bluuebunny/crossref_metadata_2025 huggingface dataset:
The Diagnosis of Multiple Personality Disorder
Authors: Fahy Thomas A.
Published: August 2008

Recently, there has been a dramatic rise in the number of case reports of multiple personality disorder (MPD). The phenomenology of the disorder is described and theories on aetiology are discussed. A review of the recent literature reveals a poverty of information on reliability of diagnosis, prevalence, or the role of selection bias. It is argued that iatrogenic factors may contribute to the development of the syndrome. There is little evidence from genetic or physiological studies to suggest that MPD represents a distinct psychiatric disorder. It is assumed that MPD is an hysterical symptom, and an attempt is made to catalogue the predisposing factors and influences that may lead to the clinical presentation.
Choice of Comparison Group and Findings of Computerised Tomography in Schizophrenia
Authors: Smith Geoffrey N. , Iacono William G. , Moreau Margaret , Tallman Karen , Beiser Morton , Flak Borys
Published: August 2008

The literature indicates that whether or not schizophrenic patients are reported to have significant lateral ventricular enlargement depends on control, and not schizophrenic-group values. This discrepancy does not result from differences in age, the ratio of males to females, the number of control subjects used in each study, or whether control groups are comprised of normal subjects or medical patients. However, medical-patient controls tend to have smaller ventricles than do normal individuals. Thus, we assessed lateral-and third-ventricle size and the degree of cortical atrophy in 30 normal volunteers, 30 medical patients, and 30 chronic schizophrenic patients. The use of a medical control group seemed to result in underestimates of ventricle and sulcal size in the normal population and, therefore, overestimates of these values in schizophrenic groups.
Phenomenology of Organic and Functional Psychoses and the Overlap Between Them
Authors: Johnstone Eve C. , Cooling N. J. , Frith C. D. , Crow T. J. , Owens D. G. C.
Published: August 2008

The Present State Examination was conducted upon 328 recently admitted psychotic patients, of whom 23 were later found to have underlying organic illness. The phenomenology in these 23 was compared with that of 92 matching controls drawn from the parent sample who conformed to DSM-III criteria for schizophrenia, mania and depression. Few significant differences were present and there was considerable overlap between the diagnostic groups.
Lifelong Eccentricity and Social Isolation
Authors: Tantam Digby
Published: August 2008

Sixty individuals are described who have lifelong eccentricity and social isolation and who have sought psychiatric treatment as a direct or an indirect result. They were predominantly young and, as in other samples of autistic people, male (6M: 1F). Most of them were of normal intelligence. They were all profoundly socially handicapped: few had lived independently, had lasting sexual relationships or spent much time in employment. Nearly a half of the subjects had been involved in antisocial behaviour at some stage. Nearly a quarter had committed a criminal offence. Violence was usually domestic, most often directed against the mother. Forty-eight per cent of subjects had a second psychiatric disorder (11.7% had a psychosis).
Repetition of Parasiticide: An Epidemiological and Clinical Study
Authors: Kreitman Norman , Casey Patricia
Published: August 2008

The dramatic clinical presentation of parasuicide tends to deflect attention from the repetitive pattern of this behaviour in many patients. In an epidemiological study of annual cohorts of parasuicides for 1972, 1977, and 1982 admitted to the Regional Poisoning Treatment Centre, Edinburgh, it was found that for certain subgroups of the population ‘repeaters' were actually commoner than ‘first-ever’ patients, and a number of risk factors were identified, of which social class was particularly important. The clinical characteristics of patients distinguished by their frequency of repetition were also described, with special attention to the stability of these differentiating features over time. It is suggested that the habitual repeater requires closer study, and that the factors which lead to initiation into a parasuicidal ‘career’ are not necessarily those which conduce to repetition.
Paradoxical Intention and Anti-Exposure in a Non-Compliant, Obsessive–Compulsive Ritualiser
Authors: Adshead Gwen , Drummond Lynne M. , Mercer Shirley
Published: August 2008

A woman with persistent obsessive-compulsive rituals showed limited improvement with exposure therapy, because of her refusal to comply fully with treatment and a lack of homework practice. She was negativistic towards therapists. Following a relapse, she was asked to try anti-exposure and to increase rituals. Paradoxically, this led to marked self exposure to the feared situation, and self-imposed response prevention, with resultant improvement, whereas anti-exposure instructions are generally anti-therapeutic in obsessive-compulsive disorder.
Fear of AIDS: the Impact of Public Anxiety in Young People
Authors: Lewin C. , Williams R. J. W.
Published: August 2008

Two young adolescents are reported in whom fears of contracting AIDS were a prominent part of their clinical presentation. Public anxiety, specific developmental vulnerability, and exposure to the media information campaign about HIV infection and AIDS are discussed as factors in the genesis and precipitation of emotional disorder in these youngsters.
Lithium in Pregnancy and Still Birth
Authors: Khandelwal S. K. , Sagar R. S. , Saxena S.
Published: August 2008

