bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychiatry in the National Health Service 1948–1998
Authors: Freeman Hugh 
Published: October 2008

BackgroundThe 50th anniversary of the inauguration of the NHS provided the occasion to review the evolution of mental health services and of psychiatry itself in Britain during that period.AimsThe principal themes to be followed were the decline of a mental hospital system that had existed for over a century, the development of an alternative policy of ‘community care’, the emergence of a numerous and well-trained psychiatric profession, and the interaction between political and legal processes and mental health care.MethodAn examination of Ministry of Health and Department of Health and Social Security files in the Public Record Office, interviews with influential figures, examination of the secondary literature, and personal experience of events described.ResultsThe material has been analysed, in the light of the expressed aims, and important trends have been described. The current situation is assessed.ConclusionsThe replacement of one system of care and treatment in Britain by another has been a process fraught with overwhelming difficulties. While adhering to the aim of ‘community care’, governments have been reluctant to provide the means for achieving this. The psychiatric profession is now faced with very large but ill-defined responsibilities.
Ethnicity and outcome of psychosis
Authors: Goater Nicky , King Michael , Cole Eleanor , Leavey Gerard , Johnson-Sabine Eric , Blizard Robert , Hoar Amanda 
Published: October 2008

BackgroundAn excess of psychotic illness in Black people has been found in cross-sectional studies. Little is known about the outcome of psychosis in different ethnic groups in the UK.AimsTo compare the incidence, nature and long-term outcome of psychosis in different ethnic groups.MethodA five-year, prospective study of an epidemiological cohort of people with a first contact for psychosis.ResultsAge-standardised incidence rates for schizophrenia and non-affective psychosis were higher for Black and Asian people than Whites. Stability of diagnosis and course of illness were similar in all ethnic groups. During the fifth year, Black people were more likely than others to be detained, brought to hospital by the police and given emergency injections.ConclusionsThe nature and outcome of psychotic illness is similar in all ethnic groups but Black people experience more adverse contacts with services later in the course of illness.
Suicide in prisons
Authors: Gore Sheila M. 
Published: October 2008

BackgroundA recent review showed that opioid users' deaths from suicide were 10 times as common as expected on the basis of age and gender. Surveys showing prisoners' high prevalence of injecting or opioid dependence have led to a new statistical approach to prison suicides.AimsTo estimate the expected number of UK prison suicides annually, having taken account of inmates' age, gender and opioid dependence.MethodBy gender, estimate the effective number of individuals (in terms of community-equivalent suicide risk) for whom prisons have a duty of care as 10 times the number of opioid-dependent inmates plus the number of non-opioid user inmates. Apply the gender and age-appropriate national suicide rates to work out the expected number of prison suicides.ResultsThe Scottish Prison Service can expect 7.1 suicides per annum, and annual totals up to 12 without exacerbation of suicides due to incarceration. For the Prison Service in England and Wales, 19.3 suicides per annum can be expected in prisons, and annual totals may range up to 28 without indicating incarceration; the total of self-inflicted deaths was 47 in 1993–94ConclusionsPrisons cannot prevent all suicides. An alert may be warranted if prison suicides exceed 12 per annum in Scotland, or 28 in England and Wales.
Burden experienced by care-givers of persons with bipolar affective disorder
Authors: Perlick Deborah , Rosenheck Robert R. , Clarkin John F. , Sirey Jo Anne , Raue Patrick , Greenfield Susan , Struening Elmer 
Published: October 2008

BackgroundFamily members of patients with schizophrenia frequently report burdens associated with caring for their relatives.AimsWe evaluate the impact of illness beliefs on the burden reported by family care-givers of people with bipolar illness.MethodThe multivariate relationships between patient symptomatology and family illness beliefs and report of burden were examined at baseline among care-givers of 266 patients with Research Diagnostic Criteria-diagnosed bipolar illness who were subsequently followed for 15 months.ResultsAt baseline, 93% of care-givers reported moderate or greater distress in at least one burden domain. As a group, care-giver illness beliefs (illness awareness, perception of patient and family control) explained an additional 18–28% of variance in burden experienced beyond the effects of the patients clinical state and history.ConclusionsCare-givers of patients with bipolar illness report widespread burden that is influenced by beliefs about the illness.
Frequency, phenomenology and anatomical–clinical correlates of major post-stroke depression
Authors: Gainotti G. , Azzoni A. , Marra C. 
Published: October 2008

