bluuebunny/crossref_metadata_2025_split huggingface dataset:
Home-Based Care and Standard Hospital Care for Patients with Severe Mental Illness: A Randomised Controlled Trial
Authors: Simpson C. J. , Seager C. P. , Robertson J. A. 
Published: October 2008

ObjectiveTo compare the efficacy of home based care with standard hospital care in treating serious mental illness.DesignRandomised controlled trial.SettingSouth Southwark, London.Patients189 patients aged 18–64 living in catchment area. 92 were randomised to home based care (daily living programme) and 97 to standard hospital care. At three months' follow up 68 home care and 60 hospital patients were evaluated.Main outcome measuresUse of hospital beds, psychiatric diagnosis, social functioning, patients' and relatives' satisfaction, and activity of daily living programme staff.ResultsHome care reduced hospital stay by 80% (median stay 6 days in home care group, 53 days in hospital group) and did not increase the number of admissions compared with hospital care. On clinical and social outcome there was a non–significant trend in favour of home care, but both groups showed big improvements. On the global adjustment scale home care patients improved by 26.8 points and the hospital group by 21.6 points (difference 5.2; 95% confidence interval -1.5 to 12). Other rating scales showed similar trends. Home care patients required a wide range of support in areas such as housing, finance, and work. Only three patients dropped out from the programme.ConclusionsHome based care may offer some slight advantages over hospital based care for patients with serious mental illness and their relatives. The care is intensive, but the low drop out rate suggests appreciation. Changes to traditional training for mental health workers are required.
Fluoxetine in Phantom Limb Pain
Authors: Power-Smith Parsley , Turkington Douglas 
Published: October 2008

Complete recovery of phantom limb pain of five years' duration occurred in a 71-year-old man following treatment with fluoxetine. There was no coexisting affective disorder. Further research is indicated in view of the postulated role of lowered central 5-hydroxy-tryptamine activity in the genesis and maintenance of chronic pain.British Journal of Psychiatry (1993), 163, 105–106
Eye-Movement Desensitisation to Overcome Post-traumatic Stress Disorder
Authors: Spector John , Huthwaite Mark 
Published: October 2008

A new treatment using a saccadic eye-movement desensitisation (EMD) procedure has recently been introduced to treat post-traumatic stress disorder, a disorder that has been difficult to treat in the past. The treatment is claimed to be very rapid and successful. This paper reports the treatment of a woman with post-traumatic stress disorder following a horrific road traffic accident using the EMD procedure.British Journal of Psychiatry (1993), 163, 106–108
Thalamo-frontal Psychosis
Authors: McGilchrist Iain , Goldstein Laura H. , Jadresic Danitza , Fenwick Peter 
Published: October 2008

A 43-year-old man presented with an 18-month history of acute-onset cyclical behavioural change affecting mood, appetite, sleep, and energy levels. This had followed an initial episode of transient drowsiness which lasted 24 hours. On examination, there was soma evidence of visual memory and frontal lobe deficits. A brain CT scan showed bilateral thalamic infarcts and a brain SPECT scan showed bilateral hypoperfusion of the frontal lobes. To our knowledge, this is the first reported case of thalamic infarction associated with acute-onset cyclical affective psychosis with clinical and neurophysiological features of frontal lobe syndrome. The case also highlights the possible role of thalamofrontal circuits in the pathogenesis of the Kleine-Levin syndrome.British Journal of Psychiatry (1993), 163, 113–115
Which Patients with Non-affective Functional Psychosis are not Admitted at First Psychiatric Contact?
Authors: Castle David J. , Phelan Michael , Wessely Simon , Murray Robin M. 
Published: October 2008

BackgroundWe wished to explore the sociodemographic and clinical characteristics associated with admission to hospital in patients with a non-organic non-affective psychosis.MethodSubjects were 484 first-contact patients with a non-affective functional psychosis from an inner-city catchment area over 20 years from the mid-1960s. Sociodemographic and clinical characteristics associated with admission to hospital were analysed.ResultsAround 20% of patients were not admitted, and the proportion did not change significantly over the years. Ethnicity, sex, and marital and employment status did not predict admission. Factors associated with admission included police involvement, and violence to self or others. A diagnosis of schizoaffective disorder, and persecutory delusions, auditory hallucinations, and bizarre behaviour were all more common in patients admitted to hospital.ConclusionsThe study indicates biases which might arise in research based exclusively on patients admitted to hospital.
The Nosological Status of Bereavement-Related Depressions
Authors: Karam Elie G. 
Published: October 2008