Although initially considered safe for the foetus, lithium has been shown to have teratogenic effects if used during the first trimester of pregnancy. Its use is also associated with a higher than expected frequency of still births and perinatal deaths. Our patient, in whom lithium prophylaxis was considered essential for clinical and social reasons, continued to take lithium without medical supervision throughout her pregnancy and had a still birth. We suggest avoiding the use of lithium at least during the first trimester of pregnancy.
Women who Kill their Parents
Authors: d'Orbán P. T. , O'Connor Art
Published: August 2008

The literature on parricide is reviewed with special reference to women. Seventeen female parricides (14 matricides, 3 patricides) were identified: in a remand prison (11), a Special Hospital (5), and a Regional Secure Unit (1). Six were schizophrenic, five had psychotic depression, three had personality disorders, and one was alcoholic. Two of the patricides had no psychiatric disorder but retaliated against violent fathers. Regardless of psychiatric diagnosis, matricides were mostly single, socially isolated women in mid-life, living alone with a domineering mother in a mutually dependent but hostile relationship. Similar characteristics are found in male matricides, who are predominantly schizophrenic. It is suggested that these features are of greater significance in matricide than the specific form of psychiatric disorder. Compared with filicides, matricides were significantly older, were single, and more often suffered from mental illness and substance abuse. Attention is drawn to the possible homicidal risk associated with delusions of poisoning and hypochondriacal delusions.
A Trial of Family Therapy v. a Relatives Group for Schizophrenia
Authors: Leff Julian , Berkowitz Ruth , Shavit Naomi , Strachan Angus , Glass Ilana , Vaughn Christine
Published: August 2008

Schizophrenic patients living in high contact with relatives having high expressed emotion (EE) were recruited for a trial of social interventions. The patients were maintained on neuroleptic medication, while their families were randomly assigned to education plus family therapy or education plus a relatives group. Eleven out of 12 families accepted family therapy in the home, whereas only six out of 11 families were compliant with the relatives group. Non-compliance was associated with a poorer outcome for the patients in terms of the relapse rate. The relapse rate over nine months in the family therapy stream was 8%, while that in compliant families in the relatives group stream was 17%. Patients' social functioning showed small, non-significant, gains. The data from the current trial were compared with data from a previous trial. The lowering of the relapse rate in schizophrenia appears to be mediated by reductions in relatives' EE and/or face-to-face contact, and is not explained by better compliance with medication. Reduction in EE and/or contact was associated with a minuscule relapse rate (5%). Very little change occurred in families who were non-compliant with the relatives group. On the basis of these findings, we recommend that the most cost-effective procedure is to establish relatives groups in conjunction with family education and one or more initial family therapy sessions in the home. It is particularly important to offer home visits to families who are unable to or refuse to attend the relatives groups.
The DST and TRH Test in Bulimia Nervosa
Authors: Kaplan Allan S. , Garfinkel Paul E. , Brown Gregory M.
Published: August 2008

Abnormal neuroendocrine responses have been found in depression and eating disorders. It remains unclear whether these reflect an underlying shared biology or epiphenomena. To evaluate this further, we conducted the 1 mg DST and the TSH response to 500 μg i.v. TRH in normal-weight bulimics and controls. Bulimics (n= 18) demonstrated significantly more DST non-suppression (45%) than controls (18%;n= 20). In the bulimic group, non-suppressors were significantly thinner than suppressors, but did not differ from them on any measure of depression. Bulimics (n= 19) and controls (n= 12) responded similarly without blunting on the TSH response to TRH. These data suggest that DST non-suppression may be related to non-specific variables such as weight. Bulimics do not demonstrate TSH blunting as found in some depressed patients. These tests do not support evidence for a biological link between these disorders.
Multiple Personality
Authors: Fahy Thomas A. , Abas Melanie , Brown Jeremy Christie
Published: August 2008

A case is reported of a young woman presenting with symptoms of so-called multiple personality disorder. It is proposed that this condition should be viewed as a non-specific psychiatric symptom.
Affective Disorders and Cerebral Vascular Disease
Authors: Starkstein Sergio E. , Robinson Robert G.
Published: August 2008

Empirical studies have recently demonstrated that major and minor depressive disorders occur in 30–50% of stroke patients, and last more than one year without treatment, although they do respond to tricyclic antidepressants. These mood disorders are not strongly associated with severity of impairment, demographic characteristics, social supports or prior personal history, but major depression is often strongly associated with left frontal or left basal ganglia lesions and pre-existing subcortical atrophy. While the aetiology of these mood disorders remains unknown, serotonergic or noradrenergic dysfunction may play a role. Mania is a rare complication of stroke: the clinical presentation and response to treatment are usually the same as mania without brain injury. Post-stroke mania is strongly associated with both a right hemisphere lesion in a limbic-connected area and a second predisposing factor, such as genetic loading for affective disorder, pre-existing subcortical atrophy or seizure disorder. This disorder may be mediated through frontal lobe dysfunction. The lesion method represents a potentially fruitful technique for investigating the mechanisms of affective disorder.
Monoamine Oxidase Inhibitors: Rehabilitation from Recent Research?
Authors: Nutt David , Glue Paul
Published: August 2008

