bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychological Sequelae Following the Gulf War
Authors: Deahl Martin P. , Gillham Adrian B. , Thomas Janice , Searle Margaret M. , Srinivasan Michael 
Published: October 2008

BackgroundThe aim was to study the effect of brief counselling and psychological debriefing following a trauma on subsequent morbidity.MethodWe investigated psychological morbidity in 62 British soldiers whose duties included the handling and identification of dead bodies of allied and enemy soldiers during the Gulf War. Of these soldiers, 69% received a psychological debriefing on completion of their duties. The subjects completed by post a demographic questionnaire, the General Health Questionnaire (GHQ-28) and the Impact of Events Scale.ResultsAfter nine months 50% had evidence of some psychological disturbance suggestive of posttraumatic stress disorder (PTSD); 18% had sought professional help; 26% reported relationship difficulties. Neither prior training nor the psychological intervention appeared to make any difference to subsequent psychiatric morbidity. Morbidity at nine months was more likely in those with a history of psychological problems and those who believed their lives had been in danger in the Gulf.ConclusionsThese findings show that a psychological debriefing following a series of traumatic events or experiences does not appear to reduce subsequent psychiatric morbidity and highlights the need for further research in military and civilian settings.
The Ward Daily Behaviour Scale
Authors: Blunden J. , Hodgkiss A. , Klemperer F. , McCarthy A. , Watson J. P. 
Published: October 2008

BackgroundThe Ward Daily Behaviour Scale is a new rating instrument that can be used to measure all the daily noteworthy behaviour of patients of various ages and diagnoses on psychiatric wards.MethodThe reliability and validity of the scale were tested on 40 patients.ResultsThis instrument proved to be both reliable and valid for use on adult acute in-patient wards.ConclusionsThe scale will be a valuable tool in a wide range of ward-based studies.
A National Audit of New Long-Stay Psychiatric Patients
Authors: Lelliott Paul , Wing John 
Published: October 2008

Background.This second report of a national audit of new long-stay (NLS) psychiatric patients describes the services caring for the patients and the reasons why patients were still in hospital.Method.Data analyses addressed the prevalence of NLS patients, the residential resources available to services, the distributions of patients within services, clinicians' views as to the appropriateness of current placement and the reasons for any inappropriate placements.Results.The average point prevalence was 6.1 per 100 000 population; it was significantly lower in England and Wales (5.6, s.d. = 3.2) than in Scotland and Northern Ireland (10.7, s.d. = 6.4, ANOVA F ratio = 10.9, P < 0.01). The estimated rate of accumulation was 1.3 per 100 000 population per year. Many English services had very few non-acute psychiatric beds and 31 % of English NLS patients, despite their protracted lengths of stay, were housed on acute wards. Assessors thought that 61 % of patients would be better placed in a non-hospital setting; 47% were thought to require a community-based residential setting, and of these over one-half were still in hospital because no suitable community placement was available.Conclusions.Many NLS patients remain in hospital because their residential needs are not met by existing community provision.
Home-Based Versus Hospital-Based Care for People with Serious Mental Illness
Authors: Marks I. M. , Connolly J. , Muijen M. , Audini B. , McNamee G. , Lawrence R. E. 
Published: October 2008