BackgroundThe validity of excluding bereavement-related depressive episodes which satisfy all the criteria of major depression is examined in this community study.MethodA total of 658 subjects were interviewed in their homes using the Diagnostic Interview Schedule. The length of the episodes of depression, the dysfunction they caused, and the frequency of seeking and receiving treatment were assessed.ResultsThe risk of recurrence did not differ whether the depressive episodes that satisfy the DSM–III–R criteria of major depression were or were not related to bereavement.ConclusionsExcluding from the repertoire of depressions all those related to external stressors might need more research, but singling out those related to bereavement does not seem to be supported by our community-based data.
Attempted Suicide in Oxford and Utrecht
Authors: Grootenhuis Martha , Hawton Keith , Rooijen Liesbeth Van , Fagg Joan 
Published: October 2008

BackgroundAttempted suicide rates are much higher in the UK than in the Netherlands. We have compared the characteristics of suicide attempters referred to general hospitals in Oxford and Utrecht.MethodWe compared the characteristics of referrals for attempted suicide to a general hospital in Oxford and one in Utrecht, for the years 1988 and 1989.ResultsMost of the attempters in Oxford were young whereas attempters in Utrecht were older; this age difference was particularly marked in females. Utrecht attempters appeared more often to have socio-economic problems and to suffer from psychiatric and personality disorders (except substance abuse), even when account was taken of the age differences of the two populations.ConclusionsThere is some evidence for different thresholds for attempted suicide in the UK and the Netherlands, although other social explanations for the difference in attempted suicide rates are feasible and require further study.
Comparison of the Efficacy, Safety and Withdrawal of Alpidem and Alprazolam in Anxious Patients
Authors: Frattola Lodovico , Garreau Martine , Piolti Roberto , Bassi Sirio , Albizzati Maria G. , Borghi Cristina , Morselli Paolo L. 
Published: October 2008

BackgroundWe investigated whether a new non-benzodiazepine anti-anxiety drug, alpidem, produces weaker withdrawal symptoms than alprazolam.MethodUnder a double-blind procedure, 122 patients suffering from general anxiety disorders were randomly allocated to either alpidem (50 mg, three times a day) or alprazolam (0.5 mg, three times a day) for six weeks, followed by a two-week placebo withdrawal phase. The diagnosis of withdrawal syndrome (WS) was made, in blind conditions, on the basis of the Withdrawal Symptom Check List (WSCL), after one or two weeks of discontinuation of active treatment.ResultsThe WS occurred significantly less frequently in the alpidem group (n = 10, 18%) than in the alprazolam group (n = 26, 48%). Typical withdrawal symptoms on the WSCL were also significantly less severe (P = 0.044) in the alpidem group compared with the alprazolam group.ConclusionsAlpidem may be a valid alternative to current benzodiazepine anxiolytic therapy because it produces fewer and weaker withdrawal symptoms than alprazolam and is better tolerated.
A National Audit of New Long-Stay Psychiatric Patients
Authors: Lelliott Paul , Wing John , Clifford Paul 
Published: October 2008

Background.This first report of a national audit of new long-stay (NLS) psychiatric patients conducted in 1992 describes the survey method and characteristics of the cohort.Method.Psychiatrists from 59 UK mental health services returned data on 905 patients, aged 18–64 on admission, who had been in hospital for between six months and three years.Results.Two particular sub-groups were observed. Younger NLS patients (aged 18–34) were predominantly single men with schizophrenia; 43% of these had a history of serious violence, dangerous behaviour or admission to a Special Hospital and over one-third were formally detained. Older NLS patients (aged 55–67) were predominantly married or previously married women, more often with a diagnosis of affective disorder or dementia and with poor personal and social functioning; over half were at moderate or severe risk of non-deliberate self-harm.Conclusions.Despite the continued policy of bed closures and focus on care in the community, some patients admitted recently to psychiatric units in the UK still have protracted hospital stays.
Home-Based Versus Out-Patient/In-Patient Care for People with Serious Mental Illness
Authors: Audini B. , Marks I. M. , Lawrence R. E. , Connolly J. , Watts V. 
Published: October 2008

