bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Cost of Comprehensive Care of People with Schizophrenia Living in the Community
Authors: Salize Hans Joachim , Rössler Wulf 
Published: October 2008

BackgroundIn community mental health care, knowledge about costs of care is very limited. Only few studies have related costs to outcome measures.MethodThis German study assesses the cost of psychiatric care of 66 schizophrenic patients during one year of living in the community. Predictors of high cost were identified.ResultsThe average cost of comprehensive community care of one patient of the cohort was US$ 353 per week. This was only 43% of the cost of constant long-term care in a psychiatric hospital. Significant predictors of total cost of community care were the number of rehabilitative problems at the beginning and at the end of the study period, the type of accommodation before index hospitalisation and the gender of patients.ConclusionsResults must be understood in terms of the characteristics of the special patient group and the catchment area we studied and are of high relevance in planning future care.
Concurrent Validity of the Opcrit Diagnostic System
Authors: Craddock Nick , Asherson Philip , Owen Michael J. , Williams Julie , McGuffin Peter , Farmer Anne E. 
Published: October 2008

BackgroundOPCRIT (a suite of computer programs that allow data entry and generate diagnoses according to 12 operational diagnostic systems) is used in a wide range of psychiatric research including both European Science Foundation and NIMH research initiatives in the molecular genetics of mental disorders. We examined its concurrent validity in 100 subjects collected for linkage studies of Bipolar Disorder and Schizophrenia.MethodWe compared diagnoses generated by OPCRIT from data rated by two trained clinicians with diagnoses made according to consensus, best-estimate, lifetime procedures by the same two raters according to DSM–III–R and RDC classifications.ResultsGood to excellent agreement was achieved between OPCRIT diagnoses and those made by consensus best-estimate procedures.ConclusionsOPCRIT provides a convenient, reliable, rapid and valid approach to polydiagnostic assessment that can be used as an adjunct to conventional (but time consuming) best-estimate consensus diagnostic procedures.
The Entry of Mentally Disordered People to the Criminal Justice System
Authors: Robertson Graham , Pearson Richard , Gibb Robert 
Published: October 2008

BackgroundThe police are the gatekeepers to the criminal justice system (CJS). It is agreed that where possible mentally ill people should be diverted to psychiatric care. The purpose of this investigation was to determine what factors were associated with the entry of obviously mentally ill people into the CJS.MethodThe population of all detainees arrested in seven London police stations was observed to determine the presence of obvious mental illness. All detainees regarded as ill or known to have significant psychiatric histories were followed through the CJS to court disposal. Defendants diagnosed as psychotic by court liaison psychiatrists were identified and the circumstances of their arrest and detention examined.ResultsOf all police detainees observed, 1.4% were found to be acutely ill. Diversion of obviously ill detainees was common practice. The factor most strongly associated with entry to the CJS was the presence of violence at time of arrest. Other factors were the persistence of (petty) offending and the operation of court warrants issued as a result of the person's failure to appear at court when required to do so.ConclusionsBoth police and courts are well aware of the inappropriateness of custody for acutely ill people and efforts are made to divert such people out of the CJS. Persistent petty offenders are often being recycled from the street to police station to court and back to the street without the benefit of care. A dedicated facility is recommended in central London to meet this need.
Individual Behavioural–Cognitive Therapy v. Marital Therapy for Depression in Maritally Distressed Couples
Authors: Emanuels-Zuurveen Lineke , Emmelkamp Paul M. G. 
Published: October 2008

BackgroundDepressed patients are often characterised by marital distress, but few studies investigate the effects of marital therapy on depressed mood and relationship dysfunction.MethodTwenty-seven depressed patients experiencing marital distress were randomly assigned to either individual behavioural–cognitive therapy or marital therapy. The individual treatment condition focused on depressed mood, behavioural activity and dysfunctional cognitions, whereas in the marital condition the partner was involved in the treatment and the focus was on the communication process in the marital relationship. MANOVAs revealed that treatment led to statistically significant improvements in depressed mood, behavioural activity and dysfunctional cognitions, an increase in relationship satisfaction and improvement of communication in patients and spouses. A significant interaction effect was found, showing that marital therapy had more impact on relationship variables than the individual treatment.ConclusionBoth individual cognitive–behaviour therapy and marital therapy lead to less depressive complaints, and both treatment conditions have a positive effect on the relationship, although the effect on the relationship is significantly stronger in couples who were treated by marital therapy compared with patients who were treated individually.
Ten-Year Prognosis of Conversion Disorder
Authors: Mace C. J. , Trimble M. R. 
Published: October 2008

