bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence of schizophrenia in Nottingham
Authors: Brewin J. , Cantwell R. , Dalkin T. , Fox R. , Medley I. , Glazebrook C. , Kwiecinski R. , Harrison G. 
Published: October 2008

BackgroundSeveral studies have reported a decline of up to 50% in the incidence of schizophrenia over recent decades. We aimed to measure changes in the incidence and diagnostic patterns of first-episode psychosis by comparing two Nottingham cohorts, identified in two equal periods separated by 14 years.MethodTwo prospectively ascertained cohorts of first-episode psychotic disorder were identified over the time periods 1978–80 and 1992–94. The earlier cohort was of the World Health Organization Determinants of Outcome of Severe Mental Disorder (DOSMD) ten-country study. The later cohort was obtained using similar methodology. Both groups were diagnosed using ICD-10 diagnostic criteria and age-standardised incidence rates were compared.ResultsThe standardised incidence rate for all psychotic disorders rose slightly from 2.49 to 2.87 per 10 000 population per year, but the F20 classification fell significantly by over a third (1.41 to 0.87 per 10 000 per year). The second study group (1992–1994) included a greater diversity of psychotic diagnoses compared with the first, in particular an increased proportion of acute and drug-related psychoses.ConclusionsMethodological considerations call for caution in interpreting such data, but we conclude that the significant fall in the narrowly defined diagnostic category of schizophrenia reflects a real change in the syndromal presentation of psychotic disorders.
Executive (frontal) dysfunction and negative symptoms in schizophrenia: Apparent gender differences in ‘static’ v. ‘progressive’ profiles
Authors: Scully Paul J. , Coakley Grainne , Kinsella Anthony , Waddington John L. 
Published: October 2008

BackgroundWhile executive (frontal lobe) dysfunction appears to be a core feature of schizophrenia, its relationship to psychopathology, age and duration of illness has yet to be explored systematically between the genders.MethodExecutive dysfunction, positive and negative symptoms were evaluated in 27 male and 21 female in-patients who were unusually well-matched on numerous demographic and clinical measures.ResultsMeasures of executive dyscontrol and negative symptoms were highly associated in both genders. However, while both executive dyscontrol and negative symptoms increased prominently with age/duration of illness among women, no such relationship was evident among men.ConclusionsThe similarly prominent levels of current executive dyscontrol and negative symptoms in male and female patients appear to have emerged via processes that differ fundamentally between the genders; among males these deficits appear to emerge and become ‘locked in’ earlier in the course of illness and to show little subsequent increase, while among females these same deficits appear to be less evident early in the course but to increase in prominence thereafter.
Service provision for people with schizophrenia
Authors: Lang F. H. , Johnstone E. C. , Murray G. D. 
Published: October 2008

BackgroundThis second report of a study of service provision for patients with schizophrenia describes patients' contact with general practice and general practitioners' (GPs’) views of the mental health services.MethodA postal questionnaire was sent to the GPs, and patients' primary care records were examined.ResultsData were collected on 131 subjects. The majority of patients (96) (73%) were in regular contact with their GP and were consulting for many different reasons; 27 (21%) were posing particular difficulties for the primary care team. GPs reported that 27 (21%) patients required additional support and that the care arrangements for 50 (38%) patients could be improved if alterations were made to the roles of the professionals already involved.ConclusionsGPs are central to service provision for patients with schizophrenia. Both additional resources and changes in working practices are required to improve patient care. The service implications of these findings are discussed.
“Anybody's child”: severe disorders of mother-to-infant bonding
Authors: Kumar R. Channi 
Published: October 2008

