bluuebunny/crossref_metadata_2025_split huggingface dataset:
Controlled trial of exposure and response prevention in obsessive–compulsive disorder
Authors: Lindsay Merran , Crino Rocco , Andrews Gavin 
Published: October 2008

BackgroundExposure and response prevention is considered a treatment of choice for obsessive–compulsive disorder (OCD). Yet there have been very few randomised controlled trials employing credible placebo conditions. This study compares exposure and response prevention with a general anxiety management intervention.MethodEighteen patients meeting DSM–IV criteria for OCD were randomly assigned to either exposure and response prevention or anxiety management. Both treatments involved approximately 15 hours of therapy over a three-week period.ResultsThere was a significant reduction in obsessive–compulsive symptoms following treatment with exposure and response prevention, while no change occurred in the control group. This was found to be statistically significant using a composite measure of OCD symptom severity, patient ratings of interference and therapist ratings of symptom severity.ConclusionsThese findings suggest that the symptom reductions associated with behaviour therapy for OCD are a result of the specific techniques of exposure and response prevention, rather than non-specific aspects of the therapy process. General anxiety management techniques are not effective in the treatment of OCD.
Service provision for people with schizophrenia
Authors: Lang F. H. , Johnstone E. C. , Murray G. D. , Forbes J. F. 
Published: October 2008

BackgroundThe aim of this study was to provide information on patients' current service use which could inform future decisions on service planning and resource allocation.MethodIndividuals with a diagnosis of schizophrenia, who had received in-patient care in the previous five years, were identified from the Lothian Case Register. Information was obtained from 193 subjects. Patients' service use over a six-month period was examined. The costs incurred in service provision were determined.ResultsPatients differed markedly in their use of services. This was not found to be related to their mental state. Average care costs were high. In-patient care accounted for most of the overall expenditure.ConclusionsThere is considerable variation in the services used by patients with schizophrenia and in the costs incurred in service provision. When planning services it is therefore important that detailed information on the patient population is available if resources are to be allocated cost-effectively.
Integration between primary and secondary services in the care of the severely mentally ill: patients' and general practitioners' views
Authors: Bindman Jonathan , Johnson Sonia , Wright Steve , Szmukler George , Bebbington Paul , Kuipers Elizabeth , Thornicroft Graham 
Published: October 2008

BackgroundCommunication between secondary and primary care is an important aspect of continuity of care. We investigated communication between general practitioners (GPs) and psychiatric teams about a representative group of patients with severe mental illness (SMI). We also sought views on GP involvement in care from the patients and their GPs.MethodsOne hundred patients with SMI were randomly selected from those under the care of two psychiatric sector teams in inner London. The patients and their GPs were interviewed.ResultsGPs' knowledge about the care their patients received was limited. Most GPs perceived their role as providing physical care and prescribing. Few patients consulted GPs for mental health care. GPs perceived themselves as less involved in the care of Black Caribbean or Black African patients.ConclusionsConsiderable discontinuities of care between secondary and primary care were identified. GP involvement in the care of patients with SMI appears limited. Better communication is necessary if care is to be shared.
One hundred in-patient suicides
Authors: Proulx France , Lesage Alain D. , Grunberg Frédéric 
Published: October 2008

BackgroundThe study aimed to define the characteristics and assess the clinical predictability and possible prevention of psychiatric in-patient suicides.MethodThe coroner's files on all suicides in the Greater Montreal Region from 1 April 1986 to 31 March 1991 were examined. The medical records of each case of suspected in-patient suicide were then reviewed and rated for predictability and preventive measures taken.ResultsA total of 3079 suicides were recorded over this five-year period (mean annual rate of 16.4 per 100 000 inhabitants). Of these, 104 (3.4%) involved hospital in-patients. Nearly half (48%) of these in-patient suicides occurred outside the hospital setting. The methods most frequently employed were hanging (36%) and jumping from high places (24%). Patients suffering from an affective disorder (45%) or schizophrenia (35%) comprised the majority of the sample. Suicides were significantly more predictable in general hospital psychiatric wards. Suicide prevention measures did not differ significantly across settings.ConclusionsThe majority of in-patient suicides were not highly predictable. For highly predictable suicides, the results underline the importance of actively treating and protecting these patients.
Prospective study of clinical and social outcome of stay in small group homes for people with mental illness
Authors: Middelboe Thomas 
Published: October 2008

