bluuebunny/crossref_metadata_2025 huggingface dataset:
Community forensic psychiatry: restoring some sanity to forensic psychiatric rehabilitation
Authors: Skipworth J. , Humberstone V.
Published: March 2003

Objective:  To review clinical and legal paradigms of community forensic mental health care, with specific focus on New Zealand, and to develop a clinically based set of guiding principles for service development in this area.

Method:  The general principles of rehabilitating mentally disordered offenders, and assertive community care programmes were reviewed and applied to the law and policy in a New Zealand forensic mental health setting.

Results: There is a need to develop comprehensive community treatment programmes for mentally disordered offenders. The limited available research supports assertive community treatment models, with specialist forensic input. Ten clinically based principles of care provision important to forensic mental health assertive community treatment were developed.

Conclusion:  Deinstitutionalization in forensic psychiatry lags behind the rest of psychiatry, but can only occur with well‐supported systems in place to assess and manage risk in the community setting. The development of community‐based forensic rehabilitation services in conjunction with general mental health is indicated.
The quantitative risk of violent crime and criminal offending: a case‐control study among the offspring of recidivistic Finnish homicide offenders
Authors: Putkonen A. , Ryynänen O.‐P. , Eronen M. , Tiihonen J.
Published: March 2003

Objective: To study if later risk of violent offending and criminality among high‐risk children can be estimated quantitatively on the basis of parental crimes.

Method:  The criminal and prison records of the offspring (N=11) of homicide recidivists (N=36) were compared with data from controls (N=220) who were matched for sex, domicile of birth and date of birth and death.

Results:  The risk (odds ratio) was increased up to 24‐fold for violent crimes (P=0.01), and up to 17‐fold for criminality (P=0.0008) among the offspring of homicide recidivists.

Conclusion:  The quantitative risk of a child for later violent offending and criminality can be estimated on the basis of parental homicide recidivism. This kind of method could be used to choose target groups for early preventive interventions, and to study the effectiveness of prevention.
Risk//need analysis in juvenile delinquents: an integrated multiprofessional longitudinal approach – a clinical pilot project
Authors: Kristiansson M.
Published: March 2003

Objective:  A clinical pilot project with the aim of performing a risk/need analysis in juvenile delinquents is presented. The main objective of this project was to test the feasibility of performing independent risk predictions by a forensic psychiatric team.

Method:  The organization, which involves a forensic psychiatric team, is described. Risk factors, risk prediction checklists and an analysis of crime characteristics and certain personality features with possible criminogenic implications are discussed.

Results:  The feasibility of the project organization has been confirmed.

Conclusion:  It appears to be possible for an independent forensic psychiatric team to perform risk/need analysis in juvenile delinquents. The integration of clinical factors involving collaboration with staff at the juvenile detention home and checklists for risk prediction are recommended. Long‐term follow up would make it possible to relate certain risk factors and evaluate risk management procedures to relapse in criminal behaviour and beneficial outcome, respectively.
Understanding the abnormal by studying the normal
Authors: Andershed H. , Kerr M. , Stattin H.
Published: March 2003

Objective:  In the present paper we ask whether it is meaningful to study psychopathic traits in non‐referred youths and whether this kind of research can be used to understand the development of criminal full‐blown psychopathy.

Method:  We review studies that have investigated the utility of assessing psychopathic traits in non‐referred samples of youths.

Results:  Research shows that psychopathic traits in non‐referred youths manifest similarly to how they are manifested among incarcerated offenders, as indicated by similarities in factor structures. Also, psychopathic traits relate similarly to frequent, violent antisocial behavior in non‐referred youths as among adult and adolescent institutionalized criminal offenders. Thus, the differences between the non‐referred conduct‐problem youths exhibiting a psychopathic personality pattern and the incarcerated, criminal youths identified as psychopathic seem to be quantitative rather than qualitative.

Conclusion:  It is concluded that research on non‐referred youth samples can provide important knowledge about the processes that underlie the development of psychopathic traits and how this development can be prevented. Implications for future research and intervention and prevention are discussed.
The Brøset violence checklist (BVC)
Authors: Woods Phil , Almvik R.
Published: March 2003

Objective:  The Brøset violence checklist (BVC) is a short‐term violence prediction instrument assessing confusion, irritability, boisterousness, verbal threats, physical threats and attacks on objects as either present or absent. The aim of this paper is to describe the evolution and usefulness of the BVC.

Method:  This paper reviews studies on the BVC and discusses implications for further research.

Results:  Empirical research has shown that it has moderate sensitivity and high specificity with an adequate inter‐rater reliability.

Conclusion:  The BVC is a useful instrument for predicting inpatient violence within the next 24‐h period. The psychometric properties of the instrument are satisfactory. Results from ongoing studies will give important information on cultural differences, the validity of the BVC in less well staffed wards, the clinical use of the checklist and its ability to predict violence throughout all the hospital stay.
Perception of aggression among psychiatric nurses in Switzerland
Authors: Abderhalden C. , Needham I. , Friedli T. K. , Poelmans J. , Dassen T.
Published: March 2003

Objective:  To identify principal components and patterns in the perception of aggression by psychiatric nurses and to explore relationships between the perception of aggression and personal and workplace characteristics.

