bluuebunny/crossref_metadata_2025 huggingface dataset:
Juvenile bipolar disorder
Authors: Janardhan Reddy Y. C. , Srinath S.
Published: March 2003

Objective: Bipolar disorder in children and adolescents is less well studied than bipolar disorder in adults. This review addresses issues related to its underdiagnosis, precursors of bipolarity, comorbidity, natural course and treatment.

Method: Literature from Medline and other searches, and earlier relevant articles including references from recent review articles on juvenile bipolarity were reviewed.

Results: Bipolar disorder in juveniles is underdiagnosed and misdiagnosed on various counts. Few recent studies have reported high rates of comorbid attention deficit and disruptive disorders, prompting some researchers to consider them as probable developmental precursors of juvenile bipolarity. There is also evidence to suggest that some juvenile depression could be pre‐bipolar, and that certain temperamental predispositions are probable precursors to bipolarity. Limited data on the natural course and outcome suggest that juvenile bipolar disorder is a highly recurring illness as in adults, and that it is associated with significant functional impairment. The psychopharmacological treatment of juvenile bipolar disorder is remarkably understudied, and treatment is often based on studies of adults.

Conclusion: There is a need for epidemiological studies of juvenile bipolar disorder. Similarly, there is an urgent need for the methodologically rigorous studies to establish the efficacy of various antimanic drugs. Finally, issues related to comorbidity and temperamental predispositions to juvenile bipolarity need greater clarity, as they may have important treatment and research implications.
The prevalence of mental health problems in Rwandan and Burundese refugee camps
Authors: De Jong J. P. , Scholte W. F. , Koeter M. W. J. , Hart A. A. M.
Published: March 2003

Objective: We examined the prevalence of mental health problems in refugees living in camps that emerged in Tanzania during the Rwanda crisis that started in 1994.

Method: Using the 28‐item version of the General Health Questionnaire (GHQ‐28), we examined two samples: a random sample (n=854) and a sample of clients of a psychosocial support programme in these camps (n=23). Sensitivity, specificity and positive‐ and negative predictive values were estimated for several cut‐off scores of the GHQ‐28.

Results: The prevalence of serious mental health problems was estimated at 50% (SE 12%). When using the GHQ‐28 as a screener, a cut‐off score of 14 is recommended.

Conclusion: Given the high prevalence of mental health problems, psychosocial programmes for large refugee populations should aim at strengthening community structures and supporting groups instead of focusing at individuals. The screening capacity of the GHQ‐28 could be used to identify mentally vulnerable groups.
Dissociative disorders in the Sultanate of Oman
Authors: Chand Suma P. , Al‐Hussaini Ala Aldin , Martin Rodger , Mustapha Sawsan , Zaidan Ziad , Viernes Nonna , Al‐Adawi Samir
Published: March 2003

Objective: To study the clinical manifestations and psychosocial aspects of dissociative (conversion) disorders (DD) in the Sultanate of Oman.

Method: A retrospective analysis was made of data derived from case records of patients admitted as in‐patients to the Sultan Qaboos University Hospital, Oman, over a period of 8 years.

Results: A higher prevalence of DD was noted in Oman compared to western countries. The female preponderance was less marked in Oman. The most common presentations were dissociative convulsions, dissociative motor and dissociative trance disorders. Interpersonal difficulties with family and academic problems were the important identified precipitants.

Conclusion: The study highlights the characteristic clinical and psychosocial features of the dissociative phenomena in Oman.
Relation of factor‐analyzed symptom dimensions of obsessive‐compulsive disorder to personality disorders
Authors: Mataix‐Cols David , Baer Lee , Rauch Scott L. , Jenike Michael A.
Published: March 2003

Objective: To assess the relation between symptom dimensions of obsessive‐compulsive disorder (OCD) and comorbid personality disorders (PDs).

Method: The scores of 75 OCD outpatients on five previously identified symptom dimensions were entered into multiple regression models as predictors of: 1) the presence of any type of PD; 2) the number of PDs; 3) the presence of any cluster A, B or C PD; and 4) the presence of each individual PD.

Results: Twenty‐eight patients (37.3%) met criteria for one or more PDs. High scores on the ‘Hoarding’ dimension were strongly related to the presence of any Axis II diagnosis, and to the number of PDs. Cluster C PDs (especially obsessive‐compulsive and avoidant) had the highest partial correlations with ‘Hoarding’. These results were independent of OCD symptom severity.

Conclusion: Previous conflicting findings about the prevalence of certain PDs in OCD might be due in part to differences in the constitution of the particular patient groups studied.
Medication adherence in psychosis: predictors and impact on outcome.A 2‐year follow‐up of first‐admitted subjects
Authors: Verdoux H. , Lengronne J. , Liraud F. , Gonzales B. , Assens F. , Abalan F. , Os J. van
Published: March 2003

Objective: To assess the baseline characteristics predicting poor medication adherence following a first admission for psychosis, and the impact of poor medication adherence on outcome.

Method: First‐admitted subjects with psychosis (n=65) were assessed at 6‐month intervals over a 2‐year follow‐up. Medication adherence was assessed using multiple sources of information.

