bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of psychopathology in young adults referred to mental health services in childhood or adolescence
Authors: Visser Jeroen Heijmens , Van Der Ende Jan , Koot Hans M. , Verhulst Frank C.
Published: August 2002

Background

For children referred to mental health services future functioning may be hampered.

Aims

To examine stability and prediction of behavioural and emotional problems from childhood into adulthood.

Method

A referred sample (n=789) aged 4–18 years was followed up after a mean of 10.5 years. Scores derived from the Child Behavior Checklist, Youth Self-Report and Teacher Report Form were related to equivalent scores for young adults from the Young Adult Self-Report and Young Adult Behavior Checklist.

Results

Correlations between first contact (T1) and follow-up (T2) scores were 0.12–0.53. Young adult psychopathology was predicted by corresponding TI problem scores. Social problems and anxious/depressed scores were predictors of general problem behaviour.

Conclusions

Problem behaviour of children and adolescents referred to outpatient mental health services is highly predictive of similar problem behaviour at young adulthood. Stability is higher for externalising than for internalising behaviour and for intra-informant than for inter-informant information. Stabilities are similar across gender. To obtain a comprehensive picture of the young adult's functioning, information from related adults may prove valuable.
Long-term predictors of cognitive outcome in a cohort of older people with hypertension
Authors: Cervilla Jorge A. , Prince Martin , Joels Suzanne , Lovestone Simon , Mann Anthony
Published: August 2002

Background

Deteriorating cognitive function in late life substantially increases the risk for dementia, for other non-cognitive morbidity, for dependency, and early death.

Aims

To identify early predictors of late-life cognitive outcome.

Method

Cognitive function, premorbid IQ, and cardiovascular risk exposure were recorded on 1083 subjects on entry to a hypertension treatment trial in 1983–1984. We followed up this cohort 9–12 years later to assess cognitive function with the Mini-Mental State Examination (MMSE), to update exposure status, and to obtain genomic material. Multivariate analysis was used to identify independent baseline predictors of cognitive outcome 9–12 years later.

Results

We followed up 387 subjects (58.6% of survivors). After adjusting for baseline cognition, poorer cognitive outcome was found to be independently associated with a family history of dementia, increasing age, less decline in systolic blood-pressure, lower premorbid IQ (rather than limited education), and abstinence from alcohol.

Conclusions

Reduction in systolic blood pressure (among hypertensives) and moderate alcohol intake could protect against cognitive deterioration in late life.
Reliability of lifetime history of bulimia nervosa
Authors: Wade Tracey D. , Bulik Cynthia M. , Kendler Kenneth S.
Published: August 2002

Background

Previous studies have found that the reliability of the lifetime prevalence of bulimia nervosa is low to moderate. However, the reasons for poor reliability remain unknown.

Aims

We investigated the ability of a range of variables to predict reliability, sensitivity, and specificity of reporting of both bulimia nervosa and major depression.

Method

Two interviews, approximately 5 years apart, were completed with 2163 women from the Virginia Twin Registry.

Results

After accounting for different base rates, bulimia nervosa was shown to be as reliably reported as major depression. Consistent with previous studies of major depression, improved reliability of bulimia nervosa reporting is associated with more severe bulimic symptomatology.

Conclusions

Frequent binge eating and the presence of salient behavioural markers such as vomiting and laxative misuse are associated with more reliable reporting of bulimia nervosa. In the absence of the use of fuller forms of assessment, brief interviews should utilise more than one prompt question, thus increasing the probability that memory of past disorders will be more successfully activated and accessed.
Total serum cholesterol in relation to psychological correlates in parasuicide
Authors: Garland Malcolm , Hickey Dara , Corvin Aidan , Golden Jeanette , Fitzpatrick Patricia , Cunningham Sean , Walsh Noel
Published: August 2002

Background

Low cholesterol may act as a peripheral marker for parasuicide.

Aims

To examine the relationship between total serum cholesterol and psychological parameters in parasuicide.

Method

Total serum cholesterol and self-rated scores for impulsivity, depression and suicidal intent were measured in 100 consecutive patients following parasuicide, pair-matched with normal and psychiatric control groups.

Results

Backward, stepwise multiple regression analysis revealed a significantly lower mean cholesterol in the parasuicide population (P<0.01). Across all groups there was an independent significant (P<0.01) negative correlation between cholesterol and self-reported scores of impulsivity. No correlation existed between cholesterol and scores for depression or suicidal intent.

Conclusions

The data confirm previous reports of low cholesterol in parasuicide. This is the first reported investigation of the construct of impulsivity in relation to cholesterol. We hypothesise that the reported increased mortality in populations with low cholesterol may derive from increased suicide and accident rates consequent on increased tendencies to impulsivity in these populations.
Cognitive therapy and recovery from acute psychosis: A controlled trial
Authors: Drury Val , Birchwood Max , Cochrane Ray
Published: August 2002

Background

This paper describes the 5-year outcome of a cohort of patients who had received a cognitive therapy intervention during an acute episode of non-affective psychosis.