Method:  Seven hundred and twenty‐nine nurses working in psychiatric inpatient departments of German‐speaking Switzerland completed the perception of aggression scale (POAS). Data analysis included factor analysis, group comparisons and multivariate analysis of covariance.

Results:  Two plausible factors were identified, representing different dimensions in the perception of aggression and accounting for 35% of the variance. Firstly, aggression is perceived as dysfunctional/ undesirable and, secondly, aggression is perceived as a functional/ comprehensible phenomenon. Only minor differences were found in the perception of aggression with regard to personal characteristics or work environment of the nurses.

Conclusion:  Nurses perceive aggression not just as a negative phenomenon. The perception of aggression as measured by POAS is independent of many characteristics expected to be related to the perception of violence, such as grade of education, work experience, etc.
A model of aggression in psychiatric hospitals
Authors: Nijman H. L. I.
Published: March 2003

Objective:  Research of the determinants of inpatient aggression indicates that certain environmental hospital variables play a role in triggering aggression in psychiatric hospitals. Yet, how patient, staff and ward variables interact in eliciting aggression is not well understood.

Method:  On the basis of earlier findings, a model was proposed in which psychopathology and distorted cognitions of the patient are combined with environmental and communicational stressors that are specific for psychiatric wards.

Results:  The proposed model elucidates how certain patient, staff and ward characteristics may interact in causing aggression. The model also emphasizes that repeated inpatient aggression may be the result of a vicious circle, i.e. inpatient violence is often followed by an increase in environmental and/or communication stress on the patient, thereby heightening the risk of a repeated outburst of violence.

Conclusion: Although tentative, the model may shed light on the mechanisms that lead to (repeated) violence.
Violence in a general hospital: comparison of assailant and other assault‐related factors on accident and emergency and inpatient wards
Authors: Winstanley S. , Whittington R.
Published: March 2003

Objective:  This study sought to compare the characteristics of aggressive incidents occurring on inpatient (medical and surgical) wards with those occurring in the accident and emergency department in terms of assailant, employee and other factors.

Method:  A prospective interview‐based survey design was adopted. Forty‐eight assaulted staff were interviewed about 69 incidents within 7 days on average of the incident occurring. The presence or absence of various assailant, employee, situation, interaction and outcome factors derived from the UK Health Services Advisory Committee's model was compared between the two settings.

Results:  Inpatient ward incidents were significantly more likely to have the following characteristics: female perpetrator, perpetrator aged over 70 years, daytime occurrence in a restricted area, resolved by support from other health care staff.

Conclusion:  Aggression frequently occurs on inpatient (medical and surgical) wards of a general hospital. Aggression management training for staff working in both accident and emergency and inpatient settings should be cognisant of the similarities and differences within general health care specialisms.
Comparing clinical risk assessments using operationalized criteria
Authors: Brown C. S. H. , Lloyd K. R.
Published: March 2003

Objective:  To compare the clinical risk assessment of patients by psychiatrists working in different mental health service settings (low, medium and high security).

Method:  Operationalized criteria of clinical factors recognized as indicating risk of harm to others were developed into a simple checklist with explicit item descriptions and definitions (OP‐RISK). This was used to compare risk assessments in a prospective cohort of 161 consecutive referrals to a high secure psychiatric hospital.

Results:  Agreement on the risk posed by a patient between psychiatrists working outside and inside high secure services using unstructured clinical risk assessment was poor (κ=−0.006). When OP‐RISK was applied to the clinical risk assessments, agreement improved (κ=0.742).

Conclusion:  Applying operationalized criteria to clinical risk assessment is useful in integrating different mental health service settings. The use of OP‐RISK may facilitate the referral process to tertiary care.
Auricular acupuncture in prison psychiatric units: a pilot study
Authors: Berman A. H. , Lundberg U.
Published: March 2003

Objective:  The study explores whether auricular acupuncture can be a viable treatment form for inmates in prison psychiatric units.

Method:  Inmates in a prison psychiatric unit and in a support unit for violent behavior were offered group treatment with auricular acupuncture three times a week over a period of 9 months. Another prison psychiatric unit served as a control group.

Results: Twenty‐two inmates received treatment, and 11 inmates received treatment for over 8 weeks. Cortisol levels were higher for inmates in the support unit than for the other two groups. Inmates treated at least 25 times were prescribed fewer psycholeptic drugs than controls. Perceived autonomy increased for treated inmates in the psychiatric unit. Inmates treated for over 8 weeks experienced improved inner harmony and calm and better clarity over future plans.

Conclusion: Acupuncture is a non‐verbal form of treatment appropriate for prison psychiatric units. The treatment facilitates contact and complements other psycho‐social treatment forms.
More than zero tolerance? Burnout and tolerance for patient aggression amongst mental health nurses in China and the UK
Authors: Whittington R. , Higgins L.
Published: March 2003

Objective:  The aim of the study was to examine attitudes toward patient aggressive behaviour amongst mental health nurses in China and the UK and the relationship between these attitudes and burnout. The UK government policy of ‘zero tolerance’ of patient aggression may conflict with practitioner attitudes and could potentially increase the risk of aggression occurring.