BackgroundSmall group homes operating according to the principles of supported housing have, during the past five years, become a cornerstone of the housing services for the long-term mentally ill in Copenhagen.MethodDuring a 2.5-year period, 47 long-term mentally ill persons were examined at the time of entry to a group home programme. Residents' psychopathology, social integration, mastery and quality of life were measured by structured interviews, including the Present State Examination (PSE–10); and their social functioning was recorded by interview with the staff. Forty-four of the residents were re-examined at follow-up after a mean of 1.1 years using the same instruments. Data on hospitalisation were obtained through the Danish Psychiatric Case Register.ResultsEighty-three per cent of the residents remained in the programme during the first year. They showed a significant improvement in subjective quality of life, PSE total score, social integration, functioning and hospitalisation index. The number of reciprocal supportive contacts in the social network increased. Lower baseline PSE total score was associated with adherence to the programme, and the improvement in quality of life during their stay was predicted by reduction in symptoms and improvement in social integration.ConclusionsA rehabilitation strategy of supplementing standard psychiatric treatment with a programme of small supportive group homes improves the quality of life, psychosocial functioning and community tenure of the long-term mentally ill.
Ethnic differences in satisfaction with mental health services among representative people with psychosis in South London: PRiSM Study 4
Authors: Parkman Sue E. , Davies Sara N. , Leese Morven , Phelan Michael , Thornicroft Graham 
Published: October 2008

BackgroundPrevious studies show that among Black Caribbeans there is a higher prevalence of schizophrenia and higher levels of both voluntary and compulsory admissions. These suggest that Black Caribbean patients may find psychiatric services less appropriate to their needs. The aim of this study was to establish the satisfaction with mental health services of representative psychosis patients in South London, especially in relation to ethnic group.MethodA random sample of all cases of psychotic disorder identified in the two sectors was interviewed using the Verona Service Satisfaction Schedule. Questionnaires from 50 Black Caribbean patients and 134 White patients were analysed.ResultsBlack Caribbean patients, particularly those of second generation born in the UK, were significantly less satisfied with almost every aspect of the services that they received than either older Black Caribbean patients born in the Caribbean or White patients. Using multiple regression analysis it was found that among the younger Black Caribbean patients, unlike the other patients, the number of previous admissions was a significant predictor of dissatisfaction.ConclusionPatients' ratings of satisfaction with mental health services are significantly worse for UK-born Black Caribbean than other patients with psychotic disorder in South London.
Brain 5-HT function in obsessive-compulsive disorder
Authors: Fineberg N. A. , Roberts A. , Montgomery S. A. , Cowen P. J. 
Published: October 2008

BackgroundDrugs that potentiate brain serotonin (5-HT) neurotransmission are effective in the treatment of obsessive–compulsive disorder (OCD), but it is unclear whether disturbances in brain 5-HT function play a role in the pathophysiology of OCD.MethodWe studied the prolactin response to the selective 5-HT releasing agent d-fenfluramine in 14 non-depressed, drug-free OCD patients, and 14 healthy controls matched for age and gender.ResultsThe prolactin response to d-fenfluramine was significantly increased in OCD patients compared with controls.ConclusionsThe disparate results of studies of 5-HT neuroendocrine function in OCD make it unlikely that disturbances of brain 5-HT function play a central role in the pathophysiology of OCD. Increased brain 5-HT neurotransmission in non-depressed OCD subjects may represent an adaptive neurobehavioural mechanism which can be amplified to therapeutic advantage by treatment with 5-HT potentiating drugs.
London–East Anglia randomised controlled trial of cognitive–behavioural therapy for psychosis
Authors: Kuipers Elizabeth , Garety Philippa , Fowler David , Dunn Graham , Bebbington Paul , Freeman Daniel , Hadley Clare 
Published: October 2008