Results: Baseline lower occupational status, alcohol misuse and the intensity of delusional symptoms and suspiciousness predicted poor medication adherence during the 2‐year follow‐up. Over this period, subjects with poor medication adherence presented more frequently with an episodic course of illness and were more frequently readmitted, especially with regard to involuntary readmission.

Conclusion: In naturalistic conditions one out of two subjects with psychosis interrupts his/her treatment in the months following his/her first discharge from hospital. Therapeutic programmes aimed at improving medication adherence should be implemented early in the course of psychosis to reduce the deleterious consequences of poor medication adherence on clinical outcome.
The causes, consequences and detection of publication bias in psychiatry
Authors: Gilbody Simon M. , Song Fujian , Eastwood Alison J. , Sutton Alex
Published: March 2003

Objective: Publication bias threatens the validity of published research, although this topic has received little attention in psychiatry. The purpose of this article is to produce a systematic overview of the causes and consequences of publication bias and to summarize the available methods with which it is detected and corrected.

Method: Empirical evidence for the existence of publication bias is reviewed and the following methods are applied to an illustrative case example from psychiatry: funnel plot analysis; the ‘file drawer method’; linear regression techniques; rank correlation; ‘trim and fill’.

Results: Small studies are particularly susceptible to publication and related bias. All methods to detect publication bias depend upon the availability of a number of individual studies with a range of sample sizes. Unfortunately, large numbers of studies of varying sample size are not always available in many areas of psychiatric research.

Conclusion: Where possible researchers should always test for the presence of publication bias. The problem of publication bias will not be solved by anything other than a prospective trials register.
Symptom profiles of gender dysphoric patients of transsexual type compared to patients with personality disorders and healthy adults
Authors: Haraldsen IR , Dahl AA
Published: March 2003

Objective: Gender dysphoric patients of transsexual type (TS) have been considered to have severe psychopathology. However, these notions have a weak empirical documentation.

Method: TS patients (n=86), patients with personality disorder (PD, n=98) and adult healthy controls (HC, n=1068) were compared by means of the Symptom Checklist 90 (SCL‐90). All patients were diagnosed by structured interviews (Axis I, II and V of DSM‐III‐R/IV). PD patients were further characterized according to the LEAD‐standard.

Results: TS patients scored significantly lower than PD patients on the Global Symptom Index and all SCL‐90 subscales. Although the TS group generally scored slightly higher than the HC group, all scores were within the normal range.

Conclusion: TS patients selected for sex reassignment showed a relatively low level of self‐rated psychopathology before and after treatment. This finding casts doubt on the view that transsexualism is a severe mental disorder.
Predictive factors for borderline personality disorder: patients' early traumatic experiences and losses suffered by the attachment figure
Authors: Liotti G. , Pasquini P. , Cirrincione R. ,   The Italian Group for the Study of Dissociation
Published: March 2003

Objective: To test the hypothesis that serious losses in the life of the attachment figure and patients' early traumatic experiences are risk factors for the development of borderline personality disorder.

Method: A multicentric hospital‐based case–control study of 66 cases and 146 controls.

Results: We estimated an odds ratio of 2.5 (95% CI 1.1–5.8) for mothers' serious losses experienced within 2 years of patients' birth and an odds ratio of 5.3 (95% CI 2.1–13) for patients' early traumatic experiences. Both of them are adjusted for the confounding effect of the other as well as for that of age, size of family and type of patient (in‐ or out‐patient), using a multiple logistic function.

Conclusion: Mourning process in the mother within 2 years of the patient's birth and patients' early traumatic experiences are predictive factors for the development of borderline personality disorder.
Mad scenes in early 19th‐century opera
Authors: Erfurth A. , Hoff P.
Published: March 2003

Objective: It is our objective to examine the phenomenon of mad scenes in bel canto opera from a modern perspective.

Method: The development of psychiatry and music at the beginning of the 19th century is described. Common elements of romantic music and mental disorders are discussed. It is shown how bel canto composers represent psychiatric illness by musical means. The psychopathology depicted in a prototypical mad scene is evaluated.

Results: Early romantic music is characterized by imagination, illusion and loss of structure; characteristics which can be well expressed in mad scenes. While madness (withdrawal into a utopian world) gained a certain attraction in society, clinical psychiatry increasingly focused on emotional causes of illness and on drug‐induction of mental disorders.

Conclusion: Mad scenes in bel canto opera can be understood as expression of an increasing interest in emotional aspects in music and society as well as in clinical psychiatry.
The variability of phenomenology in anorexia nervosa
Authors: Ngai Emily S. W. , Lee Sing , Lee Antoinette M.
Published: March 2003

Objective: To study the variability of phenomenology in Chinese patients with anorexia nervosa in Hong Kong.

Method: Longitudinal case studies of four patients.

Results: The anorexic illness was not uniformly about the fear of fatness. Rather, patients' explanations for food refusal could change over time. A typology of anorexic phenomenology emerged; namely, fat phobic type I (fat phobia consistently present), fat phobic type II (fat phobia changing to non‐fat phobic presentation), non‐fat phobic type I (consistently non‐fat phobic) and non‐fat phobic type II (non‐fat phobic initially, but fat phobic later).

