bluuebunny/crossref_metadata_2025_split huggingface dataset:
Four Behavioural Syndromes of Schizophrenia
Authors: Harvey Carol A. , Curson David A. , Panteus Christos , Taylor Jason , Barnes Thomas R. E. 
Published: October 2008

BackgroundA complementary approach to defining symptomatic subtypes of schizophrenia is to identify characteristic patterns of ‘problem behaviours’ associated with the capacity of patients to function in the community.MethodIn a large epidemiological survey, patients fulfilling Feighner criteria for schizophrenia were identified by key informants and assessed using the MRC Social Behaviour Schedule (SBS) and the Manchester Scale. An exploratory factor analysis was used to extract behavioural syndromes from the SBS data in order to compare the syndrome profiles in community, acute and long-stay subgroups and to examine their associations with symptoms and social functioning.ResultsFour behavioural syndromes were identified: Thought disturbance, ‘Social withdrawal’, ‘Depressed behaviour’ and ‘Anti-social behaviour’, which distinguished between the patient subgroups and had significant differential relationships to symptoms and social functioning variables.ConclusionsThe evaluation of disability in schizophrenia and effectiveness of treatment interventions is incomplete without an assessment of problem behaviours.
Links Between Expressed Emotion and Burden of Care in Relatives of Patients with Schizophrenia
Authors: Scazufca Marcia , Kuipers Elizabeth 
Published: October 2008

BackgroundFindings that the EE level of a relative may change over time support the idea that EE may represent the circumstances of the relationship between patient and caregiver. The present study examines to what extent EE levels in relatives are related to relatives' burden of care and their perceptions of patients' deficits in social role performance.MethodFifty patients recently admitted to hospital with DSM–III–R diagnoses of schizophrenia or schizophreniform disorder were assessed for positive and negative symptoms. Fifty relatives who were living or were in close contact with these patients were interviewed for the assessment of EE and burden of care, and to provide information about patients' social role performance and social and behaviour problems.ResultsHigh-EE relatives had considerably higher mean scores for burden of care than low-EE relatives (12.5v.6.8, respectively,P=0.002), and perceived more deficits in patients' social functioning than low-EE relatives (means: 16.2v.6.9, respectively,P=0.004). The employment status of relatives was the only socio-demographic characteristic of relatives and patients associated with EE levels, those who were working being less likely to be high EE. Patients' psychopathology was not associated with EE levels and burden of care.ConclusionsThis study shows that EE and the burden of care are related. EE and burden both measure aspects of the relationship between relatives and patients. These findings suggest that EE and burden of care are more dependent on relatives' appraisal of the patient condition than on patients' actual deficits.
The Effectiveness of Cognitive Therapy in the Treatment of Non-Psychotic Morbid Jealousy
Authors: Dolan Mairead , Bishay Nagy 
Published: October 2008

BackgroundAlthough a cognitive–behavioural formulation of morbid jealousy has been described there is little empirical research into the practical usefulness of this model. This study evaluated the effectiveness of treating non-psychotic morbid jealousy using a cognitive approach.MethodCognitive–behavioural and emotional measures of jealousy were calibrated by comparison with 40 non-jealous normal controls. These instruments were used as measures of change to assess the effectiveness of cognitive therapy in altering cognitive errors in 30 morbidly jealous out-patient referrals, divided into delayed and immediate treatment subgroups to assess the stability of the condition. Both groups completed all measures immediately before and after treatment, and at follow-up.ResultsThe instruments demonstrated significant differences between jealous and non-jealous subjects on cognitive–behavioural and emotional aspects of jealousy. The delayed treatment group showed no significant alteration in scores on any of the instruments after 12 weeks on the waiting list, confirming the stability of the condition. In the majority of cases cognitive therapy aimed at the modification of dysfunctional cognitive processes resulted in a significant improvement on all jealousy measures, immediately after treatment and at follow-up. The improvement reported by patients was supported by the partner's ratings.ConclusionThe results support the postulation of the cognitive model that modification of cognitive schema by a schema-focused treatment package results in a significant reduction in disturbance in all aspects of the jealousy syndrome.
Demographic and Obstetric Risk Factors for Postnatal Psychiatric Morbidity
Authors: Warner Rachel , Appleby Louis , Whitton Anna , Faragher Brian 
Published: October 2008