BackgroundThis paper describes severe, disorders of maternal affection and behaviour and suggests that there is an early process of mother-to-infant bonding which can go seriously wrong.MethodForty-four self-selected women who had suffered from at least one episode of postnatal mental illness described an unexpected and often catastrophic failure to love one or more of their babies.ResultsThese women reported absent affection, sometimes hate, rejection, neglect or impulses to harm, in relation to at least one of their children. These feelings often began immediately or very shortly after the birth, and with one exception, were specific to one child; such characteristics are best encapsulated by the term ‘maternal bonding disorder’. Twenty-nine of the women were multiparae; first-borns were not significantly more likely to be the focus for such feelings. There was no direct evidence of predisposing maternal personality traits or previous experiences. Postnatal mental illness and recalled severe pain during labour were significantly associated with such disorders which, in their severe forms, did not occur in the absence of postnatal mental illness.ConclusionsThe nature of the link between postnatal mental illness and disorders of maternal bonding remains unclear. Because, in multiparae, the disorder often ‘missed’ the first child, factors such as maternal personality traits or early childhood experiences cannot be regarded as sufficient causes.
Opportunities for psychiatry from genetic findings
Authors: Rutter Michael , Plomin Robert 
Published: October 2008

BackgroundThe opportunities for psychiatry deriving from available or likely genetic advances are reviewed.MethodClinical implications are considered in the context of both the misconceptions and benefits associated with relevant genetic findings.ResultsMisconceptions include that: heritability estimates have a ‘true’ fixed value; a high heritability means that environmental interventions will be ineffective; a high heritability within groups means that differences between groups will also be due to genes; genetic effects are determinative; ‘genetic’ means single abnormal genes; genes associated with disease must be bad and justify eugenic measures; gene therapy will be widely applicable; and genetic screening of the general population will be useful. The benefits include demonstrations that: both genes and environment have an ubiquitous influence; some prevailing diagnostic assumptions are mistaken; genes influence development; the effects of nature and nurture are not separate; and environmental effects tend to be person-specific. The potential value of molecular genetics lies in elucidation of causal processes as they apply to both brain systems and nature—nurture interplay; improving diagnosis and genetic counselling; and the development of improved pharmacological interventions.ConclusionAdvances in genetics will make a major impact on clinical psychiatry, and should bring practical benefits for both prevention and treatment.
Psychiatrists and their patients: Views on forms of dress and address
Authors: Gledhill Julia A. , Warner James P. , King Michael 
Published: October 2008

BackgroundDress styles and forms of address vary among psychiatrists.MethodA semi-structured interview was administered to a sample of psychiatric in-patients, and a questionnaire was sent to junior and consultant psychiatrists, to identify preferences for dress styles and terms of address.ResultsForty-nine (71%) of the inpatient sample participated. A preference was found for smart attire and white coats. Of the 69 (80%) doctors returning questionnaires, the majority supported smart dress as the most appropriate attire. Most patients preferred to be called by their first name while addressing doctors by title and surname. Junior doctors preferred to use first names when talking to patients while almost all consultants used title and surname. Doctors of all grades liked to be called by their title and surname.ConclusionsPaying more attention to the way we present ourselves and interact at work may help to facilitate the therapeutic alliance.
Ethnicity and use of acute psychiatric beds: One-day survey in North and South Thames regions
Authors: Koffman Jonathan , Fulop Naomi J. , Pashley David , Coleman Ken 
Published: October 2008

BackgroundPrevious studies have shown higher rates of psychiatric admissions, compulsory admissions, and diagnosed schizophrenia in Black ethnic groups compared with other population groups.MethodIn a point-prevalence study, demographic and clinical data were collected for adult acute and low-level secure psychiatric in-patients in all National Health Service and seven private psychiatric units in North and South Thames regions on 15 June 1994ResultsA total of 3710 adult acute and 268 low-level secure psychiatric patients were surveyed; 75% of the patients were White, 16% were Black, and 4% were Asian. Analysis reveals that a high proportion of the Black population were admitted to a psychiatric unit; that Black patients are more likely to be admitted under Section; to be located in locked wards; have an inpatient diagnosis of schizophrenia; and not be registered with a general practitioner.ConclusionsThese findings demonstrate the over-representation of Black ethnic groups within current psychiatric provision. The complement of services to all minority ethnic groups should be examined in terms of access, appropriateness and quality of care. Racism awareness and staff training need to be incorporated into mental health service provision as a matter of priority.
Disability, outcome and case-mix in acute psychiatric in-patient units
Authors: Boot Brendon , Hall Wayne , Andrews Gavin 
Published: October 2008

