bluuebunny/crossref_metadata_2025_split huggingface dataset:
Classification of Veterans with Post-Traumatic Stress Disorder Using Visual Brain Evoked P3s to Traumatic Stimuli
Authors: Attias Joseph , Bleich Avi , Gilat Shlomo 
Published: October 2008

BackgroundPost-traumatic stress disorder (PTSD) typically involves a re-experiencing of traumatic events. In a previous P3 study it was found that PTSD patients react both selectively and involuntarily to combat-related pictures, exhibiting augmented P3 event-related potentials and thus providing a brain activity measure. The clinical application of these findings in differentiating PTSD patients from controls was tested.MethodTwenty Israeli combat veterans suffering from PTSD and 20 age-matched veterans without PTSD were evaluated. P3 potentials were recorded at Pz and Cz in response to visual motor-task target stimuli (pictures of domestic animals), non-target probe stimuli (combat-related pictures), and non-target irrelevant stimuli (pictures of furnishings and flowers).ResultsUsing the Fisher Linear Discrimination Method the P3 measures correctly classified 90% of the PTSD patients and 85% of the controls.ConclusionsVisual P3s recorded in response to combat-related pictorial stimuli may introduce an efficient tool for studying higher brain activity in PTSD, complementing other behavioural and psychophysiological measurements.
A Comparison of the Characteristics of Chronic Fatigue Syndrome in Primary and Tertiary Care
Authors: Euba R. , Chalder T. , Deale A. , Wessely S. 
Published: October 2008

BackgroundTo evaluate the characteristics of Chronic Fatigue Syndrome (CFS) in primary and tertiary care.MethodA comparison of subjects fulfilling criteria for CFS seen in primary care and in a hospital unit specialising in CFS. Subjects were 33 adults fulfilling criteria for CFS, identified as part of a prospective cohort study in primary care, compared to 79 adults fulfilling the same criteria referred for treatment to a specialist CFS clinic.ResultsHospital cases were more likely to belong to upper socio-economic groups, and to have physical illness attributions. They had higher levels of fatigue and more somatic symptoms, and were more impaired functionally, but had less overt psychological morbidity. Women were over-represented in both primary care and hospital groups. Nearly half of those referred to a specialist clinic did not fulfil operational criteria for CFS.ConclusionThe high rates of psychiatric morbidity and female excess that characterise CFS in specialist settings are not due to selection bias. On the other hand higher social class and physical illness attributions may be the result of selection bias and not intrinsic to CFS.
Mental Health of Preschool Children and their Mothers in a Mixed Urban/Rural Population
Authors: Thompson Margaret J. J. , Stevenson Jim , Sonuga-Barke Edmund , Nott Peter , Bhatti Zam , Price Andy , Hudswell Matthew 
Published: October 2008

BackgroundThe prevalence rate of behaviour problems and maternal mental disturbance was estimated using a sample of 1047 families with a 3-year-old child from a mixed urban/rural area.MethodParents completed the Child Behaviour Checklist, EAS Temperament Questionnaire, Weiss–Werry–Peters Activity Scale and the GHQ–30.ResultsThe rate of behaviour problems (13.2%) was similar to that obtained in studies of urban children. The rate of maternal disturbance (27.6%) was lower than in other population samples. Few differences were found in the prevalence rates in the urban and rural areas.ConclusionsPreschool children and their parents living in non-urban areas had the same rates of problems as those in conurbations. The service needs of such families are similar regardless of locality.
Paracetamol Self-Poisoning Characteristics, Prevention and Harm Reduction
Authors: Hawton Keith , Ware Christopher , Mistry Hamant , Hewitt Jonathan , Kingsbury Stephen , Roberts Dave , Weitzel Heather 
Published: October 2008