For a long time, monoamine oxidase inhibitors (MAOIs) have been the Cinderella drugs of psycho-pharmacy. Although they were introduced just before the tricyclic antidepressants (TCAs), they rapidly became second-line treatments. Several factors contributed to this, in particular the dietary restrictions, the scattered reports of death from overdose and/or toxic interactions, and the unfavourable reports on the efficacy of phenelzine in depression from, among others, the Medical Research Council trial (1965). For a number of years afterwards, prescription of these drugs was limited to a few enthusiasts. More recently, however, their popularity has increased owing firstly to a re-evaluation of their effectiveness in tricyclic-resistant depression and in anxiety disorders, and secondly to growing awareness of the exaggerated claims made about their dangerousness (Pare, 1985).
Comments on the Northwick Park ‘Functional’ Psychosis Study
Authors: Goodwin G. M. , Johnson D. A. W. , McCreadie R. G.
Published: August 2008

“Functional psychosis is conventionally subdivided into schizophrenia and manic depressive psychosis. Response to treatment is assumed to be a validating criterion for these diagnoses. The efficacy of pimozide (a dopamine antagonist neuroleptic), lithium, and a combination of the two was compared with that of placebo in a 4-week trial in 120 functionally psychotic patients, each of whom was assessed for psychotic symptoms, manic symptoms, and depressive symptoms. The sample was subdivided into patients with predominantly elevated mood, predominantly depressed mood, and no consistent mood change. Pimozide reduced psychotic symptoms in all groups of patients. The only significant effect of lithium was to reduce elevated mood. Thus dopamine blockade seems relevant to the resolution of psychotic symptoms in all types of ‘functional’ psychosis, but the mode of action of lithium in psychotic patients concerns only mood. Application of standardised classifications of functional psychosis to these data did not change this conclusion.”
The Classification of Functional Psychoses and its Implications for Prognosis
Authors: Möller H. J. , Hohe-Schramm M. , Cording-Tömmel C. , Schmid-Bode W. , Wittchen H. U. , Zaudig M. , Von Zressen D.
Published: August 2008

One hundred and eighty-three patients suffering from functional psychoses were diagnosed according to ICD–8, RDC, and DSM–III criteria, and the concordance rates for the diagnoses compared. The heterogeneity of the diagnosis 'schizoaffective psychosis' as defined by these systems became clear. With respect to prognosis, the DSM–III diagnosis of schizophrenia was most closely related to poor outcome. Affective psychoses and schizoaffective psychoses, as well as DSM–III 'schizophreniform disorders', demonstrated a favourable prognosis.
Community Management of Schizophrenia a Two-Year Follow-Up of a Behavioural Intervention with Families
Authors: Tarrier Nicholas , Barrowclough Christine , Vaughn Christine , Bamrah J. S. , Porceddu Kathleen , Watts Susan , Freeman Hugh
Published: August 2008

The relapse and readmission rates of schizophrenic patients who participated in a controlled trial of a nine-month behavioural family intervention trial based on the EE status of their relatives are presented at two years. The patients who received the behavioural family intervention had lower rates of relapse and readmission than patients from high-EE homes who had received a short educational programme or routine treatment. The relapse rate of the behavioural family intervention group (33%) was the same as that of the low-EE group (33%), and significantly lower than that of the non-intervention high-EE group (59%).
Cholinergic Syndrome following Anticholinergic Withdrawal in a Schizophrenic Patient Abusing Marijuana
Authors: Tandon Rajiv , Dutchak Denise , Greden John F.
Published: August 2008

A 27-year-old neuroleptic-stabilised schizophrenic patient presented with a three-day history of psychomotor retardation, disturbed sleep, and social and emotional withdrawal following reduction of his anticholinergic dosage; his symptoms had intensified after an increase in neuroleptic dosage, based on a diagnosis of psychotic decompensation. Recognition of a cholinergic syndrome and institution of appropriate anticholinergic treatment resulted in rapid improvement. The clinical distinction between a cholinergic overdrive state and schizophrenic exacerbation, while sometimes difficult, can be critical in selecting appropriate management.
Types of Opiate Addiction and Notification to the Home Office
Authors: London M. , Ghodse A. H.
Published: August 2008

Hospitalised drug addicts were categorised according to the time lapse between onset of their opiate abuse and their first notification to the Home Office. Late notification correlated with a lower level of dependence, a more intermittent pattern of misuse, and a greater likelihood of alcohol abuse. It is postulated that there may be two types of addiction which lie along a continuum.
Minaprine: An Anticholinergic-Free Antidepressant?
Authors: Wheatley David
Published: August 2008

Minaprine is an amino-phenylpyridazine antidepressant reported to be relatively free of anticholinergic effects, cardiotoxicity, drowsiness, and weight gain. Minaprine (100mg t.d.s. and 100mg b.d.) was compared with mianserin (20 mg t.d.s.) in 117 depressed patients, and all three regimes produced significant reductions in scores on the HRSD at the end of six weeks' treatment. There were no anticholinergic effects, but there was a significantly greater incidence of drowsiness with mianserin than with minaprine.
Psychiatric Symptoms, Cognitive Stress and Vulnerability Factors
Authors: Harding Timothy , Zimmermann Erwin
Published: August 2008