BackgroundEighteen acute in-patient psychiatric units in Australia funded a syndicate to measure case-mix, disability and outcome of treatment. This syndicate included eight units in public general hospitals, five in stand-alone public psychiatric hospitals and five in private psychiatric hospitals.MethodUp to 100 in-patients admitted consecutively to each hospital (1359 in all) were assigned to a Diagnosis-Related Group (DRG), rated on the Health of the Nation Outcome Scales (HoNOS) and asked to complete the Medical Outcomes Trust Short Form 36 (SF36). These scales were administered again at discharge. Demographic information and length of stay were also recorded. Disability was measured by scores on the HoNOS and SF36 at admission, and outcome was assessed by the change in scores between admission and discharge.ResultsThe public hospitals treated significantly more patients with schizophrenia and fewer with affective disorders, and their case load on admission was more disabled, on the whole, than that of the private hospitals. They achieved the same outcome or health gain as the private hospitals, but needed a shorter length of stay to do so. The addition of disability scores to DRG moderately increased the ability to predict length of stay.ConclusionsRoutine outcome assessment using reliable and valid instruments is practical, and could lead to improvements in the quality of care for psychiatric patients.
Prevalence of spontaneous dyskinesia in schizophrenic and non-schizophrenic psychiatric patients
Authors: Fenton Wayne S. , Blyler Crystal R. , Wyatt Richard J. , McGlashan Thomas H. 
Published: October 2008

BackgroundAlthough movement disorders have been noted among patients never exposed to neuroleptic medications, the specificity of spontaneous dyskinesia to schizophrenia has rarely been examined.MethodBy abstracting detailed case records, we compared the prevalence of dyskinetic movements between 94 neuroleptic-naïve schizophrenic patients and 179 patients with other psychiatric disorders.ResultsDyskinetic movements were more common among patients with schizophrenia than among those with all other diagnoses, and were most often noted in the body areas typically associated with tardive dyskinesia.ConclusionsSpontaneous dyskinesia appears to be relatively specific to schizophrenia and may be intrinsic to the pathophysiology of the disorder.
Prevalence of dementia and depression among elderly people in Black and ethnic minorities
Authors: McCracken C. F. M. , Boneham M. A. , Copeland J. R. M. , Williams K. E. , Wilson K. , Scott A. , McKibbin P. , Cleave N. 
Published: October 2008

BackgroundThis study was designed to identify all elderly people of ethnic minorities living in a defined geographical area in inner-city Liverpool and to identify psychiatric morbidity and barriers to use of services. This paper reports the prevalence of dementia and depression.MethodA survey of the community was carried out using the Geriatric Mental State Examination, AGECAT and ethnically matched interviewers. The sampling frame consisted of Family Health Services Authority lists as a basis, with additional information from community lists, ‘snow-balling’ and a door-to-door survey.Results418 people were interviewed, with a high percentage (55%) of young elderly (65–74) men. The prevalence of dementia ranged from 2 to 9% and of depression from 5 to 19%, and there were no significant differences in levels between English-speaking ethnic groups and the indigenous population. Higher levels of dementia were found among non-English-speaking groups.ConclusionsA complete enumeration of the elderly in ethnic minority groups is best achieved by using several different methods. Diagnosis of dementia may be misleading among those who do not speak the dominant language.
Change in borderline symptoms one year after therapeutic community treatment for severe personality disorder
Authors: Dolan Bridget , Warren Fiona , Norton Kingsley 
Published: October 2008

