bluuebunny/crossref_metadata_2025_split huggingface dataset:
Autism – an evolving concept
Authors: Berney T. P. 
Published: August 2002

BackgroundThe rapid increase in research endeavour has not kept pace with the advent of well-publicised theories and treatments for autism.AimsTo explore some of the newer developments in biological research into autism.MethodA review of recent publications and presentations.ResultsThe concept is shifting from the narrow perception of aloof autism, described by Kanner, to a wider one that includes a spectrum extending to a broader, subclinical phenotype. The genetic basis has been established; now we need to discover the location and interaction of the relevant sites. There is considerable interest in the bowel as a pathogenetic agent, particularly in the effects of exogenous opioids and multiple viral infection (the latter posing a public health problem). Also of concern is the role of (potentially treatable) epilepsy, analogous to the Laudau-Kleffner syndrome.ConclusionsIn the absence of a cure, the implementation of ideas will continue to outstrip factual evidence. Clinicians are challenged by the availability of information (and misinformation), particularly on the internet.
Ageing and learning disability
Authors: Holland A. J. 
Published: August 2002

BackgroundAgeing is a continuation of the developmental process and is influenced by genetic and other biological factors as well as personal and social circumstances.AimsTo identify some key biological, psychological and social issues relevant to how ageing might particularly effect people with learning disabilities.MethodThis selected review considers the extent to which there are similarities and differences relative to people without learning disabilities.ResultsThere is a convergence, in later life, between people with a learning disability and those without, owing to the reduced life expectancy of people with more severe disabilities. People with Down's syndrome have particular risks of age-related problems relatively early in life.ConclusionsThe improved life expectancy of people with learning disabilities is well established. There is a lack of a concerted response to ensure that the best possible health and social care is provided for people with learning disabilities in later life.
Psychotherapy, learning disabilities and trauma: new perspectives
Authors: Hollins Sheila , Sinason Valerie 
Published: August 2002

BackgroundPsychological therapies are rarely used in people with learning disabilities. Learning disability is often given as an exclusion criterion. There is insufficient published research to conduct a systematic review. Few outcome studies of psychoanalytic or cognitive psychotherapy have been reported.AimsTo describe recent advances in understanding and practice within the learning disability field which have not received wider recognition within mainstream psychotherapy and psychiatry.MethodThe availability of different psychotherapeutic approaches is discussed. We explore developmental issues including the contribution of attachment theory to our understanding, and the effects of trauma on the lives of people with learning disabilities.ResultsTheoretical and clinical perspectives suggest that many therapeutic opportunities exist.ConclusionsPractitioners are encouraged to extend their therapeutic repertoire, and to report measurable outcomes.
Record-linkage study of epidemiology and factors contributing to hospital care uptake
Authors: Morgan Christopher L. , Ahmed Zahir , Kerr Michael P. 
Published: August 2002

BackgroundWe know little about how people with a learning disability access secondary health care.AimsTo describe the epidemiology of learning disability, the influence of deprivation on prevalence and the pattern of secondary care uptake, including the effect of institutionalisation.MethodA record-linkage study of secondary care contacts of 434 000 people between 1991 and 1997. A population with learning disability was identified; their secondary care contact was calculated and compared with the general population's.ResultsThe distribution of people with a learning disability (n = 1595) correlated significantly with deprivation. The presence of a learning disability hospital significantly affected care uptake. Place of residence also affected acute admission to the learning disability hospital. Former institution residents generated 212 admissions per 1000 patients; community patients generated 18 per 1000. The admission rate with any psychiatric diagnosis to any setting was 26.3 per 1000 people with a learning disability; 16.5% of such patients had a dual diagnosis.ConclusionsHealth provision for people with a learning disability is affected by institutional provision.
Reducing antipsychotic medication in people with a learning disability
Authors: Ahmed Zahir , Fraser William , Kerr Michael P. , Kiernan Chris , Emerson Eric , Robertson Janet , Felce David , Allen David , Baxter Helen , Thomas James 
Published: August 2002