In a consecutive sample of 208 male prisoners interviewed on the tenth day (T1) after entry, high levels of psychiatric symptoms as measured by the GHQ were recorded. These GHQ scores were strongly correlated with perceived worries and concerns of the prisoners (‘cognitive stress’). After 60 days of detention (T2), a significant fall in GHQ scores was observed, and they were still correlated with cognitive stress. A significant negative correlation between cognitive stress at T1 and GHQ scores at T2 was observed. The relationship between potential vulnerability factors (life experiences, social network, personality factors) and GHQ scores was not strong at either T1 or T2. Psychiatric symptoms are common during the early phase of imprisonment but are not durable.
The Treatment of Monodelusional Psychosis Associated with Depression
Authors: Chiu Simon , McFarlane Allan H. , Dobson Nancy
Published: August 2008

This is a report of the treatment of four patients suffering from a syndrome consisting of a single delusion in association with depression. The tendency of monodelusional syndromes to respond to a pimozide provides a rationale for nosological organisation.
Marital Adjustment and Obsessive–Compulsive Disorder
Authors: Emmelkamp P. M. G. , De Haan E. , Hoogduin C. A. L.
Published: August 2008

Fifty obsessive–compulsives were treated by behavioural therapy (self-exposure in vivo and response prevention) either with their partner directly involved in all aspects of treatment or without their partner. The two treatment formats were equally effective. Although a substantial number of obsessive–compulsives were found to have marital problems, behavioural treatment directed at the obsessive–compulsive disorder resulted in improvement irrespective of marital quality and partner involvement in the therapy. The effects of treatment led neither to a deterioration of the marriage nor to adjustment problems in the partner.
Spiritism in Puerto Rico
Authors: Hohmann Ann A. , Richeport Madeleine , Marriott Bernadette M. , Canino Glorisa J. , Rubio-Stipec Maritza , Bird Hector
Published: August 2008

Using data from the first community-based, epidemiological survey of Puerto Rico, this paper examines the current prevalence of use of spiritist healers by Puerto Ricans, the role of spiritism in the provision of mental health services, and the association between spiritism and psychiatric disorders and symptoms. Those who visit spiritists were found to be more likely to work outside the home, to have a low family income, to have sought help for emotional problems from mental health professionals, and to have mild symptoms of depression.
Anxiety and Depression in a Village in Lesotho, Africa: A Comparison with the United States
Authors: Hollifield Michael , Katon Wayne , Spain David , Pule Limakatso
Published: August 2008

Adults in a village in Lesotho, Africa, were interviewed to determine the community prevalence of major depression, panic disorder, and generalised anxiety disorder. The prevalence data were compared with data from a large epidemiological study in the United States utilising the same research instrument. There was a significantly higher prevalence of all three diagnoses in Lesotho as compared with the United States. As in the United States, women were at an increased risk for these disorders, although statistical significance was not demonstrated for depression. The majority of people (77%) who had experienced panic attacks said they had sought help for their symptoms, with the majority attending Western-trained doctors. The relationship between explanatory models and help-seeking behaviour was explored in people who had had panic attacks. Less than 40% of those with generalised anxiety disorder said they sought help.
Police Admissions to a Psychiatric Hospital
Authors: Dunn John , Fahy Thomas A.
Published: August 2008

Between October 1983 and December 1985, 268 patients were brought by police to a psychiatric hospital in south London under section 136 of the Mental Health Act 1983. Comparisons were made between ‘blacks' and ‘whites' on several clinical and demographic variables. The vast majority of admissions received a psychiatric diagnosis. An excess of black admissions was recorded. Black men were younger, were more likely than whites to be given neuroleptics, to be put on compulsory orders, and to be given an out-patient appointment when discharged from hospital. More black men were given a case-note diagnosis of schizophrenia or drug-induced psychosis. The differences in clinical management between ethnic groups could be at least partly accounted for by these differences in diagnosis. Treatment did not appear to be independent of diagnosis among the black admissions.
Psychiatry for Undergraduates
Authors: Hart J. J.
Published: August 2008

What should one offer to undergraduates as recommended reading for the 1990s? Since the question was last addressed in this journal (Mindham, 1982) much in psychiatry has altered. The student needs to be aware of the reorganisation of mental health services, with the closure of many old hospitals and the push into the community. Other changes include a growth in the elderly population, an ever-increasing number of psychotropic drugs, more emphasis on the multidisciplinary approach and the role of substance abuse in mental disorder, and the strengthened relationship between psychiatry and both general practice and other hospital medical services. There has been new mental health legislation since 1982, and the future doctor will also need to adjust to the advent of NHS reforms, with all its ramifications.
Plasma N-POMC, ACTH and Cortisol Concentrations in a Psychogeriatric Population
Authors: Leake A. , Charlton B. G. , Lowry P. J. , Jackson S. , Fairbairn A. , Ferrier I. N.
Published: August 2008