Method: Two surveys of mental health nurses were conducted, one in the People's Republic of China and one in the UK using the Perceptions of Aggression Scale (POAS). The UK sample also completed the Maslach Burnout Inventory (MBI).

Results:  Some nurses in both groups agreed that patient aggression could sometimes have positive benefits. A sense of personal accomplishment at work (MBI) was significantly associated with a tendency to endorse positive statements about aggression.

Discussion:  Nurses seem to have a complex set of attitudes toward this issue that do not simply equate with ‘zero tolerance’.
Treatment strategies in achieving remission in major depressive disorder
Authors: Kelsey J. E.
Published: March 2003

Objective:  This paper discusses strategies for achieving remission in major depressive disorder, summarizing the results of comparative studies of various antidepressants.

Method:  Antidepressant efficacy was determined as either response or remission, measured using the Hamilton Depression Rating Scale, the Clinical Global Impressions scale and other widely used instruments.

Results:  Study results suggest an advantage to pharmacotherapy that interacts with more than one neurotransmitter system, either as single mixed‐activity drugs (e.g. clomipramine, mirtazapine and venlafaxine extended‐release) or combinations of medications that are individually specific for a single neurotransmitter system.

Conclusion:  Remission should be the goal of antidepressant therapy. Treatment strategies include increasing the dosage of the chosen antidepressant; switching to an antidepressant with a different mechanism of action; augmenting one antidepressant with another agent; or using combination therapy. A substantial body of data indicates that for a subset of depressed patients, activation of multiple neurotransmitter systems is beneficial in achieving remission.
Antidepressant drugs: does it matter if they inhibit the reuptake of noradrenaline or serotonin?
Authors: Eriksson Elias
Published: March 2003

The current popularity of the selective serotonin reuptake inhibitors (SSRIs) for the treatment of depression should not conceal the fact that noradrenergic neurones also seem to influence depressed mood. Selective noradrenaline reuptake inhibitors (NRIs) such as reboxetine thus seem to be at least as effective as the SSRIs. It has been suggested that NRIs influence depression by indirectly facilitating serotonergic transmission, or that SSRIs act by facilitating noradrenaline; however, the marked differences between SSRIs and NRIs with respect to effects and side‐effect profile do not support any of these assumptions, but rather suggest that SSRIs and NRIs influence depression by parallel, independent pathways. In this review the possibility that certain symptoms within the depressive syndrome (and certain subtypes of depression) respond better to NRIs, whereas other symptoms (and subtypes) respond better to SSRIs, will be discussed. In addition, the putative usefulness of NRIs for indications other than depression will be commented upon.
The need for new and better antidepressants: reboxetine a new option
Authors: Dencker Sven J.
Published: March 2003

The selective serotonin reuptake inhibitors (SSRIs) have obtained global attention but have not demonstrated superior efficacy in major depression compared with older tricyclic antidepressants. From a pharmacological viewpoint the noradrenergic system in the brain appears to have a central role in neurotransmitter organization. The importance of noradrenaline in depression is supported by its association with clinical parameters such as vigilance and drive. Reboxetine is a selective noradrenaline reuptake inhibitor — the first in its class to be marketed. In both preclinical and clinical studies reboxetine has been found to be an effective and safe antidepressant. Furthermore, reboxetine restores a patients' social functioning, producing a better quality of remission than fluoxetine.
Noradrenaline and serotonin reuptake inhibition as clinical principles:a review of antidepressant efficacy
Authors: Humble M.
Published: March 2003

Imipramine and other subsequently developed antidepressants produce numerous neurochemical effects, some of which presumably represent active antidepressant principles. Numerous studies have compared the efficacy of selective serotonin reuptake inhibitors (SSRIs) with noradrenaline reuptake inhibitors (NRIs) with variable selectivity, such as desipramine, lofepramine, viloxazine, maprotiline or oxaprotiline. Most studies have failed to show differences in response rates or subtype responsivity. However, in some studies NRIs appear to be superior to SSRIs as regards retardation and, conversely, SSRIs appear superior as regards anxiety symptoms. Furthermore, NRIs may be more effective than SSRIs in severe depression. The novel selective NRI reboxetine has been shown to be at least as effective as imipramine, desipramine and fluoxetine in the treatment of major depression. Moreover, reboxetine may also improve social functioning significantly more than fluoxetine providing a better quality of the remission.
Outcome measures of antidepressive therapy
Authors: Rosenberg Raben
Published: March 2003