BackgroundA series of small, mainly uncontrolled, studies have suggested that techniques adapted from cognitive–behavioural therapy (CBT) for depression can improve outcome in psychosis, but no large randomised controlled trial of intensive treatment for medication-resistant symptoms of psychosis has previously been published.MethodSixty participants who each had at least one positive and distressing symptom of psychosis that was medication-resistant were randomly allocated between a CBT and standard care condition (n=28) and a standard care only control condition (n=32). Therapy was individualised, and lasted for nine months. Multiple assessments of outcome were used.ResultsOver nine months, improvement was significant only in the treatment group, who showed a 25% reduction on the BPRS. No other clinical, symptomatic or functioning measure changed significantly. Participants had a low drop-out rate from therapy (11%), and expressed high levels of satisfaction with treatment (80%). Fifty per cent of the CBT group were treatment responders (one person became worse), compared with 31% of the control group (three people became worse and another committed suicide)ConclusionsCBT for psychosis can improve overall symptomatology. The findings provide evidence that even a refractory group of clients with a long history of psychosis can engage in talking about psychotic symptoms and their meaning, and this can improve outcome.
Controlled acute and follow-up trial of cognitive therapy and pharmacotherapy in out-patients with recurrent depression
Authors: Blackburn I.-M. , Moore R. G. 
Published: October 2008

BackgroundWe report a randomised controlled trial, in both the acute and maintenance stage of treatment, in 75 outpatients with recurrent major depression.MethodPatients were allocated to three groups: 16 weeks of acute treatment and two years' maintenance treatment in the following way: antidepressants and maintenance antidepressants; cognitive therapy and maintenance cognitive therapy: antidepressants and maintenance cognitive therapy. Both completers' and end-point data were analysed.ResultsIn the acute phase of treatment, all patients improved significantly and there was no significant difference among treatments, or in the pattern of improvement over time. In the maintenance stage of treatment, patients kept improving over time in all three groups and there was no significant difference among treatments. Cognitive therapy was consistently superior to medication.ConclusionsThe results indicate that maintenance cognitive therapy has a similar prophylactic effect to maintenance medication and is a viable option for maintenance after acute treatment with medication in recurrent depression.
Risk factors for suicide in patients with schizophrenia: Nested case–control study
Authors: Rossau Charlotte Dahl , Mortensen Preben Bo 
Published: October 2008

BackgroundOf 9156 patients admitted to psychiatric hospitals in Denmark between 1970 and 1987 and diagnosed for the first time as having schizophrenia, 508 committed suicide. The purpose of the study was to identify risk factors for suicide among patients with schizophrenia, particularly factors relating to hospitalisation.MethodFrom the cohort of all 9156 patients, the 508 who had committed suicide were individually matched to 10 controls from the same cohort, and data were analysed using conditional logistic regression.ResultsSuicide risk was particularly high during the first 5 days after discharge, and increased risk was also associated with multiple admissions during the previous year, previous suicide attempts, previous diagnosis of depression, male gender, and previous admissions to general hospitals for physical disorders. After adjusting for these factors, no effect was found for age. There was some evidence of an excess of suicides during temporary leave from the psychiatric department.ConclusionsThe findings suggest that preventive measures could be focused on the first period after discharge, when closer monitoring and better social support may be needed. This may also apply to patients on temporary leave during a period of admission.
Adverse social circumstances and depression in people of Pakistani origin in the UK
Authors: Husain Nusrat , Creed Francis , Tomenson Barbara 
Published: October 2008