Conclusion: The variability of anorexic phenomenology challenges the current fat phobia paradigm and has implications on the diagnosis, treatment and psychometric assessment of eating disorders.
Autism and Asperger syndrome: coexistence with other clinical disorders
Authors: Gillberg and C. , Billstedt E.
Published: March 2003

Objective: To provide a clinically useful analysis of the extent to which autism and Asperger syndrome coexist with other disorders.

Method: Selective review of the literature detailing data pertaining to symptoms and disorders sometimes encountered in connection with autism or Asperger syndrome.

Results: A large number of medical conditions, psychiatric disorders and behavioural and motor dyscontrol symptoms are associated with autism and Asperger syndrome.

Conclusion: Comorbidity is to be expected in autism spectrum disorders — directly or indirectly. Comorbid conditions may be markers for underlying pathophysiology and suggest a more varied treatment approach. There is a great need for in‐depth research into this area, meaning that the exclusion criteria of current diagnostic manuals, i.e. those that rule out a diagnosis of autism in some disorders, and a diagnosis of certain other disorders in autism may have to be revised.
Assessment of dysfunctional working models of self and others in schizophrenic patients: a summary of data collected in nine nations
Authors: Perris C. , Frank N. , Gusmao R. , Henry L. , Lundberg M. , Schaub A. , Simos G. , Richter J. , Rognoni R. , Ruchkin V. , Valls J. ,   International Research Group*
Published: March 2003

Objective: To investigate the cross‐cultural feasibility of a new scale for assessing dysfunctional working models of self and others, and to evaluate its discriminative power.

Method: Schizophrenic patients (N=351), non‐psychotic patients (N=86) and non‐clinical subjects (N=511) collected in 10 centres completed the DWM‐S. Current psychopathology was assessed by means of the BPRS.

Results: Alpha coefficients were high in all samples. Mean scores on the DWM‐S appeared to be comparable in all countries, suggesting cross‐national generalizability. No significant correlation was found with sex, age, levels of psychopathology and duration of illness. Discriminant analyses showed that more than 70% of the schizophrenic patients are correctly classified.

Conclusion: The DWM‐S is an easily administered self‐report instrument which allows to pinpoint internal dysfunctional working models of self and others in various types of patients. It is a useful tool for case conceptualization, especially when psychotherapeutic interventions are part of the treatment programme.
A general population survey on patterns of benzodiazepine use and dependence in Lebanon
Authors: Naja W. J. , Pelissolo A. , Haddad R. S. , Baddoura R. , Baddoura C.
Published: March 2003

Objective: In Lebanon, benzodiazepines are often available without medical prescription. We aimed to carry out the first community‐based pharmaco‐epidemiological study on benzodiazepine consumption in the Middle East Area.

Method: The prevalence of past‐month benzodiazepine use was assessed in a 1000‐subject randomized sample from the Lebanese community, and risk factors were studied in a group of 496 current users.

Results: Benzodiazepine use during the past month was found in 9.6% of subjects. Four variables were significantly associated with use: age higher than 45 years, female sex, cigarette smoking and the existence of a recent life event. Benzodiazepine dependence was found in 50.2% of users.

Conclusion: Benzodiazepine use in Lebanon is particularly high, and can be related to well‐known factors such as female sex and age, but other potent specific variables, such as war stress or the lack of control on drug access, can be hypothesized.
Teacher‐reported problem behaviour in Turkish immigrant and Dutch children:a cross‐cultural comparison
Authors: Crijnen Alfons A. M. , Bengi‐Arslan Leyla , Verhulst Frank C.
Published: March 2003

Objective: To compare problem behaviour in Turkish immigrant children living in the Netherlands versus problem behaviour in Dutch children from the general population as reported by teachers.

Method: Teacher's Report Forms (TRF) were filled out by Dutch teachers, and for a subsample also by Turkish immigrant teachers, concerning 524 Turkish immigrant children selected randomly from the immigrant population in two large cities in the Netherlands. TRFs completed for Turkish immigrant children were compared with TRFs filled out for 1625 children selected randomly from the Dutch general population.

Results: No significant differences were revealed between children from both cultures on the TRF total problems, internalizing, externalizing and specific syndrome scales. Turkish immigrant teachers, however, reported higher total problems, internalizing and anxious/depressed scores for immigrant children than did Dutch teachers for the same immigrant children.

Conclusion: No significant differences were found in the levels of behavioural and emotional problems reported by Dutch teachers for Turkish immigrant versus Dutch children. However, Turkish immigrant teachers reported high levels of anxiety and depression in immigrant children which go largely undetected by their Dutch teachers.
Symptoms of eating disorders in obsessive‐compulsive disorder
Authors: Grabe H. J. , Thiel A. , Freyberger H. J.
Published: March 2003

Objective: Despite some empirical evidence suggesting an association between primary OCD and eating disorder (ED) within the ‘obsessive‐compulsive spectrum’, the relationship at a symptomatological level has not been investigated.