Method

Thirty-four out of the original 40 patients who had taken part in a randomised controlled trial of a cognitive intervention were assessed, using standardised instruments completed at entry into the study. In the original trial, half the patients received a cognitive therapy programme (CT group) and the other half received recreational activities and support (ATY group).

Results

At follow-up no significant differences in relapse rate, positive symptoms or insight between the groups were found, although the CT group did show significantly greater perceived ‘Control over illness’ than the ATY group. For individuals who had experienced a maximum of one relapse in the follow-up period, self-reported residual delusional beliefs and observer-rated hallucinations and delusions were significantly less in the CT than in the ATY group.

Conclusion

Cognitive therapy applied in the acute phase of a psychotic disorder can produce enduring and significant clinical benefits if experience of relapse can be minimised.
Cognitive–behavioural techniques for general psychiatrists in the management of patients with psychoses
Authors: Turkington Douglas , Kingdon David
Published: August 2002

Background

Recent research progress showing the benefits of cognitive therapy in schizophrenia leaves the general psychiatrist unsure whether to attempt to use such techniques.

Aims

To test whether cognitive–behavioural techniques are beneficial in the management of patients with schizophrenia in general psychiatric practice.

Method

A randomised controlled study comparing the use of cognitive–behavioural techniques and befriending in schizophrenia.

Results

Significant improvement in symptoms occurred in the group treated with cognitive–behavioural techniques but not in the befriending group. During the 6-month follow-up period the cognitive–behavioural group tended to have shorter periods in hospital.

Conclusions

General psychiatrists could help their patients with schizophrenia by using cognitive–behavioural techniques. Such techniques are well within the capability of general psychiatrists, but their application would involve more of the consultant's time spent in direct contact with patients with psychoses.
Early termination of treatment in personality disorder treated in a psychotherapy hospital
Authors: Chiesa Marco , Drahorad Carla , Longo Silvia
Published: August 2002

Background

Factors underlying premature discontinuation of psychosocial in-patient treatment are still unclear.

Aims

Investigation of early discontinuation of specialised in-patient psychosocial treatment in a sample of people with personality disorder.

Method

Out of 134 consecutive admissions to the Cassel Hospital, 42 early drop-outs and 92 patients who remained were compared on demographic and clinical variables. Early drop-outs were invited for in-depth interviews, to explore their hospital experiences.

Results

The early drop-out group and the group which remained showed significant differences in occupational status, borderline personality disorder (BPD) and the treatment programme to which they were allocated. All three independent variables predicted early discontinuation of treatment. The qualitative analysis of interview transcripts identified significant problems in institutional dimensions.

Conclusions

Important subjects and process variables contributing to early drop-out in people with personality disorder were identified, with potential implications for clinical practice.
Psychotherapies in psycho-oncology
Authors: Bloch Sidney , Kissane David
Published: August 2002

Background

There is ample scope to devise forms of psychotherapy in consultation–liaison psychiatry, including the newly evolving area of psycho-oncology.

Aims

To highlight the development of psychotherapy in psycho-oncology, providing two illustrations.

Method

We report on conceptual and clinical research in the context of oncology and palliative care, focusing on (a) an approach for families at risk of maladaptive bereavement; and (b) a group programme for women newly diagnosed with early-stage breast cancer.

Results

We were able to introduce new forms of psychological treatment for specific clinical groups, and anecdotal evidence points to useful benefits for participants.

Conclusions

Psychotherapists should grasp the opportunity to bring their skills to the medical arena, but need to subject newly devised interventions to well-designed and methodologically rigorous research.
A neurobiologically informed perspective on psychotherapy
Authors: Gabbard Glen O.
Published: August 2002

Background

Polarisation of biological and psychosocial aspects of psychiatry has promoted a form of Cartesian dualism. Current knowledge of the interaction between biology and psychology makes it possible to consider a truly integrative approach to treatment.

Aims

The aim of this overview is to consider conceptual models of how psychotherapy may affect the brain.

Method

The literature discussing the mutual influence of genes and environment is surveyed. Relevant data involving the influence of psychotherapy on the brain are also reviewed.

Results

Research findings suggest that the brain responds to environmental influence through the alteration of gene expression; that psychotherapy has specific measurable effects on the brain; and that implicit memory may be modified by psychotherapeutic interventions.

Conclusions

Advances in neuroscience research have led to a more sophisticated understanding of how psychotherapy may affect brain functioning. These developments point the way towards a new era of psychotherapy research and practice in which specific modes of psychotherapy can be designed to target specific sites of brain functioning.
Measurement and psychotherapy
Authors: Margison Frank R. , Barkham Michael , Evans Chris , McGrath Graeme , Clark John Mellor , Audin Kerry , Connell Janice
Published: August 2002

Background

Measurement is the foundation of evidence-based practice. Advances in measurement procedures should extend to psychotherapy practice.

Aims

To review the developments in measurement relevant to psychotherapy.

Method

Domains reviewed are: (a) interventions; (b) case formulation; (c) treatment integrity; (d) performance (including adherence, competence and skilfulness); (e) treatment definitions; (f) therapeutic alliance; and (g) routine outcome measurement.