BackgroundThe meaning of post-stroke depression is controversial.AimsTo investigate the hypothesis that major post-stroke depression (PSD) may be due to organic factors (left frontal lesions) immediately after the stroke, but to psychosocial factors in later stages.MethodWe studied 153 consecutive stroke patients, categorised on the basis of time elapsed since stroke, lesion location and presence/absence of major PSD, Fifty-eight were examined in the first two months following the stroke, 52 between two and four months, and 43 after four months or more. The symptom profiles and anatomical–clinical correlates of major PSD were studied in each subgroup. A group of 30 patients affected by a functional form of major depression were also investigated.ResultsThe symptom profiles and anatomical–clinical correlates of major PSD were not different in the acute and more chronic stages. Clear symptom differences were, however, observed between major PSD and endogenous major depression. Motivated (reactive) symptoms prevailed in the former, whereas unmotivated symptoms prevailed in the latter.ConclusionsOur data are more consistent with a psychological than with a neurological model of post-stroke depression.
Group treatment of auditory hallucinations
Authors: Wykes Til , Parr Ann-Marie , Landau Sabine 
Published: October 2008

BackgroundCognitive–behavioural therapy has been shown to be effective in reducing psychotic symptoms, but few patients have access to these services. Group cognitive treatment may provide a less costly service with similar benefits.AimsTo explore the effectiveness of group cognitive–behavioural therapy on insight and symptoms, particularly auditory hallucinations.MethodTwenty-one DSM–IV diagnosed patients with schizophrenia with treatment-resistant, distressing auditory hallucinations were referred to a group programme consisting of six sessions of cognitive treatment following a strict protocol which emphasised individual power and control as well as coping strategies.ResultsThere were significant changes in all three main outcome measures following treatment; those changes were maintained at follow-up and were greater than changes over the waiting-list period. Specifically, there were changes in perceived power and distress as well as increases in the number and effectiveness of the coping strategies.ConclusionsGroup treatment for auditory hallucinations needs further investigation but does look promising and may provide a less costly alternative to individual cognitive treatment.
“To see oursels as others see us”
Authors: David Anthony S. 
Published: October 2008

BackgroundThis paper takes as its starting point the paper by Aubrey Lewis entitled “The psychopathology of insight” published in 1934, unreferenced.AimsTo attempt to explore the historical antecedents and consequences of this work.MethodSpeculative review.ResultsLewis's approach to phenomenology, contemporaneous movements in psychology and Lewis's own life and times – notably the eugenics legislation in Nazi Germany – probably shaped his conclusions. Modern concepts of insight, which emphasise neuropsychology as well as social psychology, were anticipated in Lewis's writings.ConclusionsThe concept of insight has stimulated research into difficult theoretical and practical areas such as self-awareness and treatment compliance, respectively. Concern over a patients capacity for insight has the potential to humanise psychiatry.
Pragmatic randomised controlled trials in psychiatry
Authors: Hotopf Matthew , Churchill Rachel , Lewis Glyn 
Published: October 2008

BackgroundRandomised controlled trials (RCTs) are the most important method of evaluating new treatments and treatment policies. Despite this, there are relatively few large pragmatic RCTs in psychiatry.AimsTo explore the main advantages of large pragmatic RCTs and the obstacles to performing them in psychiatry.MethodA narrative review of literature on pragmatic RCTs with examples drawn from psychiatry and other medical specialities.ResultsObstacles to performing pragmatic RCTs in psychiatry include the complexity of psychiatric interventions, the complexity of outcomes used in psychiatry and the difficulties of blinding subjects and investigators to some psychiatric interventions.ConclusionsResearchers need to frame questions in a form that is relevant to clinicians and to convince clinicians to cooperate in simple large pragmatic trials.
In vivo occupancy of striatal and temporal cortical D2/D3 dopamine receptors by typical antipsychotic drugs
Authors: Bigliani Valeria , Mulligan Rachel S. , Acton Paul D. , Visvikis Dimitris , Ell Peter J. , Stephenson Caroline , Kerwin Robert W. , Pilowsky Lyn S. 
Published: October 2008