Method: First, comparisons of Eating Disorder Inventory (EDI) scores between 61 patients with primary OCD and 288 control subjects were performed. Secondly, the associations between EDI subscores and Hamburg Obsessive‐Compulsive Inventory (HZI) dimensions in OCD patients were investigated by multiple regression analyses, controlling for the impact of general psychopathology.

Results: The OCD patients showed significantly higher EDI‐scores than controls. However, only distinct OCD symptom dimensions were significantly associated with the core symptoms of ED in females.

Conclusion: Our results point to a differential gender and symptom‐specific relationship between OCD and ED, calling into question a simple dimensional conceptualization of the ‘obsessive‐compulsive spectrum’.
Factors in the onset of schizophrenia:a comparison between London andTrinidad samples
Authors: Bhugra D. , Hilwig M. , Mallett R. , Corridan B. , Leff J. , Neehall J. , Rudge S.
Published: March 2003

Objective: Sociodemographic factors play an important role in the genesis of mental disorders. High rates of unemployment and other social factors have been reported previously among African‐Caribbeans with schizophrenia in London. The aim of the present study was to compare these factors in Trinidad with London African‐Caribbeans.

Method: Using internationally defined criteria, patients with first‐onset schizophrenia were recruited in both countries, and information on the onset of symptoms, help‐seeking, pathways into care, premorbid personality and educational and employment status were collected. These two samples are compared on a number of these factors. A total of 56 cases of first onset of psychosis coming into contact with psychiatric services in Trinidad were studied. Of these, 46 cases were diagnosed as having schizophrenia using the CATEGO program. Over a period of 2 years, 38 African‐Caribbean patients with schizophrenia were recruited in London.

Results: African‐Caribbean patients with schizophrenia in London were more likely to be admitted for perceived threat to others and to have shown loss of interest and serious neglect and to have assaulted others. A lower proportion were admitted via a psychiatrist and a higher proportion by the police. The unemployment rate among the London sample of African‐Caribbeans was much higher than that in the general population, whereas this was not the case for the Trinidad patients.

Conclusion: These findings are discussed in the context of culture and aetiology of schizophrenia, and suggestions with regard to future research are made.
Co‐occurrence of Axis I and Axis II disorders in substance abusers
Authors: Verheul R. , Kranzler H. R. , Poling J. , Tennen H. , Ball S. , Rounsaville B. J.
Published: March 2003

Objective:This study examined the co‐occurrence of anxiety/mood and personality disorders (PDs) in substance abusers, the impact of anxiety/mood disorders on the symptom profiles of PDs, and the impact of anxiety/mood disorders and PDs on pre‐treatment status.

Method:Current anxiety/mood disorders and PDs and pre‐treatment status were assessed using semi‐structured interviews in 370 treated substance abusers.

Results:Anxiety/mood disorders and PDs frequently co‐occurred, with the overall pattern of associations being non‐specific. The strongest associations were of social phobia with avoidant and schizotypal PD, and of major depression with borderline PD. However, symptom profiles of PDs were not associated with anxiety/mood disorders. Finally, anxiety/mood disorders and PDs were both independently and differentially associated with poor pre‐treatment characteristics.

Conclusion:The findings suggest the clinical importance of obtaining both Axis I and Axis II diagnoses in treated substance abusers, and highlight the distinctiveness of the Axis I and Axis II disorders.
Are neurological abnormalities in schizophrenic patients and their siblingsthe result of perinatal trauma?
Authors: Cantor‐Graae E. , Ismail B. , McNeil T. F.
Published: March 2003

Objective: Previous findings of increased neurological abnormalities in schizophrenic patients and their non‐psychotic siblings raise the question of possible causes. The purpose of the present study was to examine the role of perinatal trauma in the aetiology of neurological abnormality.

Method: Obstetric information obtained from hospital records for 55 schizophrenic patients and 19 non‐psychotic siblings was scored blindly and separately from a neurological assessment of hard and soft signs.

Results: Obstetric complications (OCs) were significantly increased in patients but not in siblings compared to their respective neonatal control groups. Neurological abnormalities were related to OCs in siblings but not in patients. Neurological abnormalities in patients were negatively related to reduced neonatal head circumference.

Conclusion: Early somatic trauma may increase the probability of neurological abnormality in individuals who are genetically ‘at risk’.
Outcome of schizophrenia in a non‐industrialized society: comparative study between Bali and Tokyo
Authors: Kurihara T. , Kato M. , Reverger R. , Yagi G.
Published: March 2003

Objective: The aim of the present study was to contrast the outcome of schizophrenic patients between Bali and Tokyo, the former being a non‐industrialized society and the latter an industrialized society in Asia. Method: A total of 51 Balinese schizophrenics and 40 schizophrenics in Tokyo were evaluated by five outcome measures at a 5‐year follow‐up. Results: No significant difference was found in the mean scores of the Positive and Negative Syndrome Scale, Eguma's Social Adjustment Scale and the re‐admission rates between the subjects in the two sites. The cumulative length of stay in hospital during the 5‐year period was significantly shorter in Bali. The percentage of subjects on psychiatric medication at the follow‐up was significantly lower in Bali than that in Tokyo. Conclusion: Although the clinical outcome of schizophrenics in Bali was not superior to that in Tokyo, the subjects in Bali tended to be able to live in society without neuroleptic medication.
Potential for misdiagnosis amongTurkish migrants with psychotic disorders:a clinical controlled study in Germany
Authors: Haasen C. , Yagdiran O. , Mass R. , Krausz M.
Published: March 2003