BackgroundThe use of antipsychotic drugs in people with learning disabilities is currently receiving intensified scrutiny and attempts are being made to reduce it.AimsA randomised controlled trial was designed to investigate factors influencing antipsychotic drug reduction among people with learning disabilities prescribed such medication for behavioural problems.MethodThirty-six participants randomly allocated to the experimental group underwent four, monthly 25% drug reduction stages. There were no planned drug changes for the control group (n = 20).ResultsTwelve participants (33%) completed full withdrawal; afurther seven (19%) achieved and maintained at least a 50% reduction. Drug reduction was associated with increased dyskinesia and higher activity engagement but not increased maladaptive behaviour. Some setting characteristics were associated with drug reinstatement.ConclusionsA substantial proportion of people with learning disability prescribed antipsychotic medications for behavioural purposes rather than for treating psychotic illness can have their drugs reduced or withdrawn.
Open peer review: A randomised controlled trial
Authors: Walsh Elizabeth , Rooney Maeve , Appleby Louis , Wilkinson Greg 
Published: August 2002

BackgroundMost scientific journals practise anonymous peer review. There is no evidence, however, that this is any better than an open system.AimsTo evaluate the feasibility of an open peer review system.MethodReviewers for the British Journal of Psychiatry were asked whether they would agree to have their name revealed to the authors whose papers they review; 408 manuscripts assigned to reviewers who agreed were randomised to signed or unsigned groups. We measured review quality, tone, recommendation for publication and time taken to complete each review.ResultsA total of 245 reviewers (76%) agreed to sign. Signed reviews were of higher quality, were more courteous and took longer to complete than unsigned reviews. Reviewers who signed were more likely to recommend publication.ConclusionsThis study supports the feasibility of an open peer review system and identifies such a system's potential drawbacks.
Functional anatomy of verbal fluency in people with schizophrenia and those at genetic risk
Authors: Spence Sean A. , Liddle Peter F. , Stefan Martin D. , Hellewell Jonathan S. E. , Sharma Tonmoy , Friston Karl J. , Hirsch Steven R. , Frith Christopher D. , Murray Robin M. , Deakin J. F. William , Grasby Paul M. 
Published: August 2002

BackgroundPET studies of verbal fluency in schizophrenia report a failure of ‘deactivation’ of left superior temporal gyrus (STG) in the presence of activation of left dorsolateral prefrontal cortex (DLPFC), which deficit has been attributed to underlying ‘functional disconnectivity’.AimTo test whether these findings provide trait-markers for schizophrenia.MethodWe used H215O PET to examine verbal fluency in 10 obligate carriers of the predisposition to schizophrenia, 10 stable patients and 10 normal controls.ResultsWe found no evidence of a failure of left STG deactivation in carriers or patients. Instead, patients failed to deactivate the precuneus relative to other groups. We found no differences in functional connectivity between left DLPFC and left STG but patients exhibited significant disconnectivity between left DLPFC and anterior cingulate cortex.ConclusionsFailure of left STG ‘deactivation’ and left fronto-temporal disconnectivity are not consistent findings in schizophrenia; neither are they trait-markers for genetic risk. Prefrontal functional disconnectivity here may characterise the schizophrenic phenotype.
Changes in suicide in England and Wales, 1960–1997
Authors: McClure G. M. G. 
Published: August 2002

BackgroundMethods of suicide and suicide rates in England and Wales have fluctuated considerably since the 1960s.AimsTo review the changes that have occurred in suicide rates in England and Wales between 1960 and 1997.MethodSuicide rates, derived from total annual suicides and the estimated annual resident population, were obtained from the Office for National Statistics.ResultsSuicide rates decreased in both genders between the early 1960s and the mid-1970s. The rate for males then increased between 1975 and 1990, while the rate for females continued to fall. Between 1990 and 1997, the rate decreased for males and females in all age groups, particularly for those using motor vehicle exhaust gas; the latter finding is associated with increasing use of catalytic converters.ConclusionsFollowing the increase in suicide among males until 1990 there was a decrease for both genders between 1990 and 1997, consistent with the ‘Health of the Nation’ target.
Season of birth in schizophrenia: no latitude at the equator
Authors: Parker Gordon , Mahendran Rathi , Koh Eng Seng , Machin David 
Published: August 2002