BackgroundPrevious work suggests neurological disease commonly supervenes in cases of conversion disorder but has not identified clear predisposing factors. Patients' subsequent use of services has been neglected.MethodClinical outcomes for 73 patients investigated for pseudoneurological symptoms at a neurological hospital 10 years earlier were compared with findings on presentation. Fifty-six patients complied with a structured interview concerning use of services.ResultsThirty patients had no relief from their original symptom at follow-up. They had been older, with more chronic symptoms, and different auxiliary psychiatric diagnoses. In 11 patients a clear neurological diagnosis was subsequently made for the original symptom. Provisional neurological diagnoses at presentation had been disproportionately common among these 11. Small numbers of patients with poor outcomes made most use of hospital and community services. High attenders met screening criteria for somatisation disorder at follow-up.ConclusionsThe prognosis for chronic symptoms remains poor, but subsequent rediagnosis of neurological disease is less frequent than commonly supposed. Somatisation disorder may develop if hospital contact does not lead to diagnosis of another disease.
Manchester and Oxford Universities Scale for the Psychopathological Assessment of Dementia (MOUSEPAD)
Authors: Allen N. H. P. , Gordon Sheila , Hope Tony , Burns Alistair 
Published: October 2008

BackgroundThere is increasing awareness of the importance of psychopathological and behavioural changes in dementia and a need for an instrument to measure these features which achieves an appropriate compromise between brevity and breadth. We describe a newly developed 59-item instrument: the MOUSEPAD.MethodReliability, sensitivity and validity were examined with 30 carers, each of whom was interviewed four times over six weeks.ResultsFor different symptom groups, kappa ranged from 0.43 to 0.93 for test–retest reliability, from 0.56 to 1.0 for inter-rater reliability, and from 0.43 to 0.67 for the validation study.ConclusionsThe scale may be useful as an outcome measure in drug trials, for correlating psychopathological and behavioural changes with post-mortem findings, and in epidemiological surveys.
An Index of Need for Psychiatric Services based on In-patient Utilisation
Authors: Smith Peter , Sheldon Trevor A. , Martin Stephen 
Published: October 2008

BackgroundThe paper describes the development of an index of the relative need for psychiatric services for the purposes of distributing NHS funds in England.MethodThe study is based on an empirical analysis of all psychiatric in-patient completed episodes in England in 1991/92. Any index of need should be independent of the effect of variations in health care supply on the use of psychiatric services. In order to disentangle the influences of supply from social and clinical determinants of utilisation, two stage least squares regression and multilevel modelling techniques were used.ResultsThe outcome was an index comprising six health and socio-economic variables. This is now being used by the NHS Executive to distribute about £2.2 billion of annual NHS expenditure for psychiatric services between English health authorities.ConclusionIt is shown that the index is much more sensitive to needs and therefore more redistributive than the previous index of need used in the NHS.
Who Responds to Electroconvulsive Therapy?
Authors: Sobin Christina , Prudic Joan , Devanand D. P. , Nobler Mitchell S. , Sackeim Harold A. 
Published: October 2008

BackgroundIt has been reported that real ECT is more effective than simulated treatment among depressed patients with delusions and/or retardation, and that ECT is not effective among depressed patients who lack these features.MethodIn two randomised, double-blind studies, 143 patients with major depression were subtyped regarding psychosis, retardation and agitation. In both studies, low dosage, right unilateral ECT was ineffective compared with other forms of ECT. This report examined whether the depressive subtypes differed in clinical response to the ineffective and effective forms of ECT.ResultsThe therapeutic advantage of effective forms of ECT was similar across the depression subtypes. Patients who lacked both psychosis and retardation showed this pattern.ConclusionsThe findings cast doubt on the utility of these depression subtypes in predicting ECT response. ECT is a viable treatment option for patients with major depression regardless of the presence or absence of psychosis, retardation and/or agitation.
Mental Health, ‘Burnout’ and Job Satisfaction among Hospital and Community-Based Mental Health Staff
Authors: Prosser David , Johnson Sonia , Kuipers Elizabeth , Szmukler George , Bebbington Paul , Thornicroft Graham 
Published: October 2008