Objective: The elevated rate of schizophrenia among migrants has been explained in part by possible misdiagnosis. In this study an attempt is made to quantify the extent of potential misdiagnosis among migrants in comparison to non‐migrants. Method: One hundred patients of Turkish origin (Tr‐Pat) and a control group of 50 patients of German origin (G‐Pat), all with a paranoid‐hallucinatory syndrome upon admission, were examined by an interviewer of Turkish origin (Tr‐Int), an interviewer of German origin (G‐Int) and the clinican. The diagnostic evaluation was then compared. Results: Nineteen per cent of Tr‐Pat and 4% of G‐Pat showed diagnostic disagreement between the three raters, while in 8% of Tr‐Pat and 0% of G‐Pat the two research diagnoses disagreed. In Tr‐Pat with ‘bad’ German knowledge showed tendentially more (29%) diagnostic disagreement than Tr‐Pat with ‘good’ German knowledge (17%). Conclusion: The rate of potential misdiagnosis is higher among migrants, yet not strongly correlated to poor second language proficiency.
Extrapyramidal symptoms and oestrogen
Authors: Thompson K. N. , Kulkarni J. , Sergejew A. A.
Published: March 2003

Objective: The present study aimed to investigate neuroleptic side‐effect severity in women with psychosis, and to investigate their putative association with variations in sex steroids over the menstrual cycle. Based on the oestrogen hypothesis, which postulates a synergistic relationship between oestrogen and neuroleptics, it was hypothesized that oestrogen would exacerbate extrapyramidal symptoms.

Method: Twenty‐five psychotic women were assessed using the ESRS and blood hormone analysis. Testing was conducted twice, 2 weeks apart, in a randomized cross‐over design.

Results: Contrary to expectation the results indicated that high levels of oestrogen reduce hyperkinetic symptoms in women with psychosis, and this effect appears to be further potentiated when both estrogen and progesterone are high.

Conclusion: On the basis of these findings, and receptor studies in animals, it was concluded that oestrogen has different effects on dopamine dynamics in the mesolimbic and mesostriatal pathways.
Association between oestradiol and puerperal psychosis
Authors: Ahokas A. , Aito M. , Turtiainen S.
Published: March 2003

Objective: Postpartum psychiatric disorders with long‐lasting adverse sequelae are common during the childbearing years. These disorders can be severe and resistant to conventional psychiatric treatment methods. We present two consecutive cases with puerperal psychosis who were refractory to conventional treatment methods but responded successfully to oestrogen therapy.

Method: Serum oestradiol concentration was measured by radioimmunoassay and the documented oestradiol deficiency replaced with physiological oestradiol sublingually. The treatment effect was evaluated by the Brief Psychiatric Rating Scale.

Results: In both cases the baseline oestradiol concentration was low (28 and 69 pmol/L). During the treatment with oestradiol, there was a concomitant elevation of the concentration of serum oestradiol, which coincided with the decline in psychotic symptoms.

Conclusion: The observation of low serum oestradiol together with psychotic symptoms and successful treatment with oestradiol suggests that oestradiol may have a causal relevance to puerperal psychosis and significance in the treatment of this condition.
Suicide mortality in mental retardation:a 35‐year follow‐up study
Authors: Patja Kristiina , Iivanainen Matti , Raitasuo Seija , Lönnqvist Jouko
Published: March 2003

Objective: We investigated suicide mortality among people with mental retardation (MR) over a period of 35 years.

Method: The nationwide, population‐based cohort of 2369 people with MR was followed‐up from a representative sample of 9.4% of the population in Finland in 1962. The standardized mortality ratio of suicides was calculated and case studies of all MR suicides based on all available data were performed.

Results: Women with MR had an equal suicide risk to Finnish women in general, while men had only one‐third of the population risk. Risk factors for suicide were similar to those in the general population. Most suicide victims had mild MR and were hospitalized for comorbid mental disorders. Suicide methods were passive and alcohol was involved in only one case.

Conclusion: Suicide mortality in MR is significantly lowered among males. Suicide prevention in MR should be focused on people with comorbid mental disorders. Problems in adjustment to new circumstances need to be recognized. Appropriate and adequate treatment of comorbid depression is emphasized.
Criminality and aggression among psychotic in‐patients: frequency and clinical correlates
Authors: Tuninger E E. , Levander S. , Bernce R. , Johansson G.
Published: March 2003

Objective: Violence is common among patients with psychoses. The aim of the study was to examine relations between diagnoses, crimes, demographic variables and aggressive behaviour during admission to hospital.

Method: During 14 months 257 patients were consecutively referred to a unit with high staff/patient ratio. They were assessed for clinical symptoms at admittance and discharge. Also legal status, coercive measures, criminality and sentences were examined.

