bluuebunny/crossref_metadata_2025 huggingface dataset:
Childhood Sexual Experiences with Adults
Authors: Palmer Robert L. , Coleman Linda , Chaloner Deborah , Oppenheimer Rhoda , Smith Jennifer
Published: October 2008

Reports of childhood sexual experiences with adults were collected from 120 women attending general-practice surgeries and 115 women psychiatric patients. The method of study, research team and county of residence were the same for the two groups. The psychiatric patients tended to report rates of events higher than the general-practice attenders by a factor of 2–3. The results suggest an association between such experiences and later psychiatric patienthood and are compatible with a causal role for them in some cases.
Prognosis of Depression in the Elderly
Authors: Brodaty Henry , Harris Lynne , Peters Karin , Wilhelm Kay , Hickie Ian , Boyce Philip , Mitchell Philip , Parker Gordon , Eyers Kerrie
Published: October 2008

The prognosis of depression in the elderly was investigated in a mixed-age sample of 242 consecutive referrals, with DSM-III defined unipolar major depressive episode, to a specialist unit for mood disorders. Subjects were followed up at about 1 and 3.8 years. There was no significant difference in outcome between younger (under 40 years), middle aged (40–59 years) and older (60 years or more) depressed patients. For the 61 elderly subjects with depression, prognosis improved with time, with 25% having a lasting recovery at the first and 41% at the second follow-up. Early onset, recurrence, and poor premorbid personality were associated with a worse prognosis. Three (5%) elderly depressives had committed suicide and seven (11%) had died from natural causes by the second follow-up. Despite some methodological limitations, our findings suggest a more optimistic outlook and the need for longer, more assertive treatment for elderly, depressed patients.
Computerised Tomography in Newly Diagnosed Schizophrenia and Schizophreniform Disorder
Authors: Rubin Pia , Karle Agnete , Hemmingsen Ralf , Noring Ulla , Møller-Madsen Susanne , Hertel Charlotte , Povlsen Uffe Juul
Published: October 2008

Patients with newly diagnosed schizophrenia (n = 27) or schizophreniform disorder (n = 22) and 24 healthy volunteers were investigated by CT scan, the investigators being blind to subject status. The patients had never received medication or had been treated only briefly with neuroleptics. The patients had significantly smaller brain volume and brain length than the controls. The patients had greater sulcal enlargement in the case of both Sylvian and interhemispheric fissures and surface sulci in the frontal and parietal regions. The sulcal enlargement was more pronounced in male patients and on the left hemisphere. The study revealed no enlargement of the lateral ventricles and only a trend towards enlargement of the third ventricle in the patients. The findings were not explained by substance abuse or level of education.
Persistence of the Decline in the Diagnosis of Schizophrenia Among First Admissions to Scottish Hospitals from 1969 to 1988
Authors: Geddes John R. , Black Roger J. , Whalley Lawrence J. , Eagles John M.
Published: October 2008

Age-standardised rates were calculated for first admissions to hospital in Scotland with ICD-9 diagnoses of schizophrenia, affective psychoses, paranoid psychoses, reactive psychoses and depressive neuroses (ICD-9 295, 296, 297, 298 and 300.4) for the period 1969–88. First-admission rates for schizophrenia declined by an average of 3.3% per year in males and 4.4% per year in females over the period. The first-admission rate in males in 1988 was 8.4/100 000 (57% of 1969 rate) and in females was 4.8/100 000 (43% of 1969 rate). Rates for depressive neuroses, affective psychoses, reactive psychoses and combined psychoses also fell. Rates for mania rose, as did those for paranoid states in males. The decrease in first-admission rates is likely to reflect a true decrease in the incidence of schizophrenia over the period. The decline was unlikely to be accounted for by diagnostic change because there was no reciprocal increase in any other diagnosis sufficient to account for the change, and the rates for combined psychoses also decreased. There was evidence that rates for schizophrenia declined to a greater extent in younger age groups, especially in females. This could imply the presence of a birth cohort effect.
Prader-Willi Syndrome and Psychoses
Authors: Clarke David J.
Published: October 2008

Prader-Willi syndrome (PWS) is associated with an insatiable appetite and (often) other maladaptive behaviours (self-injury, sleep disorders, insistence on routines, and temper tantrums). Psychoses are not a recognised feature. Most affected people have a chromosome 15 abnormality (deletion, disomy, structural rearrangement, etc.). Three people with PWS who developed psychotic disorders in early adult life are described. The nature of the psychoses and the significance of the association are discussed.
Negative Features, Retrieval Processes and Verbal Fluency in Schizophrenia
Authors: Allen Heidi A. , Liddle Peter F. , Frith Christopher D.
Published: October 2008

Twenty chronic schizophrenic patients, ten matched normal controls and nine depressed controls performed categorical verbal fluency tasks for three minutes each on five separate occasions. On each occasion the schizophrenic patients generated significantly fewer words than the controls. Comparison of the different occasions showed that the schizophrenic patients had as many words available in their inner lexicons but were inefficient in retrieving them. The schizophrenic patients also generated fewer clusters of related words and more words outside the specified category. Reduced ability to generate words while the lexicon remained intact was more marked in patients with negative features. Patients with incoherence, in contrast, were more likely to produce inappropriate words. We propose that both poverty of speech and incoherence of speech reflect problems in the retrieval of words from the lexicon. To cope with these problems patients with poverty of speech terminate their search prematurely while the patients with incoherence commit errors in selecting words for output.
Treatment of Cocaine Abuse with Monoamine Oxidase Inhibitors
Authors: Brewer Colin
Published: October 2008