A variety of outcome measures assessing antidepressive therapy are available. However, in randomized clinical trials, the Hamilton Rating Scale for Depression (HAM‐D) is often the primary outcome measure. Results from factor analysis and Rasch item analysis indicate that the HAM‐D is heterogeneous and that the sum of items scores may not be an adequate measure of the severity of depression. A Melancholia Scale of 11 items has been suggested as a more valid measure of the core symptoms of affective syndrome. Other global outcome measures, focusing on health‐related quality of life issues and on social functioning as well as macro‐economic analyses are also used in depression. Applying stringent and well‐documented outcome measures in randomized clinical trials of antidepressants may give the clinician a better indication of the most appropriate drug for treatment of the individual patient.
Reboxetine: its effects as measured by the Social Adaptation Self‐evaluation Scale
Authors: Healy David
Published: March 2003

The determination of the outcome of treatment for depression is important both for the symptoms of depression and social functioning. The aim of this review is to evaluate the outcome of two clinical trials comparing reboxetine and fluoxetine on depressive symptoms and social functioning. These studies used both conventional measures of outcome such as the Hamilton Rating Scale for Depression (HAM‐D) and the Social Adaptation Self‐evaluation Scale (SASS), a patient‐centred, disease non‐specific scale of social functioning, which was developed for measuring social functioning in depressed people. These findings, set against a background of all studies in which antidepressants have been compared using quality of life instruments, suggest that while some patients may appear to the clinician to have recovered, they may remain less than fully well and differences in selectivity for neurotransmitter systems may play a part in the degree of wellbeing that recovered patients might expect.
Epidemiological research in mental disorders: lessons for the next decade of research — the NAPE Lecture 1999
Authors: Wittchen Hans‐Ulrich
Published: March 2003

Objective: To provide an overview of the progress in the field of epidemiology of mental disorders during the last decades, and to discuss challenges for the future.

Method: Following a review of the achievements of psychiatric epidemiology up to this point, current shortcomings in the research and publications in the field are presented. Suggestions for changes in research and solutions to current deficits are proposed.

Results: Future research needs to cover a broader spectrum of psychopathology, including inquiries into sub‐threshold characterizations; explore etiopathogenic processes and pathways including genetic, neuroscientific and psychological factors for the onset and persistence of psychopathology; and provide a better assessment of help‐seeking behaviors and service utilization.

Conclusion: Future epidemiological research should strengthen the emerging collaborative links with the neurosciences, clinical research and public health by acknowledging the full range of available epidemiological designs and methods, beyond the current emphasis on large‐scale, cross‐sectional general population studies.
PET measurements of brain glucose metabolism and blood flow in major depressive disorder: a critical review
Authors: Videbech P.
Published: March 2003

Objective: To show that PET investigations of brain function in patients with major depression can contribute with valuable pathophysiological knowledge about brain function of these states.

Methods: PET studies of cerebral blood flow or glucose metabolism in patients with unipolar or bipolar depression were reviewed.

Results: The studies have great discrepancies related to sample size, subject selection, imaging protocol and image analysis. In spite of this shortcoming, there is evidence that patients with major depression have reduced blood flow and metabolism in the prefrontal cortex, particularly when they exhibit psychomotor retardation. Abnormalities are also found in the anterior cingulate gyrus and the basal ganglia. A few studies point to the possibility that response to antidepressant treatment can be predicted from PET scans.

Conclusion: This evidence is consistent with the hypothesis that depressive symptoms are caused by dysfunction of regions of the limbic system and the frontal lobes in close connection with the basal ganglia.
Comorbidity of the anxiety disorders in a community‐based older population inThe Netherlands
Authors: Van Balkom A. J. L. M. , Beekman A. T. F. , De Beurs E. , Deeg D. J. H. , Van Dyck R. , Van Tilburg W.
Published: March 2003

Objective: The aim of the study was to investigate patterns of comorbidity among the anxiety disorders in a community‐based older population, and the relationship of these disorders with major depression, use of alcohol and benzodiazepines, cognitive impairment and chronic somatic illnesses.

Method: The data were derived from the Longitudinal Aging Study Amsterdam (LASA) study. A two‐stage screening design was adopted to identify respondents with anxiety disorders.

Results: In total, 10% of the elderly with an anxiety diagnosis suffered from two or more anxiety disorders. Major depression (13% vs. 3%), benzodiazepine use (24% vs. 11%) and chronic somatic diseases (12% vs. 7%) were significantly more prevalent in respondents with an anxiety disorder than in respondents without anxiety disorders. Heavy or excessive alcohol intake (5% vs. 4%) and cognitive impairment (11% vs. 13%) were not significantly associated with any anxiety disorder.

Conclusion: When anxiety disorders are diagnosed, in older people there is a relatively high probability of comorbid conditions being present.
Sources of coercive behaviours in psychiatric admissions
Authors: Lidz C. W. , Mulvey E. P. , Hoge S. K. , Kirsch B. L. , Monahan J. , Bennett N. S. , Eisenberg M. , Gardner W. , Roth L. H.
Published: March 2003

Objective: Coercion during psychiatric admissions has been a topic of debate for many years. Although there has been considerable research on patients' perceptions of coercion, there has been no work on who places pressures on patients to be admitted.

Method: This article integrates interview data from interviews with patients, admitting staff and family and friends to describe the pressures brought to bear on patients to be admitted.