BackgroundThe social origins of depression in people of Pakistani origin in the UK are not fully understood; they may not be the same as for the indigenous White population.MethodPatients attending a GP's surgery were screened with the Personal Health Questionnaire to detect depressive illness, which was confirmed using the Psychiatric Assessment Schedule; the estimated prevalence of major depression was 42%. Forty-four people with depression and 33 non-depressed comparison subjects were successfully interviewed using the Life Event and Difficulty Schedule, either in Urdu or English.ResultsSeventy-five per cent of the sample were Pakistani born; 57% of cases and 33% of non-cases spoke English with difficulty. Seventy-five per cent of the cases and 36% of the non-cases had experienced an independent severe event and/or a major difficulty (P=0.0015). Difficulties associated with depression were most commonly in the marital, health and housing categories; overt racial harassment and discrimination were rare.ConclusionsThis is a preliminary study because of the small sample of GP attenders. The somatic presentation of depression in this population is clear. Acceptable forms of social support and help with marital, housing and employment problems will be needed to help relieve the depression in this population.
Expressed emotion and depression
Authors: Hayhurst H. , Cooper Z. , Paykel E. S. , Ramana R. , Vearnals S. 
Published: October 2008

BackgroundPrevious studies show that criticism by relatives during acute depressive illness predicts relapse over nine months, but the course of criticism over time and its relation to the course of illness, have not been examined in depressed patients.MethodThirty-nine depressed patients and their partners, were interviewed separately at three-monthly intervals over about one year. Illness was assessed by Research Diagnostic Criteria and Hamilton Depression Rating Scale. Criticism was measured by the Camberwell Family Interview.ResultsCriticism when patients were most depressed predicted neither remission nor subsequent relapse. Patients who fully recovered, with or without later relapse, had partners who were consistently uncritical, or critical only at presentation. Patients with residual symptoms during remission had more persistently critical partners.ConclusionsThe nature of the association between criticism and depression could not be unequivocally established, although it appeared likely that continuing criticism was a result of continuing depression. Relatives' understanding of the illness may mediate between levels of criticism and the course of depression.
Social indicators and the prediction of psychiatric admission in different diagnostic groups
Authors: Boardman Anthony P. , Hodgson Richard E. , Lewis Martyn , Allen Keith 
Published: October 2008

BackgroundRecent findings indicate that the established association between social indicators of deprivation and psychiatric admission rates may not hold across all diagnoses.MethodAdmission rates in individuals aged 16–64 years for 71 electoral wards in North Staffordshire were calculated for six diagnostic groups using data from the Korner Episode System for 1987–1993. These were correlated with selected individual census variables, Townsend and Jarman indices. The ability of regression models to predict admission rates was tested.ResultsThe strongest correlations were found for total admissions (r0.44–0.79). Strong correlations were found for neurotic disorders/depression (r0.29–0.62), schizophrenia (r0.24–0.59), all non-psychotic disorders combined (r0.41–0.71) and all psychotic disorders combined (r0.33–0.67). Predicted admission rates for total admissions, psychotic and non-psychotic admissions using regression models showed strong positive correlations with observed admission rates.ConclusionsThe strong correlations between social indicators of deprivation and total psychotic admission rates are consistent with the results of previous studies. The strong associations between social indicators and admissions for non-psychotic disorders is contrary to previous findings and may be partly explained by the relatively high admission rates for neurotic disorders.
Driver suicides
Authors: Ohberg Annakatri , Penttila Antti , Lonnqvist Jouko 
Published: October 2008

BackgroundTo study driver suicides, all motor vehicle driver fatalities in Finland from 1987 to 1991 were analysed.MethodCases were collected from all driver fatalities (n=1419), as those that accident investigation teams considered possible suicides (n=99). Drivers committing suicide classified according to ICD–9 by two forensic pathologists were selected as cases (n=84). Drivers of unintentional motor vehicle fatalities served as the control group.ResultsWhile 5.9% of all driver fatalities were classified as suicides, the figure given in the official statistics was 2.6%. Driver suicides accounted for 1.2% of all suicides. Fifty per cent of driver suicides were committed by men aged between 15 and 34 years. The victims had often suffered from life-event stress, mental disorders and had alcohol misuse problems. The cases were usually head-on collisions between two vehicles with a large weight disparity.ConclusionsMisclassification of driver suicides does not significantly influence the total suicide rate. However, people who commit suicide by this method could often be recognised, and prevention of these events would improve traffic safety.
Weather conditions and fatal self-harm in North Cheshire 1989–1993
Authors: Salib Emad , Gray Nicola 
Published: October 2008