Results

Modern methods of measurement can support ‘evidence-based practice’ for psychological treatments. They also support ‘practice-based evidence’, a complementary paradigm to improve clinical effectiveness in routine practice via the infrastructure of Practice Research Networks (PRNs).

Conclusions

Advances in measurement derived from psychotherapy research support a model of professional self-management (practice-based evidence) which is widely applicable in psychiatry and medicine.
Psychotherapy for patients with complex disorders and chronic symptoms
Authors: Guthrie E.
Published: August 2002

Background

A clear distinction has been made between efficacy and effectiveness in relation to the methods of evaluation of new psychological treatments in psychiatry. Efficacy trials target patients with relatively pure conditions, who may not be representative of the patients who are usually referred for psychological treatment in a clinical setting. Few studies have explored the benefits of psychotherapy in patients with complex disorders and enduring symptoms.

Aims

To explore the rationale for the distinction between efficacy and effectiveness, particularly in relation to outcome studies of patients with complex and enduring disorders.

Method

A narrative review with examples drawn from the literature, and an illustration of a recent naturalistic outcome study which combines features of both efficacy and effectiveness.

Results

Studies of patients with complex and mixed disorders can be designed so that they retain internal validity, but also have external validity and are relevant to clinical practice.

Conclusion

Studies which evaluate psychological interventions should be carried out in populations of patients clinically representative of those who are likely to receive the intervention, should it be shown to be of benefit.
Effectiveness of psychotherapeutic treatment of personality disorder
Authors: Bateman Anthony W. , Fonagy Peter
Published: August 2002

Background

Psychiatrists have been criticised for failing to develop adequate treatment for personality disorder. Psychotherapeutic treatments are promising, but their effectiveness is uncertain.

Aims

To investigate the evidence for effectiveness of psychotherapeutic treatment for personality disorder.

Method

Systematic literature review.

Results

There is evidence for the effectiveness of psychotherapy for personality disorder. Problems of case identification, comorbidity, randomisation, specificity of treatment and outcome measurement are inadequately addressed. Authors mainly relied on cohort studies. Evidence neither suggests superiority of one type of therapy over another nor indicates which subgroups of patients should be offered psychotherapy as in-patient, day patient, or out-patient.

Conclusions

New research strategies are needed to show that personality change is both measurable and clinically meaningful. Effectiveness studies using randomised controlled designs are required. The literature suggests that effective treatment should be long-term, integrated, theoretically coherent and focused on compliance.
Psychological therapies for post-traumatic stress disorder
Authors: Adshead Gwen
Published: August 2002

Background

After exposure to traumatic stressors, a subgroup of survivors (20–30%) will develop post-traumatic stress disorder (PTSD).

Aims

Since the incidence and prevalence rates for PTSD in the community are significant, it is important that general practitioners and psychiatrists be familiar with possible therapeutic options. In this review we shall look at the published evidence about the effectiveness of psychological treatments for PTSD.

Method

The psychopathological mechanisms involved in PTSD are discussed. Studies of the effectiveness of different psychological therapies are reviewed.

Results

The review suggests that persistent fear or shame reactions are key aspects of PTSD. Evidence from systematic reviews suggests that psychotherapeutic treatments are effective in the therapy of reactions based on fear, and may increase the effectiveness of pharmacological therapy. There is less systematic evidence for the efficacy of interventions for symptoms based on shame.

Conclusions

Although a proportion of patients with complex or chronic PTSD may require specialist interventions, most patients can be treated effectively by a general psychiatric service which can offer both pharmacological and psychological interventions.
Definition and prevalence of severe and persistent mental illness
Authors: Ruggeri Mirella , Leese Morven , Thornicroft Graham , Bisoffi Giulia , Tansella Michele
Published: August 2002

Background

There is little consistency in how severe mental illness (SMI) is defined in practice, and no operational definitions.

Aims

To test two operationalised definitions, based on the National Institute of Mental Health (1987) definition: the first uses three criteria (diagnosis of psychosis; duration of service contact ≥ 2 years; GAF score ≤ 50), the second only the last two.

Method

Annual prevalence rates of SMI in two European catchment areas for each criterion and the criteria combined were calculated.

Results

The first definition produced rates of 2.55 and 1.34/1000 in London and Verona, respectively; the second permitted an additional 0.98/1000 non-psychotic disorders to be included in Verona.

Conclusions

The three-dimensional definition selects a small group of patients with SMI who have psychotic disorders. The two-dimensional approach allows estimates of SMI prevalence rates which include all forms of mental disorder.
Long-term survival, place of death, and death certification in clinically diagnosed pre-senile dementia in northern England
Authors: Kay David W. K. , Forster Donald P. , Newens Andrew J.
Published: August 2002

Background

Information on survival and cause of death in pre-senile dementia is scarce and the organisation of services controversial.

Aims

To study survival, place of death and death certification in pre-senile dementia.

Method

Patients aged 45–64 were identified from hospital and community sources in the Northern health region (1985–89) and classified as having pre-senile dementia of Alzheimer type (PDAT) or pre-senile vascular dementia (PVD) by applying an algorithm to case notes. Deaths were ascertained from the National Health Service Central Registry (NHSCR) to 31 December 1998. Survival analysis was performed using the SPSS/PC program, and expected survival calculated from life tables.