Results: Health‐care professionals appear to be the most important source of pressures on patients, and to have the most impact on patients' perceptions of coercion. However, there are differences in type of pressure, and the pressures used by family and friends appear to having the most longstanding impact.

Conclusion: Legal and clinical efforts to reduce the level of coercive pressures on patients need to recognize the importance of mental‐health professionals, including especially those who are not legally mandated to participate in the admission process.
Somatoform syndromes and disordersin a representative population sample of adolescents and young adults: prevalence, comorbidity and impairments
Authors: Lieb Roselind , Pfister Hildegard , Mastaler Marianne , Wittchen Hans‐Ulrich
Published: March 2003

Objective: To present prevalence findings of DSM‐IV somatoform symptoms, syndromes and disorders in a representative sample of adolescents and young adults.

Method: Data come from the Early Developmental Stages of Psychopathology (EDSP) study, in which a total of 3021 respondents aged 14–24 years were assessed by the Munich‐Composite International Diagnostic Interview.

Results: Although specific DSM‐IV somatoform disorders were relatively rare with a lifetime rate of 2.7%, a considerably higher proportion of respondents met criteria for clinically significant somatoform syndromes as defined by the Somatic Symptom Index SSI4, 6 (lifetime: 1.7%), as well as the undifferentiated somatoform/dissociative syndrome USDS (lifetime: 9.1%), resulting in an overall prevalence rate of 12.6%. Somatoform conditions are often comorbid with other mental disorders and were found to be associated with remarkable impairments and disabilities.

Conclusions: Somatoform disorders and syndromes in young adults are frequent, impairing and often associated with the development of other mental disorders.
Maternity blues and attachment to children in mothers of full‐term normal infants
Authors: Nagata M. , Nagai S. , Sobajima H. , Ando T. , Nishide Y. , Honjo S.
Published: March 2003

Objective: This study was conducted for evaluating incidence of maternity blues in Japan, in addition to clarifying the relationship between maternity blues and maternal attachment, and the factors involved.

Method: A questionnaire survey was conducted on 417 mothers having given birth at the Nagoya Daini Red Cross Hospital. The questionnaire consisted of Zung's self‐rating depression scale, and a ‘postpartum maternal attachment’ scale, consisting of subscales on ‘core maternal attachment’ and ‘anxiety regarding children’. The survey was conducted 5.2 days±1.46 postpartum.

Results: ZSDS scores over 40 amounted to 66.8% of the responses. Analysis of the two scales revealed significant correlation/inverse correlation between ‘maternity blues’ and ‘anxiety regarding children’/‘core maternal attachment’. Path analysis revealed ‘maternity blues’ to be influencing ‘core maternal attachment’ and ‘anxiety regarding children’.

Conclusion: It was found that the incidence of maternity blues may be higher in Japan than was believed previously, and that an intimate association exists between ‘maternity blues’ and ‘postpartum maternal attachment’.
Regional differences in schizophrenia incidence in Denmark
Authors: Schelin E. M. , Munk‐Jørensen P. , Olesen A. V. , Gerlach J.
Published: March 2003

Schelin EM, Munk‐Jørrgensen P, Olesen AV, Gerlach J. Regional differences in schizophrenia incidence in Denmark. Acta Psychiatr Scand 2000: 101: 293–299. © Munksgaard 2000.

Objective: To examine the regional distribution of schizophrenia incidence in Denmark.

Method: A cohort consisting of 2441 Danish psychiatric patients, with first‐time admissions between January 1, 1978 and December 31, 1982, and diagnosed as having schizophrenia (ICD‐8) at least once in a 10‐year period of observation was divided into three regional groups by degree of urbanization.

Results: Incidence increased for both sexes with increasing urbanization. A diagnostic delay was most pronounced in the least urbanized areas and was most pronounced for women.

Conclusion: Our study confirms the existence of regional differences in schizophrenia incidence on a national basis. Marked regional differences in diagnostic delay were also demonstrated. A possible explanation could be regional differences in diagnostic procedures, underlining the importance of uniform diagnostic patterns as a means for reliable mapping of psychiatric morbidity and, hopefully, adequate treatment.
Changes in negative symptoms and the risk of tardive dyskinesia: a longitudinal study
Authors: van Ss J. , Walsh E. , van Horn E. , Tattan T. , Bale R. , Thompson S. G.
Published: March 2003

Van Os J, Walsh E, van Horn E, Tattan T, Bale R, Thompson SG, on behalf of the UK700 Group. Changes in negative symptoms and the risk of tardive dyskinesia: a longitudinal study

Acta Psychiatr Scand 2000: 101: 300–306. © Munksgaard 2000.

Objective: To examine whether the development of tardive dyskinesia (TD) is accompanied by a parallel process of worsening negative symptoms in a longitudinal study.

Method: A sample of 708 psychotic patients were followed over a period of 2 years, using the Abnormal Involuntary Movement Scale and the Scale for the Assessment of Negative Symptoms (SANS).