Background.The effect of a randomised controlled withdrawal of home-based care was studied for half of a sample of seriously mentally ill (SMI) patients from an inner London catchment area, compared with the effects of continuing home-based care.Method.Patients, aged 18–64, had entered the trial at month 0 when facing emergency admission for SMI. After at least 20 months home-based care (Phase I), patients were randomised at month 30 into Phase II (months 30–45) to have either further home-based care (DLPII, n = 33) or be transferred to out-/in-patient care (DLP-control, n = 33). They were assessed at 30, 34, and 45 months. Phase I control patients (n = 10) were assessed again at month 45. Measures used were number and duration of in-patient admissions, independent ratings of clinical and social function, and patients' and relatives' satisfaction.Results.The slim clinical and social gains from home-based v. out-/in-patient care during Phase I were largely lost in Phase II. Duration of crisis admissions increased from Phase I to Phase II in both DLPII and DLP-control patients. During Phase II, patients' and relatives' satisfaction remained greater for home-based than out-/in-patient care patients. At 45 months, compared with the Phase I controls, DLPII patients and relatives were more satisfied with care. Such satisfaction was independent of clinical/social gains.Conclusions.The loss of Phase I gains were perhaps due to attenuation of home-based care quality and to benefits of Phase I home-based care lingering into Phase II in DLP-controls. The Phase II home-based care team suffered from low morale.
The Outcome of Training Community Psychiatric Nurses to Deliver Psychosocial Intervention
Authors: Brooker Charles , Falloon Ian , Butterworth Antony , Goldberg David , Graham-Hole Victor , Hillier Valerie 
Published: October 2008

Background.A prospective quasi-experimental design was used to evaluate the effect of training CPNs to undertake psychosocial intervention with families caring for a relative with schizophrenia.Method.Patients meeting predetermined criteria were allocated to either an initial waiting-list control group or a delayed intervention group. The CPNs were trained to offer family interventions to a total target group of 48. Treatment was eventually accepted by 85%, of whom 81 % (n = 34) were followed-up for 12 months. Families received a weekly mean session of 47 minutes (compared with 33 minutes in the controls). The main outcome measures are frequency and severity of symptoms (KGV), social functioning (SFS) and days in hospital. Carers' minor psychiatric morbidity (GHQ) and knowledge (KASI) are also reported.Results.In the patient group both the positive and negative symptoms of schizophrenia improved significantly (P ≤ 0.001 and P ≤ 0.01 respectively) to 12-month follow-up, as did a global measure of social functioning (P ≤ 0.001). Tentative evidence was also collected that family intervention reduced in-patient episodes. Benefits for relatives included a decrease in minor psychiatric morbidity (P ≤ 0.05) and an increase in knowledge about neuroleptic drugs (P ≤ 0.001).Conclusions.The study offers some evidence that CPNs can be taught to improve the outcome for families who care for a relative with schizophrenia.
Family-Based Intervention for Schizophrenic Patients in China
Authors: Xiong Wei , Phillips M. R. , Hu Xiong , Wang Ruiwen , Dai Qinqing , Kleinman J. , Kleinman A. 
Published: October 2008

Background.We developed and evaluated a comprehensive, ongoing intervention for families of schizophrenic patients appropriate for China's complex family relationships and unique social environment.Method.Sixty-three DSM–III–R schizophrenic patients living with family members were enrolled when admitted to hospital and randomly assigned to receive standard care or a family-based intervention that included monthly 45-minute counselling sessions focused on the management of social and occupational problems, medication management, family education, family group meetings, and crisis intervention.Results.At 6, 12, and 18-month follow-ups by blind evaluators, the proportion of subjects rehospitalised was lower, the duration of rehospitalisation was shorter, and the duration of employment was longer in the experimental group than in the control group; these differences were statistically significant at the 12 and 18-month follow-ups and were not explained by differences in drug compliance. Family intervention was associated with significantly lower levels of family burden.Conclusions.This intervention is less costly than standard treatment, is suitable for urban families of schizophrenic patients in China and feasible given the constraints of the Chinese mental health system.
Cognitive Therapy, Analytic Psychotherapy and Anxiety Management Training for Generalised Anxiety Disorder
Authors: Durham Robert C. , Murphy Tom , Allan Thérèse , Richard Karen , Treliving Linda R. , Fenton George W. 
Published: October 2008