Results: Of the 257 patients, 38% were found in the police register and 33% had been prosecuted. Those patients committed 2525 crimes, including 292 acts of violence. Problems during admittance were related more to positive symptoms at admittance than to earlier criminality.

Conclusion: Criminality rate is high among patients with functional psychoses. Many patients, especially women, had never been evaluated by a forensic psychiatrist. The psychiatric services have to consider the importance of preventing psychotic relapses and thereby also preventing violence and criminality.
Comparison of four groups of substance‐abusing in‐patients with different psychiatric comorbidity
Authors: Hättenschwiler J. , Rüesch P. , Modestin J.
Published: March 2003

Objective:  Comparisons of different groups of dual patients are rare, yet potential differences could have therapeutic implications. In this study, four groups of psychiatric in‐patients with substance use disorder were compared to each other: patients with no psychiatric comorbidity, patients with comorbid schizophrenia and patients with affective and personality disorder.

Method:  Apart from sociodemographic, therapy‐related variables and a detailed survey of their substance use, all subjects were assessed with BPRS and SCL‐90‐R.

Results:  No differences were found in the patients' demography, psychosocial adjustment and substance consumption career. Significant differences were found in regard to some therapy variables reflecting adherence to treatment and global outcome and to the level of psychopathology.

Conclusion:  Both substance use and comorbid psychiatric disorder have a variable impact on distinct areas of patients' general condition and functioning. The group with comorbid affective disorder appeared to be the most difficult to treat and the therapeutic approach to this disorder deserves reconsideration.
Naltrexone as a treatment of self‐injurious behavior — a case report
Authors: Griengl H. , Sendera A. , Dantendorfer K.
Published: March 2003

Objective: Self‐injurious behavior (SIB) is a phenomenon associated with different psychopathological conditions such as psychosis, mental retardation and especially severe personality disorders — mainly of the borderline subtype. It has been suggested that a blockade of the endogenous opioid system might lead to a reduction of the urge to SIB.

Method: The case and successful treatment of SIB with naltrexone in a patient with borderline personality disorder and dysthymia is described.

Results: After treatment trials with neuroleptics, antidepressants and valproate the patient was treated with naltrexone in a dosis of 50 mg/day and did not show SIB over a follow‐up period of 32 weeks.

Conclusion: Naltrexone could be effective in reducing SIB in patients with psychiatric disorders by blocking the positive reinforcement of SIB, which is reached by the release of endogenous opioides. Placebo‐controlled studies of the efficacy of naltrexone in treating SIB should be undertaken.
Quality of life in treated and never‐treated schizophrenic patients
Authors: Green Carla A. , Fenn Darien S. , Moussaoui Driss , Kadri Nadia , Hoffman William F.
Published: March 2003

Objective: To evaluate quality of life (QOL) among treated and never‐treated schizophrenic patients.

Method: QOL ratings were obtained for (a) 112 Moroccan participants with schizophrenia who had never received neuroleptic medications, (b) matched samples of chronically‐medicated schizophrenic patients in Morocco and the United States and (c) matched community controls in both countries.

Results: QOL ratings were generally higher for US groups, although Moroccan controls obtained higher ratings than US controls for some domains. QOL ratings were higher for controls compared to patients within each country, although US patients' scores were similar to controls on some dimensions. We found no differences between treated and untreated Moroccan patients for any QOL domain, although relationships among predictors were different.

Conclusion: Within the context of Moroccan culture, benefits of medications alone are not evident in QOL scores. QOL appears to be a complex construct influenced by different factors within each of the groups studied.
The validity of proxy‐based data in suicide research: a study of patients 50 years of age and older who attempted suicide.  II. Life events, social support and suicidal behavior
Authors: Conner Kenneth R. , Conwell Yeates , Duberstein Paul R.
Published: March 2003

Objective: To investigate the validity of proxy respondent reports of stressful life events, social support and suicidal behavior among individuals who attempted suicide.

Method: Subjects were 80 psychiatric in‐patients admitted following a suicide attempt. Data based on structured interviews with proxy respondents were compared with data based on interviews with subjects (gold standard).

Results: Specificity was higher than sensitivity across life event categories, and agreement was substantial for public and observable events (e.g. parent's death) but lower for more ambiguous events. Proxies were good judges of subject reports of frequency of social interaction but not perceived emotional support. Proxies were good judges of past history of suicide attempts and level of suicidal intent.

Conclusion: Results support proxy‐based data on suicidal behavior and certain aspects of social support and stressful life events in research of suicidal behavior in this age group, with potential implications for interpreting postmortem research of completed suicide.
Neuropsychological impairment in patients treated with depot neuroleptics:a longitudinal study
Authors: Tuninger E. , Levander S.
Published: March 2003

Objective: To assess neuropsychological impairments among chronic functional psychotic patients over time, and relations with symptoms, drug dose and side effects.

Method: Thirty‐four patients, representative of the most ill one‐third of all patients with chronic functional psychoses known to the psychiatric services in a city catchment area, were assessed for clinical symptoms, drug side effects and by neuropsychological tests at study entry. They were then assessed repeatedly over 2 years.