BackgroundPostnatal depression follows 10% of live births but there is little consensus on the risk factors associated with its development. Previous smaller studies have been unable to quantify the impact of independent risk factors as relative and attributable risks.MethodThe Edinburgh Postnatal Depression Scale (EPDS) was used to screen a systematic sample of 2375 women, six to eight weeks after delivery. Information on socio-demographic and obstetric variables was collected at the screening interview. The risk factors associated with high EPDS scores (>12) were determined and entered stepwise into a regression model.ResultsFour independent variables were found to be associated with an EPDS score above this threshold. These were an unplanned pregnancy (OR 1.44); not breast-feeding (OR 1.52), and unemployment in either the mother, i.e. no job to return to following maternity leave (OR 1.56), or the head of household (OR 1.50). These four variables appeared to explain the risk associated with other risk factors.ConclusionsAlthough a direct aetiological role for these risk factors is not certain, they may indicate strategies for the prevention of affective morbidity in postnatal women. These may include reducing unwanted pregnancy and employment for women after childbirth.
Drug and Alcohol Problems among Individuals with Severe Mental Illnesses in South London
Authors: Menezes Paulo R. , Johnson Sonia , Thornicroft Graham , Marshall Jane , Prosser David , Bebbington Paul , Kuipers Elizabeth 
Published: October 2008

BackgroundHigh rates of comorbid alcohol and drug disorders have previously been found among individuals with severe mental illnesses such as schizophrenia and bipolar affective disorders. Clinical and social outcomes have been reported to be worse in this group and service costs greater than in individuals with severe mental illness only. These ‘dual diagnosis’ patients have mainly been investigated in the USA, and there has been very little research in Europe, where patterns of substance abuse may be different.MethodAll patients with psychotic illnesses who had any contact with the mental health services in a geographically defined sector in South London over a specified period were studied. Individuals with problems related to alcohol or drugs were identified using standardised interviews with subjects and their keyworkers. Data on psychiatric service use during the previous 2 years were also obtained.ResultsOne hundred and seventy-one subjects with psychotic illnesses were interviewed (response rate: 78.4%). The one-year prevalence rate for any substance problem was 36.3% (95% CI=29.1–43.5), for alcohol problems it was 31.6% (95% CI=24.6–38.5), and for drug problems 15.8% (95% CI=10.3–21.3). Young male subjects were at higher risk of having substance problems. Patients with substance problems had spent almost twice as many days in hospital as those without such problems over the previous two years (difference=26.3 days, 95% CI=3.8–48.7).ConclusionsThe prevalence of substance problems among people suffering from severe mental disorders is high, and seems to be associated with greater use of in-patient services. This is a significant clinical problem, with cost implications. Further investigation is needed for adequate service provision.
Relationship Between Insight, Educational Background and Cognition in Schizophrenia
Authors: Macpherson Rob , Jerrom Bill , Hughes Anthony 
Published: October 2008

BackgroundThere is a paucity of research into the relationship between insight and variables including cognitive function, educational background and symptomatology in schizophrenia.MethodSixty-four patients with DSM–III–R diagnosis schizophrenia were assessed with the Schedule for Assessment of Insight, Mini Mental State cognitive test, a new measure of knowledge about treatment (the Understanding of Medication Questionnaire), and educational background and compliance assessments.ResultsInsight scores correlated significantly with a range of variables. In a multiple regression analysis only knowledge about treatment and number of years in education explained a significant proportion of insight.ConclusionEducational background and the intellectual ability required to learn complex concepts, such as models of mental illness, appear to be more important than previously considered. Research is limited by the lack of a generally accepted definition of insight.
An Epidemiological Study of Dementia in a Rural Community in Kerala, India
Authors: Shaji S. , Promodu K. , Abraham Tony , Roy K. Jacob , Verghese Abraham 
Published: October 2008