Elderly patients with depression and Alzheimer-type dementia (ATD) were compared with age-matched control subjects using a protocol which measured Cortisol, adrenocorticotrophic hormone (ACTH) and N-terminal pro-opiomelanocortin (N-POMC) to determine diurnal variation and the effect of dexamethasone administration. Depressed patients had significantly elevated Cortisol concentrations both before and after dexamethasone administration. Basal ACTH and N-POMC concentrations were normal in depressed patients but were both elevated, compared with controls, after dexamethasone. By contrast, in ATD patients, Cortisol was elevated only after dexamethasone, as was ACTH, but not N-POMC. This may imply that the pattern of secretion of POMC-derived peptides underlying increased Cortisol secretion is different in ATD from that in depression.
Mentally Retarded Criminal Offenders in Denmark
Authors: Lund Jens
Published: August 2008

Based on data from the Danish Central Criminal Register, the total number of mentally retarded offenders serving statutory care orders on a census day decreased from 290 in 1973 to 91 in 1984. The reduction was caused by shorter sentences and a dramatic decrease in the number of sentenced borderline retarded offenders; the total number of sentences per year slightly decreased, and the number of first-time sentences was stable. Crimes of property are decreasing among this population, while violence, arson, and sexual offences are increasing. Behaviour disorder was found in 87.5% of 91 offenders serving care orders in 1984. Offensive behaviour was significantly predicted by early institutionalisation, having retarded or divorced parents of low socio-economic status, and behaviour disorder of social-aggressive type. Independent significant effects were attributed to behaviour disorder and low socioeconomic background. All predictors were closely correlated. Biological factors did not have any significant predictive value.
Aetiological Heterogeneity of Schizophrenia: The Problem and the Evidence
Authors: Dalén Per , Hays Peter
Published: August 2008

When Kraepelin formulated the concept of dementia praecox, he lumped together a number of diagnostic categories. One of his reasons for doing so was that he had seen many patients who ended up in the same kind of demented state, even though their initial symptoms might have been quite different. He noted that even some cases presenting with mania, or melancholia, took the same downhill course as did the more classic cases of dementia praecox. Kraepelin, aware of the striking paradigm of general paresis, stated that “a single morbid process” explained the downhill course (Kraepelin, 1983, p. 68).
A Comparative Study of Family-Based and Patient-Based Behavioural Management in Obsessive-Compulsive Disorder
Authors: Mehta M.
Published: August 2008

Thirty obsessive-compulsive patients were randomly allocated to two treatment conditions. In group A a significant family member was trained to act as cotherapist at home, whereas in group B, only the patient was seen and given home assignments. All 30 patients received a similar treatment regime of systematic desensitisation, exposure, and response prevention. The family-based approach resulted in greater improvement in anxiety, depression, obsessive symptoms, and in social adjustment in occupational and household responsibilities. The personality pattern of the family members also appeared to influence outcome.
Prediction of Response to Electroconvulsive Therapy
Authors: Hickie Ian , Parsonage Brian , Parker Gordon
Published: August 2008

In an open study of 35 depressed patients, psychomotor disturbance, assessed by the CORE rating system, significantly predicted response to ECT in patients with a ‘retarded’ but not those with an ‘agitated’ type of illness. In multivariate analyses, psychomotor disturbance was the sole predictor of response. This preliminary study suggests that the CORE system, which has been shown to differentiate endogenous and non-endogenous depressive disorders, has predictive validity in relation to ECT response.
Psychiatric Phenomena in Alzheimer's Disease. II: Disorders of Perception
Authors: Burns Alistair , Jacoby Robin , Levy Raymond
Published: August 2008

In a sample of 178 patients with AD, visual hallucinations had been experienced by 13% and auditory hallucinations by 10%. Thirty per cent had misidentification syndromes; these were associated with a younger age and younger age at onset of illness, and proportionally more men than women were affected. There was a reduced 30-month mortality rate in this group. Subjects with hallucinations had a greater deterioration in cognitive function at 12-month follow-up, which could not be accounted for by neuroleptic medication.
The (Frequently) Neuroleptic (Potentially) Malignant Syndrome
Authors: Kellam A. M. P.
Published: August 2008

Since a previous review (Kellam, 1987), the subject of neuroleptic malignant syndrome (NMS) has continued to cause considerable interest, particularly in the USA where there is still controversy about its frequency, despite two attempts to survey prospectively all cases admitted to two different hospitals. Cases of NMS are now being more widely recognised by non-psychiatrists, especially geriatricians.
A Double-Blind Placebo-Controlled Study of Buspirone in Diazepam Withdrawal in Chronic Benzodiazepine Users
Authors: Ashton C. H. , Rawlins M. D. , Tyrer S. P.
Published: August 2008

A double-blind placebo-controlled trial of 23 chronic benzodiazepine users showed that overall, buspirone did not appear to be helpful in alleviating benzodiazepine withdrawal symptoms. Buspirone (5 mg t.d.s.) or placebo was administered for four weeks before, during and after diazepam withdrawal. Patients taking buspirone had a markedly higher dropout rate (seven out of 11) than those taking placebo (one out of 12). Mean daily diazepam dosage at entry was significantly higher in the buspirone group, but overall initial diazepam dosage was not related to outcome. Higher subjectively rated anxiety at the start of withdrawal was significantly related to higher dropout rate, irrespective of treatment, and was greater (although not significantly so) in the buspirone group.
Collected and Neglected: Are Oxford Hostels for the Homeless Filling up with Disabled Psychiatric Patients?
Authors: Garety P. , Toms R. M.
Published: August 2008