BackgroundWe aimed to study the effect of weather conditions on the rate of all deaths due to fatal self-harm (FSH) reported in a population of 350 000. In this study the term FSH refers to all coroners' verdicts which were recorded in a specified period and included suicide, misadventure and open verdict.MethodFive-year data of FSH in North Cheshire was analysed in relation to meteorological data, which were measured at the nearest meteorological office to the study population.ResultsSmall but significant positive correlations were demonstrated between occurrence of FSH and hours of sunshine (P < 0.01) and diurnal variations in daily temperature (P < 0.05). These effects were independent of gender and psychiatric history.ConclusionsWeather may influence the occurrence of FSH, probably interacting with biological and social variables. The rate of FSH death appears to be positively related to fine weather conditions, during early summer, and not to extreme weather conditions as previously reported.
Minor psychiatric disorder in NHS trust staff: Occupational and gender differences
Authors: Wall T.D. , Bolden R.I. , Borrill C.S. , Carter A.J. , Golya D.A. , Hardy G.E. , Haynes C.E. , Rick J.E. , Shapiro D.A. , West M.A. 
Published: October 2008

BackgroundIt is widely suggested that many National Health Service (NHS) workers experience high levels of minor psychiatric disorder. However, inadequacies of sampling and measurement in studies to date have not allowed this suggestion to be properly evaluated.MethodThe present study was designed to overcome these methodological weaknesses by using a sample of over 11 000 employees from 19 NHS trusts and a well-established measure of minor psychiatric disorder for which there are comparative data.ResultsThe findings show that 26.8% of the health service workers reported significant levels of minor psychiatric disorder, compared with 17.8% of people in the general population. Psychiatric morbidity was highest among managers, doctors, nurses and professions allied to medicine, with each of these groups recording higher rates than their professional counterparts outside the health service. It was lower among those in support occupations, such as administrative and ancillary staff. A feature of the findings was that female doctors and managers showed a much higher prevalence of minor psychiatric disorder than their male colleagues.ConclusionStudies are required to establish the organisational, occupational and individual determinants of minor psychiatric disorder among NHS employees.
Brazilian multicentric study of psychiatric morbidity
Authors: Almeida-Filho Naomar , De Jesus Mari Jair , Coutinho Evandro , França Josimar Farias , Fernandes Jefferson , Andreoli Sérgio Baxter , Busnello Ellis D'Arrigo 
Published: October 2008

BackgroundPsychiatric morbidity studies in developing countries have used diagnostic procedures of low reliability, without a clinical definition of caseness, producing descriptive data with limited application for mental health planning.MethodA two-stage cross-sectional design (with a sample size of 6476) was conducted to estimate the prevalence of DSM–III psychiatric diagnoses in three metropolitan areas of Brazil (Brasília, São Paulo and Porto Alegre). All subjects were screened for the presence of psychopathology with a 44-item instrument (the QMPA) and a subsample was selected for a psychiatric interview.ResultsAge-adjusted prevalence of cases potentially in need of care ranged from 19% (São Paulo) to 34% (Brasília and Porto Alegre). Anxiety disorders comprised the highest prevalences (up to 18%). Alcoholism yielded the most consistent prevalence levels, around 8% in all sites. Depression showed great variation between areas: from less than 3% (São Paulo and Brasília) to 10% (Porto Alegre)ConclusionsOverall prevalences were high in comparison with previous studies conducted in Brazil. A female excess of non-psychotic disorders (anxiety, phobias, somatisation and depression) and a male excess for alcoholism were consistently found.