A cocaine-abusing patient was treated with phenelzine and tranylcypromine, under supervision, as deterrent drugs; other medical and psychological treatments had fated. When he eventually risked using cocaine there was no hypertensive reaction. Nevertheless, the deterrent effect seemed helpful in breaking his pattern of cocaine use, as confirmed by hair analysis for cocaine.
Antidepressant Effect of Lithium in Patients with Systemic Lupus Erythematosus and Cerebral Infarction, Treated with Corticosteroid
Authors: Terao Takeshi , Mizuki Tunetaka , Ohji Taro , Abe Kazuhiko
Published: October 2008

Two depressive patients with systemic lupus erythematosus (SLE) and cerebral infarction, while being treated with corticosteroid, are described. In both cases, lithium was remarkably effective and no severe side-effects occurred. These findings suggest that lithium can be a useful antidepressant agent in the treatment of depressive SLE patients.
Debt and Deliberate Self-poisoning
Authors: Hatcher Simon
Published: October 2008

This study is a descriptive survey of financial difficulties in a consecutive series of patients who deliberately poisoned themselves. Over three months 160 such patients presented to the liaison psychiatry service at Leeds General Infirmary. Information was available on 147 of these patients, of whom 54 (37%) had problem debts. Patients in debt were more likely to harm themselves with greater suicidal intent and, after the episode, to report more symptoms of depression and hopelessness. Psychiatrists were more likely to diagnose mental illness in those in debt.
Acute Dystonic Reactions Complicated by Psychotic Phenomena
Authors: Thornton A. , McKenna P. J.
Published: October 2008

Four schizophrenic patients are reported in whom the acute development of dystonic muscle spasms, usually involving gaze deviation, was accompanied by the exacerbation or appearance of psychotic symptoms. In all cases the relationship between the neurological and psychiatric phenomena was close, and sometimes the presentation was bizarre or dramatic. The similarity of these states to the complex neuropsychiatric disturbances seen in post-encephalitic Parkinsonism is emphasised.
Psychotic Men Remanded in Custody to Brixton Prison
Authors: Robertson Graham , Dell Susanne , James Katie , Grounds Adrian
Published: October 2008

All referrals to medical officers in Brixton Prison over a five-month period in 1989 were examined. This paper reports the progress through this remand prison of those men who were considered to be suffering from a major psychiatric disorder. Many men had been charged with relatively minor offences. The net effect of medical intervention was to delay release from custody. Because of the administrative delays inherent in the system of medical referral and hospital admission under section 37 of the Mental Health Act 1983, it was those prisoners who were most ill who tended to remain in prison for the longest periods. Judged in terms of its efficiency to ensure speedy treatment for mentally ill remanded offenders, the present system is regarded as cumbersome and extremely inefficient. It is suggested that greater use should be made of section 48 of the 1983 Act to divert mentally ill, remanded offenders from prison.
Whorwell et al's “Physiological Effects of Emotion: Assessment Via Hypnosis”
Authors: Rogers T. D. , Waxman David
Published: October 2008

“Assessment of the physiological effects of physical and emotional stress has been hampered by a lack of suitable laboratory techniques. Since hypnosis can be used safely to induce specific emotional states of considerable intensity, we studied the effect on distal colonic motility of three hypnotically induced emotions (excitement, anger, and happiness) in 18 patients aged 20–48 years with irritable bowel syndrome. Colonic motility index was reduced by hypnosis on its own (mean change 19.1; 95% CI 0.8, 37.3; P < 0.05) and this change was accompanied by decreases in both pulse (12; 8, 15) and respiration (6; 4, 8) rates (P < 0.001 for both). Anger and excitement increased the colonic motility index (50.8; 29.4, 72.2; and 30.4; 8.9, 51.9, respectively; P < 0.01 for both), pulse rate (26; 22, 30; and 28; 24, 32; P < 0.001 for both), and respiration rate (14; 12, 16; and 12; 10, 14; P < 0.001 for both). Happiness further reduced colonic motility although not significantly from that observed during hypnosis alone. Changes in motility were mainly due to alterations in rate than in amplitude of contractions. Our results indicate that hypnosis may help in the investigation of the effects of emotion on physiological functions; this approach could be useful outside the gastrointestinal system. Our observation that hypnosis strikingly reduces fasting colonic motility may partly explain the beneficial effects of this form of therapy in functional bowel disorders.”
Psychiatric Presentation of Crohn's Disease
Authors: Rickards H. , Prendergast M. , Booth I. W.
Published: October 2008

Four children presented to child psychiatric clinics with a variety of symptoms. They were all later recognised as having Crohn's disease. There was a significant delay between the onset of symptoms and diagnosis, compared with a control group of patients with Crohn's disease whose presentation was with predominantly gastrointestinal symptoms, which was associated with evidence of increased morbidity. Children with abdominal and psychiatric symptoms occurring in combination need serial assessments of physical status, including height and weight, and measurements of inflammatory and nutritional status.
A. I. F. Scott & C. P. L. Freeman's “Edinburgh Primary Care Depression Study”
Authors: Scott J. , Moon C. A. L. , Blacker C. V. R. , Thomas J. M.
Published: October 2008