BackgroundIf the established winter excess in births of people who subsequently develop schizophrenia is an effect of ‘seasonality’, this would be testable by examining the pattern of births in an equatorial region with no formal seasons.AimsTo investigate whether there is any variation in month of birth among patients from equatorial Singapore with a diagnosis of schizophrenia.MethodAll 9655 patients discharged from Singapore's national psychiatric hospital with a diagnosis of schizophrenia were included (year of birth range 1930–1984). We analysed aggregated data, as well as the data of subsamples grouped according to birth-year periods, in order to examine secular trends. One patient subsample (those born 1960–84) allowed exact matching againstthe general population data set and close testing of any seasonal influence.ResultsMonthly variation in births was evident for both patients and controls; the patterns were very similar, apart from the patient sample showing a trough in March–April.ConclusionsIn an equatorial region, where ‘seasons’ are absent, no seasonal excess in births of those later developing schizophrenia was evident.
Impaired regulation of brain serotonin function during dieting in women recovered from depression
Authors: Smith K. A. , Williams C. , Cowen P. J. 
Published: August 2002

BackgroundAmino acid mixtures that lower brain availability of the serotonin (5-HT) precursor tryptophan produce acute depressive relapse in women with a history of major depression. Dieting also lowers brain tryptophan availability, but its effects on brain 5-HT function in recovered depressed women have not been studied.AimTo test the hypothesis that women with a history of major depression would show impaired regulation of brain 5-HT function during a period of dieting-induced tryptophan depletion.MethodWomen with and without a history of major depression were placed on a daily 1000 kcal (approximately 4200 kJ) diet for three weeks. Before the diet and in the final week we measured fasting plasma tryptophan levels and the prolactin response to an intravenous tryptophan challenge.ResultsDieting lowered plasma tryptophan levels equivalently in women with and without a history of depression. In women without a history of depression, dieting also increased the prolactin response to tryptophan. This increase did not occur in women with a history of depression.ConclusionsWomen with a history of depression showed impaired regulation of brain 5-HT function in response to dieting.
Mortality and causes of death in a total national sample of patients with affective disorders admitted for the first time between 1973 and 1993
Authors: Høyer Eyd Hansen , Mortensen Preben Bo , Olesen Anne V. 
Published: August 2002

BackgroundThe high mortality from suicide in patients admitted to hospital with an affective disorder is well documented, although specific causes of mortality and changes in mortality are less well studied.AimsTo describe the pattern of mortality in patients with affective disorder and to study changes in suicide riskduring the study period.MethodAll patients (n=54 103) admitted for the first time to a psychiatric hospital in Denmarkduring the period 1973–1993 because of affective disorder were included in this study. The mortality rate was compared with that of the general population.ResultsMortality from natural and unnatural causes was elevated in all subgroups of affective disorder. The risk of suicide among patients ill for one year or less after first admission increased during the period 1973–1993.ConclusionsMore attention should be paid to the risk of suicide and to physical illness in patients with affective disorders.
Tokophobia: An unreasoning dread of childbirth
Authors: Hofberg Kristina , Brockington Ian 
Published: August 2002

BackgroundSome women dread and avoid childbirth despite desperately wanting a baby. This is called tokophobia.AimsTo classify tokophobia for the first time in the medical literature.MethodTwenty-six women noted to have an unreasoning dread of childbirth were interviewed by the same psychiatrist, who was not the treating doctor. A qualitative analysis of these psychiatric interviews was performed.ResultsPhobic avoidance of pregnancy may date from adolescence (primary tokophobia), be secondary to atraumatic delivery (secondary tokophobia) or be a symptom of prenatal depression (tokophobia as a symptom of depression). Pregnant women with tokophobia who were refused their choice of delivery method suffered higher rates of psychological morbidity than those who achieved their desired delivery method.ConclusionsTokophobia is a specific and harrowing condition that needs acknowledging. Close liaison between the obstetrician and the psychiatrist in order to assess the balance between surgical and psychiatric morbidity is imperative with tokophobia.
Jerusalem syndrome
Authors: Bar-El Yair , Durst Rimona , Katz Gregory , Zislin Josef , Strauss Ziva , Knobler Haim Y. 
Published: August 2002