“Objective – To assess the severity of psychiatric symptoms among residents of hostels for homeless people. Design – Survey of residents in two hostels in Oxford, comprising three weeks of background fieldwork, a demographic questionnaire, and rating behaviour over two weeks with a behavioural rating scale (REHAB) and mental state with the brief psychiatric rating scale. Setting – Two hostels for homeless people in Oxford. Subjects – 146 Medium to long term residents, of whom 48 were selected by hostel workers by the following criteria: continuous residence for at least two months, signs of persistent severe mental disability, and difficulty in coping independently in the community. Two subjects died during the study; three (previously long term psychiatric inpatients) declined to be assessed on the psychiatric scale. Main outcome measure – Behavioural disturbance and mental state. Results – Only a third of the total sample had been born in Oxfordshire. Subjects had been accepted into the hostel either by arrangement with the local psychiatric service (22) or straight off the streets (26); 43 had had a previous (non-drug related) psychiatric admission. Subjects were significantly more likely than other residents to have spent longer (> 80 weeks) in a hostel in the past three years (p<0.02). With reference to norms for deviant behaviour, the 46 subjects assessed showed considerable deviant behaviour (average weekly scores: 0(11 subjects), 1 (14), 2–3 (16), and ≥4 (5)) not significantly different from that expected in moderately to severely handicapped psychiatric inpatients (χ2 = 1 · 3, df = 3, p > 0 · 7); 22 had scores equivalent to those in most severely handicapped inpatients. Of the 43 subjects assessed with the psychiatric rating scale, 16 had symptoms of neurosis, 29 of florid psychosis, and 32 of a deficit state. Symptoms of deficit state were positively correlated with ratings of low social activity on the behavioural scale (Spearman's rank correlation coefficient 0 · 30, p = 0 · 03). Conclusions – Hostels are having to care for long term severely affected psychiatric patients discharged into the community. The suitability of the services offered to such subjects should be assessed.”
Regional Cerebral Blood Flow in Patients with Affective Disorders
Authors: Delvenne V. , Delecluse F. , Hubain Ph. P. , Schoutens A. , De Maertelaer V. , Mendlewicz J.
Published: August 2008

Regional cerebral blood flow at rest was measured in 38 patients with major depressive disorders and 16 controls by SPECT with inhalation of xenon-133. All subjects had been withdrawn from medication. The mean hemispheric cerebral blood flow was not statistically different between the controls and the different subgroups of depressed patients defined either by biological markers or clinical characteristics. However, the predominantly cortical blood flow, measured on the outer cerebral rim of the third tomographic slice, was significantly lower on the left hemisphere in bipolar patients when compared with normals and unipolar patients. The same lateralisation was observed in patients with an endogenous depression according to the Newcastle scale.
Towards a Cognitive-Behavioural Intervention for Adult Grief Reactions
Authors: Kavanagh D. J.
Published: August 2008

Published accounts of behavioural interventions for grief have relied on exposure and habituation to grief cues as the primary strategy. Such an approach is excessively narrow, since it does not adequately confront the challenges that are posed by a bereavement. Many people cope with a bereavement by themselves, and for those, intervention may well be counterproductive. A cognitive-behavioural intervention, following models for depression/anxiety, can assist vulnerable individuals obtain a more rapid or complete adjustment.
Two-Year Follow-up of the Sheffield Psychotherapy Project
Authors: Shapiro David A. , Firth-Cozens Jenny
Published: August 2008

Of 40 depressed and anxious patients who received treatment during the Sheffield Psychotherapy Project, 31 completed the BDI and SCL-90 at two-year follow-up. At both group and individual levels, outcomes were very similar to those obtained at the completion of treatment. Substantial minorities of patients reported major life events and seeking further help for psychological problems during the two years, but these reports were not reliably associated with symptoms at follow-up. Patients recalled very different elements in prescriptive and exploratory therapies as helpful, with a notable emphasis upon prescriptive therapy's relaxation and anxiety management as a source of problem solution.
Hypochondriasis and Somatosensory Amplification
Authors: Barsky Arthur J. , Wyshak Grace
Published: August 2008

A self-report questionnaire completed by 177 out-patients showed that hypochondriasis and amplification had a zero-order correlation of 0.56, and in stepwise multiple regression amplification accounted for 31 % of the variance in hypochondriasis, after sociodemographic variables had been accounted for. Fears of ageing and death, and a childhood history of illness in the family, increased the R2 to 0.50. Amplification was more powerful in women than in men and was also a significant (although weaker) correlate of somatisation, explaining 12% of the variance. Somatisation also correlated with being female, the propensity to seek medical care, and a diminished sense of efficacy over one's health. Our findings are consistent with the possibility that somatosensory amplification occurs in hypochondriasis.
The Efficacy of Lithium in Prophylaxis of Unipolar Depression Evidence from its Discontinuation
Authors: Souza F. G. M. , Mander A. J. , Goodwin G. M.
Published: August 2008