BackgroundWe test the hypotheses that (a) cognitive therapy is of comparable efficacy to psychodynamic psychotherapy, (b) 8–10 sessions of therapy is as effective as 16–20 sessions, and (c) brief therapist training is as effective as intensive training.MethodOf 178 out-patients referred to a clinical trial of psychological treatment for generalised anxiety, 110 patients met DSM–III–R criteria for generalised anxiety disorder and were randomly assigned to three different forms of psychotherapy. The main comparison was between cognitive therapy and analytic psychotherapy, delivered by experienced therapists at weekly or fortnightly intervals over six months. A third treatment, anxiety management training, was delivered at fortnightly intervals by registrars in psychiatry after a brief period of training. Eighty patients completed treatment and were assessed before treatment, after treatment, and at six-month follow-up.ResultsCognitive therapy was significantly more effective than analytic psychotherapy, with about 50% of patients considerably better at follow-up. Analytic psychotherapy gave significant improvement but to a lesser degree than cognitive therapy. There was no significant effect for level of contact. Patients receiving anxiety management training showed similar improvements to cognitive therapy after treatment, with rather lower proportions showing clinically significant change.ConclusionsCognitive therapy is likely to be more effective than psychodynamic psychotherapy with chronically anxious patients. Significant improvements in symptoms can be achieved by trainee psychiatrists after only brief instruction in behaviourally based anxiety management. However, the superiority of cognitive therapy at follow-up suggests that the greater investment of resources required for this approach is likely to pay off in terms of more sustained improvement. There is no evidence that 16–20 sessions of treatment is more effective, on average, than 8–10 sessions.
The Nithsdale Schizophrenia Surveys
Authors: Mccreadie R. G. , Connolly M. A. , Williamson D. J. , Athawes R. W. B. , Tilak-Singh D. 
Published: October 2008

BackgroundThe aim was to examine in a population of schizophrenic patients the clinical correlates of ‘neurodevelopmental’ schizophrenia and their relationship to putative aetiological factors.MethodPremorbid social adjustment, premorbid schizoid and schizotypal personality traits, and the obstetric history of 40 schizophrenic patients and their 102 sibs were assessed through interviews with their mothers. Patients' premorbid level of intelligence was assessed by the National Adult Reading Test and current symptoms by the Positive and Negative Syndrome Scale and the Subjective Deficit Syndrome Scale.ResultsPatients had more schizoid and schizotypal traits than their sibs. They showed a deterioration in social adjustment between childhood and adolescence; sibs' social adjustment improved. There were statistically significant associations between current negative schizophrenic symptoms, premorbid deterioration in social adjustment, and schizoid and schizotypal personality traits, and between an early age of onset of illness and the same premorbid assessments. There was no evidence that patients with a family history of severe mental illness leading to hospitalisation, or a history of definite obstetric complications, had poorer premorbid functioning or more severe current symptoms.ConclusionsWe have confirmed clinical correlates of ‘neurodevelopmental’ schizophrenia but found no association between these and obstetric complications or a family history of severe mental disorder.
Oculogyric Spasm in Asian Psychiatric In-patients on Maintenance Medication
Authors: Tan Chay-Hoon , Chiang Peck-Chiam , Ng Li-Ling , Chee Kuan-Tzee 
Published: October 2008