Background.A controlled study tested whether the superior outcome of community care for serious mental illness (SMI) in Madison and in Sydney would also be found in inner London.Method.Patients from an inner London catchment area who faced emergency admission for SMI (many were violent or suicidal) were randomised to 20 months or more of either home-based care (Daily Living Programme, DLP; n = 92), or standard in-patient and later out-patient care (controls, n = 97). Most DLP patients had brief in-patient stays at some time. Measures included number and duration of in-patient admissions, independent ratings of clinical and social function, and patients' and relatives' satisfaction.Results.Outcome was superior with home-based care. Until month 20, DLP care improved symptoms and social adjustment slightly more, and enhanced patients' and relatives' satisfaction. From 3 to 18 months DLP care greatly reduced the number of in-patient bed days as long as the DLP team was responsible for any in-patient phase its patients had. Cost was less. DLP care did not reduce the number of admissions, nor of deaths from self-harm (3 DLP, 2 control). One DLP patient killed a child. Even at 20 months many DLP and control patients still had severe symptoms, poor social adjustment, no job, and need for assertive follow-up and heavy staff input. (Beyond 20 months most gains were lost apart from satisfaction.)Conclusions.It is unclear how much the gain until 20 months from home-based care was due to its site of care, its being problem-centred, its teaching of daily living skills, its assertive follow-up, the home care team's keeping responsibility for any in-patient phase, its coordination of total care (case management), or to other care components. Home-based care is hard to organise and vulnerable to many factors, and needs careful training and clinical audit if gains are to be sustained.
Community Psychiatric Nurse Teams: Intensive Support Versus Generic Care
Authors: Muijen Matt , Cooney Margaret , Strathdee Geraldine , Bell Ray , Hudson Annette 
Published: October 2008

Background.This study evaluated whether a community psychiatric nurse (CPN) team providing a comprehensive aftercare service, using a case management approach, improves psychopathology and social functioning of the long-term mentally ill, and reduces hospital use compared with a generic CPN team.Method.Patients suffering from severe and persistent mental health problems were randomised to intensive aftercare or generic care after referral to the CPN manager. Each group contained 41 patients who were assessed at baseline and at 6, 12 and 18 months by an independent research psychologist. Outcome measures included the GAS, PSE, SAS, patient and relatives' satisfaction, number of admissions, and length of stay.Results.No difference between the groups was found on any of the outcome measures, despite the much higher number of contacts of the intensive (n = 52) versus generic CPNs (n = 13) and the much greater range of interventions.Conclusions.Intensive aftercare for people with persistent mental health problems was not found to be of greater benefit than generic CPN care. Many factors need to be considered for aftercare to be effective, including community resources, process of care, and staff training.
Community Psychiatric Nurses in Primary Health Care
Authors: Gournay Kevin , Brooking Julia 
Published: October 2008

Background.Community psychiatric nurses (CPNs) are increasingly working in primary health care with non-psychotic patients. This study was designed to test the efficacy of this work.Method.The study was carried out in six health centres in north London with a total of 36 participating general practitioners (GPs) and 11 CPNs. Using a randomised controlled trial, 177 patients were referred by their GP and randomly allocated to continuing GP care, immediate community psychiatric nursing intervention, or placed on a 12-week waiting-list, after which time the patient was offered CPN intervention. A range of measures of symptoms and social function were used, and ratings were carried out at assessment and at 24 weeks.Results.Patients improved on all measures over time (P < 0.001 for all measures). However, there was no difference between the group of patients receiving GP care and patients seen by the CPN. Improvements seemed to be independent of the amount of contact. Drop-out rates from CPN intervention were high (50%). CPN drop-outs were more disabled to start with, but did as well as CPN treatment completers. Patients were more likely to drop out with trained than untrained CPNs. There was no evidence that referral to a CPN saved GP time.Conclusions.The results add weight to the argument that CPNs should refocus their activity on people with serious mental health problems, and indicate that CPN education should focus on skill acquisition and interventions of proven effectiveness.
A Twin Study of Depressive Symptoms in Childhood
Authors: Thapar Anita , McGuffin Peter 
Published: October 2008

Background.Although depression in childhood appears to be familial, transmission of symptoms could be genetic or environmental. Twin studies enable us to separate these effects. Our aim was to assess the importance of genetic and environmental factors on depressive symptoms during childhood and adolescence in an epidemiological sample of twins.Method.Questionnaires (including the Mood and Feelings questionnaire) were mailed to a systematically ascertained sample (411 twin pairs) aged between 8 and 16 years. The overall response rate was 77%.Results.Data for the whole sample were best explained by an additive genetic model, with heritability of depressive symptom scores estimated at 79%. However, on splitting the sample, symptoms in children (aged 8 to 11) could be explained by shared environmental factors only, while symptoms in adolescents (aged 11 to 16) remained highly heritable.Conclusions.The results suggest that although depressive symptoms appear to be largely heritable, the influence of genetic and environmental factors may vary with age.
The Clinical Diagnosis and Misdiagnosis of Senile Dementia of Lewy Body Type (SDLT)
Authors: Mckeith I. G. , Fairbairn A. F. , Perry R. H. , Thompson P. 
Published: October 2008