BackgroundParacetamol is now the most common drug used for self-poisoning in the UK and is associated with potentially fatal liver damage. Patients admitted to hospital because of paracetamol overdoses were studied in order to determine their characteristics and factors which might have deterred them from taking paracetamol or reduced the dangers of the overdose.MethodEighty patients were studied in hospital using a structured interview schedule, measures of depression and suicidal intent, information collected through the Oxford Monitoring System for Attempted Suicide, and the results of liver function tests.ResultsAcute liver dysfunction (25 patients) was associated with consumption of more than 25 tablets (odds ratio 4.46, 95% CI 1.31 to 17.41, P = 0.014). The proportionate use of tablets from blister packs (60%) and loose preparations (46%; 5 patients using both types) reflected their general availability. More of those who took tablets from a loose preparation consumed 25 or more tablets (69%) than those who used a blister-pack preparation (40%; odds ratio = 3.0, 95% CI 1.12 to 9.95, P = 0.028). Only 20 patients thought that any type of warning label would have deterred them from taking a paracetamol overdose.ConclusionsEstablishing a maximum number of tablets (e.g. 25) that can be available in individual preparations is likely to reduce the dangers of paracetamol self-poisoning. The potential effects of other measures are uncertain.
Cognitive Processes in Delusional Disorders
Authors: Fear Christopher , Sharp Helen , Healy David 
Published: October 2008

BackgroundStudies of schizophrenics with persecutory delusions have shown cognitive biases in subjects who are deluded. It has been suggested that their delusions defend against depression. This study challenges the assumption that delusional disorder (DD) patients are covertly depressed.MethodClinical and demographic data and responses to questionnaires designed to assess schizotypy, depression, dysfunctional attitudes, attributional and attention biases were collected from 29 patients satisfying DSM–III–R criteria for DD. These were compared with 20 matched normal controls and results from published studies of schizophrenics.ResultsDD subjects did not show abnormal levels of overt or covert depression or schizotypy. They showed high levels of dysfunctional attitudes (P < 0.0001), a distinctive attributional style (P = 0.01), and increased attention to threat-related stimuli (P = 0.01).ConclusionsDD is a distinct disorder predicated upon sensitivity to threat and biases of attention and attribution. These findings may have implications for the cognitive therapy of these disorders.
Childhood Emotional Abuse
Authors: Thompson Anne E. , Kaplan Carole A. 
Published: October 2008

BackgroundThe assessment and management of childhood emotional abuse is of increasing importance in psychiatric practice. At present there are no consensus views about the definition of emotional abuse and information from research is limited.MethodInformation about emotional abuse from the medical, psychological, social science and legal literature is summarised. Definitions and proposed mechanisms of damage are discussed. Current research data and an overview of childhood and adult sequelae are presented. Proposals for clinical and medico-legal practice are made.ResultsTheoretical models of emotional abuse and its consequences are derived from theories of childhood psychological development. Empirical research is beginning to show that emotional abuse may have a profound effect on aspects of psychological development in children.ConclusionsThe developmental theories and methods of assessment well established in psychiatry are useful approaches to the clinical assessment and further understanding of emotional abuse.
Psychological Markers in the Detection of Autism in Infancy in a Large Population
Authors: Baron-Cohen Simon , Cox Antony , Baird Gillian , Swettenham John , Nightingale Natasha , Morgan Kate , Drew Auriol , Charman Tony 
Published: October 2008

BackgroundInvestigation to see if there are key psychological risk indicators for autism in a random population study of children at 18 months of age; and to assess how well these discriminate children who receive a diagnosis of autism from other forms of developmental delay.MethodSixteen thousand children in the southeast of England were screened for autism by their health visitor or GP, during their routine 18-month-old developmental check-up, using the CHAT (Checklist for Autism in Toddlers). From a previous high-risk study we predicted that children at 18 months of age who failed three items (‘protodeclarative pointing‘, ‘gaze-monitoring‘, and ‘pretend play’) would be at risk for receiving a diagnosis of autism. From other evidence, we further predicted that those 18-month-olds who failed one or two of the key items (either pretend play, or protodeclarative pointing and pretend play) would be at risk for developmental delay without autism.ResultsTwelve children out of the total population of 16 000 consistently failed the three key items. Of these, 10 (83.3%) received a diagnosis of autism. Thus, the false positive rate was 16.6% (2 out of 12 cases), and even these 2 cases were not normal. When the 10 children with autism were reassessed at 3.5 years of age, their diagnosis remained the same. Thus the false positive rate among the cases diagnosed with autism was zero. In contrast, of 22 children who consistently failed either protodeclarative pointing and/or pretend play, none received a diagnosis of autism, but 15 (68.2%) received a diagnosis of language delay.ConclusionsConsistent failure of the three key items from the CHAT at 18 months of age carries an 83.3% risk of autism; and this pattern of risk indicator is specific to autism when compared to other forms of developmental delay.
The Treatment of Depression: Prescribing Patterns of Antidepressants in Primary Care in the UK
Authors: Donoghue J. M. , Tylee A. 
Published: October 2008