BackgroundThe objective was to investigate the occurrence and characteristics of oculogyric spasm (OGS) in an Asian country.MethodAll 2035 Asian (88% Chinese, 7% Malays and 5% Indonesians) psychiatric in-patients in the state psychiatric hospital in Singapore were surveyed for occurrence of oculogyric spasm (OGS) over a two-month period.ResultsThirty-four patients (1.7%) developed OGS (53% male and 47% female). All the 34 patients had been on maintenance antipsychotic drugs for more than five months. Eighteen patients had recurrent attacks. The mean chlorpromazine equivalent daily dose for those patients with recurrent OGS was 511 mg. This was significantly higher (P < 0.05) than the 277 mg daily dose received by those without recurrent OGS. Most (68%) of the attacks occurred between 1400–2000 h suggesting that OGS may have a diurnal variation.ConclusionsGS presenting as tardive dystonia may be due to a relative increase in cholinergic activity.
Neuroleptic Medication for Dystonia
Authors: Young C. S. , Stewart J. B. , Fenton G. W. 
Published: October 2008

BackgroundThe presence of dysphoric symptoms associated with neuroleptic medication is commonly reported.MethodNeuroleptic treatment of a segmental dystonia resulted in a disabling depressive illness, which when treated with antidepressants led to the return of the involuntary movements.ResultsThe use of several different antidepressants and neuroleptics confirmed the association between drugs and symptoms. Genetic studies excluded “poor metaboliser status” as a reason for the patient's sensitivity to these drugs.ConclusionsThe case illustrates a delicate imbalance between dose of neuroleptic medication and depressive symptoms. We should be aware of the possibility of mood changes in patients treated with neuroleptics for a variety of conditions.
Postal Self-Exposure Treatment of Recurrent Nightmares
Authors: Burgess Mary , Marks Isaac M. , Gill Michael 
Published: October 2008

BackgroundCase reports suggest that recurrent nightmares are alleviated by behavioural treatment. We have administered such treatment to a client by post.MethodThe frequency of nightmares was recorded by the client before and during treatment, and at one and six months follow-up. Nightmare problem and target scales, and treatment expectation were recorded at the end of each period. Treatment was by rehearsal relief, self-administered using written instructions.ResultsA reduction in nightmare frequency from 5.5 per week in the baseline period to an average of one per week resulted after treatment.ConclusionsThe client's chronic nightmares were lastingly relieved after self-administered exposure treatment. A controlled trial is underway.
The Prevalence of Autistic Disorder among Children with a Learning Disability
Authors: Deb Shoumitro , Prasad K. B. G. 
Published: October 2008

BackgroundIt has been suggested recently that the prevalence of autistic disorder may be rising. No prevalence study specifically among learning disabled children exists and so this study was prompted.Method. 767 children with a learning disability who attended 16 different special schools in the Grampian region of north-east Scotland were studied for a diagnosis of autistic disorder according to the DSM–III–R criteria. The study was conducted in three stages. In the first screening stage, a questionnaire was completed for each child by their teachers. In the second stage, teachers completed another questionnaire based on DSM–III–R criteria for autistic disorder. A final diagnosis was made on the basis of examination and information gathered from the questionnaires.ResultsQuestionnaires were completed for 634 (82.7%) children. 14.3% of children with a learning disability fulfilled the diagnostic criteria for autistic disorder. There was a male: female ratio of 3:1. This gave a 9 per 10 000 minimum prevalence of autistic disorder among all school-age children in the Grampian region. There was a higher prevalence of autistic disorder in the cities compared with rural areas. The prevalence did not change with age but increased with decreasing IQ.
Clinical Features and Diagnostic Criteria of Depression in Down's Syndrome
Authors: Cooper Sally-Ann , Collacott Richard A. 
Published: October 2008

BackgroundDepression occurs commonly in people with Down's syndrome, although there is little published about this association. This study explores the limitations of Diagnostic Criteria for Research, based on ICD-10 (DCR) and DSM–III–R depressive criteria.MethodCase note examination identified 42 adults with Down's syndrome who have sustained 56 depressive episodes. The clinical features are reported.ResultsAll episodes were diagnosed as depression. DSM–III–R criteria for major depressive episode were met by 50% of the episodes. DCR for depressive episode of at least mild severity were fulfilled by 68%.ConclusionsThese criteria were unduly restrictive for this group. Commonly occurring symptoms are not included in the criteria, while certain criteria items never occurred. Criteria should be modified to facilitate future research.