BackgroundThis community-based epidemiologic study of dementia in a rural population in India investigated the prevalence of various dementing disorders in the community, psychosocial correlates of the morbidity, and assessment of the risk factors associated with dementia.MethodA door to door survey was conducted to identify elderly people aged 60 and above. A total of 2067 elderly persons were then screened with a vernacular adaptation of the MMSE. All those who scored 23 and below had a detailed neuropsychological evaluation by CAMDEX–Section B, and the care-givers of the people with confirmed cognitive impairment were interviewed using CAMDEX–Section H to confirm the history of deterioration or impairment in social or personal functioning. In the third phase the subjects with confirmed cognitive impairment were evaluated at home as to whether they satisfied the DSM–III–R criteria for dementia. Subcategorisation of dementia was done based on ICD–10 diagnostic criteria. Five per cent of those whose screening was negative were randomly selected and evaluated during each stage.ResultsSixty-six cases of dementia were identified from 2067 persons aged 60 and above, a prevalence rate of 31.9 per thousand After correction this rate was 33.9 per thousand. Fifty-eight per cent of the dementia cases were diagnosed as vascular dementia and 41% satisfied the criteria for ICD–10 dementia in Alzheimer's disease. There were more women in the Alzheimer's disease group; smoking and hypertension were associated with vascular dementia while a family history of dementia was more likely in the Alzheimer's group.ConclusionDementia is an important cause of morbidity in the geriatric population in this community, where families take responsibility for the care of relatives with dementia.
Explaining Suicide: The Views of Survivors of Serious Suicide Attempts
Authors: O'Donnell Ian , Farmer Richard , Catalán José 
Published: October 2008

BackgroundThere is a dearth of information on the motivational aspects of serious suicide attempts, in particular those which involve violent methods. Clarification of the reasons which lie behind such acts may suggest appropriate preventive strategies.MethodInterviews were carried out with 20 individuals who had attempted suicide by jumping in front of a railway train. Demographic and psychiatric data were collected for each case and the Suicidal Intent Scale was administered.ResultsIn most cases the act had been impulsive and was characterised by an extremely high level of suicidal intent. The majority were receiving psychiatric treatment at the time of their suicide attempt. In some cases, survival and the aftermath of the attempt appeared to have a beneficial effect on mental state.ConclusionsWhile high levels of psychiatric morbidity and high suicidal intent were common, impulsivity and improved mental state indicate that there are similarities between high and low suicide intent survivors.
Comparative Incidence of Depression in Women and Men, During Pregnancy and after Childbirth
Authors: Areias M. E. G. , Kumar R. , Barros H. , Figueiredo E. 
Published: October 2008

BackgroundComparing women's and men's emotional reactions to childbirth can clarify the impact on mental health of childbirth as a life event.MethodFifty-four first-time mothers attending obstetric services in Oporto, Portugal, and 42 of their husbands or partners participated in a longitudinal study of their mental health. All subjects were given a semi-structured clinical interview (SADS) at 6 months antenatally and at 12 months postnatally and sub-samples were interviewed at 3 months postnatally. At all these times all the mothers and fathers also completed a translated version of a self-rating scale for depression, the Edinburgh Postnatal Depression Scale (EPDS).ResultsMore women than men had past histories of depression but their rates of depression did not differ significantly during pregnancy. In the first 3 months postnatally, nearly a quarter of the women ‘at risk’ were found to have become depressed (major, minor and intermittent) in contrast with less than 5% of the men. In the next nine months men were more prone to become depressed than previously and their conditions tended to follow an earlier onset of depression in their spouses.ConclusionComparisons of EPDS and SADS ratings showed that the translated EPDS was a valid instrument for women but it was less satisfactory when applied to men.
Correlates of Postnatal Depression in Mothers and Fathers
Authors: Areias M. E. G. , Kumar R. , Barros H. , Figueiredo E. 
Published: October 2008