Results

Median survival time from diagnosis was 6.08 years and did not differ significantly in PDAT and PVD, or by age or gender; 19.3% of deaths occurred at home, 24.5% in nursing or residential homes and 56.3% in hospital; 72.4% of the death certificates mentioned dementia or Alzheimer's disease; 15.4% were still alive.

Conclusions

Pre-senile dementia has a variable but usually chronic course, requiring appropriate planning and services.
Selective serotonin reuptake inhibitor treatment in the UK: Risk of relapse or recurrence of depression
Authors: Claxton Ami J. , Li Zhiming , McKendrick Jan
Published: August 2002

Background

Patients with depression are often not prescribed antidepressants for an adequate period of time.

Aims

The impact of antidepressant prescribing patterns on the risk of relapse or recurrence of depression is examined.

Method

The Medi Plus UK Primary Care Database was used to identify patients treated for depression with a selective serotonin reuptake inhibitor (SSRI). Records were used to construct hierarchical prescription patterns (less than 120 days, switching/augmentation, upward titration, or stable use) as indicators for the occurrence of relapse or recurrence of depression.

Results

Patients with stable use experienced the lowest risk of relapse or recurrence. Factors significantly associated with increased risk include prior use of anxiolytic medications, more comorbid conditions and younger age.

Conclusions

The SSRI prescription pattern most consistent with recommended depression treatment guidelines was associated with the lowest risk of relapse or recurrence.
Interhemispheric asymmetry of motor cortical excitability in major depression as measured by transcranial magnetic stimulation
Authors: Maeda Fumiko , Keenan Julian P. , Pascual-Leone Alvaro
Published: August 2002

Background

Neuroimaging studies of major depressive disorder (MDD) indicate interhemispheric differences in prefrontal cortical activity (right greater than left).

Aims

To investigate whether there are any interhemispheric differences of motor cortical excitability in MDD.

Method

Eight patients with treatment-refractory MDD off medication were assessed for the severity of their depression, and transcranial magnetic stimulation studies (bilateral motor threshold and paired-pulse studies) were conducted. Eight normal controls were also studied.

Results

MDD patients showed significant interhemispheric differences in motor threshold and paired-pulse curves, both of which showed lower excitability on the left hemisphere. Such differences were absent in controls.

Conclusions

Our findings may aid the further understanding of the neurophysiology underlying MDD.
Effects of chewing betel nut (Areca catechu) on the symptoms of people with schizophrenia in Palau, Micronesia
Authors: Sullivan Roger J. , Allen John S. , Otto Caleb , Tiobech Josepha , Nero Karen
Published: August 2002

Background

Although millions of people with schizophrenia live in betel chewing regions, the effects of betel chewing on their symptoms are unknown. Betel nut alkaloids include potent muscarinic cholinomimetics: recent research suggests that these agents may be therapeutic in schizophrenia.

Aims

To compare the primary and extrapyramidal symptom profiles and substance-using habits of betel chewing v. non-chewing people with schizophrenia.

Method

A cross-sectional study of 70 people with schizophrenia. Symptom ratings measured by the Positive and Negative Syndrome Scale (PANSS) and Extrapyramidal Symptom Rating Scale (ESRS), and demographic and substance-use data, were compared for 40 chewers and 30 non-chewers of betel nut.

Results

Betel chewers with schizophrenia scored significantly lower on the positive (P=0.001) and negative (P=0.002) sub-scales of the PANSS than did non-chewers. There were no significant differences in extrapyramidal symptoms or tardive dyskinesia.

Conclusions

Betel chewing is associated with milder symptomatology and avoidance of more harmful recreational drugs. These initial results indicate that longitudinal research is merited.
The London Depression Intervention Trial
Authors: Leff J. , Vearnals S. , Brewin C. R. , Wolff G. , Alexander B. , Asen E. , Dayson D. , Jones E. , Chisholm D. , Everitt B.
Published: August 2002

Background

Relapse of depression is associated with a criticising attitude of the patient's partner.

Aims

To compare the relative efficacy and cost of couple therapy and antidepressant drugs for the treatment and maintenance of people with depression living with a critical partner.

Method

A randomised controlled trial of antidepressant drugs v. couple therapy. The subjects were 77 people meeting criteria for depression living with a critical partner.

Results

Drop-outs were 56.8 % from drug treatment and 15% from couple therapy. Subjects' depression improved in both groups, but couple therapy showed a significant advantage, according to the Beck Depression Inventory, both at the end of treatment and after a second year off treatment. Adding the costs of the interventions to the costs of services used showed there was no appreciable difference between the two treatments.

Conclusions

For this group couple therapy is much more acceptable than antidepressant drugs and is at least as efficacious, if not more so, both in the treatment and maintenance phases. It is no more expensive overall.
Developmental psychiatry – insights from learning disability∗
Authors: Hollins Sheila
Published: August 2002

Background

The Blake Marsh lecture, an annual lecture on learning disability, was endowed in 1963 in memory of Dr Blake Marsh, the former medical superintendent of Bromham House Colony in Bedford. The first lecture was given in 1967.