BackgroundCurrent clinical classifications do not contain specific diagnostic categories for patients with senile dementia of the Lewy body type (SDLT), recently proposed as the second commonest neuropathological cause of dementia in the elderly. This study determines how existing clinical diagnosis systems label SDLT patients and suggests how such patients may be identified.MethodA range of clinical diagnostic criteria for dementia were applied to case notes of autopsy-confirmed SDLT (n = 20), dementia of Alzheimer type (DAT; n = 21) and multi-infarct dementia (MID; n = 9) patients who had received psychogeriatric assessment. The predictive validity of each set of clinical criteria was calculated against the external criterion of neuropathological diagnosis.ResultsMany SDLT patients erroneously met criteria for MID (35% with Hachinski scores ≥ 7) or for DAT (15% by NINCDS ‘probable AD’, 35% by DSM–III–R DAT and 50% by NINCDS ‘possible AD’). Up to 85% of SDLT cases could be correctly identified using recently published specific criteria.ConclusionsDLT usually has a discernible clinical syndrome and existing clinical classifications may need revision to diagnose correctly such patients.
Cerebral Hemiatrophy and Schizophrenia
Authors: Puri B. K. , Hall A. D. , Lewis S. W. 
Published: October 2008

BackgroundNeuroimaging of a treatment-resistant patient with schizophrenia revealed the existence of cerebral hemiatrophy. The association of schizophrenia with cerebral hemiatrophy has not previously been reported.ResultsNeuroimaging with X-ray computerised tomography showed marked reduction in the volume of the left cerebral hemisphere with secondary enlargement of the left lateral fissure and cortical sulci. High resolution cranial single-photon emission computerised tomography showed a functional deficit of the regional cerebral blood flow in the left lateral parietal and left temporal lobes.ConclusionsCerebral hemiatrophy may belong to the lengthening list of neurodevelopmental cerebral anomalies associated with schizophrenia.
Transsexualism and Gender Reassignment
Authors: Snaith R. P. , Hohberger A. D. 
Published: October 2008

SummaryGender reassignment for carefully assessed transsexual patients is now an established and accepted practice in many parts of the world. In other areas customary attitudes to those with sexual differences prevents consideration. A large number of autobiographies by reassigned patients have been published and all throw light on the experience of the writers. The one which may be recommended is that by Morris (1974). For the interested layperson enquiring about the nature of transsexualism the brief book by Hodgkinson (1987) may be recommended.
Predicting Symptomatic and Behavioural Outcomes of Community Care
Authors: Wykes Til 
Published: October 2008

BackgroundMany studies of community care show little overall improvement in patient functioning. This study investigated whether cognitive impairment mediates the effect of the increased opportunities offered by the community.MethodBehaviour, symptoms, sociodemographic variables and information processing of a random sample of chronic psychiatric patients were examined. Six years later, social and behavioural outcomes were measured.ResultsThe overall change in the group was negligible. Individual variation can be accounted for by two factors: time since transfer to the community, and initial information processing problems. Patients transferred for at least three years showed significant improvements. Schizophrenic patients without information processing problems improved, but those with deficits got worse.ConclusionsThe identification of mediating factors should allow better rehabilitation plans, and alleviate the toxic effects that transfer has on some patients' functioning.
Personality Disorder in Later Life: A Community Study
Authors: Cohen Bruce J. , Nestadt Gerald , Samuels Jack F. , Romanoski Alan J. , McHugh Paul R. , Rabins Peter V. 
Published: October 2008