BackgroundConsensus has been achieved about how depression should be treated in primary care, and guidelines have been issued by the Royal Colleges of General Practitioners and Psychiatrists, and by the British Association for Psychopharmacology. One of the principal recommendations is to prescribe antidepressant medicine at effective doses. This study was established to investigate how current prescribing practices in primary care compared with these guidelines.MethodInformation on prescribing of antidepressant medicines was obtained using three independent data sources: Prescribing Analysis and Cost (PACT) data; medical notes; and a large, computerised patient record database.ResultsData were obtained on populations in excess of 1.5 million people, and over 80 000 prescriptions were reviewed. All three data sources showed very similar patterns of prescribing, in particular that as many as 88% of prescriptions for older tricyclic antidepressants are prescribed by GPs at doses below those recommended by the consensus guidelines. Newer antidepressants – lofepramine and the SSRIs – are prescribed comparatively well.ConclusionsPrescribing of antidepressants by GPs is not in line with the consensus recommendations on dosage. This may have major educational implications for GPs. A pragmatic approach to improve prescribing in the short term may be to advocate the use of lofepramine or the SSRIs as first line treatment for depression. This study validates the use of PACT data as a useful audit tool in this area of clinical practice.
Continuing Clozapine Despite Neutropenia
Authors: Wesson Michael L. , Finnegan David M. , Clark Peter I. 
Published: October 2008

BackgroundA 40-year-old chronic schizophrenic patient whose psychosis and associated violent behaviour resolved on clozapine, required chemotherapy for a testicular teratoma with pulmonary metastases. His treatment was initially delayed due to refusal to consent.TreatmentThe patient finally agreed to orchidectomy and cytotoxic therapy, and following agreement by the CPMS, clozapine continued to be dispensed despite neutropenia and ‘red alert’ status on full blood count.DiscussionThis is the only patient to continue clozapine despite ‘red alert’ status, and as such is an exceptional case, but may open the way for such patients in the future.
Acute Frontal Lobe Syndrome and Dyscontrol Associated with Bilateral Caudate Nucleus Infarctions
Authors: Petty Richard G. , Bonner Deirdre , Mouratoglou Vassilis , Silverman Marisa 
Published: October 2008

BackgroundA 67-year-old man presented with acute onset of spatial and temporal disorientation, memory loss and associated episodic dyscontrol. Investigations showed infarctions of both caudate nuclei. This patient presented a unique opportunity to study the relationship between the lesions, his behaviour, and neuropsychological testing.MethodSingle case report Investigations included interviews to determine cognitive impairment i.e. WAIS-R, MMSE, and neurological examination.ResultsExtensive neuropsychological testing revealed severe impairment on tasks requiring planning, memory or abstract thought. These findings are very similar to those seen in Huntington's disease.ConclusionsA neurobiological hypothesis is proposed to account for his symptoms, and recent discoveries in the basic sciences used to inform his management.
Sensible Hypothesis Testing in Deluded, Depressed and Normal Subjects
Authors: Bentall Richard P. , Young Heather F. 
Published: October 2008

BackgroundPrevious research has indicated that deluded patients may experience difficulties when testing hypotheses. In this study, hypothesis-testing strategies were assessed in patients with persecutory delusions, depressed patients and normal controls.MethodSubjects were presented problem items describing typical everyday situations with either positive or negative outcomes and were required to choose strategies to prove that one of three variables was responsible for the outcomes.ResultsConsistent with previous research into sensible reasoning, subjects chose to manipulate the variable hypothesised to be responsible for the outcome (disconfirmation strategy) more when the outcome was negative than when it was positive, and chose to manipulate the remaining variables (confirmation strategy) more when the outcome was positive. No group differences were observed.ConclusionsNo evidence was found of abnormal hypothesis-testing strategies in deluded patients.
Use of Clozapine in a Child with Treatment-Resistant Schizophrenia
Authors: MacEwan Thomas H. , Morton Michael J. S. 
Published: October 2008