Aims

To review the speciality of the psychiatry of learning disability and how it is currently practised in the UK.

Method

Clinical, service, research and educational issues in learning disability psychiatry are reviewed and illustrated.

Results

Key issues which emerge in all four areas include the importance of communication skills, consultation with users and carers, professional education and partnership.

Conclusions

The psychiatry of learning disability is a complex, varied and stimulating branch of psychiatry with a strong developmental focus.
West London first-episode study of schizophrenia
Authors: Barnes Thomas R. E. , Hutton S. B. , Chapman M. J. , Mutsatsa S. , Puri B. K. , Joyce Eileen M.
Published: August 2002

Background

Studies in schizophrenia suggest that a longer initial period of untreated illness is associated with a poorer clinical outcome.

Aims

To determine whether, in first-episode schizophrenia, a longer duration of untreated psychosis (DUP) or of untreated illness (DUI) (DUP plus any prodrome) is associated with clinical variables that could mediate a poor prognosis.

Method

Clinical, social, neuropsychological and oculomotor function data on 53 patients with first-episode schizophrenia were related to the DUP and DUI.

Results

Comparing short and long DUP groups split around the median showed no statistically significant differences (except age); patients in the latter group tended to perform worse on an executive attentional set-shifting task, and were more likely to be unemployed, and living alone or homeless.

Conclusions

There was little evidence of any association between either DUP or DUI and progressive deterioration in the schizophrenic illness or the development of resistance to initial drug treatment. Social variables that augur a poor prognosis may be associated with delayed presentation of schizophrenia to psychiatric services.
Causes of the excess mortality of schizophrenia
Authors: Brown Steve , Inskip Hazel , Barraclough Brian
Published: August 2002

Background

The excess mortality of schizophrenia is well recognised, but its precise causes are not well understood.

Aims

To measure the standardised mortality ratio (SMR) and examine the reasons for any excess mortality in a community cohort with schizophrenia.

Method

We carried out a 13-year follow-up of 370 patients with schizophrenia, identifying those who died and their circumstances.

Results

Ninety-six per cent of the cohort was traced. There were 79 deaths. The SMRs for all causes (298), for natural (232) and for unnatural causes (1273), were significantly higher than those to be expected in the general population, as were the SMRs for disease of the circulatory, digestive, endocrine, nervous and respiratory systems, suicide and undetermined death. Smoking-related fatal disease was more prominent than in the general population.

Conclusions

Some of the excess mortality of schizophrenia could be lessened by reducing patients' smoking and exposure to other environmental risk factors and by improving the management of medical disease, mood disturbance and psychosis.
No association between breast-feeding and adult psychosis in two national birth cohorts
Authors: Leask S. J. , Done D. J. , Crow T. J. , Richards M. , Jones P. B.
Published: August 2002

Background

It has been proposed that breast-feeding might have a protective effect against the development of adult schizophrenia.

Aims

To test this hypothesis.

Method

Using prospective data from two UK national birth cohorts, the feeding histories of those who later developed schizophrenia were compared with the remaining population at risk. Analyses in each cohort were considered to be independent tests of the hypothesis.

Results

There were no differences in feeding histories. In the 1946 birth cohort (n=4447) 30 cases of DSM–III–R schizophrenia arose by age 43; 24.1% of cases v. 23.6% of controls were entirely bottle-fed; 17.3% v. 12.3% were breast-fed for under I month; 58.6% v. 64.1% were breast-fed beyond I month. In the 1958 cohort (n=18 856), 40 cases of CATEGO nuclear schizophrenia arose by age 28; 24.1% of cases v. 31.7% of controls were entirely bottle-fed; 27.6% v. 24.9% were breast-fed for under 1 month; 48.3% v. 43.4% were breast-fed beyond 1 month.

Conclusions

These findings provide no evidence of any effect of breast-feeding in protecting against the risk of later schizophrenia.
Changes in regional cerebral blood flow due to cognitive activation among patients with schizophrenia
Authors: Toone B. K. , Okocha C. I. , Sivakumar K. , Syed G. M.
Published: August 2002

Background

The regional cerebral blood flow (rCBF) response to the Wisconsin Card Sort Test (WCST) has been used to assess the functional integrity of the prefrontal cortex in patients with schizophrenia.

Aims

In this study, patients were divided into two groups according to whether they had made few or many perseverative errors on a modified version of the WCST. A control group consisted of normal volunteers. The groups were then compared with respect to rCBF response to WCST activation.

Method

rCBF was measured during administration of a modified version of the WCST and during a card sorting control task, using single photon emission computerised tomography (SPECT).

Results

Performance of the modified WCST was associated with a widespread and substantial increase in rCBF, particularly in the frontal region. The poorly performing group of patients with schizophrenia showed only a modest increase in rCBF in the left anterior cingulate region.

Conclusion

Subjects with schizophrenia are able to respond to specific neuropsychological challenge with activation of the frontal regions.
The revised Beliefs About Voices Questionnaire (BAVQ–R)
Authors: Chadwick Paul , Lees Susan , Birchwood Max
Published: August 2002

Background

We present a revised Beliefs About Voices Questionnaire (BAVQ–R), a self-report measure of patients' beliefs, emotions and behaviour about auditory hallucinations.