Forty unipolar patients satisfying DSM–III criteria for major depression who discontinued lithium therapy were retrospectively compared with 105 similar patients who continued the drug and served as a control group. The time to readmission from starting lithium was compared while both groups were still on lithium, and after discontinuation in one group and further continuation in the control group. The progressive increase in the probability of recurrence over two years was the greatest after discontinuation of lithium. For the patients who eventually discontinued lithium, the cumulative probability of recurrence in two years was 0.08 on lithium and 0.58 after stopping it. The probability of recurrence was unchanged over the duration of the study for patients who continued to take lithium. There was no evidence of a lithium withdrawal syndrome within three months of stopping the drug. The results support the view that the everyday clinical use of lithium as prophylaxis is beneficial in unipolar depression.
The Functions of Asylum
Authors: Wing J. K.
Published: August 2008

Many of the functions of large psychiatric hospitals were those of asylum. As the structure of services has changed and the role of the large hospital has diminished, the necessity to continue to cover their functions has tended to be forgotten, partly because it has been thought that, even at best, they were purely protective. Such a point of view cannot be sustained. The functions of asylum have always been both refuge and recuperation. ‘Community care’ will come to deserve the odium now attached to the worst practices of former times if the tradition of asylum practised in the best of the large hospitals is not (with appropriate modification) acknowledged, properly placed in the psychiatric curriculum, and given high priority in service planning.
Somatosensory Evoked Potentials in Schizophrenia a Lateralisation Study
Authors: Furlong Paul , Barczak Paul , Hayes Gwilym , Harding Graham
Published: August 2008

The SSEPs obtained from 19 schizophrenics defined by RDC, DSM–III and PSE criteria Were compared with those from a control group of healthy volunteers. Previous findings of an abnormal lack of lateralising response in schizophrenic patients were not replicated. No significant difference in either amplitude or morphology between the traces obtained from the two groups were recorded. Ipsilateral and contralateral latencies for stimulation of the left and right index finger showed no significant difference in peak latency for any component between patient and control group. When mean peak-to-peak amplitudes were plotted the contralateral component was always greater in amplitude than the ipsilateral one. An objective measure of the degree of lateralisation, the percentage lateralisation quotient, showed no lateralisation differences between the patient and control groups. A case of myogenic contamination of ipsilateral components was observed calling into doubt findings where no temporal region monitoring has been performed.
Extrapyramidal Signs, Primitive Reflexes and Frontal Lobe Function in Senile Dementia of the Alzheimer Type
Authors: Girling D. M. , Berrios G. E.
Published: August 2008

Of 146 elderly subjects suffering from Alzheimer-type dementia, 44% were found to have significant extrapyramidal signs. Although extrapyramidal signs were more common in those who had taken neuroleptic drugs in the preceding six months, 22 subjects (15%) who were drug free also had extrapyramidal signs. Scores for cognitive function and for ‘frontal lobe’ signs (verbal fluency, evidence of perseveration, and primitive reflexes) were found to correlate well with scores for extrapyramidal signs, suggesting that they reflect changes in a common substratum. It is tentatively suggested that this might be an abnormality in the dopamine system.
Delusional Misidentification of Familiar Inanimate Objects a Rare Variant of Capgras Syndrome
Authors: Abed R. T. , Fewtrell W. D.
Published: August 2008

A 52-year-old woman presented exclusively with delusional misidentification of inanimate objects in the context of a short-lived acute psychotic episode. Certain theories are useful in understanding the formation of delusions of doubles in the patient (e.g. processes intrinsic to the depersonalisation/derealisation phenomena may have been aetiologically significant), but the actual choice of objects remains difficult to explain.
Incidence of Suicide in Persons With Cancer
Authors: Misono Stephanie , Weiss Noel S. , Fann Jesse R. , Redman Mary , Yueh Bevan
Published: August 2008

Purpose

The purpose of this study was to characterize suicide rates among patients with cancer in the United States and identify patient and disease characteristics associated with higher suicide rates. Prior studies, mostly in Europe, have suggested that patients with cancer may be at increased risk for suicide, but large cohort studies comparing patients with cancer with the general population have not been performed in the United States.

Methods

Patients in the study were residents of geographic areas served by the Surveillance, Epidemiology, and End Results (SEER) program who were diagnosed with cancer from 1973 to 2002. Comparisons with the general US population were based on mortality data collected by the National Center for Health Statistics. This was a retrospective cohort study of suicide in persons with cancer.

Results

Among 3,594,750 SEER registry patients observed for 18,604,308 person-years, 5,838 suicides were identified, for an age-, sex-, and race-adjusted rate of 31.4/100,000 person-years. In contrast, the suicide rate in the general US population was 16.7/100,000 person-years. Higher suicide rates were associated with male sex, white race, and older age at diagnosis. The highest suicide risks were observed in patients with cancers of the lung and bronchus (standardized mortality ratio [SMR] = 5.74; 95% CI, 5.30 to 6.22), stomach (SMR = 4.68; 95% CI, 3.81 to 5.70), oral cavity and pharynx (SMR = 3.66; 95% CI, 3.16 to 4.22), and larynx (SMR = 2.83; 95% CI, 2.31 to 3.44). SMRs were highest in the first 5 years after diagnosis with cancer.