BackgroundSchizophrenia can be diagnosed in adults and requires treatment with antipsychotic medication. Clozapine is used effectively in adults with treatment-resistant schizophrenia but little is published on the use of clozapine in children.MethodSupported by parental consent and a second opinion, standardised observations were used to chart the progress of treatment with clozapine in a child in-patient detained under mental health legislation with severe drug-resistant schizophrenia and tardive dyskinesia.ResultsSixteen months of clozapine treatment led to significant reduction of symptomatology with marked improvement in social functioning and diminished tardive dyskinesia.ConclusionsThis case illustrates the successful use of clozapine in treatment-resistant childhood schizophrenia.
Patients with Schizophrenia Remember that an Event has Occurred, but not When
Authors: Rizzo Lydia , Danion Jean-Marie , Van Der Linden Martial , Grangé Danielle 
Published: October 2008

BackgroundThe context memory deficit hypothesis of schizophrenia postulates that the long-term deficit associated with this disorder is related to a memory impairment for contextual information.MethodTo test this hypothesis, memory for temporal context was assessed in 33 patients with schizophrenia and 33 normal subjects, using a recency discrimination task.ResultsWhereas patients were able to recall and recognise target items, they were unable to recognise from among the target items those which had been most recently learned.ConclusionsSchizophrenia is associated with a temporal context memory deficit.
Public Education for Community Care
Authors: Wolff Geoffrey , Pathare Soumitra , Craig Tom , Leff Julian 
Published: October 2008

BackgroundThe findings from a controlled study of the effect of a public education campaign on community attitudes to mentally ill people are presented.MethodA census of neighbours' attitudes toward mental illness was conducted in two areas before the opening of supported houses for the mentally ill. In one area an educational campaign was conducted The attitude survey was then repeated in both areas and patients' social contact with neighbours was recorded.ResultsRespondents exposed to the didactic component of the campaign showed only a small increase in knowledge about mental illness but there was a lessening of fearful and rejecting attitudes in the experimental area and not in the control area Neighbours in the experimental area were more likely to make social contact with both staff and patients. It was social contact which was directly associated with improved attitudes rather than educationper se.Patients in the experimental area made contact and even friendships with neighbours whereas those in the control area did not.ConclusionsThe public education campaign did not lead to significant changes in neighbours' knowledge of mental illness. However, their attitudes improved and patients' social integration was enhanced.
A Controlled Trial of Dothiepin and Placebo in Treating Benzodiazepine Withdrawal Symptoms
Authors: Tyrer Peter , Ferguson Brian , Hallström Cosmo , Michie Marian , Tyrer Stephen , Cooper Stephen , Caplan Richard , Barczak Paul 
Published: October 2008

BackgroundThe possibility that treatment with tricyclic antidepressants, in the form of dothiepin, might attenuate benzodiazepine withdrawal symptoms was investigated in a double-blind trial.MethodEighty-seven non-depressed psychiatric out-patients with putative normal dose benzodiazepine dependence had their benzodiazepines reduced in stepwise amounts of 20% of the original dose for eight weeks. The patients were randomised to receive dothiepin (with dosage increasing to 150 mg/day) or placebo as an aid to withdrawal before benzodiazepine reduction and these drugs were taken for four further weeks before being stopped.ResultsFewer patients entered and completed the study than expected and a Type II error was possible in the results. Although there was some evidence of withdrawal symptoms being less marked in those patients allocated to dothiepin this was independent of any antidepressant effect as depression scores were lower in the placebo group in the early phase of withdrawal (P<0.01). Of those completing the study, greater satisfaction (P=0.03) was recorded by those who had received dothiepin; no other differences reached statistical significance.ConclusionsDothiepin (and by implication other tricyclic antidepressants) might have some value in reducing benzodiazepine withdrawal symptoms but does not aid drug withdrawal.
Confirmatory Factor Analysis of the Fear Questionnaire with Social Phobia Patients
Authors: Cox Brian J. , Parker James D. A. , Swinson Richard P. 
Published: October 2008