Aims

To improve measurement of omnipotence, a pivotal concept in understanding auditory hallucinations, and elucidate links between beliefs about voices, anxiety and depression.

Methods

Seventy-one participants with chronic auditory hallucinations completed the BAVQ–R, and 58 also completed the Hospital Anxiety and Depression Scale.

Results

The mean Cronbach's α for the five sub-scales was 0.86 (range 0.74–0.88). The study supports hypotheses about links between beliefs, emotions and behaviour, and presents original data on how these relate to the new omnipotence sub-scale. Original data are also presented on connections with anxiety and depression.

Conclusions

The BAVQ–R is more reliable and sensitive to individual differences than the original version, and reliably measures omnipotence.
Reappraising insight in psychosis
Authors: Cuesta Manuel J. , Peralta Victor , Zarzuela Amalia
Published: August 2002

Background

Many patients suffering from psychosis are unaware of their disorder and symptoms.

Aims

To investigate whether insight changes with time, and how it relates to patients' psychopathology, and to examine the correlations between insight scales in patients with psychoses.

Method

Seventy-five consecutively admitted in-patients with schizophrenia, affective disorder with psychotic symptoms, or schizoaffective disorder were examined after remission of an acute episode and at follow-up (>6 months). Three different scales were used to assess insight.

Results

To some extent, insight into past episodes improved over time in patients with psychosis, regardless of diagnosis. Few significant relationships between insight and psychopathology remained stable at follow-up. The higher the negative and disorganisation dimensions at baseline, the less did attitudes to treatment vary when tested at follow-up. No predictive value for variability of psychopathological dimensions was found for insight dimensions. The insight scales used were highly intercorrelated, suggesting that they measure the same construct.

Conclusions

Insight and psychopathology seem to be semi-independent domains.
Ethnic differences in admissions to secure forensic psychiatry services
Authors: Coid Jeremy , Kahtan Nadji , Gault Simon , Jarman Brian
Published: August 2002

Background

Persons of African – Caribbean origin are more frequently imprisoned, and increasing evidence suggests they are detained more frequently in psychiatric hospitals, following offending behaviour.

Aims

To estimate population-based prevalence rates of treated mental disorder in different ethnic groups compulsorily admitted to secure forensic psychiatry services.

Method

A survey was recorded of 3155 first admissions, from 1988 to 1994, from half of England and Wales, with 1991 census data as the denominator adjusted for under-enumeration.

Results

Compulsory admissions for Black males were 5.6 (CI 5.1–6.3) times as high as, and for Asian males were half, those for White males; for Black females, 2.9 (CI 2.4–4.6) times as high and for Asian females one-third of those for White females. Admissions of non-Whites rose over the study period. Patterns of offending and diagnoses differed between ethnic groups.

Conclusions

Variations in compulsory hospitalisation cannot be entirely attributed to racial bias. Community-based services may be less effective in preventing escalating criminal and dangerous behaviour associated with mental illness in African–Caribbeans.
Substance misuse as a marker of vulnerability among male prisoners on remand
Authors: Brooke Deborah , Taylor Caecilia , Gunn John , Maden Anthony
Published: August 2002

Background

More treatment for substance misuse should be provided within prisons.

Aims

To examine differences between prisoners on remand with substance misuse problems and other prisoners on remand.

Method

Random selection and interview of unconvicted male prisoners (n=750, a 9.4% sample), plus examination of the prison medical record.

Results

Of the sample of 750, 253 subjects (33.7%) reported either drug- or alcohol-related health problems or dependency. Compared with other prisoners on remand, they reported more childhood adversity, conduct disorder, self-harm, past psychiatric treatment and current mood disorder, and had fewer qualifications, were more likely to be unemployed and have more housing difficulties.

Conclusions

One-third of unconvicted men in prison report substance-related problems, and these are a marker for vulnerability within a disadvantaged population. Health care providers should involve this group in treatment and rehabilitation, both inside prison and following release.
The Clinician Assessment of Fluctuation and the One Day Fluctuation Assessment Scale
Authors: Walker M. P. , Ayre G. A. , Cummings J. L. , Wesnes K. , McKeith I. G. , O'Brien J. T. , Ballard C. G.
Published: August 2002

Background

The identification of fluctuating confusion is central to improving the differential diagnosis of the common dementias.

Aims

To determine the value of two rating scales to measure fluctuating confusion.

Method

The agreement between the clinician-rated scale and the scale completed by a non-clinician was determined. Correlations between the two scales were calculated; variability in attention was calculated on a computerised cognitive assessment and variability in delta rhythm on an electroencephalogram (EEG).

Results

The Clinician Assessment of Fluctuation and the computerised cognitive assessment were completed for 155 patients (61 Alzheimer's disease, 37 dementia with Lewy bodies, 22 vascular dementia, 35 elderly controls). A subgroup (n=40) received a further evaluation using the One Day Fluctuation Assessment Scale and an EEG. The two scales correlated significantly with each other, and with the neuropsychological and electrophysiological measures of fluctuation.