Conclusion

Patients with cancer in the United States have nearly twice the incidence of suicide of the general population, and suicide rates vary among patients with cancers of different anatomic sites. Further examination of the psychological experience of patients with cancer, particularly that of patients with certain types of cancer, is warranted.
Preoperative Staging of Large Primary Breast Cancer With [18F]Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Compared With Conventional Imaging Procedures
Authors: Fuster David , Duch Joan , Paredes Pilar , Velasco Martín , Muñoz Montserrat , Santamaría Gorane , Fontanillas Montserrat , Pons Francesca
Published: August 2008

Purpose

To evaluate the utility of positron emission tomography (PET) and [18F]fluorodeoxyglucose in the initial staging of large primary breast tumors.

Patients and Methods

This prospective study was approved by the ethics committee, and all patients gave their informed consent before enrollment. Sixty consecutive patients with large (> 3 cm) primary breast cancer diagnosed by clinical examination and breast magnetic resonance imaging (MRI) were entered onto the study. The mean age was 57 ± 13 years. Chest computed tomography (CT), liver ultrasonography, bone scan, and PET/CT were performed in all patients. All findings were histologically confirmed, and/or at least 1 year of follow-up was required. Correlation between parameters was calculated using Pearson's correlation coefficient. P < .05 was considered statistically significant.

Results

Primary tumor was identified by both PET/CT and MRI in all patients. Multifocal and/or multicentric tumors were found in 19 patients by MRI. Axillary lymph node metastases were found in 20 of 52 patients. Extra-axillary metastatic lymph nodes were also found in three patients. One patient showed an infiltrated lymph node in the contralateral axilla. The sensitivity and specificity for PET/CT to detect axillary lymph nodes metastases were 70% and 100%, respectively. PET/CT diagnosed all extra-axillary lymph nodes. The overall sensitivity and specificity of PET/CT in detecting distant metastases were 100% and 98%, respectively; whereas the sensitivity and specificity of conventional imaging were 60% and 83%, respectively. PET led to a change in the initial staging in 42% of patients.

Conclusion

PET/CT underestimates locoregional lymph node staging in large primary breast cancer patients. PET/CT is a valuable tool to discard unsuspected extra-axillary lymph nodes and distant metastases.
Dlx genes pattern mammalian jaw primordium by regulating both lower jaw-specific and upper jaw-specific genetic programs
Authors: Jeong Juhee , Li Xue , McEvilly Robert J. , Rosenfeld Michael G. , Lufkin Thomas , Rubenstein John L. R.
Published: August 2008

Dlx transcription factors are implicated in patterning the mammalian jaw,based on their nested expression patterns in the first branchial arch(primordium for jaw) and mutant phenotypes; inactivation of Dlx1 and Dlx2 (Dlx1/2-/-) causes defects in the upper jaw,whereas Dlx5/6-/- results in homeotic transformation of the lower jaw into upper jaw. Therefore, the `Dlx codes' appear to regionalize the jaw primordium such that Dlx1/2 regulate upper jaw development,while Dlx5/6 confer the lower jaw fate. Towards identifying the genetic pathways downstream of Dlx5/6, we compared the gene expression profiles of the wild-type and Dlx5/6-/- mouse mandibular arch (prospective lower jaw). We identified 20 previously unrecognized Dlx5/6-downstream genes, of which 12 were downregulated and 8 upregulated in the mutant. We found a Dlx-regulated transcriptional enhancer in close proximity to Gbx2, one of the Dlx5/6-downstream genes, strongly suggesting that Gbx2 is a direct target of Dlx5/6. We also showed that Pou3f3 is normally expressed in the maxillary (prospective upper jaw) but not mandibular arch, is upregulated in the mandibular arch of Dlx5/6-/-,and is essential for formation of some of the maxillary arch-derived skeleton. A comparative analysis of the morphological and molecular phenotypes of various Dlx single and double mutants revealed that Dlx1, 2, 5 and 6 act both partially redundantly and antagonistically to direct differential expression of downstream genes in each domain of the first branchial arch. We propose a new model for Dlx-mediated mammalian jaw patterning.
Two highly related regulatory subunits of PP2A exert opposite effects on TGF-β/Activin/Nodal signalling
Authors: Batut Julie , Schmierer Bernhard , Cao Jing , Raftery Laurel A. , Hill Caroline S. , Howell Michael
Published: August 2008

We identify Bα (PPP2R2A) and Bδ (PPP2R2D), two highly related members of the B family of regulatory subunits of the protein phosphatase PP2A, as important modulators of TGF-β/Activin/Nodal signalling that affect the pathway in opposite ways. Knockdown of Bα in Xenopusembryos or mammalian tissue culture cells suppresses TGF-β/Activin/Nodal-dependent responses, whereas knockdown of Bδenhances these responses. Moreover, in Drosophila, overexpression of Smad2 rescues a severe wing phenotype caused by overexpression of the single Drosophila PP2A B subunit Twins. We show that, in vertebrates,Bα enhances TGF-β/Activin/Nodal signalling by stabilising the basal levels of type I receptor, whereas Bδ negatively modulates these pathways by restricting receptor activity. Thus, these highly related members of the same subfamily of PP2A regulatory subunits differentially regulate TGF-β/Activin/Nodal signalling to elicit opposing biological outcomes.