and December 1998 were surveyed, and papers that reported on RCTs were examined to judge the adequacy of the reporting of the process of randomisation.

Results

We found 183 papers which claimed to report on RCTs (73 in the BJP and 110 in the AJP). Nine (8.2%) of those in the AJP and six (8.2%) in the BJP described the technique of creating the randomisation sequence. Two (1.8%) of those in the AJP and 11 (15.1%) of those in the BJP described the mechanism of allocating treatment. One paper in the AJP and five papers in the BJP described both the generation of random numbers and allocation.

Conclusions

Adequate reporting of the method of randomisation was uncommon. The RCT status of some of the papers must therefore be in doubt.
Long-Term Disease-Free Survival After Gemtuzumab, Intermediate-Dose Cytarabine, and Mitoxantrone in Patients With CD33+ Primary Resistant or Relapsed Acute Myeloid Leukemia
Authors: Chevallier Patrice , Delaunay Jacques , Turlure Pascal , Pigneux Arnaud , Hunault Mathilde , Garand Richard , Guillaume Thierry , Avet-Loiseau Herve , Dmytruk Nathalia , Girault Stephane , Milpied Noel , Ifrah Norbert , Mohty Mohamad , Harousseau Jean-Luc
Published: October 2008

Purpose

To determine the antitumor activity and safety of a combination of gemtuzumab ozogamicin (GO), intermediate-dose cytarabine, and mitoxantrone (MIDAM) in patients with refractory or relapsed CD33+ acute myeloid leukemia (AML).

Patients and Methods

We treated 62 patients with refractory (n = 18) or relapsed (n = 44) CD33+ AML. Median age was 55.5 years. Salvage regimen consisted of GO 9 mg/m2 on day 4, cytarabine 1 g/m2 every 12 hours on days 1 through 5, and mitoxantrone 12 mg/m2/d on days 1 through 3. Median follow-up time was 26.5 months.

Results

Thirty-one patients (50%) achieved complete remission (CR), and eight patients (13%) had CR with delayed platelet recovery (CRp); the overall response (OR; CR + CRp) rate was 63%. A significantly higher OR rate was achieved in patients who had relapsed versus refractory AML (73% v 39%, respectively; P = .007) and patients with CD33 expression more than 98% of the blast population versus less than 98% (79% v 52.3%, respectively; P = .03). The overall, event-free, and disease-free survival rates were 41%, 33%, and 53% at 2 years, respectively. Leukocytosis more than 20,000/μL at MIDAM therapy, high-risk cytogenetics, and absence of postremission therapy were adverse prognostic factors. Age, disease status, and/or CD33 expression did not influence survival parameters. Four early toxic deaths occurred; a grade 3 to 4 hyperbilirubinemia rate of 16% was observed, and two patients had veno-occlusive disease (3%).

Conclusion

The MIDAM regimen seems to be an effective salvage regimen for refractory/relapsed CD33+ AML patients. These encouraging results support the need for a randomized phase III trial before considering this combination of GO and chemotherapy as superior or the standard of care treatment for refractory/relapsed CD33+ AML patients.
Phase III Trial of Consolidation Therapy With Yttrium-90–Ibritumomab Tiuxetan Compared With No Additional Therapy After First Remission in Advanced Follicular Lymphoma
Authors: Morschhauser Franck , Radford John , Van Hoof Achiel , Vitolo Umberto , Soubeyran Pierre , Tilly Herve , Huijgens Peter C. , Kolstad Arne , d’Amore Francesco , Diaz Marcos Gonzalez , Petrini Mario , Sebban Catherine , Zinzani Pier Luigi , van Oers Marinus H.J. , van Putten Wim , Bischof-Delaloye Angelika , Rohatiner Ama , Salles Gilles , Kuhlmann Jens , Hagenbeek Anton
Published: October 2008

Purpose

We conducted an international, randomized, phase III trial to evaluate the efficacy and safety of consolidation with yttrium-90 (90Y)–ibritumomab tiuxetan in patients with advanced-stage follicular lymphoma in first remission.

Patients and Methods

Patients with CD20+ stage III or IV follicular lymphoma, who achieved a complete response (CR)/unconfirmed CR (CRu) or partial response (PR) after first-line induction treatment, were randomly assigned to receive 90Y-ibritumomab tiuxetan (rituximab 250 mg/m2 on day −7 and day 0 followed on day 0 by 90Y-ibritumomab tiuxetan 14.8 MBq/kg; maximum of 1,184 MBq) or no further treatment (control). The primary end point was progression-free survival (PFS), which was calculated from the time of random assignment.

Results

A total of 414 patients (consolidation, n = 208; control, n = 206) were enrolled at 77 centers. 90Y-ibritumomab tiuxetan consolidation significantly prolonged median PFS (after a median observation time of 3.5 years) in all patients (36.5 v 13.3 months in control arm; hazard ratio [HR] = 0.465; P < .0001) and regardless of whether patients achieved PR (29.3 v 6.2 months in control arm; HR = 0.304; P < .0001) or CR/CRu (53.9 v 29.5 months in control arm; HR = 0.613; P = .0154) after induction treatment. Median PFS with consolidation was prolonged in all Follicular Lymphoma International Prognostic Index risk subgroups. After 90Y-ibritumomab tiuxetan consolidation, 77% of patients in PR after induction converted to CR/CRu, resulting in a final CR rate of 87%. The most common toxicity with 90Y-ibritumomab tiuxetan was hematologic, and grade 3 or 4 infections occurred in 8% of patients.