BackgroundConcerns have been expressed that staff burnout may make community mental health care difficult to sustain. This study compares stress and job satisfaction between community and hospital-based staff.MethodThe GHQ-12, the Maslach Burnout Inventory and a job satisfaction measure were used to study 160 Inner London staff.ResultsCommunity staff scored significantly higher on the GHQ-12 and the ‘emotional exhaustion’ component of the Maslach Burnout Inventory than hospital-based in-patient, day care or out-patient staff. Satisfaction did not vary significantly between settings.ConclusionsThese results may be explained in several ways. Community work may be inherently more stressful than hospital work, or may currently be stressful because of inadequate resources, training or supervision. The results may also reflect widespread recent changes in community services or the specific effects of working in a deprived area.
Victims and Perpetrators of Child Sexual Abuse
Authors: Hilton M. R. , Mezey G. C. 
Published: October 2008

BackgroundThis article aims to inform clinicians of current thinking in the area of victims and perpetrators of child sexual abuse. It covers prevalence data as well as identification, effects and interventions with victims, and also characteristics, assessment and treatment of perpetrators.MethodThe review is based on manual searches and the authors' own clinical experience.ResultsAll clinicians should be aware of signs and symptoms that raise the possibility that someone has been or is being sexually abused and also of the possibilities of abuse of boys and of women as abusers. Methods of intervening are discussed, both in relation to victims and perpetrators. The importance of thoroughness when assessing perpetrators is emphasised because of their tendency to deny and/or minimise their offending. The demands of this work are underlined in a section on the necessary qualifications and characteristics of therapists working in this area.ConclusionsDespite the lack of agreement in definitions and outcome measures used in research there are some positive findings in relation to clinical efficacy. In particular, the need for long-term treatment with those offenders who are more seriously deviant has been supported by recent research. There is a need for continuing attempts to standardise definitions and measures to aid realistic comparison of research results.
Paroxetine versus Clomipramine in the Treatment of Obsessive–Compulsive Disorder
Authors: Zohar Joseph , Judge Rajinder ,   Ocd Paroxetine Study Investigators
Published: October 2008

BackgroundThe aim was to assess the effect of a flexible dose of paroxetine, compared with clomipramine and placebo, in obsessive-compulsive disorder (OCD).MethodIn a multinational randomised study, 406 subjects with OCD of at least six months duration received double-blind mediation for up to 12 weeks. Doses were adjusted according to therapeutic effect and side-effects. Primary efficacy measures were the Yale–Brown Obsessive–Compulsive Scale and the National Institute of Mental Health Obsessive–Compulsive Scale. Secondary efficacy measures were the Montgomery–åsberg Depression Rating Scale, Symptom Check-List (90), Clinical Global Impression, and Patients' Global Evaluation.ResultsParoxetine was significantly more effective than placebo, and of comparable efficacy to clomipramine. Paroxetine had significantly superior tolerability to clomipramine on three measures: CGI efficacy index, anticholinergic adverse events, and adverse events leading to withdrawal.ConclusionParoxetine is as effective as clomipramine in the treatment of OCD. The comparable efficacy and better tolerability of paroxetine suggest that it would be an appropriate treatment for OCD.
Suicide in the 18 Years After Deliberate Self-harm
Authors: De Moore Gregory M. , Robertson Andrew R. 
Published: October 2008