“Objective - To compare the clinical efficacy, patient satisfaction, and cost of three specialist treatments for depressive illness with routine care by general practitioners in primary care. Design - Prospective, randomised allocation to amitriptyline prescribed by a psychiatrist, cognitive behaviour therapy from a clinical psychologist, counselling and case work by a social worker, or routine care by a general practitioner. Subjects and setting - 121 patients aged between 18 and 65 years suffering depressive illness (without psychotic features) meeting the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition for major depressive episode in 14 primary care practices in southern Edinburgh. Main outcome measures - Standard observer rating of depression at outset and after four and 16 weeks. Numbers of patients recovered at four and 16 weeks. Total length and cost of therapist contact. Structured evaluation of treatment by patients at 16 weeks. Results - Marked improvement in depressive symptoms occurred in all treatment groups over 16 weeks. Any clinical advantage of specialist treatments over routine general practitioner care were small, but specialist treatment involved at least four times as much therapist contact and cost at least twice as much as routine general practitioner care. Psychological treatments, especially social work counselling, were most positively evaluated by patients. Conclusions - The additional costs associated with specialist treatments of new episodes of mild to moderate depressive illness presenting in primary care were not commensurate with their clinical superiority over routine general practitioner care. A proper cost-benefit analysis requires information about the ability of specialist treatment to prevent future episodes of depression.”
Functional Anatomy of Obsessive–Compulsive Phenomena
Authors: McGuire P. K. , Bench C. J. , Frith C. D. , Marks I. M. , Frackowiak R. S. J. , Dolan R. J.
Published: October 2008

Regional cerebral blood flow was measured with H215O positron emission tomography in four patients with obsessive–compulsive disorder. Patients were scanned on 12 occasions in the same session, with each scan paired with brief exposure to one of a hierarchy of contaminants that elicited increasingly intense urges to ritualise. The relationship between symptom intensity and regional cerebral blood flow (rCBF; an index of neural activity) was subsequently examined in the group and in individual patients. The group showed significant positive correlations between symptom intensity and blood flow in the right inferior frontal gyrus, caudate nucleus, putamen, globus pallidus and thalamus, and the left hippocampus and posterior cingulate gyrus. Negative correlations were evident in the right superior prefrontal cortex, and the temporoparietal junction, particularly on the right side. The pattern in single subjects was broadly similar, although individual differences in neural response were also observed. A graded relationship between symptom intensity and regional brain activity can thus be identified in obsessive–compulsive disorder. It is hypothesised that the increases in rCBF in the orbitofrontal cortex, neostriatum, global pallidus and thalamus were related to urges to perform compulsive movements, while those in the hippocampus and posterior cingulate cortex corresponded to the anxiety that accompanied them.
Behavioural Family Management in Schizophrenia
Authors: Randolph Eugenia T. , Eth Spencer , Glynn Shirley M. , Paz George G. , Leong Gregory B. , Shaner Andrew L. , Strachan Angus , Vort Walter Van , Escobar Javier I. , Liberman Robert P.
Published: October 2008

To test further the highly successful outcomes of a controlled study of in-home behavioural family management (BFM) for schizophrenic patients, a clinic-based version of this intervention was compared with customary care alone for 41 schizophrenic patients in a Veterans Administration (VA) mental health clinic. Monthly Brief Psychiatric Rating Scale (BPRS) ratings, conducted by clinic psychiatrists who were ‘blind’ to the patients' assignment, revealed that 3 (14%) patients who received behavioural family management as well as customary care, as compared with 11 (55%) patients who received customary care alone, had symptomatic exacerbations during the first year of treatment.
Prevalence of Australia Antigen (HBsAg) in Institutionalised Patients with Psychosis
Authors: Chaudhury S. , Chandra S. , Augustine M.
Published: October 2008

In a study of 100 institutionalised patients with psychosis and an equal number of age- and sex-matched healthy controls from the same regional background, the prevalence of Australia antigen (HBsAg) was 11 and 2, respectively. Institutionalised psychotic patients are a high-risk group for hepatitis B virus infection.
Imprinting and Anticipation
Authors: Asherson Philip , Walsh Cathy , Williams Julie , Sargeant Mathew , Taylor Celia , Clements Alison , Gill Michael , Owen Michael , McGuffin Peter
Published: October 2008

Among 29 multiply affected pedigrees, age of onset among parents and offspring was examined for evidence of both anticipation and genomic imprinting. The results do not suggest that either mechanism is operating in schizophrenia, but only very large effects can be confidently excluded.
What Price Depression?
Authors: Jönsson Bengt , Bebbington Paul E.
Published: October 2008