Results: All patients were seriously impaired in the tests. The impairment was stable over time, in spite of substantial changes in the clinical state. The impairment was unrelated to drug and drug dose. Patients with prominent negative symptoms were most impaired and most unable to rate their performance in the tests.

Conclusion: Patients with chronic functional psychoses do relapse often, also late in the course of the disease. Negative symptoms, marked impairments in simple neuropsychological tests and impaired self‐monitoring went together.
Working memory in schizophrenia and mania: correlation with symptoms during the acute and subacute phases
Authors: McGrath John , Chapple Ben , Wright Margie
Published: March 2003

Objective: The aims of this study were to examine working memory in the acute–subacute phase of schizophrenia and mania and to examine correlations between working memory and specific symptom domains.

Method: Visuospatial working memory and symptom profiles were assessed in three groups (schizophrenia group, n=19; mania, n=12; controls, n=19) on two occasions separated by 4 weeks.

Results: Both patient groups had significant deficits on working memory compared to the well controls and the schizophrenia and mania groups were equally impaired. All groups showed equivalent improvement over time. In the patient groups, impaired working memory was significantly correlated with the presence of both negative symptoms and positive thought disorder.

Conclusion: Impaired working memory is found in both schizophrenia and mania during the acute–subacute phases. Further research is required in order to clarify the neurocognitive mechanisms linking impaired working memory with both negative symptoms and positive thought disorder.
Depression in relation to age and gender in the general population: the Nord‐Trøndelag Health Study (HUNT)
Authors: Stordal E. , Bjartveit Krüger M. , Dahl N. H. , Krüger Ø. , Mykletun A. , Dahl A. A.
Published: March 2003

Objective: Previous sample studies of depression have shown a higher prevalence of depression in women, and an inconsistent relation to age has been found for both genders. The aim of the present study was to investigate depression in relation to gender and age in the general adult population.

Method: Of the total population of 92 100 individuals aged 20–89 years and living in Nord‐Trøndelag county of Norway, 62 344 (67.7%) filled in valid ratings of depression on the Hospital Anxiety and Depression Scale (HADS).

Results: Minimal gender difference was found in dimensional depression scores and in prevalence rates of depression. Both these measures were found to increase continuously with age in both genders.

Conclusion: Our results of this population‐based study differ from most sample studies reported, and these discrepancies are discussed with focus on study design, self‐rating, and the concept of depression covered by HADS.
Early detection and intervention in first‐episode schizophrenia: a critical review
Authors: Larsen T. K. , Friis S. , Haahr U. , Joa I. , Johannessen J. O. , Melle I. , Opjordsmoen S. , Simonsen E. , Vaglum P.
Published: March 2003

Objective: To review the literature on early intervention in psychosis and to evaluate relevant studies.

Method: Early intervention was defined as intervention in the prodromal phase (primary prevention) and intervention after the onset of psychosis, i.e. shortening of duration of untreated psychosis (DUP) (secondary prevention).

Results: We found few studies aimed at early intervention, but many papers discussing the idea at a more general level. We identified no studies that prove that intervention in the prodromal phase is possible without a high risk for treating false positives. We identified some studies aimed at reducing DUP, but the results are ambiguous and, until now, no follow‐up data showing a positive effect on prognosis have been presented.

Conclusion: Early intervention in psychosis is a difficult and important challenge for the psychiatric health services. At the time being reduction of DUP seems to be the most promising strategy. Intervention in the prodromal phase is more ethically and conceptually problematic.
Raised levels of plasma interleukin‐1β in major and postviral depression
Authors: Owen B. M. , Eccleston D. , Ferrier I. N. , Young H.
Published: March 2003

Objective: Interleukin‐1β (IL‐1β) is released as part of the acute phase immune response and can directly stimulate the release of corticotrophin‐releasing hormone and thus induce hypothalamic–pituitary–adrenal axis hyperactivity. Major depression has been shown to be accompanied by both an acute phase immune response, including raised IL‐1β production and hypothalamic–pituitary–adrenal axis hyper‐activity. In this study the possible role of IL‐1β in major depression and postviral depression was investigated.

Method: Plasma IL‐1β levels were measured in four groups; patients suffering from postviral depression (n=17), patients with major depression (n=20), subjects who were postviral and euthymic (n=12) and normal controls (n=20).

Results: IL‐1β serum concentrations were significantly elevated in both groups of depressed patients compared to controls. The serum concentrations of IL‐1β were higher in the postviral group than in the major depression group; this difference was not significant.

Conclusion: These data confirm previous suggestions of elevated IL‐1β levels in major depression and postviral depression. IL‐1β is known to induce depressive symptoms as well as sickness behaviour and may contribute to the hypothalamic–pituitary–adrenal axis hyperactivity found in mood disorders.
Psychopharmacological treatment and psychiatric morbidity in 390 cases of suicide with special focus on affective disorders
Authors: Andersen U. A. , Andersen M. , Rosholm J. U. , Gram L. F.
Published: March 2003

Objective: The aim of this study was, on the basis of data from health‐care registers, to describe the adequacy of psychopharmacological treatment in suicides.