Results: Of 361 individuals with no prior evidence of dyskinesia, 46 (13%) developed TD by year 2. Independent of the effects of male sex (odds ratio (OR) = 2.18, 95% confidence interval: 1.004.74), age (OR per quartile group = 1.39, 95% CI: 1.01–1.90), duration of exposure to antipsychotic medication (OR = 2.35 per 8 months, 95% CI: 1.174.72) and average SANS score (OR per quartile group = 1.38, 95% CI: 0.99–1.93), worsening of negative symptoms over the 2 previous years was asSociated with TD onset (OR per quartile group = ‐l.46, 95% CI: 1.07–2.00).

Conclusion: The development of TD is linked, independent of the effect of antipsychotics and older age, to an illness‐related pathological process, characterized by worsening negative symptoms.
Does increasing dose improve efficacyin patients with poor antidepressantresponse: a review
Authors: Corruble E. , Guelfi J. D.
Published: March 2003

Objective: Therapeutic strategies in depressed patients with no or partial response to adequate first‐line antidepressant medication remain a matter of concern. This paper focuses on the strategy of dose increase.

Method: This review was based on a systematic Medline search of papers dealing with antidepressant dose issues in major depression since the 1960s.

Results: The strategy of dose increase is poorly studied in clinical trials.

Conclusion: Until this strategy is better studied, caution is advised in its use. However, antidepressants for which this strategy seems to be the most relevant are tricyclic drugs and serotonin and noradrenaline reuptake inhibitors. These results are discussed both in terms of therapeutic strategies for the clinician and in terms of clinical research.
Suicide attempts and impulse control disorder are related to low cerebrospinalfluid 5‐HIAA in mentally disorderedviolent offenders
Authors: Lidberg L. , Belfrage H. , Bertilsson L. , Mattila Evenden M. , Åsberg M.
Published: March 2003

Objective: The aim of this study was to investigate the relationship between low cerebrospinal fluid 5‐hydroxyindoleacetic acid (CSF 5‐HIAA) and aggressive acts in mentally disordered violent offenders.

Method: CSF concentrations of 5‐hydroxyindoleacetic acid (5‐HIAA), homovanillic acid and 4‐hydroxy‐3‐methoxyphenyl glycol weremeasured in 35 drug‐free men convicted of homicide and currently undergoing forensic psychiatric investigation in a high security hospital.

Results: The mean metabolite concentrations in the homicide offenders did not differ from those of age‐ and body‐height matched malecontrol subjects. One‐third of the murderers had made oneor several suicide attempts, and their mean concentration ofspinal fluid 5‐HIAA was significantly lower than that ofthe remaining murderers. Subjects with impulse controldisorder also had lower mean CSF 5‐HIAA. A consistentpattern of higher CSF 5‐HIAA in subjects with moreself‐reported anxiety traits was observed.

Conclusion: The association between serotonin and suicidal behaviour holds for yet another subject group. Determining CSF 5‐HIAA might be worth while in the routine assessment of psychiatrically ill homicide offenders.
Low novelty‐seeking differentiates obsessive‐compulsive disorder from major depression
Authors: Kusunoki K. , Sato T. , Taga C. , Yoshida Y. , Komori K. , Narita T. , Hirano S. , Iwata N. , Ozaki N.
Published: March 2003

Objective: To make a direct comparison of patients with obsessive‐compulsive disorder (OCD) and major depression (MD) and a normal control group in terms of the Temperament and Character Inventory (TCI) personality dimensions.

Method: Additionally to 43 patients with primary OCD, 43 MD patients and 43 normal subjects who were matched against the OCD patients for sex and age filled out the TCI.

Results: Compared to the controls, the OCD and MD patients scored significantly higher on harm avoidance and significantly lower on self‐directedness and co‐operativeness. The OCD patients scored significantly lower on novelty‐seeking than the MD patients and the controls.

Conclusion: Whereas OCD and MD share similar personality deviations on harm avoidance, self‐directedness and co‐operativeness, OCD is distinguishable from MD in terms of low novelty‐seeking. Low novelty‐seeking may have a profound relationship to the specific aetiology of OCD.
The prevalence of comorbid substance misuse and its influence on suicidal ideation among in‐patients with schizophrenia
Authors: Kamali M. , Kelly L. , Gervin M. , Browne S. , Larkin C. , O'Callaghan E.
Published: March 2003

Objective:To estimate the prevalence, and identify the clinical correlates of comorbid substance misuse (abuse or dependence) among readmissions with schizophrenia, particularly to establish whether comorbid substance misuse is associated with higher rates of depressive symptoms and suicidal ideation.

Method:Over 12 months, consecutive readmissions from a catchment area psychiatric service with DSM‐IV schizophrenia/schizoaffective disorder were assessed using clinical assessments of symptomatology including depression, insight and compliance. Comorbid substance misuse was diagnosed using DSM‐IV criteria.

Results:Of 102 readmissions 40% had lifetime, while 20% had current comorbid substance misuse and were predominately young males. Comorbid substance misuse had no statistically significant impact on positive, negative or depressive symptomatology. However, those currently misusing substances reported more suicidal ideation compared with past or non‐substance misusers.