BackgroundJerusalem's psychiatrists expect to encounter, as the millennium approaches, an ever-increasing number of tourists who, upon arriving in Jerusalem, may suffer psychotic decompensation.AimsTo describe the Jerusalem syndrome as a unique acute psychotic state.MethodThis analysis is based on accumulated clinical experience and phenomenological data consisting of cultural and religious perspectives.ResultsThree main categories of the syndrome are identified and described, with special focus on the category pertaining to spontaneous manifestations, unconfounded by previous psychotic history or psychopathology.ConclusionsThe discrete form of the Jerusalem syndrome is related to religious excitement induced by proximity to the holy places of Jerusalem, and is indicated by seven characteristic sequential stages.
Doctors on tribunals
Authors: Richardson Genevra , Machin David 
Published: August 2002

BackgroundMental health review tribunals are required to apply legal criteria within a clinical context. This can create tensions within both law and psychiatry.AimsTo examine the role of the medical member of the tribunal as a possible mediator between the two disciplines.MethodObservation of tribunal hearings and panel deliberations and interviews with tribunal members were used to describe the role of the medical member.ResultsThe dual roles imposed on the medical member as witness and decisionmaker and as doctor and legal actor create formal demands and ethical conflicts that are hard, in practice, either to meet or to resolve.ConclusionsThe structure for providing tribunals with access to expert psychiatric input and advice requires reconsideration.
Role of risk assessment in reducing homicides by people with mental illness
Authors: Munro Eileen , Rumgay Judith 
Published: August 2002

BackgroundImproved risk assessment has been stressed as the way to reduce homicides by people with mental illness. The feasibility of predicting rare events needs examining.AimsTo examine the findings of public inquiries into homicides by people with mental illness to see if they support the claim that better risk assessment would have averted the tragedy.MethodAnalysis was made of the findings of the public inquiries between 1988 and 1997 in relation to the predictability and preventability of the homicides.ResultsOf the homicides considered by the inquiry panels, 27.5% were judged to have been predictable, 65% preventable and 60% of the patients had a long-term history containing violence or substantial risk factors for violence.ConclusionsImproved risk assessment has only a limited role in reducing homicides. More deaths could be prevented by improved mental health care irrespective of the risk of violence. If services become biased towards those assessed as high risk, then ethical concerns arise about the care of both violent and non-violent patients.
Adolescent psychiatric in-patients
Authors: Kjelsberg Ellen 
Published: August 2002

BackgroundResearch has demonstrated increased mortality rates in adolescent psychiatric in-patients.AimsTo investigate this excess mortality by calculating standardised mortality ratios (SMRs) relative to cause of death, diagnosis, cohort and age.MethodA nationwide Norwegian sample of 1095 former adolescent psychiatric in-patients were followed up 15–33 years after first hospitalisation by record linkage to the National Death Cause Registry.ResultsThe SMR was significantly increased for almost all causes of death investigated. In males, all psychiatric diagnoses had significantly increased SMRs, whereas in females, organic mental disorder, anxiety disorder and affective disorder had non-significantly increased SMRs. The SMR was significantly elevated for all age-spans and cohorts investigated.ConclusionsA broad prevention strategy is needed to combat the increased mortality rates found in adolescent psychiatric in-patients.
Assessing young people who deliberately harm themselves
Authors: Hurry Jane , Storey Pamela 
Published: August 2002