Method: Data on consecutive suicides in a Danish County (Funen) in the period of 1 April 1991–31 December 1995 were identified in the Danish Psychiatric Central Register, the National Patient Register, the National Health Insurance and Odense University Pharmacoepidemiological Database.

Results: Twenty‐five per cent of the suicides previously hospitalized due to affective disorders and 3% of the suicides without psychiatric hospitalizations at all, received an apparently adequate treatment with antidepressants the month before suicide.

Conclusion: The most striking finding was the insufficiency of treatment with antidepressants in the group of suicides without psychiatric hospitalization, in particular in light of the fact that depression is assumed to be present in at least 50% of all suicides.
Mortality among homeless people with schizophrenia in Sydney, Australia:a 10‐year follow‐up
Authors: Babidge N. C. , Buhrich N. , Butler T.
Published: March 2003

Objective: The aims were first, to describe deaths in a cohort of homeless people compared to the general population and secondly, to compare deaths among the individuals with schizophrenia to those without schizophrenia.

Method: Mortality was assessed in a cohort of 708 homeless subjects, 506 with schizophrenia who were referred 10 years previously to psychiatric outreach clinics. Standardized mortality ratios (SMRs) were calculated.

Results: Eighty‐three people (12%) had died, 19 from suicide. The SMR was 3.76 for homeless men and 3.14 for homeless women. There was a non‐significant trend for higher excess mortality among men without schizophrenia compared to men with schizophrenia. SMRs for suicide were significantly elevated among homeless men.

Conclusion: Homeless people in inner Sydney have death rates three to four times higher than people in the general population of New South Wales. Excess mortality was greatest for younger age groups.
Sociopsychiatric characteristics of adolescents who use computers to excess
Authors: Yang Chang‐Kook
Published: March 2003

Objective: This study attempted to investigate current computer use by Korean adolescents, consequences of its excessive use and its relationship to psychiatric symptoms.

Method: Questions for computer use, Computer‐Related Addictive Behavior Inventory (CRABI), computer‐induced behavioral alterations and Symptom Checklist‐90‐Revision (SCL‐90‐R) were assessed in 1296 students (12–19 years).

Results: Students were divided into three group users: minimal users (63.4%), moderate users (30.5%) and excessive users (6.1%). Computer‐induced behavioral alterations occurred most frequently to excessive users and it was significantly correlated with total CRABI score. Average score on nine symptom dimensions and three global indexes of SCL‐90‐R were able to discriminate four decreasing orders of subjective psychiatric complaints: most frequent in excessive users and then moderate, non‐ and mild users, in order.

Conclusion: Those adolescents with excessive computer use were found to show serious sociopsychiatric problems.
Impact of phase‐specific treatment of first episode of psychosis on Wisconsin Quality of Life Index (client version)
Authors: Malla Ashok K. , Norman Ross M. G. , McLean Terry S. , McIntosh Elizabeth
Published: March 2003

Objective: The objective of this study was to assess the impact of a phase‐specific community‐focused treatment program on different dimensions of self‐reported quality of life in a representative sample of first episode psychosis patients.

Method: Data were collected on patients presenting with a first episode of psychosis on the Wisconsin Quality of Life Index (client version), positive and negative symptoms, and demographic and clinical variables at baseline following clinical stabilization and at 1 year.

Results: Complete data on a representative sample of 41 patients showed a significant improvement in most dimensions of the WQOL at 1 year; these changes were generally independent of changes in symptoms and there were no significant differences in the magnitude of improvement in QOL between those with DUP < or >6 months.

Conclusion: Patients with a first episode of predominantly schizophrenia spectrum psychosis show a highly significant improvement in subjectively assessed quality of life following a year of phase‐specific comprehensive treatment.
Cognitive behaviour therapy with coping training for persistent auditory hallucinations in schizophrenia: a naturalistic follow‐up study of the durability of effects
Authors: Wiersma D. , Jenner J. A. , Van De Willige G. , Spakman M. , Nienhuis F. J.
Published: March 2003

Objective: To investigate the durability of positive effects of cognitive behaviour therapy (CBT) with coping training on psychotic symptoms and social functioning.

Method: Forty patients with schizophrenia or related psychotic disorders and refractory auditory hallucinations were given CBT and coping training in an integrated single family treatment programme. In a naturalistic study patients were followed after 2 and 4 years since the start of treatment.

Results: The treatment improved overall burden of ‘hearing voices’, with a generalization into daily functioning. Improvement with regard to fear, loss of control, disturbance of thought and interference with thinking was sustained by 60% of the patients while one‐third improved further. Complete disappearance of hallucinations occurred in 18% of the patients.

Conclusion: CBT with coping training can improve both overall symptomatology and quality of life, even over longer periods of time, but a status of persistent disablement indicates a continuing need for mental health care.
Lithium intoxication secondary to unrecognized pontine haemorrhage
Authors: Novak‐Grubic V. , Tavcar R.
Published: March 2003

Lithium prophylaxis carries a substantial risk of medical complications, especially in the case of concomitant medical conditions. We describe a patient with unrecognized cerebrovascular haemorrhage, admitted to hospital due to lithium intoxication.