Conclusion:Readmissions with comorbid substance misuse were more likely to report suicidal ideation, and may represent a group of individuals who are at higher risk of suicide.
Long‐term psychiatric patients in vocational rehabilitation programmes: a naturalistic follow‐up study over 3 years
Authors: Reker Th. , Hornung W. P. , Schonauer K. , Eikelmann B.
Published: March 2003

Objective: This paper aims at assessing the vocational integration attained after a 3‐year period by psychiatric patients who participated in different vocational rehabilitation programmes.

Method: In the north‐western German region of Westphalia‐Lippe a naturalistic follow‐up study was carried out on 471 patients from three different types of vocational rehabilitation programmes. The sample comprised chronically ill patients with a history of repeated and long‐term hospitalization.

Results: After 3 years 11% of the patients were in competitive employment, 67% (still) in sheltered employment, 7% in out‐patient work therapy programmes and 15% were unemployed. It is important to notice that 74% achieved their subjective rehabilitation goals expressed at baseline.

Conclusion: Vocational rehabilitation programmes are an essential part in the treatment of people with chronic mental illness. Integration into work varies markedly while patients' satisfaction is comparably good. Competitive employment represents a realistic objective only for patients with high motivation and favourable preconditions.
Service use and costs of people with dual diagnosis in South London
Authors: McCrone P. , Menezes P. R. , Johnson S. , Scott H. , Thornicroft G. , Marshall J. , Bebbington P. , Kuipers E.
Published: March 2003

Objective: To compare the service use and costs of individuals who have a dual diagnosis of psychosis and substance abuse with those who have a diagnosis of psychosis but no substance abuse.

Method: Patients with psychosis were identified and a representative sample were interviewed. Six‐month service use was measured and costs calculated. Regression models were developed to predict costs from background characteristics and dual diagnosis status.

Results: A greater proportion of the patients with dual diagnosis used community psychiatric nurses, in‐patient care and the emergency clinic. The regression analysis revealed that dual diagnosis patients had significantly higher ‘core’ psychiatric service costs (a difference of £1362) and non‐accommodation service costs (£1360) than non‐dual‐diagnosis patients. The difference when all services were analysed was £1046, but this was not statistically significant.

Conclusion: Specific interventions for dual diagnosis patients should be introduced and assessed in terms of individual outcomes, service use and costs.
Differences between patients with schizophrenia within and without a high security psychiatric hospital
Authors: Miller P. McC. , Johnstone E. C. , Lang F. H. , Thomson L. D. G.
Published: March 2003

Objective: To report and discuss differences between schizophrenic patients in the community and those in maximum security care.

Method: Comparison of 193 community schizophrenic patients with 169 in high security care. Data included case notes, interviews and cognitive tests.

Results: Compared to high security patients, community patients tended to be female and married. They had higher school achievement, higher premorbid IQ and better occupational levels, were less likely to have a family history of alcohol abuse, to have had police contact and to have attempted suicide. They had more frequent shorter psychiatric admissions and fewer current and lifetime schizophrenic symptoms. Logistic regression models discriminated the groups with considerable accuracy.

Conclusion: Patients needing high security care may be recognizable when schizophrenia is first diagnosed. Progression to the State Hospital seems to result from schizophrenia together with other factors such as deprivation rather than from a worse schizophrenic process per se.
A longitudinal study of prisoners on remand: psychiatric prevalence, incidence and psychopathology in solitary vs.non‐solitary confinement
Authors: Andersen H. S. , Sestoft D. , Lillebæk T. , Gabrielsen G. , Hemmingsen R. , Kramp P.
Published: March 2003

Objective: To compare two levels of stress (solitary confinement (SC) and non‐SC) among remand prisoners as to incidence of psychiatric disorders in relation to prevalent disorders.

Method: Longitudinal repeated assessments were carried out from the start and during the remand phase of imprisonment. Both interview‐based and self‐reported measures were applied to 133 remand prisoners in SC and 95 remand prisoners in non‐SC randomly selected in a parallel study design.

Results: Incidence of psychiatric disorders developed in the prison was significantly higher in SC prisoners (28%) than in non‐SC prisoners (15%). Most disorders were adjustment disorders, with depressive disorders coming next. Incident psychotic disorders were rare. The difference regarding incidence was primarily explained by level of stress (i.e. prison form) rather than confounding factors. Quantitative measures of psychopathology (Hamilton Scales and General Health Questionnaire) were significantly higher in subjects with prevalent and incident disorders compared to non‐disordered subjects.

Conclusion: Different levels of stress give rise to different incidence of psychiatric morbidity among remand prisoners. The surplus of incident disorders among SC prisoners is related to SC, which may act as a mental health hazard.
Alcoholism and depression in a Swedish female population: co‐morbidity andrisk factors
Authors: Spak Lena , Spak Fredrik , Allebeck Peter
Published: March 2003

Objective: Our aims were to study associations between depressive disorders and alcohol dependence/abuse (ADA) in a female population‐based sample, and to identify risk indicators common to both depressive disorders and ADA.

Method: Three hundred and sixteen women in a stratified randomized sample were interviewed face to face. They were asked about their childhood/adolescence and alcohol habits. Clinical lifetime diagnoses according to DSM‐III‐R were made. Depressive disorders includes different mood disorders.