BackgroundThe dopamine hypothesis proposes that antipsychotic drugs act primarily through limbic cortical D2/D2-like dopamine receptor blockade.AimTo evaluate this hypothesis with the D2/D3-selective SPET probe [123I]-epidepride.Method[123I]-epidepride SPETscans were performed on 12 patients with schizophrenia treated with antipsychotics and 11 age-matched healthy controls. [123I]-epidepride specific binding to D2/D3 dopamine receptors was estimated, and relative percentage D2/D3 receptor occupancy by typical antipsychotic drugs determined.ResultsMean (s.d.) daily dose was 669.12 (516.8) mg chlorpromazine equivalents. Mean percentage D2/D3 receptor occupancy was 81.6 (8.1) and 73.2 (13.9) in the temporal cortex and striatum respectively.ConclusionsTypical antipsychotic drug treatment is associated with substantial temporal cortical D2/D3 receptor occupancy. The relationship between this and efficacy is poor in patients with treatment-resistant schizophrenia.
Neuropsychological function in euthymic patients with bipolar disorder
Authors: Ferrier I. N. , Stanton Biba R. , Kelly T. P. , Scott Jan 
Published: October 2008

BackgroundThe assumption that patients with bipolar disorder make a full inter-episode recovery has been challenged by limited evidence that suggests that neuropsychological dysfunction in bipolar disorder may persist beyond episodes of illness.AimsTo test the hypothesis that patients with euthymic bipolar disorder show neuropsychological impairment.MethodA battery of neuropsychological tests (assessed attention, working memory, learning and executive function) was administered to three matched groups of subjects: good-outcome patients with bipolar disorder (n=21); poor-outcome patients with bipolar disorder (n=20); controls (n=20). All patients were clinically euthymic, although some had low levels of depressive symptoms.ResultsPatients performed worse than controls on a number of neuropsychological tests. When age, premorbid IQ and depressive symptoms were controlled for, the results indicated impairment of executive function.ConclusionsThese findings provide good evidence for the existence of neuropsychological impairment in patients with euthymic bipolar disorder, although the possible effect of medication should not be overlooked. This may be of clinical relevance and raises questions about the course and outcome of the illness.
Evaluating mental health policy in England
Authors: Bindman Jonathan , Beck Andrew , Glover Gyles , Thornicroft Graham , Knapp Martin , Leese Morven , Szmukler George 
Published: October 2008

BackgroundThe Care Programme Approach (CPA) and supervision register policies in England are intended to prioritise patients to receive specialist mental health care.AimsTo describe and evaluate the practical application of the policies.MethodA questionnaire survey of key informants in mental health provider trusts and an analysis of aggregated data collected by health authorities using the Mental Illness Needs Index as a measure of population need.ResultsOn average, 1175 per 100 000 total population are subject to the CPA (95% Cl=1055–1309) and 8.6 per 100 000 (95% Cl=7.5–9.9) are on supervision registers. Wide local variations in the number of people subject to the CPA and supervision registers are not explained by variations in population need.ConclusionsPrioritisation to receive specialist mental health services is carried out inconsistently, and inequitable use of resources may result.
Effectiveness of cognitive therapy for delusions in routine clinical practice
Authors: Jakes Simon , Rhodes John , Turner Trevor 
Published: October 2008

BackgroundPrevious studies have suggested that cognitive therapy is effective in modifying delusions.AimsTo assess the effectiveness of cognitive therapy on patients seen in routine clinical work.MethodEighteen patients with chronic delusions were treated using cognitive therapy, after the method of Chadwick and Lowe. A single-case multiple-baseline experimental design was used, including a control treatment. Each subject was used as their own control.ResultsSix patients reduced conviction in their delusions during cognitive therapy and not during the control treatment. Seven patients' conviction ratings did not change. Five patients showed a variable response. Degree of conviction did not fall to zero in any patient. All patients reported that the therapy had been helpful; six spontaneously mentioned changes in psychotic thinking.ConclusionsOne-third of patients with chronic delusions whom we treated responded to delusion modification with a reduction in degree of belief. Change within therapy sessions predicted outcome, as did variation in the conviction during baseline. Cognitive therapy with delusions should aim at reducing distress as well as conviction.
Altered cerebral perfusion measured by SPECT in relatives of patients with schizophrenia
Authors: Blackwood Douglas H. R. , Glabus Mike F. , Dunan Julie , O'Carroll Ronan E. , Muir Walter J. , Ebmeier Klaus P. 
Published: October 2008