BackgroundThe Fear Questionnaire is an internationally popular measure in anxiety disorder research, but its validity with social phobia patients has not been clearly demonstrated.MethodA confirmatory factor analysis was conducted using the Fear Questionnaire responses of 122 social phobia patients.ResultsThe results indicated that the proposed three-factor model of the scale (agoraphobia, social phobia, and Wood/injury dimensions) provided a good fit to the data.ConclusionsThese data provide strong support for the validity of the scale and for the multidimensional view of fears proposed by Arrindell.
The Use of Environmental Strategies and Psychotropic Medication in the Management of Delirium
Authors: Meagher David J. , O'Hanlon Donal , O'Mahony Edmond , Casey Patricia R. 
Published: October 2008

BackgroundThis paper examines the pattern and frequency of implementation of environmental strategies and the use of psychotropic medication in the management of patients with delirium in an acute hospital setting.MethodThe study involved 46 consecutive referrals to a consultation psychiatry service each of whom met ICD–10 criteria for delirium. Patients were subdivided into hyperactive, hypoactive and mixed subtypes of delirium and assessed regarding severity of delirium, the use of psychotropic medication prior to consultation and the implementation of environmental measures in their management.ResultsMean age was 60.1 years. Thirty per cent of patients were of the hyperactive subtype, 24% hypoactive and 46% mixed. Psychotropic medication was given to 56.5% prior to consultation and this is significantly associated with severity of delirium and in particular, with hyperactive delirium subtype. Of eight environmental strategies only four were instituted in over 50% of the patients prior to consultation. The application of these strategies was associated with overall severity of delirium, agitation, mood lability and sleep-wake cycle disturbance. It was not significantly associated with severity of disorientation or with disturbed perception/thinking.ConclusionSimple environmental strategies such as limiting changes in staff, minimising noise levels and involving relatives in re-orientation are frequently overlooked in the management of patients with delirium. Our study suggests that the implementation of environmental strategies occurs primarily in response to behavioural challenges rather than to limit the core features of delirium.
Successful Treatment of Tardive Dystonia with Clozapine and Clonazepam
Authors: Shapleske J. , Mckay A. P. , Mckenna P. J. 
Published: October 2008

BackgroundTardive dystonia is an uncommon complication of neuroleptic treatment which is frequently disabling and poorly responsive to treatment.MethodThe case is reported of a 28-year-old patient with schizophrenia who developed severe, generalised tardive dystonia after five years of neuroleptic treatment. Stopping neuroleptic medication and treatment with tetrabenazine, an anticholinergic and a benzodiazepine were ineffective. Treatment with clozapine and then the novel combination of clozapine plus clonazepam was instituted.ResultsTreatment with clozapine alone brought about limited improvement. Addition of clonazepam resulted in virtually complete disappearance of all abnormal movements. This remission has been sustained for nearly two years.ConclusionsThis report adds to two other cases suggesting that the combination of clozapine and clonazepam may be an effective treatment for tardive dystonia.
Obstetric Complications and Schizophrenia: A Case Control Study Based on Standardised Obstetric Records
Authors: Kendell R. E. , Juszczak E. , Cole S. K. 
Published: October 2008

BackgroundThere have been many reports of a higher incidence of ‘obstetric complications’ in the histories of schizophrenics than of controls, but because of the methodological shortcomings of most of these comparisons the relationship remains controversial.MethodComprehensive records covering all psychiatric hospital admissions and all hospital deliveries in Scotland since 1971 made it possible to identify the obstetric records of people born in 1971–74 who were subsequently admitted to hospital with a diagnosis of schizophrenia, and then to compare their standardised obstetric records with those of closely matched controls.ResultsOne hundred and fifteen schizophrenic/control pairs were compared. The former showed a highly significant (P < 0.001) excess of complications of both pregnancy and delivery. In particular, there was a significant excess of pre-eclampsia (10 v. 2) and of infants detained in hospital for neonatal care (18 v. 6).ConclusionThe raised incidence of obstetric complications often reported in people with schizophrenia is genuine and probably contributes to the aetiology of the condition.