BackgroundClinical and demographic information on patients seen as a result of deliberate self-harm (DSH) was collected in an attempt to identify factors in the index episode of DSH predictive of subsequent suicide.MethodSpecific data were prospectively collected on all DSH patients who lived in Blacktown Municipality, Sydney, Australia, and seen from October 1975 to September 1976. Follow-up at 18 years was by evaluation of coroners' records and identification of ‘probable suicide’.ResultsTwo hundred and twenty-three patients harmed themselves on one or more occasions. Follow-up at 18 years showed that 15 of the 223 (6.7%) had completed suicide. The proportion at five and eight years was 4.0% and at 10 years was 4.5%. Identified predictors of suicide were: narcotic overdose; more than one episode of DSH in the year of the study; planned episode; and mental illness. Teenage narcotic-abusing males were at greatest risk, and in females a planned episode was the most powerful predictor.ConclusionsSuicides continued to occur over 18 years. One of the striking differences between this and other studies is the finding of teenage male DSH, associated with narcotic abuse, as a strong predictor of subsequent suicide. These findings are particularly relevant to the issue of young male suicide, which increased from the 1970s onwards in Australia and elsewhere.
The Course of Schizophrenia Over 13 Years
Authors: Mason Peter , Harrison Glynn , Glazebrook Cristine , Medley Ian , Croudace Tim 
Published: October 2008

BackgroundThis paper describes the 13 year course of illness in an epidemiologically defined and representative cohort of patients selected when they were experiencing their first episode of schizophrenia.MethodIn a 13-year follow-up study of 67 patients with ICD–9 schizophrenia, identified in Nottingham in 1978–80, the course of illness (symptoms, disability and hospitalisation) was assessed using standardised instruments, applied at onset 1, 2, and 13 years. Time to first relapse and first readmission were calculated and plotted as survival curves and patients were assigned to the course types described by Ciompi.ResultsThe survival curves show that first relapses and first readmissions occur during the first five years. The amount of time spent in psychotic episodes and in hospital is greatest in the first year of follow-up, but stable thereafter. Social adjustment improves from entry to the study to the first follow-up year, but there is a small deterioration in social adjustment between 2 and 13 years.ConclusionsThe findings reported suggest that after the initial episode the course of schizophrenia is relatively stable. The data support neither concepts of progressive deterioration nor progressive amelioration. There was no evidence of a ‘late recovery’.
Cognitive Therapy and Recovery from Acute Psychosis: a Controlled Trial
Authors: Drury Val , Birchwood Max , Cochrane Ray , MacMillan Fiona 
Published: October 2008

BackgroundA trial of CT in acute psychosis conducted by the authors has shown a significant impact on the rate and degree of recovery of positive symptoms, the focus of the intervention. This paper seeks to determine whether these effects generalise to other features of acute psychosis including dysphoria, insight and ‘low level’ psychotic thinking which were not directly targeted.MethodMeasures of dysphoria, insight and psychotic thinking were taken over a six-month period following presentation for acute psychosis. Using survival analysis, time to recovery from psychosis using three definitions of increasing stringency was compared between the CT and control group.ResultsCT was associated with a 25–50% reduction in recovery time depending on the definition used.ConclusionThe impact of the CT intervention extended beyond positive symptoms to include insight, dysphoria and ‘low level’ psychotic thinking. Nevertheless this kind of ‘clinical’ recovery required a median of 20 weeks to complete. Implications for clinical models of acute care are discussed.
Double-Blind, Placebo-Controlled, Crossover Trial of Glycine Adjuvant Therapy for Treatment-Resistant Schizophrenia
Authors: Heresco-Levy Uriel , Javitt Daniel C. , Ermilov Marina , Mordel Clara , Horowitz Avraham , Kelly Dalia 
Published: October 2008

BackgroundIt has been proposed that schizophrenia is associated with underactivity of brain glutamatergic neurotransmission, especially at the level of the N-methyl-D-aspartate (NMDA) subtype of glutamate receptor. Glycine potentiates NMDA receptor-mediated neurotransmission, indicating that it may serve as an effective therapeutic agent in the treatment of schizophrenia.MethodEleven treatment-resistant patients with chronic schizophrenia completed a double-blind placebo-controlled, six-week, randomly assigned, crossover treatment trial of 0.8 g/kg body weight/day of glycine, added to their prior antipsychotic treatment.ResultsGlycine was well tolerated, resulted in significantly increased serum glycine levels and induced a mean 36 (7%) reduction in negative symptoms (P < 0.0001). Significant improvments were also induced in depressive and cognitive symptoms. The greatest reduction in negative symptoms was registered in the patients who had the lowest baseline serum glycine levels.ConclusionsThese results extend previous findings and suggest an additional approach to the pharmacotherapy of negative symptoms and cognitive deficits in schizophrenia.
Emotional Overinvolvement in Parents of Patients with Schizophrenia or Related Psychosis: Demographic and Clinical Predictors
Authors: Bentsen Håvard , Boye Birgitte , Munkvold Ole Georg , Notland Tor Helge , Lersbryggen Annette B. , Oskarsson Kirsti H. , Ulstein Ingun , Uren Gunvor , Bjørge Heidi , Berg-Larsen Rolf , Lingjærde Odd , Malt Ulrik F. 
Published: October 2008