Conclusions

Both scales are useful instruments for the clinical assessment of fluctuation in dementia.
Brain weight in suicide
Authors: Salib Emad , Tadros George
Published: August 2002

Background

There is little available literature on the effect of suicide methods on brain weight.

Aims

To explore variations in postmortem brain weight in different methods of fatal self-harm (FSH) and in deaths from natural causes.

Method

A review of a sample of coroners' records of elderly persons (60 and above). Verdicts of suicide, misadventure and open verdicts were classified as FSH. Post-mortem brain weight for 142 FSH victims and 150 victims of unexpected, sudden or unexplained death due to natural causes, and from various methods of FSH, were compared.

Results

Brain weight of victims of FSH was significantly higher than of those who died of natural causes (P<0.01); brain weights in both groups were within the normal range for this age group. There was no significant difference in brain weight between different methods of FSH (P>0.05).

Conclusions

The findings require critical examination and further research, to include data from younger age groups. A regional or national suicide neuropathological database could be set up if all victims of FSH underwent routine neurohistochemical post-mortem examination.
Price, cost and value of opiate detoxification treatments
Authors: Gossop Michael , Strang John
Published: August 2002

Background

Treatments in different settings have different costs. A dilemma arises if expensive treatments lead to better outcomes.

Aims

To investigate conflicts between the priorities of cost minimisation, clinical effectiveness, and cost-effectiveness in the detoxification of opiate addicts.

Method

Cost and clinical effectiveness were examined using published outcome data. The main outcome measures were: achieving a drug-free state on completion of detoxification; the economic costs of treatment.

Results

In terms of simple cost, in-patient detoxification is much more expensive than out-patient treatment (ratio, 24:1). With adjustment for successful outcome, the costs are almost identical (ratio, 0.9:1). Comparison of specialist and general psychiatry in-patient settings showed that even when adjusted for clinical outcomes, the specialist setting is more costly (ratio, 1.9:1), although the outcomes are better.

Conclusions

Naïve adherence to cost and cost-containment considerations is dangerous. Discussion of treatment costs is misleading if not informed by, and adjusted for, evidence of effectiveness. This is especially important where marked differences in outcome between treatment options exist.
Expenditure on mental health care by English health authorities: A potential cause of inequity
Authors: Bindman Jonathan , Glover Gyles , Goldberg David , Chisholm Daniel
Published: August 2002

Background

The York resource allocation formula includes a calculation of the amount needed to purchase mental health services equitably in each health authority in England. However, the amount which is actually spent on services is at the discretion of the authority.

Aims

To compare expenditure on mental health services with allocation, and test the hypothesis that differences between them are to the disadvantage of services in deprived areas.

Method

A comparison of routine expenditure and allocation data, and linear regression modelling of the ratio of expenditure to allocation.

Results

The ratio of expenditure to allocation varies widely. Relative underspending occurs more frequently in deprived areas, although not in the four inner-London health authorities.

Conclusions

The intentions of the York formula are not achieved in practice. The implications of the formula for mental health should be made explicit to health authorities, and shortfalls in mental health expenditure relative to allocation should be justified at a local level.
Relationship between psychotic disorders in adolescence and criminally violent behaviour: A retrospective examination
Authors: Clare Patrick , Bailey Susan , Clark Andrew
Published: August 2002

Background

The interaction between psychosis and violence in adults is an important area of research receiving attention. To date there is little available data examining this relationship in adolescence.

Aims

To investigate the possible relationships between criminally violent types of behaviour, and psychopathology and social factors, among adolescents suffering from a psychotic disorder.

Method

A retrospective case note study of 39 in-patients diagnosed as having a psychotic disorder and admitted to one of two adolescent psychiatry units (one secure, one open). Cases were divided into a ‘violent’ and a ‘non-violent’ group, and these two groups were then compared for social and psychopathological variables.

Results

There was no association between recorded psychopathology and criminally violent behaviour. Criminally violent behaviour was associated with a history of emotional or physical abuse, contact with social or mental health services, and previous criminal behaviour.

Conclusions

These findings fail to echo results of studies in adult schizophrenia; they suggest that violent behaviour in psychosis is associated more closely with social factors than with specific symptoms of the psychotic illness. Potential explanations are discussed.
Aims, outcome measures, study sites and patient sample
Authors: Becker Thomas , Knapp Martin , Knudsen Helle Charlotte , Schene Aart H. , Tansella Michele , Thornicroft Graham , Vázquez-Barquero José Luis ,   Epsilon Study Group
Published: August 2002

Background

Cross-national research into the care of people with severe mental illnesses is hampered by a lack of standardised measures. The European Psychiatric Services: Inputs Linked to Outcome Domains and Needs (EPSILON) Study is a European Union funded project within the BIOMED-2 programme. The project aims to develop standardised instruments to facilitate future cross-national research.

Aims

To describe the aims, outcome measures, study sites and patient samples of the EPSILON Study.