BackgroundThe view that severe personality disorder (SPD) is untreatable derives from poor-quality studies of treatment outcome which use indirect measures of SPD pathology. This study evaluates the impact of psychotherapeutic in-patient treatment on core personality disorder symptoms.Method137 SPD patients completed the Borderline Syndrome Index (BSI) on referral and one year post-treatment (‘admitted’, n=70) or one year post-referral (‘non-admitted’, n=67); 22 of the non-admitted group were refused extra-contractual referral funding for their treatment.ResultsThere was a significantly greater reduction in BSI scores in the treated than in the non-admitted group. Changes in BSI scores were significantly positively correlated with length of treatment. Assessment of the reliability and clinical significance of changes in individual subjects showed that the magnitude of this change was reliable and clinically significant in 42.9% of the admitted sample, compared with only 17.9% of the non-admitted sample (18.2% of the unfunded group)ConclusionsSpecialist in-patient treatment is effective in reducing core SPD psychopathology.
Personality disorder and psychopathology in Tourette's syndrome: A controlled study
Authors: Robertson Mary M. , Banerjee Sube , Fox-Hiley Paul J. , Tannock Charles 
Published: October 2008

BackgroundSome specialists associate a wide variety of psychopathologies with Tourette's syndrome (TS), while others suggest that there is no psychopathology specifically associated. Few controlled studies have been conducted to address this issue, and none has investigated personality disorder in TS.MethodAdults with TS and controls were evaluated using standardised psychiatric rating scales, including self-rated (STPCD) and clinician-rated (SCID–II) assessments of personality disorder, to investigate associations between personality disorder, other psychopathology and TS.ResultsSignificantly more TS patients (25/39 (64%)) than controls (2/34 (6%)) had one or more personality disorders. TS subjects were also more likely to have more personality disorders. TS patients had significantly more depression, anxiety and obsessionality than controls. The SCID–II and STCPD were moderately well correlated.ConclusionsTS patients have a high prevalence of personality disorder and psychopathology when compared with controls. These results are the first to suggest a high level of personality disorder in a TS clinic population.
The evolving face of psychiatric epidemiology
Authors: Mann Anthony 
Published: October 2008

In 1978, Michael Shepherd gave a Maudsley Bequest Lecture in which it was necessary for him to argue from first principles for the need for epidemiological research within clinical psychiatry (Shepherd, 1978). This paper will take stock of the 20 years since his lecture and point to the new directions for this research approach. Shepherd listed the contributions of psychiatric epidemiology as follows:
(a)the completion of the spectrum of disease;(b)the establishment of outcome;(c)the actuarial assessment of morbidity risk;(d)the evaluation of efficacy of treatment; and(e)the conceptual construction of diag nosis/classification.
DSM–IV and ICSD–90 insomnia symptoms and sleep dissatisfaction
Authors: Ohayon Maurice M. , Caulet Malijaï , Priest Robert G. , Guilleminault Christian 
Published: October 2008

BackgroundThe complex nature of insomnia and its relationship with organic and mental disorders render diagnosis problematic for epidemiologists and physicians.MethodA representative UK sample (non-institutionalised, > 14 years old) was interviewed by telephone (n=4972; 79.6% participation rate) with the Sleep-EVAL system. Subjects fell into three groups according to presence of insomnia symptom (s) and/or sleep dissatisfaction.ResultsInsomnia symptoms occurred in 36.2% of subjects. Most of these (75.9%), however, reported no sleep dissatisfaction. In comparison, those also with sleep dissatisfaction had higher prevalence of sleep and mental disorders and longer duration of insomnia symptoms, and were more likely to take sleep-promoting medication, dread bedtime, and complain of light sleep, poor night-time sleep and daytime sleepiness.ConclusionsInsomnia sufferers differ as to whether they are satisfied or dissatisfied with sleep. Although insomnia symptoms are common in the general population, sleep disturbances among sleep-dissatisfied individuals are more severe. Sleep dissatisfaction seems a better indicator of sleep pathology than insomnia symptoms.
Four-year remission of transsexualism after comorbid obsessive–compulsive disorder improved with self-exposure therapy
Authors: Marks Isaac M. , Mataix-Cols David 
Published: October 2008