BackgroundGenetic studies in schizophrenia are hampered by the complex heterogeneous clinical phenotype. Biological variables identified as trait markers of risk could clarify the mode of inheritance, define clinical subgroups and provide clues about aetiology.AimsTo use single photon emission computed tomography (SPECT) to compare brain perfusion maps in patients with schizophrenia (n=19), their asymptomatic ‘high-risk’ relatives (n=36) and control subjects (n=34) and to examine the relationships between imaging, memory and P300 event-related potential.MethodSPECT, memory tests and P300 recording were carried out.ResultsIn the patients with schizophrenia and their relatives, perfusion was reduced in left inferior prefrontal and anterior cingulate cortex and increased bilaterally in a subcortical region. Perfusion significantly correlated with verbal memory and P300 amplitude in left inferior prefrontal cortex and with P300 latency in anterior cingulate cortex.ConclusionsMedication– and symptom-free relatives had altered regional perfusion intermediate between subjects with schizophrenia and controls. Impaired perfusion, verbal memory and P300 appear to be related traits associated with an increased risk of illness.
No evidence for left superior temporal dysfunction in asymptomatic schizophrenia and bipolar disorder
Authors: Dye Stephen , Spence Sean , Bench Christopher , Hirsch Steven , Stefan Martin , Sharma Tonmoy , Grasby Paul 
Published: October 2008

BackgroundPositron emission tomography (PET) studies have revealed functional left superior temporal gyrus (STG) abnormalities in symptomatic schizophrenia during word generation.AimsTo discover if this dysfunction is present in asymptomatic schizophrenia. To determine whether, without concurrent symptomatology, schizophrenia and bipolar affective disorder (BPD) are distinguishable by differing regional cerebral blood flow (rCBF) patterns during word generation.MethodA PETverbal fluency protocol was applied to six patients with BPD in remission and six patients with asymptomatic schizophrenia. Analysis included 10 control subjects from a contemporaneous study.ResultsAll groups showed relative reduction of rCBF in both superior temporal cortices. There were no quantitative differences in any group comparison. All groups exhibited negative covariation between rCBF in left prefrontal and right (but not left) temporal regions.ConclusionsAbnormal patterns of left STG function cannot be regarded as a trait marker for schizophrenia. Functional abnormalities may reflect aspects of mental state.
Schizophrenia with onset after age 50 years
Authors: Brodaty Henry , Sachdev Perminder , Rose Noelene , Rylands Kylie , Prenter Leanne 
Published: October 2008

BackgroundSchizophrenia occurring for the first time in late life may be a distinct entity or part of a continuum.AimsCan late-onset schizophrenia (LOS) and early-onset schizophrenia (EOS) be differentiated by their phenomenology and risk factors to their development?MethodConvenience samples of 27 DSM–III–R defined LOS subjects, 30 EOS subjects and 34 control subjects were systematically assessed.ResultsPremorbidly, both groups of subjects with schizophrenia had personality traits that were different from controls but not from each other. The EOS subjects had more family members with a history of psychiatric illness or schizophrenia and less hearing impairment than the other two groups, which did not differ from each other. Clinically, LOS and EOS subjects were similar, except that EOS subjects had more negative symptom scores, tended to have more delusions of guilt/sin and of being controlled and more formal thought disorder, and had significantly poorer instrumental activities of daily living.ConclusionsPhenomenology and risk factors do not distinguish discrete LOS.
Schizophrenia with onset after age 50 years
Authors: Sachdev Perminder , Brodaty Henry , Rose Noelene , Cathcart Stuart 
Published: October 2008