Conclusion

Consolidation of first remission with 90Y-ibritumomab tiuxetan in advanced-stage follicular lymphoma is highly effective with no unexpected toxicities, prolonging PFS by 2 years and resulting in high PR-to-CR conversion rates regardless of type of first-line induction treatment.
Preoperative Bevacizumab Does Not Significantly Increase Postoperative Complication Rates in Patients Undergoing Hepatic Surgery for Colorectal Cancer Liver Metastases
Authors: Kesmodel Susan B. , Ellis Lee M. , Lin E. , Chang George J. , Abdalla Eddie K. , Kopetz Scott , Vauthey Jean-Nicolas , Rodriguez-Bigas Miguel A. , Curley Steven A. , Feig Barry W.
Published: October 2008

Purpose

Although bevacizumab (BV) increases survival rates when used with chemotherapy (CTX) in patients who have metastatic colorectal cancer (CRC), an increase in wound complications has been observed in patients who undergo surgery while receiving BV. We therefore evaluated whether neoadjuvant BV is associated with an increase in postoperative complications in patients undergoing surgery for CRC liver metastases.

Patients and Methods

Two subgroups of patients who received neoadjuvant CTX + BV (n = 81) or CTX alone (n = 44) were identified from a database of patients who underwent surgery for CRC liver metastases. Univariate and multivariate logistic regression models were used to evaluate the association of patient and tumor characteristics, neoadjuvant therapy, and operative factors with postoperative complications.

Results

Postoperative complications developed in 40 patients (49%) who received CTX + BV and 19 patients (43%) who received CTX. The median time from BV discontinuation to surgery was 58 days (range, 31 to 117 days). No significant associations were identified between BV use and timing of BV discontinuation and postoperative complications. On multivariate analysis, lower serum albumin and concomitant surgical procedures were associated with an increased risk of developing any complication (P = .035 and .023, respectively), and lower serum albumin was associated with hepatobiliary complications (P = .016).

Conclusion

Neither the use of BV nor timing of BV administration was associated with an increase in complication rates. These data suggest that the combination of BV with neoadjuvant CTX in patients who have CRC liver metastases does not increase surgical complications. To determine the optimal timing of surgery in patients receiving neoadjuvant BV, confirmatory prospective studies are required.
Nonclassic Actions of Vitamin D
Authors: Bikle Daniel
Published: October 2008

Context: Vitamin D receptors are found in most tissues, not just those participating in the classic actions of vitamin D such as bone, gut, and kidney. These nonclassic tissues are therefore potential targets for the active metabolite of vitamin D, 1,25(OH)2D. Furthermore, many of these tissues also contain the enzyme CYP27B1 capable of producing 1,25(OH)2D from the circulating form of vitamin D. This review was intended to highlight the actions of 1,25(OH)2D in several of these tissues but starts with a review of vitamin D production, metabolism, and molecular mechanism.

Evidence Acquisition: Medline was searched for articles describing actions of 1,25(OH)2D on parathyroid hormone and insulin secretion, immune responses, keratinocytes, and cancer.

Evidence Synthesis: Vitamin D production in the skin provides an efficient source of vitamin D. Subsequent metabolism to 1,25(OH)2D within nonrenal tissues differs from that in the kidney. Although vitamin D receptor mediates the actions of 1,25(OH)2D, regulation of transcriptional activity is cell specific. 1,25(OH)2D inhibits PTH secretion but promotes insulin secretion, inhibits adaptive immunity but promotes innate immunity, and inhibits cell proliferation but stimulates their differentiation.

Conclusions: The nonclassic actions of vitamin D are cell specific and provide a number of potential new clinical applications for 1,25(OH)2D3 and its analogs. However, the use of vitamin D metabolites and analogs for these applications remains limited by the classic actions of vitamin D leading to hypercalcemia and hypercalcuria.
Lack of Therapeutic Effect of the Histone Deacetylase Inhibitor Vorinostat in Patients with Metastatic Radioiodine-Refractory Thyroid Carcinoma
Authors: Woyach Jennifer A. , Kloos Richard T. , Ringel Matthew D. , Arbogast Daria , Collamore Minden , Zwiebel James A. , Grever Michael , Villalona-Calero Miguel , Shah Manisha H.
Published: October 2008

Context: Aberrant histone deacetylase activity is seen in a variety of malignancies, and histone deacetylase inhibitors such as vorinostat have been shown to induce cell death and sensitize cells to cytotoxic chemotherapy in thyroid cancer cell lines. This phase II study was undertaken to assess objective response to vorinostat in patients with advanced thyroid cancer.

Experimental Design: A total of 19 patients with differentiated thyroid cancer (n = 16) and medullary thyroid cancer (n = 3) were enrolled in the study. Patients received oral vorinostat at a starting dose of 200 mg twice daily, with dose adjustments allowed as necessary for toxicity. Patients were treated for 2 wk, followed by 1 wk off therapy (3-wk cycle) until disease progression or study withdrawal. Responses were measured by Response Evaluation Criteria in Solid Tumors criteria and correlated with tumor markers.

Results: No patient achieved a partial or complete response. Median duration of therapy in patients with differentiated thyroid cancer was 17 wk, whereas in medullary thyroid cancer patients it was 25 wk. Reasons for termination included progression of disease by RECIST criteria (n = 7), clinical progression (n = 3), and adverse events (AEs) (n = 9). AEs were primarily grade 1–3; no clinical grade 4 or grade 5 events were observed. Clinical grade 3 AEs consisted of fatigue, dehydration, ataxia, pneumonia, bruises, and deep vein thrombosis. Severe thrombocytopenia was seen in seven patients (grade 3, n = 5; grade 4, n = 2) and was associated with minor bleeding or bruises.

Conclusions: Vorinostat at this dose and schedule is not an effective treatment for advanced thyroid cancer.