The purpose of this study was twofold: to measure the overall direct costs of depression for 1990 in the UK, and to develop a model to illustrate issues in the evaluation of the relative cost-effectiveness of the pharmacological treatment of depression. We compared a tricyclic antidepressant, imipramine, with paroxetine, a newer antidepressant. For assessing the cost of illness, we used a top-down approach. We calculated direct but not indirect costs. Cost-effectiveness was evaluated by developing a simulation model based on the theory of clinical decision analysis to compare the costs and outcome of each treatment. From this we estimated the expected cost per patient and the cost per successfully treated patient. The total cost to the nation of depressive illness was estimated to be £222 million. The expected costs per patient were found to be similar for paroxetine and imipramine (£430 v. £424). The costs per successfully treated patient were found to be lower for paroxetine (£824) than for imipramine (£1024). The results were stable when a sensitivity analysis was applied to the variables employed in the model. The most sensitive variable was the cost of treatment failure. Our model thus reveals that medication that appears expensive in terms of cost per day may not be so when patient compliance and the total costs of treatment are taken into account.
Exacerbation of Obsessive–Compulsive Symptoms Associated with Clozapine
Authors: Eales M. J. , Layeni A. O.
Published: October 2008

We report a case in which clozapine caused a marked and disabling exacerbation of obsessive–compulsive rituals in a patient with schizophrenia.
Delusional Gross Replacement of Inanimate Objects
Authors: Castillo Pura M. , Berman Carol W.
Published: October 2008

Three cases of a misidentification syndrome are presented. In this syndrome, which may be Capgras' or a new syndrome that we refer to as delusional gross replacement of inanimate objects, patients believe that their new possessions are replaced by inferior copies of the original objects by identified individuals. The patients believe that these individuals want to enhance themselves at the patients' expense, and feel persecuted by them.
The Genetics of Mental Retardation
Authors: Thapar Anita , Gottesman Irving I. , Owen Michael J. , O'Donovan Michael C. , McGuffin Peter
Published: October 2008

Individuals affected by mental retardation are a clinically and aetiologically heterogeneous group. This heterogeneity is particularly highlighted when we consider the genetics of mental retardation. Recent advances in molecular genetic techniques have enabled us to understand more about the molecular basis of several genetic syndromes associated with mental retardation. In contrast, where there is no discrete cause, the interplay of genetic and environmental influences remains poorly understood.
Electroencephalographic Abnormalities in Monozygotic Twins with Tourette's Syndrome
Authors: Hyde Thomas M. , Emsellem Helene A. , Randolph Christopher , Rickler Kenneth C. , Weinberger Daniel R.
Published: October 2008

The association of attentional, neuropsychological, and behavioural abnormalities with Tourette's syndrome (TS) suggests that the abnormal function of the disorder extends beyond the motor circuits of the basal ganglia. To explore this possibility we studied, with conventional 18-channel electroencephalography, monozygotic twins ranging from 8 to 26 years of age, where at least one member of the twin pair suffered from TS. In nine out of the 11 twin pairs that differed in clinical severity of the tic disorder, the twin with the more severe course of illness had a significantly more abnormal electroencephalogram (EEG) by qualitative visual analysis. Most of the differences were due to excessive frontocentral theta activity, suggesting dysfunction outside the basal ganglia. There was also a significant relationship between a lower global neuropsychological testing score and a worse overall EEG. In eight of nine twin sets with different global neuropsychological testing scores, the twin with the lower score had a worse EEG. A similar relationship was found between birth weight and overall EEG quality. In the nine sets that differed in birth weight, the twin with a lower birth weight had a worse EEG in seven of the sets. The EEG findings are unlikely to be a medication effect because the same result was seen in the six twin pairs who had been medication-free for at least six months before entry into the study. The origin of this slowing may relate to the interaction between environmental insults to the central nervous system and the genetic component of TS, an interaction producing damage to the cortex, thalamus, or both.
Dosage of Haloperidol for Mania
Authors: Rifkin Arthur , Doddi Seshagiri , Karajgi Basawaraj , Borenstein Michael , Munne Ralph
Published: October 2008

Background

We compared three doses of a neuroleptic as a treatment for mania.

Method

Forty-seven newly admitted in-patients with mania were randomised to receive 10, 30, or 80 mg a day of oral haloperidol, under double-blind conditions for up to six weeks. All subjects received prophylactic benztropine.

Results

Repeated-measures analysis of variance and survival analysis showed no difference in outcome by the different doses. Excluding drop-outs (38%), most of whom left the study during the first two weeks, 72% of the subjects responded. Side-effects were minimal; there were no differences among the three doses. Non-responders received more adjunctive lorazepam than responders.

Conclusions

The limited data suggest that more than 10 mg a day of haloperidol offers no advantage in mania.
The Clinical Characteristics of Major Depression as Indices of the Familial Risk to Illness
Authors: Kendler Kenneth S. , Neale Michael C. , Kessler Ronald C. , Heath Andrew C. , Eaves Lindon J.
Published: October 2008

Background

From both a clinical and an aetiological perspective, major depression (MD) is probably a heterogeneous condition. We attempt to relate these two domains.

Method

We examined which of an extensive series of clinical characteristics in 646 female twins from a population-based register with a lifetime diagnosis of MD predicts the risk for MD in co-twins. MD was defined by DSM–III–R criteria.

Results

Four variables uniquely predicted an increased risk for MD in the co-twin: number of episodes, degree of impairment and co-morbidity with panic disorder or bulimia. One variable uniquely predicted decreased risk: co-morbidity with phobia. Variables that did not uniquely predict risk of MD in the co-twin included age at onset, number and kind of depressive symptoms, treatment seeking, duration of the longest episode and co-morbidity with generalised anxiety disorder and alcohol dependence.