Method, results, conclusions

See companion papers in this supplement.
Methodology of a multi-site reliability study
Authors: Schene Aart H. , Koeter Maarten , van Wijngaarden Bob , Knudsen Helle Charlotte , Leese Morven , Ruggeri Mirella , White Ian R. , Vázquez-Barquero José Luis ,   EPSILON Study Group
Published: August 2002

Background

The European Psychiatric Services: Inputs Linked to Outcome Domains and Needs (EPSILON) Study aims to produce standardised versions in five European languages of instruments measuring needs for care, family or caregiving burden, satisfaction with services, quality of life, and sociodemographic and service receipt.

Aims

To describe background, rationale and design of the reliability study, focusing on reliable instruments, reliability testing theory, a general reliability testing procedure and sample size requirements.

Method

A strict protocol was developed, consisting of definitions of the specific reliability measures used, the statistical methods used to assess these reliability coefficients, the development of statistical programmes to make inter-centre reliability comparisons, criteria for good reliability, and a general format for the reliability analysis.

Conclusion

The reliability analyses are based on classical test theory. Reliability measures used are Cronbach's α, Cohen's κ and the intraclass correlation coefficient. Intersite comparisons were extended with a comparison of the standard error of measurement. Criteria for good reliability may need to be adapted for this type of study. The consequences of low reliability, and reliability differing between sites, must be considered before pooling data.
Caregiving in schizophrenia: development, internal consistency and reliability of the Involvement Evaluation Questionnaire – European Version
Authors: van Wijngaarden Bob , Schene Aart H. , Koeter Maarten , Vázquez-Barquero José Luis , Knudsen Helle Charlotte , Lasalvia Antonio , McCrone Paul ,   EPSILON Study Group
Published: August 2002

Background

In international research on the consequences of psychiatric illnesses for relatives of patients, the need for an internationally standardised measure has been identified.

Aims

To test the internal consistency and the test-retest reliability of the Involvement Evaluation Questionnaire (IEQ) in five European countries.

Method

The IEQ was administered twice to a sample of relatives or friends of patients with an ICD-10 diagnosis of schizophrenia. Reliability was tested using Cronbach's α, intraclass correlation coefficients and standard error of measurement. Reliability estimates were tested between sites.

Results

Test sample sizes ranged from 30 to 90 across sites, and retest sample sizes ranged from 21 to 77. Cronbach's α values of IEQ sub-scales and sumscore were substantial at most sites; but at two, α values were moderate. Intraclass correlation coefficients were substantial to high at all sites. The standard errors of measurement differed across sites, indicating differences in performance.

Conclusion

The reliability of the IEQ in five languages varies across sites, but is sufficiently high in at least four out of five.
Client Socio-Demographic and Service Receipt Inventory – European Version: development of an instrument for international research
Authors: Chisholm D. , Knapp M. R. J. , Knudsen H. C. , Amaddeo F. , Gaite L. , van Wijngaarden B. ,   EPSILON Study Group
Published: August 2002

Background

Cross-cultural comparison of mental health service utilisation and costs is complicated by the heterogeneity of service systems. For data to be locally meaningful yet internationally comparable, a carefully constructed approach to its collection is required.

Aims

To develop a research method and instrument for the collection of data on the service utilisation and related characteristics of people with mental disorders, as the basis for calculating the costs of care.

Method

Various approaches to the collection of service use data and key stages of instrument development were identified in order to select the most appropriate methods.

Results

Based on previous work, and following translation and cross-cultural validation, an instrument was developed: the Client Socio-Demographic and Service Receipt Inventory – European Version (CSSRI–EU). This was subsequently administered to 404 people with schizophrenia across five countries.

Conclusion

The CSSRI – EU provides a standardised yet adaptable method for collating service receipt and associated data alongside assessment of patient outcomes.
Reliability of the Camberwell Assessment of Need – European Version
Authors: McCrone Paul , Leese Morven , Thornicroft Graham , Schene Aart H. , Knudsen Helle Charlotte , Vázquez-Barquero José Luis , Lasalvia Antonio , Padfield Sarah , White Ian R. , Griffiths Gwyn ,   EPSILON Study Group
Published: August 2002

Background

The five-country European Psychiatric Services: Inputs Linked to Outcome Domains and Needs (EPSILON) Study aimed to develop standardised and reliable outcome instruments for people with schizophrenia. This paper reports reliability findings for the Camberwell Assessment of Need – European Version (CAN-EU).

Method

The CAN – EU was administered in each country, at two points in time to assess test – retest reliability, and was rated by two interviewers at the first administration. Cronbach's α, test–retest reliability and interrater reliability were compared between the five sites. Reliability coefficients and standard errors of measurement for summary scores were estimated.

Results

Sites varied in levels and spread of needs. Alphas were 0.48, 0.58 and 0.64 for total, met and unmet needs respectively. Test–retest reliability estimates, pooled over sites, were 0.85 for the total needs, 0.69 for met needs and 0.78 for unmet needs. Pooled estimates for interrater reliability were higher, at 0.94, 0.85 and 0.79 for total, met and unmet needs respectively. There were statistically significant differences in interrater reliability between sites.

Conclusion

The results confirm the feasibility of using CAN–EU across sites in Europe and its psychometric adequacy.