BackgroundThis exploratory study compares the prevalence of personality disorders and traits in people over and under 55 years of age. The comorbidity between personality and other psychiatric disorders is also examined.MethodPsychiatrists examined 810 subjects in a two-stage community survey. The semi-structured Standardized Psychiatric Examination was used to diagnose all DSM-III personality disorders and other psychiatric disorders.ResultsThe older subjects were significantly less likely than the younger subjects to have any personality disorder (6.6% v. 10.5%; relative odds = 0.42, 95% confidence interval = 0.25–0.70, P<0.001). Antisocial and histrionic personality disorders were much less prevalent in the older than younger subjects (P < 0.05). The older subjects also had significantly fewer maladaptive personality traits (x2 = 88.9, d.f. = 3, P < 0.001). The patterns of comorbidity between personality disorders and other psychiatric disorders were different in the two age groups.ConclusionsIt is important to evaluate personality in patients of all ages. While some older patients no longer meet criteria for personality disorder, maladaptive traits may become evident during times of stress.
A Controlled Psychiatric Study of Individuals at Risk for Huntington's Disease
Authors: Shiwach Raj S. , Norbury C. Gail 
Published: October 2008

BackgroundThe study tested specific hypotheses that (a) there is an increased incidence of psychiatric disorders in asymptomatic heterozygotes for Huntington's disease (HD) compared with the normal homozygotes, and (b) there is an increased incidence of psychiatric disorders in the adult offspring of Huntington's disease patients compared with their partners.MethodA controlled study was made of 93 apparently healthy individuals (at 50% risk), who had given DNA samples for the predictive test, and 70 of their partners. Current and past psychopathology was assessed and compared with the DNA predictive test results based on linkage analyses. The results of psychiatric assessments of the two groups were compared.ResultsDNA test results were available for 53 subjects (of 93). Five subjects at risk for HD were omitted from the study. The asymptomatic heterozygotes (n = 20) showed no significant increase in the incidence of any psychiatric episode, depression, schizophrenia or behavioural disorder when compared with the normal homozygotes (n = 33). The whole tested group showed a significantly greater number of psychiatric episodes than their partners (n = 43).ConclusionsAsymptomatic HD gene carriers do not have a greater incidence of psychiatric disorders than the non-gene carriers born to a HD parent.
Propofol Anaesthesia in Electroconvulsive Therapy
Authors: Fear Christopher F. , Littlejohns Carl S. , Rouse Eryl , McQuail Paul 
Published: October 2008

BackgroundThe induction agent propofol is known to reduce electroconvulsive therapy (ECT) seizure duration. It is assumed that outcome from depression is adversely affected by this agent. This study compares propofol and methohexitone as induction agents for ECT.MethodIn a prospective, randomised, double-blind study 20 subjects with major depressive disorder (DSM-III-R criteria) received propofol or methohexitone anaesthesia. The Hamilton Depression Rating Scale and Beck Depression Inventory were used to assess depression before therapy, at every third treatment, and at the end of therapy. Seizure duration was measured using the cuff technique.ResultsMean seizure durations (P < 0.01) and mean total seizure duration (P < 0.01) were shorter in the propofol group. There was no difference in outcome.ConclusionsUse of propofol may not adversely affect outcome from depression and it is not necessarily contraindicated as an induction agent for ECT. Our results should be interpreted cautiously, and larger studies are needed.
Psychiatric Disorders in a Paediatric Primary Care Clinic
Authors: Gureje O. , Omigbodun O. O. , Gater R. , Acha R. A. , Ikuesan B. A. , Morris J. 
Published: October 2008

BackgroundThe proportion of children with psychiatric disorders treated in primary care is not known in most developing countries.MethodIn a two-stage epidemiological study, 990 children aged between 7 and 14 years were screened with the parents' version of the Rutter scale. Of these, a stratified sample of 227 was interviewed jointly with their mothers, using the children's version of the Schedule for Affective Disorders and Schizophrenia (K-SADS).ResultsWe obtained a weighted prevalence of 19.6 ± 2.5% for the presence of one or more DSM-III-R disorders. Depressive disorders were present in 6.0%, anxiety-related disorders in 4.7%, and conduct disorders in 6.1%.ConclusionPsychiatric disorders in children are common in primary care. Doctors working at this level of care need the skills to detect and treat them.
Psychiatric Morbidity in Primary Health Care in Santiago, Chile Preliminary Findings
Authors: Araya Ricardo , Wynn Robert , Leonard Richard , Lewis Glyn 
Published: October 2008