BackgroundWe compare and contrast some correlates of paternal and maternal depression after the live birth of a first child, as part of a longitudinal study.MethodFifty-four first-time mothers attending obstetric services in Oporto, Portugal, and 42 of their husbands or partners participated in a longitudinal study of their mental health. All subjects were given a semi-structured clinical interview (SADS) at six months antenatally and at 12 months postnatally and sub-samples were interviewed at three months postnatally. At all these times all the mothers and fathers also completed a translated version of a self-rating scale for depression, the Edinburgh Postnatal Depression Scale (EPDS) and a series of other questionnaires and interviews to measure different psychosocial variables. Profiles of risk factors associated with depression in the first postnatal year were analysed by means of logistic regressions.ResultsIn the mothers, aside from a history of depression, the only other powerful predictor of postnatal depression was the mean objective negative impact score of life events. ‘Postnatal’ depression in fathers was associated with a history of depression in themselves and with the presence of depression in their wives or partners during pregnancy and soon after delivery.ConclusionPrevention and early treatment of depression in fathers may benefit not only themselves but also their spouses and their children.
Alcohol and Drugs in Suicides
Authors: Ohberg Annakatri , Vuori Erkki , Ojanperä Ilkka , Lonnqvist Jouko 
Published: October 2008

BackgroundAlcohol and drugs use were assessed in a nationwide one year suicide study in Finland.MethodAlcohol and drugs use were analysed in 1348 suicides, 96.5% of all suicides in the study year. Relative suicide risks for drugs were defined by relating the number of suicides committed by use of various drugs to drug availability.ResultsAlcohol was detected twice as often in men as in women; the opposite was the case with drugs. The drugs most commonly used for suicide were neuroleptics and antidepressants, which were, in 74.3% and 77.4% of the cases, respectively, the victim's own prescribed drugs. Antidepressants were found in 19.0% of women and only 4.8% of men. Relative suicide risk for antidepressants varied substantially between different compounds.ConclusionsUndertreatment of depression is a challenge for suicide prevention. Those who commit suicide by antidepressants use their own drugs. Relative suicide risk for a drug should be considered when choosing treatment for depressive patients.
The Galway Study of Panic Disorder IV
Authors: O'Rourke D. , Fahy T. J. , Prescott P. 
Published: October 2008

BackgroundA long-term outcome study of DSM–III–R panic disorder included the Present State Examination (PSE) at baseline and follow up five to six years later.MethodPSE test–retest and individual within-patient change scores on various PSE syndromes were assessed for consistency with either a categorical view of panic disorder as a stable clinical entity or panic disorder as one facet only of a ‘general neurotic syndrome’.ResultsPSE profile at baseline was virtually identical with that at follow up. Few patients had ‘changed’ in PSE syndrome diagnosis after five to six years.ConclusionThese data, although not conclusive, are supportive of the concept of DSM–III–R panic disorder as a stable clinical entity and are correspondingly difficult to reconcile with the view that panic disorder is but one facet only of a general neurotic syndrome.
The Mental Health Residential Care Study: Classification of Facilities and Description of Residents
Authors: Lelliott Paul , Audini Bernard , Knapp Martin , Chisholm Daniel 
Published: October 2008

BackgroundThe NHS is no longer a virtual monopoly provider of mental health residential care. This makes it difficult to assess the volume, range and adequacy of local provision.MethodLocal data collectors used standard instruments to collect detailed information about 368 facilities (with 1951 residents) providing mental health residential care in eight districts. Because local definitions were inconsistent, facilities were reclassified on the basis of facility size and extent of day and night cover. The eight categories of accommodation are compared on levels of staffing, staff qualifications and the characteristics of their residents.ResultsThere was a nearly threefold variation between districts in the total number of residential places available per unit of population, and even greater variation in the number of places with 24-hour waking cover. Most residents have long-term, severe mental illness and severe impairment. Long-stay wards accommodate people who pose greater risk of violence than do the two types of non-hospital facility with 24-hour waking cover (P<0.001). The former also employ a much greater proportion of staff with formal care qualifications and, in particular, nursing qualifications than the latter (49% v. 15%, P < 0.001).ConclusionsIt is suggested that one consequence of the diversification in provision of mental health residential accommodation has been a relative reduction in the proportion of provision available to the most severely disabled. This might apply particularly to those who pose a risk of acting violently.
Life Events and Primary Affective Disorders
Authors: Pardoen D. , Bauwens F. , Dramaix M. , Tracy A. , Genevrois C. , Staner L. , Mendlewicz J. 
Published: October 2008