Conclusions

Our results suggest that the clinical features of MD can be meaningfully related to the familial vulnerability to illness, particularly with respect to recurrence, impairment and patterns of co-morbidity.
Safety and Side-effects of Alprazolam Controlled Study in Agoraphobia with Panic Disorder
Authors: O'Sullivan G. H. , Noshirvani H. , Basoglu M. , Marks I. M. , Swinson R. , Kuch K. , Kirby M.
Published: October 2008

Background

The widespread use of benzodiazepines has led to increasing recognition of their unwanted effects. The efficacy of alprazolam and placebo in panic disorder with agoraphobia, and the side-effect and adverse effect profiles of both drug groups were measured.

Method

In London and Toronto 154 patients who met DSM–III criteria for panic disorder with agoraphobia were randomised to alprazolam or placebo. Subjects in each drug group also received either exposure or relaxation. Treatment was from weeks 0 to 8 and was then tapered from weeks 8 to 16.

Results

Mean alprazolam dose was 5 mg daily. Compared with placebo subjects, alprazolam patients developed more adverse reactions (21 % v. 0%) of depression, enuresis, disinhibition and aggression; and more side-effects, particularly sedation, irritability, impaired memory, weight loss and ataxia. Side-effects tended to diminish during treatment but remained significant at week 8. Despite this, the drop-out rate was low.

Conclusions

Alprazolam caused side-effects and adverse effects during treatment but many patients were willing to accept these.
Service use and Costs of Home-Based Versus Hospital-Based Care for People with Serious Mental Illness
Authors: Knapp M. , Beecham J. , Koutsogeorgopoulou V. , Hallam A. , Fenyo A. , Marks I. M. , Connolly J. , Audini B. , Muijen M.
Published: October 2008

Background.

The Daily Living Programme (DLP) offered problem-oriented, home-based care for people aged 17–64 with severe mental illness facing emergency admission to the Bethlem–Maudsley Hospital. The multidisciplinary DLP team acted as direct provider and link with other services. Each patient had a key worker. Cost-effectiveness was assessed.

Method.

The comprehensive costs of DLP and standard in-patient care were compared within a randomised controlled trial. Cost measures ranged over all service inputs and living expenses. The costs of informal care and lost employment were also considered. Assessments of service use, costs and outcomes were conducted at referral, 4, 11 and 20 months.

Results.

The DLP was significantly less costly than standard treatment in both short and medium term (P = 0.000). Cost savings accrued almost exclusively to the NHS, with no other agency's costs being higher.

Conclusions.

Coupled with mildly encouraging outcome results over the 20 month period, the DLP was clearly cost-effective in this medium term.
The South London Somatisation Study
Authors: Craig T. K. J. , Drake H. , Mills K. , Boardman A. P.
Published: October 2008

Background.

A study of the influence of life-event stress on the onset and course of acute somatisation in primary care.

Method.

Forty-four somatisers were compared with 11 subjects who had psychiatric disorder but complained only of psychological symptoms, 39 patients who had ‘mixed’ conditions involving independent physical and psychiatric illness, 90 patients who had physical illness, and 123 healthy members of the general population.

Results.

Severely threatening life events were more common among all subjects with psychiatric disorder. A novel contextual rating of the potential of stressors to produce symptoms for ‘secondary gain’ was developed. In the 38 weeks before symptom onset, somatisers and psychologisers were more likely to have experienced at least one event which had this potential. Somatisers were also less likely to adopt neutralising coping efforts when faced with such a crisis.

Conclusions.

The likelihood of adopting neutralising efforts was closely related to the presence of a joint index of parental problems in care and exposure to physical illness in the subject's childhood. In a two-year follow-up, subsequent functional illnesses were also associated with experiences which had secondary-gain potential, and subjects with childhood risk factors continued to have higher rates of crises with secondary-gain potential and to fail to adopt neutralising coping strategies.
Merycism or Rumination Disorder
Authors: Parry-Jones Brenda
Published: October 2008

Background

In the ‘fashionable’ field of eating disorders, there has been a notable gap in the historiography of rumination, allowing considerable scope for constructing a comprehensive historical profile of this disorder.

Method

A wide-ranging examination of printed material, both etymological and medical, backed by a Medline computer search, uncovered extensive sources, some of considerable rarity, including case reports from the early 17th century onwards. Extracted data focused on incidence, sex distribution, age range, outcome and causation, and the findings are discussed in relation to diagnostic criteria in DSM–III–R and ICD–10.

Results

While confirming the frequency of rumination in infants and the mentally retarded, the study demonstrated, particularly, the need to recognise its occurrence in normal adults, occasionally as a collateral behaviour in anorexia and bulimia nervosa, and suggested that its prevalence, distorted by secrecy, exceeded estimated levels.

Conclusions

In future reviews of classification, existing anomalies and inadequacies in the status and description of rumination would benefit from integrating some of the historical conclusions.
Depression in Parkinson's Disease
Authors: Ring H. A. , Bench C. J. , Trimble M. R. , Brooks D. J. , Frackowiak R. S. J. , Dolan R. J.
Published: October 2008

Background

This study investigated biological correlates of depression in patients with idiopathic Parkinson's disease (PD). We tested the hypothesis that in patients with PD and depression, there was regional dysfunction involving brain areas previously implicated in functional imaging studies of patients with primary depression.