BackgroundThe aims were to determine the prevalence of psychiatric morbidity among primary care attenders in a poor suburb of Santiago and to study the relationship with health service use.MethodA cross-sectional survey was made of 163 consecutive attenders to a primary care clinic.ResultsEleven per cent of the sample gave a psychological reason for consultation and the prevalence of psychiatric morbidity was 53%, defined using the revised Clinical Interview Schedule. Women and those of lower socio-economic status were at higher risk. Physicians recognised 14% of the psychiatric morbidity. Attenders with psychiatric morbidity consulted more frequently.ConclusionsThere is a need to improve the recognition and management of psychiatric morbidity in primary care in Chile and other less developed countries. This could lead to the more efficient use of scarce health care resources in primary care.
Psychosurgery: Stereotactic Subcaudate Tractotomy
Authors: Bridges P. K. , Bartlett J. R. , Hale A. S. , Poynton A. M. , Malizia A. L. , Hodgkiss A. D. 
Published: October 2008

BackgroundStereotactic subcaudate tractotomy (SST) is the only type of psychosurgery performed at the Geoffrey Knight Unit, London, where nearly 1300 operations have been done since 1961. Statistically reliable data are not available to prove the effectiveness of SST. A detailed statement about contemporary psychosurgery is given.MethodRelevant publications from the Unit and via Medline are discussed. The outcome figures are reviewed. The outcome is assessed at the Unit in global and clinical terms, associated with results of self-completed questionnaires.ResultsST allows 40–60% of patients to live normal or near-normal lives, perhaps with continuation of medication. A reduction in suicide rate to 1% postoperatively, from 15% in cases of uncontrolled affective disorders is seen.ConclusionAs a treatment of last resort, no controlled trial against a comparable treatment is possible. It appears reasonable to offer SST to patients with suicidal and deluded depression or with frequently swinging moods, not responding to other treatments.
Sexual Murder
Authors: Grubin Don 
Published: October 2008

BackgroundLittle is known about men who kill in a sexual context. The present study compares a group of sexual murderers with a group of men who had raped but not killed.MethodTwenty-one men who murdered women in the course of a sexual attack and 121 men convicted of rape were interviewed in six prisons. Victim statements were obtained in 103 cases (73%). Assessment consisted of a 90-minute semi-structured interview, the Eysenck 1–7 questionnaire, and the Schonell reading test.ResultsThe most notable characteristic distinguishing the men who killed was their lifelong isolation and lack of heterosexual relationships.ConclusionsA better understanding of the social and emotional isolation commonly found in sexual murderers may provide important insights into why some sexual offenders go on to kill.
Prediction of Outcome Following a First Episode of Schizophrenia
Authors: Geddes John , Mercer Gavin , Frith C. D. , MacMillan Fiona , Owens David G. C. , Johnstone Eve C. 
Published: October 2008

BackgroundAlthough previous studies have attempted to identify predictors of outcome in schizophrenia, few have prospectively studied first episode patients for an adequate follow-up period.MethodThe psychopathological predictors of outcome were investigated in a subgroup of 51 subjects, originally included in the Northwick Park study of first episode schizophrenia who were followed up 7.3 years (s.d. 1.1, range 5.3– 10.3) after first admission in the Harrow study. Forty-four subjects (24 men, 20 women) were traced. Outcome measures were time to first readmission, occupational level and total duration of hospital admission at five years after first admission.ResultsA survival analysis of time to first relapse revealed that the presence of subjective feelings of depression (CATEGO syndrome SD) during the first admission was associated with early relapse while the presence of depressive delusions (CATEGO syndrome DD) and higher educational attainment protected against early relapse. Total duration of hospitalisation at five years after first onset was positively associated with the presence of CATEGO syndromes SD and OD (biological features of depression) and negatively associated with female sex. Poor occupational outcome was not significantly associated with any psychopathological predictors.ConclusionsOur findings challenge the conventional view that symptoms of depression are associated with better outcome in schizophrenia.