BackgroundThere has been no report of comorbid transsexualism and obsessive–compulsive disorder (OCD) or of their differential course over follow-up.MethodSuch comorbidity and follow-up are documented in a case report.ResultsA man who had been transsexual and homosexual since early adolescence developed severe OCD at age 40 as he became depressed when his mother, to whom he was very close, died. Two years later he was referred for his OCD. He refused treatment for his transsexualism. As his OCD and mood improved with self-exposure therapy, his transsexualism and homosexuality remitted also. Four years later depression and transsexualism recurred and remained to six-year follow-up despite full remission in OCD continuing throughout.ConclusionsThe sequence is like that in other cases in whom unusual sexual behaviour remitted for years after comorbid disorders improved with various treatments, or after circumstances changed.
Needs assessment for mentally disordered offenders and others requiring similar services
Authors: Cohen Andrea , Eastman Nigel 
Published: October 2008

BackgroundThe government has highlighted the service needs of mentally disordered offenders (MDOs) and has introduced policies which have driven MDO needs assessment.MethodBased on a literature review and a national survey of agencies likely to be conducting needs assessment, the paper reviews government policy regarding MDO needs assessment and examines the particular problems of conducting needs assessment for MDOs.ResultsA methodological framework for MDO needs assessment is presented, and different needs assessment approaches are discussed. The methodological and practical limitations of conducting MDO needs assessment are emphasised, as is the role of subjective judgement in both research design and interpretation.ConclusionsNeeds assessment is value-laden. Also, no single needs assessment approach can address all the issues of importance to purchasers and providers. Substituting the term ‘perspectives on need’ for the term needs assessment would help to reflect the lack of a single ‘truth’ about need and emphasise the role of subjective political judgement in designing and interpreting research on ‘need’.
London–East Anglia randomised controlled trial of cognitive–behavioural therapy for psychosis
Authors: Garety Philippa , Fowler David , Kuipers Elizabeth , Freeman Daniel , Dunn Graham , Bebbington Paul , Hadley Clare , Jones Steven 
Published: October 2008

BackgroundDespite growing evidence of the effectiveness of cognitive–behavioural therapy (CBT) for psychosis, typically only about 50% of patients show a positive response to treatment. This paper reports the first comprehensive investigation of factors which predict treatment outcome.MethodIn a randomised controlled trial of CBT for medication-resistant psychosis (see Part I) measures were taken at baseline of demographic, clinical and cognitive variables. Changes over time were assessed on the Brief Psychiatric Rating Scale and the relationship between potential predictor variables and outcome was investigated using analysis of variance and covariance.ResultsA number of baseline variables were identified as predictors of good outcome in the CBT group. Key predictors were a response indicating cognitive flexibility concerning delusions (P=0.005) and the number of recent admissions (P=0.002). Outcome was less predictable in the control group and was not predicted by any cognitive variable.ConclusionsGood outcome is strongly predicted in patients with persistent delusions by a cognitive measure, while this was not the case in controls. Thus we argue that positive outcome in CBT is due in part to specific effects on delusional thinking.
Serotonin 5-HT2 receptor imaging in major depression: focal changes in orbito-insular cortex
Authors: Biver Françoise , Wikler David , Lotstra Françoise , Damhaut Philippe , Goldman Serge , Mendlewicz Julien 
Published: October 2008

BackgroundSerotonin receptors may play an important role in the pathophysiology of affective disorders. We studied type-2 serotonin (5-HT2) receptors in the brain of patients with major depression.MethodUsing positron emission tomography (PET) and the selective radioligand [18F]altanserin, we investigated 5-HT2 receptor distribution in eight drug-free unipolar depressed patients and 22 healthy subjects. Data were analysed using Statistical Parametric Mapping 95.ResultsIn depressed patients, [18F]altanserin uptake was significantly reduced in a region of the right hemisphere including the posterolateral orbitofrontal cortex and the anterior insular cortex. A trend to similar changes was found in the left hemisphere. No correlation was found between the uptake and the Hamilton rating scale score.ConclusionsPathophysiology of depression may involve changes in 5-HT2 receptor in brain regions selectively implicated in mood regulation.