BackgroundUnipolar and bipolar patients with a chronic illness pattern were investigated to determine whether they experienced a higher number of life events prior to the onset of recurrent affective episodes.MethodThe study participants consisted of 27 recovered bipolar patients, 24 recovered unipolar patients and 26 healthy control subjects. Life events and psychiatric status were assessed by bimonthly interviews over the period of one year using the Inventory for Recent Life Events and the Research Diagnostic Criteria.ResultsIn both unipolar and bipolar patients, analyses revealed no significant differences in the number of life events experienced, irrespective of whether the patients had presented with a depressive episode of at least minor intensity during the study (all P > 0.1). Specifically, an increase in marital problems was observed in bipolar patients prior to the onset of recurrent hypomanic and manic episodes (P=0.06).ConclusionThe causal association between life events and the onset of depression, shown to be relevant in non-chronically depressed subjects, does not apply in chronic affective disorders. In addition, our results suggest that marital events have an impact on the onset of recurrent hypomanic and manic episodes.
Deliberate Self-Poisoning and Self-Injury in Children and Adolescents Under 16 Years of Age in Oxford, 1976–1993
Authors: Hawton Keith , Fagg Joan , Simkin Sue 
Published: October 2008

BackgroundDeliberate self-harm (DSH) is common in adolescents in the United Kingdom and suicide has greatly increased in frequency in older male adolescents. There is, however, very little information about DSH in older children and young adolescents.MethodAnalysis of data collected by the Oxford Monitoring System for Attempted Suicide between 1976 and 1993 for all cases of DSH in under 16-year-olds referred to the general hospital in Oxford.ResultsSeven hundred and fifty-five individuals were involved in 854 episodes of DSH. There were very few cases under 12 years of age but after that the behaviour increased greatly in frequency with each year of age, especially in girls. Eighty-five per cent were girls, the sex ratio being 5.7 girls to each boy. Most cases involved self-poisoning. During the final six years of the study period paracetamol was involved in 54.7% of overdoses, compared with 19.5% in 1976–1981. A minority of individuals had had previous psychiatric treatment. The most frequent problems were relationship difficulties with parents, followed by difficulties with friends, school and social isolation. Among those who reported previous episodes of DSH, in the majority of cases these had not come to medical attention. Repetition of self-harm occurred in 9.4% of cases within a year of an episode and 19.3% during the overall study period. There was some indication that repetition was most common in youngsters discharged from the Accident and Emergency Department without a psychiatric assessment.ConclusionsDSH in under 16-year-olds is not uncommon and there is evidence that it occurs far more frequently in the community than is reflected in general hospital figures. The problem of paracetamol self-poisoning in this age group needs to be addressed. A psychiatric assessment should be performed in all cases coming to the general hospital.
Age at Onset in Schizophrenia and Risk of Illness in Relatives
Authors: Kendler Kenneth S. , Karkowski-Shuman Laura , Walsh Dermot 
Published: October 2008

BackgroundFor many common medical and neuropsychiatric disorders, early age at onset reflects high familial liability to illness. However, for schizophrenia, most studies do not find such a relationship.MethodUsing Cox proportional hazard models, we investigate this question in the epidemiologically-based Roscommon family study.ResultsNo relationship was found between age at onset in schizophrenic probands and the hazard rate for schizophrenia in their relatives. Similar results were obtained when the definition of illness was expanded to include schizoaffective disorder and other non-affective psychoses.ConclusionsFor schizophrenia, a ‘common-sense’ model for age of onset (i.e. those with highest familial liability to illness succumb first while those with lower liability survive longer before falling ill) does not seem to apply. Our results are more consistent with a model in which variation in age at onset of schizophrenia is due to random developmental effects or to environmental experiences unique to the individual.