BackgroundMany young people who harm themselves have chronic mental health or social problems or are at risk of future self-harm or even suicide. The accident and emergency (A&E) clinic is an important gateway to treatment.AimsTo describe the psychosocial assessment of 12- to 24-year-old patients attending A&E clinics following deliberate self-harm (DSH) and to identify features of service management and provision which maximise specialist assessment.MethodA postal questionnaire was sent to a sample of one in three A&E departments in England. In a representative sample of 18 of these hospitals, staff were interviewed and 50 case notes per hospital were examined.ResultsPsychosocial assessment by non-specialist doctors in A&E departments tended to be of variable quality, focused on short-term risk. Around 43% of patients aged 12–24 were assessed by a specialist; specialist assessment was associated with high admission rates and the presence of on-site psychiatric departments and DSH teams.ConclusionsYoung DSH patients at risk often go unidentified; as a result their psychological problems may not be treated. Hospitals are frequently unaware of the proportion of patients discharged without adequate assessment.
Parental high concern and adolescent-onset anorexia nervosa
Authors: Shoebridge Philip , Gowers Simon G. 
Published: August 2002

BackgroundRobust evidence that anorexia nervosa is preceded rather than accompanied by high-concern (overprotective) parenting is limited.AimsTo look for evidence of parental high concern occurring before any onset of disorder.MethodForty consecutive referrals of adolescent girls with DSM – III – R anorexia nervosa were compared with matched controls using obstetric records and maternal interviews.ResultsIndex mothers reported higher rates of: near-exclusive child care (P=0.02), infant sleep difficulties (P=0.018), severe distress at first regular separation (P=0.048), high maternal trait anxiety levels (P=0.008) and later age for first sleeping away from home (P=0.009). More index families had experienced a severe obstetric loss prior to their daughter's birth (P=0.066).ConclusionsThis study lends evidence to the clinical contention that high-concern parenting in infancy is associated with the later development of anorexia nervosa. This may derive, in part, from aspects of unresolved grief.
Impact of hospitalisation on the outcome of adolescent anorexia nervosa
Authors: Gowers S. G. , An J. Weetm , Shore A. , Hossain F. , Elvins R. 
Published: August 2002

BackgroundOwing to the lack of controlled trials of treatment setting in adolescent anorexia nervosa, the benefits and costs of in-patient treatment are not established.AimsTo clarify the relationship between a range of presenting features, treatment received and medium- to long-term outcome in adolescent anorexia nervosa.MethodA range of presenting variables were rated for 75 cases of DSM – III – R anorexia nervosa at presentation to an adolescent service, including the Morgan–Russell Global Assessment Score. Cases were followed up at 2–7 years and outcome rated according to reliable methods. Setting of treatment received was also recorded.ResultsTwo out of 75 cases had died by the time of follow-up. Adequate data for 72 enabled an outcome category to be assigned. The 21 who had received in-patient treatment had a significantly worse outcome than the 51 never admitted to hospital. Multivariate analysis suggests admission to be the major predictor of poor outcome.ConclusionsThe benefits and costs of admission to hospital require further investigation, ideally in a randomised-controlled trial. The negative consequences of in-patient treatment are neglected in research.
First-episode major depression in adolescents
Authors: Goodyer I. M. , Herbert J. , Tamplin A. , Altham P. M. E. 
Published: August 2002

BackgroundThere is little information on whether patterns of steroids precede and are associated with depressive onset.AimsTo establish whether there is an association between salivary cortisol and/or dihydroepiandrosterone (DHEA) levels and depression independent of psychosocial risk.MethodTwo subgroups of adolescents in the community at high (n=181) and low (n=65) risk for psychopathology were interviewed for recent psychiatric disorder at entry and again at 12 months. Salivary samples (08.00 and 20.00 h) for hormone estimations and self-reports on current mood and cognitive style were obtained at both assessments.ResultsNeither hormone was associated with risk status, current mood or cognitive style at entry. Of 31 onsets of major depression that occurred over the next 12 months, 30 came from the high-risk group but were not associated with any particular pattern of risk. Increased negative mood and feelings and DHEA (08.00 h) hypersecretion at entry were associated with subsequent major depression.ConclusionsBoth negative mood and feelings and alterations in adrenal steroid function precede the onset of first-episode major depression in adolescents. Variation in levels of hormones may arise from more distal origins than recent life events and current ongoing difficulties.