Method

Using positron emission tomographic measurements of regional cerebral blood flow (rCBF), patterns of resting rCBF were measured in ten patiens with PD and major depression, and ten patients with PD alone. The results were compared with findings from ten patients with primary depression and ten normal controls, scanned using identical methods as part of an earlier study. Groups were matched for age, sex and symptom severity.

Results

Bilateral decreases in rCBF were observed in anteromedial regions of the medial frontal cortex and the cingulate cortex (Brodmann's areas (BA) 9 and 32) in the depressed PD group, compared with those with PD alone and compared with normal controls. This regional disturbance overlapped that observed in patients with primary depression.

Conclusions

The findings indicate that the medial prefrontal cortex is a common area of neural dysfunction in the manifestation of both primary depression and depression in PD.
Exorcism-resistant Ghost Possession Treated with Clopenthixol
Authors: Hale Anthony S. , Pinninti Narsimha R.
Published: October 2008

Background

An Indian man now in Britain explained his criminal behaviour as episodic ghost possession. Traditional exorcisms failed to help.

Method

‘Western’ diagnosis of dissociative state or paranoid schizophrenia was made. Treatment commenced using trifluoperazine and clopenthixol.

Results

The patient underwent remission during neuroleptic treatment, despite previous evidence of genuine possession.

Conclusions

Many cultures give rise to apparently genuine cases of ghost possession. Neuroleptics may relieve symptoms of exorcism-resistant possession.
Suicide in Children and Adolescents in England and Wales 1960–1990
Authors: McClure G. M. G.
Published: October 2008

Background

Following reports of recent increases in adult male suicides in England and Wales, suicide rates for children and adolescents are reviewed.

Method

By using estimated mid-year populations for five-year age bands, the suicide rates for 10–14 year-olds and 15–19 year-olds are calculated between 1960–1990. The same method is used to obtain rates for ‘undetermined’ death and ‘accidental’ death by causes comparable to suicide.

Results

The only group to show an increase in suicide rate since the 1970s has been males aged 15–19 years. This increase persists even when ‘undetermined’ and ‘accidental’ death rates for causes similar to suicide are examined. The increase is associated with an increase in hanging and self-poisoning with vehicle exhaust gas.

Conclusions

The increase in suicide rate in 15–19 year-old males may indicate increased psychosocial stress, particularly affecting this age/gender group.
Tiapride in the Prevention of Relapse in Recently Detoxified Alcoholics
Authors: Shaw G. K. , Waller S. , Majumdar S. K. , Alberts J. L. , Latham C. J. , Dunn G.
Published: October 2008

Background

The aim was to investigate the effect of tiapride (100 mg three times a day for at least one month) on outcome following detoxification.

Method

The setting was a tertiary referral centre. The study design was randomised, double-blind, and placebo-controlled. One hundred routinely admitted alcohol-dependent patients were entered, and 54 completed the trial. Outcome was assessed by considering drinking status at three months and six months follow-up, and by comparing psychological status at intake and follow-up using the Crown-Crisp Experiential Index, the Litman Self-esteem scale and a Satisfaction with Life Situations scale. We also compared performance over the six months before admission with the three and six months of follow-up on measures of health, social and drinking variables.

Results

Tiapride proved better (usually at statistically highly significant levels) than placebo at promoting: abstinence, self-esteem, and satisfaction with life situations; and at reducing: alcohol consumption, use of health service resources, and levels of neuroticism.

Conclusions

Tiapride merits serious consideration in the longer-term treatment of alcoholic patients.
Linguistics, Human Communication and Psychiatry
Authors: Thomas Philip , Fraser William
Published: October 2008

Background

Psycholinguistics and sociolinguistics have extended our understanding of the abnormal communication seen in psychosis, as well as that of people with autism and Asperger's syndrome. Psycholinguistics has the potential to increase the explanatory power of cognitive and neuropsychological approaches to psychosis and new methods of assessment and therapy are now being developed, based on linguistic theory.

Method

MEDLINE literature search was used.

Results

Of 205 relevant articles identified, 65 were selected for review.

Conclusions

Greater familiarity with linguistic theory could improve psychiatrists' assessment skills and their understanding of the relevance of human communication to the new cognitive models of psychosis.
The Function of the Hypothalamic–Pituitary–Adrenal Axis in Alzheimer's Disease
Authors: O'Brien John T. , Schweitzer Isaac , Ames David , Mastwyk Maree , Colman Peter
Published: October 2008

Background

To investigate an association between HPA axis dysfunction, depression and cognitive impairment, we assessed subjects with mild Alzheimer's disease (AD).

Method

Sixteen non-depressed subjects with AD according to NINCDS/ADRDA criteria and 18 normal controls underwent the insulin hypoglycaemia (IH) test and the dexamethasone suppression test (DST).

Results

The AD subjects showed a blunted response of adrenocorticotrophic hormone (ACTH) to IH compared with controls (P = 0.019). ACTH response (area under curve) correlated with a score for cognitive ability (CAMCOG) (r = 0.64, P < 0.01). AD subjects had a shorter time to peak cortisol level than controls (P = 0.004), although total cortisol response was normal.

Conclusions

The AD subjects show evidence of adrenal hyper-responsiveness and normal immediate (rate-sensitive) glucocorticoid feedback. An association between HPA axis dysfunction and organic brain pathology in AD subjects may be mediated by cell loss in the hippocampus.
Suicide in the Mentally Ill
Authors: King Elizabeth
Published: October 2008

Background

Information on risk factors associated with high rates of suicide is necessary, if suicide rates among the mentally ill are to be reduced.