Results: Half the women with ADA also had a depressive disorder, and 25% of the women with depressive disorders also had ADA. Alcohol intoxication before the age of 15 and psychological and/or psychiatric problems before the age of 18 years increased the risk for ADA and depressive disorders in our study.

Conclusion: Our results support previous findings of an association between depressive disorders and ADA, beginning early in life.
Loss as a determinant of PTSD in a cohort of adult survivors of the 1988 earthquake in Armenia: implications for policy
Authors: Armenian Haroutune K. , Morikawa Masahiro , Melkonian Arthur K. , Hovanesian Ashot P. , Haroutunian Nune , Saigh Philip A. , Akiskal Knarig , Akiskal Hagop S.
Published: March 2003

Objective: To study the relationship of post‐traumatic stress disorder (PTSD) to severity of the disaster experience.

Method: A sample of 1785 adult participants of an epidemiological study initiated in the immediate aftermath of the 1988 earthquake in Armenia were interviewed about 2 years following the disaster based on the NIMH DIS‐Disaster Supplement. All 154 cases of pure PTSD were compared with 583 controls without symptoms satisfying psychiatric diagnoses of interest.

Results: PTSD cases included more persons from areas with the worst destruction. Having the highest level of education compared to lowest (OR 0.6 [95% CI 0.4–0.9]), being accompanied at the moment of the earthquake (OR 0.6 [95% CI 0.4–0.9]) and making new friends after the earthquake (OR 0.6 [95% CI 0.5–0.8]) were protective for PTSD. PTSD risk increased with the total amount of loss to the family (OR for highest level of loss 4.1 [95% CI 2.3–7.5]).

Conclusion: Based on this large population sample, we believe that early support to survivors with high levels of loss may reduce PTSD following earthquakes.
Measurement of violence during in‐patient treatment and association with psychopathology
Authors: Steinert T. , Wölfle M. , Gebhardt R‐P.
Published: March 2003

Objective: Four available instruments for the measurement of violence were compared. The association between psychopathological status at admission and violence during in‐patient treatment was examined.

Method: In 199 consecutively admitted patients (143 with schizophrenia or schizoaffective disorder, 56 with non‐psychotic disorders), the PANSS was recorded at the time of admission. Violent behaviour against self and others was assessed for the total period of in‐patient treatment using the scales MOAS, SDAS, SOAS and VS.

Results: The sumscores of the scales correlated highly (r between 0.78 and 0.91), but the scales differed in sensibility and inter‐rater reliability. There was a strong association between thought disorders and violent behaviour during in‐patient treatment in psychotic patients (beta=0.34; P<0.001).

Conclusion: Although constructed to measure different aspects of violence, all investigated instruments correlated highly. The psychopathological status at admission is associated with violent behaviour during in‐patient treatment.
Suicide prevention — a medical breakthrough?
Authors: Isacsson G.
Published: March 2003

Objective: The author hypothesized, based on research until 1991, that a five‐fold increase in the use of antidepressants might reduce Swedish suicide rates by 25%. A subsequent 3.5‐fold increase in the use of antidepressants provided a ‘natural experimental situation’ forprospectively testing this hypothesis.

Method: Swedish statistics on suicide, use of antidepressants,unemployment and alcohol consumption were obtained for1978–96. Time‐series of the latter variables were compared with suicide rates. Demographic subgroups regarding age, gender and county were analysed. Suicide rates were also compared with the use ofantidepressants in Denmark, Norway and Finland.

Results: Suicide rates decreased in accordance with the a priori hypothesis. Alcohol consumption and unemployment rates did not correlate well with suicide rates.

Conclusion: This naturalistic study is not conclusive. Theincreased use of antidepressants appears, however, to be one of the contributing factors to the decrease in the suicide rate. It is of great scientific and clinical importance that this be evaluated byfurther studies.
Comparison of the standard and the computerized versions of the Symptom Check List (SCL‐90‐R): a randomized trial
Authors: Schmitz Norbert , Hartkamp Norbert , Brinschwitz Carsten , Michalek Silke , Tress Wolfgang
Published: March 2003

Objective: The purpose of this study was to examine whether computer administration of the Symptom Check List (SCL‐90‐R) is equivalent to paper‐and‐pencil originals.

Method: 282 psychosomatic outpatients were randomly assigned to computer or paper‐and‐pencil conditions. Statistical equivalence tests were used to examine psychometric equivalence for the means. Reliabilities and correlations were compared for the two methods of administration.

Results: No systematic differences were observed in group means for most of the subscales. Subjects of the computer‐administered group scored higher on the SCL‐90‐R subscale ‘Obsessive‐Compulsive’ and ‘Anger‐Hostility’ than the control subjects. Gender and administration mode interaction was observed for one subscale, while age and administration interaction was observed for another subscale.

Conclusion: Using computer‐administered tests makes administration and scoring of tests more efficient. The differences between the two administration modes were small, although noticeable. Further research is needed to determine whether computer environment, computer experience and age may influence the test results.