BackgroundLate-onset schizophrenia (LOS) may have a basis in age-related coarse brain disease, but empirical support for this is conflicting.AimsIs LOS characterised by more neurological disease than early-onset schizophrenia (EOS)?MethodDSM–III–R–defined LOS subjects (n=27) were compared with 30 EOS and 34 volunteer control subjects on neurological status, neuropsychological test performance and brain magnetic resonance imaging (MRI)ResultsLOS and EOS groups had more ‘soft’ neurological signs and drug-induced movement abnormalities, and performed more poorly on tests assessing speed of information processing, memory and frontal executive functioning. On MRI, the LOS and EOS groups had greater lateral ventricular size than the control group. The LOS subjects also had more signal hyperintensities in periventricular white matter and subcortical nuclei than controls.ConclusionsLOS and EOS subjects were very similar on neuropsychological, neurological and structural neuroimaging parameters, except that there were more MRI periventricular hyperintensities in LOS subjects.
Validation of the Hospital Anxiety and Depression Scale for use with adolescents
Authors: White David , Leach Chris , Sims Ruth , Atkinson Michelle , Cottrell David 
Published: October 2008

BackgroundThe Hospital Anxiety and Depression Scale (HADS), developed for use with adults, has potential with adolescents.AimsTo test the HADS's validity with adolescents.MethodThe HADS was given to 248 schoolchildren and to 48 psychiatric outpatients and 38 deliberate self-harm inpatients aged 12–17, and validated against ICD–10 diagnoses for the out-patients.ResultsThe HADS has adequate test-retest reliability and factor structure, and discriminates between adolescents diagnosed with depressive or anxiety disorders and those without these diagnoses.ConclusionsThe psychometric properties of the HADS and its shortness make it useful for screening and in clinical settings with adolescents.
Axis I comorbidity in bipolar disorder with psychotic features
Authors: Pini Stefano , Dell'Osso Liliana , Mastrocinque Concettina , Marcacci Giovanni , Papasogli Alessandra , Vignoli Serena , Pallanti Stefano , Cassano Giovanni B. 
Published: October 2008

BackgroundAxis I comorbidities are prevalent among patients with severe bipolar disorder but the clinical and psychopathological implications are not clear.AimsTo investigate characteristics of four groups of patients categorised as follows: substance abuse only (group I), substance abuse associated with other Axis I disorders (group 2), non-substance-abuse Axis I comorbidity (group 3), no psychiatric comorbidity (group 4)MethodConsecutive patients with bipolar disorder with psychotic features (n=125) were assessed using the Structured Clinical Interview for DSM–III–R – patient version, and several psychopathological scales.ResultsBy comparison with group 4, group I had a higher risk of having mood-incongruent delusions, group 2 had an earlier age at onset of mood disorder, a more frequent onset with a mixed state and a higher risk of suicide, and group 3 had more severe anxiety and a better awareness of illness.ConclusionsSubstance abuse, non-substance-abuse Axis I comorbidity and their reciprocal association are associated with different characteristics of bipolar disorder.
The EPSILON study of schizophrenia in five European countries
Authors: Becker Thomas , Knapp Martin , Knudsen Helle Charlotte , Schene Aart , Tansella Michele , Thornicroft Graham , Vázquez-Barquero José Luis 
Published: October 2008

BackgroundThere is a lack of cross-national research on care for people with schizophrenia.AimsTo produce standardised European versions of five instruments in key areas of mental health service research in five languages, and to compare data from five European countries regarding patients with schizophrenia and mental health care provision and costs.MethodFive centres, in Amsterdam, Copenhagen, London, Santander and Verona, participated. Instruments assessing needs, service use, informal carer involvement, quality of life, and service satisfaction were subjected to a conversion procedure including translation, back-translation, focus group discussion and reliability assessment. Patients of local mental health services with a Schedules for Clinical Assessment in Neuropsychiatry diagnosis of schizophrenia were interviewed.ResultsService provision varied between sites; 404 patients were studied. instrument reliability was found to be good.ConclusionsThe instruments developed were reliable across the range of countries, and will facilitate future comparative health service research.