BackgroundParental emotional overinvolvement (EOI) may entail a worse outcome in schizophrenia. In the present study we examined demographic and clinical predictors of EOI.MethodThe predictors were examined in a Norwegian sample of 41 recently admitted patients (schizophrenia or schizophreniform disorder) and 66 parents. Parents' expressed emotion was assessed by the Camberwell Family Interview.ResultsRegression analyses showed that higher EOI was significantly related, on the part of the parent to being a mother, single, spending more time with the patient; and, on the part of the patient, to no substance misuse, more anxiety–depression, and less uncritical and aggressive behaviour. EOI was not linked to previous hospital admissions.ConclusionOur analyses indicate that characteristics of the parent and of the parent–patient dyad seem to be the most important determinants of EOI. EOI is probably not linked to psychotic relapse, but rather to affective disturbances in the patient.
Antidepressant-Treated Patients in Ambulatory Care
Authors: Bingefors Kerstin , Isacson Dag , Von Knorring Lars , Smedby Björn , Wicknertz Kristina 
Published: October 2008

BackgroundNon-institutionalised patients treated with antidepressants have been shown to have indicators of a generalised vulnerability, such as high rates of health service use and excessive prescription drug use. Therefore, mortality in this patient group is of interest.MethodAll first-incidence antidepressant users in a defined population during a five-year period were identified. Their total mortality during a nine-year follow-up was analysed. Cox proportional hazards regression was used to analyse total mortality, and mortality in cardiovascular disease, controlling for baseline chronic medical disease.ResultsAntidepressant treatment at the index date was a statistically significant predictor for increased long-term mortality in the over-65s, even when controlling for pre-existing chronic medical disease. Baseline ischaemic heart disease and concurrent antidepressant treatment significantly predicted mortality from cardiovascular causes.ConclusionPrescribed antidepressant treatment identifies patients who are at risk of increased mortality. For the physician in ambulatory care, knowledge of a patient's antidepressant treatment history may be a valuable tool in managing patient care.
Women's Self-Esteem: A Community Study of Women who Report and do not Report Childhood Sexual Abuse
Authors: Romans Sarah E. , Martin Judy , Mullen Paul 
Published: October 2008

BackgroundThe determinants of self-esteem have been little studied in non-clinic samples. It has been suggested recently that child sexual abuse (CSA) may be a major determinant of low self-esteem in adulthood.MethodThe psychosocial circumstances associated with low self-esteem in two random samples of women, one reporting CSA, the other not were compared, with particular emphasis on characteristics of family of origin. A two-phase (postal-then-interview) random community study assessed self-esteem and related variables.ResultsPsychosocial variables predicting low self-esteem were the same in the two groups. They included being a follower or a loner, having an overcontrolling mother, being poorly qualified, giving a history of depressive disorder and displaying current psychiatric disorder. In addition, the subject's CSA status led to low self-esteem but only when it was of the most intrusive type. The CSA women had a substantially lower mean total self-esteem score. However, not all aspects of self-esteem were diminished equally; 12/30 items differed between the two groups, and two of the five generated self-esteem factors, which we named Pessimism and Fatalism, which differed between the control group and the whole CSA group. There were no differences for Likeability and Determination.ConclusionsPredictors of low self-esteem for women include childhood temperament, a poor relationship with the mother, low qualification attainment, psychiatric morbidity, both previous and current, and, only when it is the most intrusive, CSA.