Method

We used ICD-9 E-codes to define deaths on which suicide or open (undetermined death) verdicts were returned, among residents of a catchment area defined by OPCS area codes. Relative risks of suicide and undetermined deaths for recent patients (those in contact with a psychiatric service in the year preceding death) were calculated.

Results

Of the 286 persons, 108 were recent patients. Eighty-four per cent suffered from schizophrenia or depression. Risks of suicide and undetermined death for these patients were 31 and 20 times, respectively, those of other residents. Social risk factors varied with diagnosis.

Conclusion

Over 90% of recent patients were receiving medical care at time of death; not all were treated appropriately. Recognising medical and social risk factors in recent patients, and effective monitoring of treatment, is important.
Prevalence of Asperger's Syndrome in a Secure Hospital
Authors: Scragg Peter , Shah Amitta
Published: October 2008

Background

The hypothesis that Asperger's syndrome (AS) may go unrecognised in forensic populations was examined by ascertaining the prevalence in Broadmoor Special Hospital.

Method

The entire male patient population was screened by examination of case notes. Identified cases were subject to the next stage of the study, which involved observation and interviewing of patients, and a semi-structured interview of key staff.

Results

A prevalence of 1.5% (0.6% to 3.3%, 95% CI) was found. The addition of equivocal cases increased the prevalence to 2.3%.

Conclusion

The prevalence of AS in Broadmoor Hospital is greater than that reported for the general population.

British Journal of Psychiatry (1994), 165, 679–682
The Reliability and Validity of the Proposed Axis V (Disabilities) of ICD–10
Authors: Daradkeh Tewfik K. , Saad A.
Published: October 2008

Background

The purpose of this study was to examine the reliability and validity of the newly proposed axis V (disabilities) of ICD-10.

Method

Eighty-six acutely ill men and women were prospectively recruited from the Al Ain psychiatric units, UAE. Both versions of ICD–10, the Clinical Descriptions and Diagnostic Guidelines and the Diagnostic Criteria for Research (DCR) were used for coding axis I psychiatric diagnosis and its grade of severity; the WHO Disability Assessment Schedule was used to assess disabilities.

Results

Inter-rater reliability of the DAS items ranged from moderate to good, and axis V ratings correctly predicted 84% of the observed classification on axis I.

Conclusion

Axis V is a valid measure of disabilities, but is limited by its modest reliability.

British Journal of Psychiatry (1994), 165, 683–685
What is Existential Psychotherapy?
Authors: Cohn Hans W.
Published: October 2008

Most forms of psychotherapy are rooted in psychoanalytical concepts. Although the majority of psychotherapists and counsellors do not comply with the classical Freudian model – they do not see their clients four or five times a week nor do they sit behind them while they are lying on a couch – they accept the basic psychoanalytical project. This can perhaps be expressed in the following way: unacceptable ‘instinctual’ wishes are warded off and ‘repressed’ into the ‘unconscious’. When they try to return to consciousness, they have to do so in disguise – and a common disguise is that of a symptom. This symptom has to be demasked, so to speak – what has been unconscious has to be made conscious for the symptom to disappear. This is, of course, an over-simplified account, but it is, I think, the essence of the psychoanalytical process and has remained central to psychotherapeutic endeavour.
Inner London Collaborative Audit of Admissions in Two Health Districts
Authors: Flannigan C. B. , Glover G. R. , Feeney S. T. , Wing J. K. , Bebbington P. E. , Lewis S. W.
Published: October 2008

Background

There is pressure on acute admission services in inner-city areas. Two deprived London districts with markedly different acute bed ratios but similar sociodemographic backgrounds were compared to test the hypothesis that more facilities mean better service.

Method

An instrument for auditing the use of short-stay hospital beds was constructed to collect information concerning admissions to, and short-stay patients in, the chosen districts during a three-month period.

Results

There was a higher admission rate and substantially greater use of beds per unit population in south Southwark than in Hammersmith & Fulham. Much of the difference was attributable to a higher rate of admission of patients with affective disorders in south Southwark.

Conclusions

The results are not explained by variations in population need, longer in-patient stay, or poorer aftercare leading to early relapse. The question of whether there is over-provision of services compared with real need in south Southwark, or under-provision (particularly for people with affective disorders) in Hammersmith & Fulham, is considered but left open for discussion following a study of ethnic issues and the reasons for admission.
Adolescent Girls I Self-Reported Mood Disturbance in a Community Population
Authors: Monck Elizabeth , Graham Philip , Richman Naomi , Dobbs Rebecca
Published: October 2008

Background

This study was undertaken to fill gaps in our knowledge of the rate of mood disorder in teenage girls in transition from school to further education, employment or unemployment.

Method

Girls aged 15–20 years (n = 529) whose names were drawn from general practitioner age/sex registers were interviewed at home and completed the Great Ormond Street Mood Questionnaire. Their mothers completed the 28-item General Health Questionnaire (GHQ). Social background variables were obtained.

Results

Of the girls, 20.8% scored over the cut-off point previously established to indicate risk of psychiatric disorder. Scoring over the cut-off point was not associated with age or parental social class. It was associated with parental separation/divorce (P < 0.004), with maternal self-report on the GHQ (P < 0.001), and with parental unemployment (P < 0.04). Lowest self-report scores were obtained by girls who had left school and were in employment (P < 0.01).

Conclusions

About one in five of girls aged 15–20 are at risk of affective disorder. Self-reported mood disturbance is associated with a wide range of social and familial background variables, but not with age or parental socioeconomic status.
The Salford Family Intervention Project: Relapse Rates of Schizophrenia at Five and Eight Years
Authors: Tarrier Nicholas , Barrowclough Christine , Porceddu Kathleen , Fitzpatrick Elizabeth
Published: October 2008

Background

This study assessed the long-term effects of family intervention on schizophrenic relapse.

Method

Forty schizophrenic patients who had participated in a family intervention trial and who had not experienced relapse at two years after discharge from the index admission were traced through case notes and hospital records. The percentage of patients experiencing a relapse was estimated for patients in the family intervention group, the high-EE control group, and the low-EE control group, at five years and eight years after discharge.

Results

There were significantly fewer relapses in the family intervention group than in the high-EE control group at both five years and eight years. The number of relapses in the low-EE control group was lower than in the high-EE control group, but this just failed to reach significance.

Conclusions

The benefit of family intervention and the predictive power of EE are sustained over eight years. Expressed emotion (EE) has remained a remarkably robust predictor of relapse in schizophrenia. Kavanagh (1992) cited 20 out of 23 prospective studies that showed patients who returned to live with high-EE relatives had higher relapse rates over 9–12 months after discharge than did patients returning to live with low-EE relatives. Seventeen of these studies reported this difference to be significant.

British Journal of Psychiatry (1994),165, 829–832
Multiple Axis-II Diagnoses of Personality Disorder
Authors: Dolan Bridget , Evans Chris , Norton Kingsley
Published: October 2008

Background

Simultaneous diagnosis of more than one personality disorder (PD) has been termed ‘comorbidity’ or ‘co-occurrence’ implying that single diagnoses are the norm and multiple diagnoses interesting exceptions. Surveys of PD subjects in fact show 1.5–5.6 diagnoses per subject. Our study explores the hypothesis that multiple PD diagnosis is common and increases with increasingly personality disordered populations.

Method

The PDQ–R questionnaire was administered to three UK samples: referrals for specialist PD in-patient treatment (n = 275); high tariff offenders attending a probation centre (n = 57); and undergraduate students (n = 274).

Results

Means of 6.0 (95% CI 5.7–6.3), 4.0 (3. 1–5.0) and 3.4 (3.0–3.8) PDQ–R diagnoses per subject were found respectively. High rates of PD diagnosis in individual subjects suggest that multiple diagnosis is the norm rather than the exception.

Conclusions

Multiple diagnosis of PD is better construed as ‘breadth’ of psychopathology rather than comorbidity and is a function of sampling frame. High rates of multiple diagnoses question the interpretation of studies of any single PD. The graded construct of ‘breadth’ of axis–II pathology may further our understanding of PD.
Trends and Availability of Suicide Methods in Finland
Authors: Ohberg A. , Lonnqvist J. , Sarna S. , Vuori E. , Penttila A.
Published: October 2008

Background

Trends and availability of the methods used for suicide in Finland were analysed in order to base proposals for prevention of access to methods.

Methods

Finnish suicides from 1947 to 1990 were analysed by sex, age, time period and suicide method using confidence intervals for rates, χ2 test for trends and suicide risks for different medicines.

Results

Suicide rate by parathion, a highly lethal pesticide and commonly used for suicide in the 1950s, decreased after its availability was restricted, but this was offset by an increased rate by other methods. Since 1982, the suicide risk for antidepressants and neuroleptics increased coincident with their availability, although that for barbiturates remained stable but high despite a reduction in availability. Suicide risk for antidepressants other than tricyclics decreased despite increased availability.

Conclusion

Restriction of a method reduces its use for suicide, but other methods tend to replace it. Restrictive measures should focus on some specific situations. Antidepressants other than tricyclics are recommended for the treatment of suicidal depressive patients.
Polymerase Chain Reaction (PCR) Search for Viral Nucleic Acid Sequences in Schizophrenia
Authors: Sierra-Honigmann A. M. , Carbone K. M. , Yolken R. H.
Published: October 2008

Background

Previous studies looking for evidence of viral infection in schizophrenics have yielded conflicting results. We searched for viral nucleic acids to test the hypothesis of the viral aetiology of schizophrenia.

Method

We used the polymerase chain reaction (PCR) to search for cytomegalovirus (CMV), human immunodeficiency virus (HIV), influenza A, Borna disease virus (BDV), and bovine viral diarrhoea virus (BVDV) in: hippocampus from three schizophrenic and three non-schizophrenic subjects; cerebrospinal fluid (CSF) from 48 schizophrenic patients; CSF and peripheral blood mononuclear cells (PBMC) from nine sets of identical twins discordant for schizophrenia; and SK-N-SHEP cells co-cultured with schizophrenic and non-schizophrenic brain homogenates. All patients met DSM–III–R criteria.

Results

Virus-specific nucleic acids were not found in any of the samples tested.

Conclusions

The absence of viral nucleic acids in the samples tested suggest that, in these patients, schizophrenia is not associated with a persistent or latent infection due to these viruses.