bluuebunny/crossref_metadata_2025_split huggingface dataset:
Total serum cholesterol in relation to psychological correlates in parasuicide
Authors: Garland Malcolm , Hickey Dara , Corvin Aidan , Golden Jeanette , Fitzpatrick Patricia , Cunningham Sean , Walsh Noel 
Published: August 2002

BackgroundLow cholesterol may act as a peripheral marker for parasuicide.AimsTo examine the relationship between total serum cholesterol and psychological parameters in parasuicide.MethodTotal serum cholesterol and self-rated scores for impulsivity, depression and suicidal intent were measured in 100 consecutive patients following parasuicide, pair-matched with normal and psychiatric control groups.ResultsBackward, stepwise multiple regression analysis revealed a significantly lower mean cholesterol in the parasuicide population (P<0.01). Across all groups there was an independent significant (P<0.01) negative correlation between cholesterol and self-reported scores of impulsivity. No correlation existed between cholesterol and scores for depression or suicidal intent.ConclusionsThe data confirm previous reports of low cholesterol in parasuicide. This is the first reported investigation of the construct of impulsivity in relation to cholesterol. We hypothesise that the reported increased mortality in populations with low cholesterol may derive from increased suicide and accident rates consequent on increased tendencies to impulsivity in these populations.
Cognitive therapy and recovery from acute psychosis: A controlled trial
Authors: Drury Val , Birchwood Max , Cochrane Ray 
Published: August 2002

BackgroundThis paper describes the 5-year outcome of a cohort of patients who had received a cognitive therapy intervention during an acute episode of non-affective psychosis.MethodThirty-four out of the original 40 patients who had taken part in a randomised controlled trial of a cognitive intervention were assessed, using standardised instruments completed at entry into the study. In the original trial, half the patients received a cognitive therapy programme (CT group) and the other half received recreational activities and support (ATY group).ResultsAt follow-up no significant differences in relapse rate, positive symptoms or insight between the groups were found, although the CT group did show significantly greater perceived ‘Control over illness’ than the ATY group. For individuals who had experienced a maximum of one relapse in the follow-up period, self-reported residual delusional beliefs and observer-rated hallucinations and delusions were significantly less in the CT than in the ATY group.ConclusionCognitive therapy applied in the acute phase of a psychotic disorder can produce enduring and significant clinical benefits if experience of relapse can be minimised.
Cognitive–behavioural techniques for general psychiatrists in the management of patients with psychoses
Authors: Turkington Douglas , Kingdon David 
Published: August 2002

BackgroundRecent research progress showing the benefits of cognitive therapy in schizophrenia leaves the general psychiatrist unsure whether to attempt to use such techniques.AimsTo test whether cognitive–behavioural techniques are beneficial in the management of patients with schizophrenia in general psychiatric practice.MethodA randomised controlled study comparing the use of cognitive–behavioural techniques and befriending in schizophrenia.ResultsSignificant improvement in symptoms occurred in the group treated with cognitive–behavioural techniques but not in the befriending group. During the 6-month follow-up period the cognitive–behavioural group tended to have shorter periods in hospital.ConclusionsGeneral psychiatrists could help their patients with schizophrenia by using cognitive–behavioural techniques. Such techniques are well within the capability of general psychiatrists, but their application would involve more of the consultant's time spent in direct contact with patients with psychoses.
Early termination of treatment in personality disorder treated in a psychotherapy hospital
Authors: Chiesa Marco , Drahorad Carla , Longo Silvia 
Published: August 2002

BackgroundFactors underlying premature discontinuation of psychosocial in-patient treatment are still unclear.AimsInvestigation of early discontinuation of specialised in-patient psychosocial treatment in a sample of people with personality disorder.MethodOut of 134 consecutive admissions to the Cassel Hospital, 42 early drop-outs and 92 patients who remained were compared on demographic and clinical variables. Early drop-outs were invited for in-depth interviews, to explore their hospital experiences.ResultsThe early drop-out group and the group which remained showed significant differences in occupational status, borderline personality disorder (BPD) and the treatment programme to which they were allocated. All three independent variables predicted early discontinuation of treatment. The qualitative analysis of interview transcripts identified significant problems in institutional dimensions.ConclusionsImportant subjects and process variables contributing to early drop-out in people with personality disorder were identified, with potential implications for clinical practice.
Psychotherapies in psycho-oncology
Authors: Bloch Sidney , Kissane David 
Published: August 2002

BackgroundThere is ample scope to devise forms of psychotherapy in consultation–liaison psychiatry, including the newly evolving area of psycho-oncology.AimsTo highlight the development of psychotherapy in psycho-oncology, providing two illustrations.MethodWe report on conceptual and clinical research in the context of oncology and palliative care, focusing on (a) an approach for families at risk of maladaptive bereavement; and (b) a group programme for women newly diagnosed with early-stage breast cancer.ResultsWe were able to introduce new forms of psychological treatment for specific clinical groups, and anecdotal evidence points to useful benefits for participants.ConclusionsPsychotherapists should grasp the opportunity to bring their skills to the medical arena, but need to subject newly devised interventions to well-designed and methodologically rigorous research.
A neurobiologically informed perspective on psychotherapy
Authors: Gabbard Glen O. 
Published: August 2002

BackgroundPolarisation of biological and psychosocial aspects of psychiatry has promoted a form of Cartesian dualism. Current knowledge of the interaction between biology and psychology makes it possible to consider a truly integrative approach to treatment.AimsThe aim of this overview is to consider conceptual models of how psychotherapy may affect the brain.MethodThe literature discussing the mutual influence of genes and environment is surveyed. Relevant data involving the influence of psychotherapy on the brain are also reviewed.ResultsResearch findings suggest that the brain responds to environmental influence through the alteration of gene expression; that psychotherapy has specific measurable effects on the brain; and that implicit memory may be modified by psychotherapeutic interventions.ConclusionsAdvances in neuroscience research have led to a more sophisticated understanding of how psychotherapy may affect brain functioning. These developments point the way towards a new era of psychotherapy research and practice in which specific modes of psychotherapy can be designed to target specific sites of brain functioning.
Measurement and psychotherapy
Authors: Margison Frank R. , Barkham Michael , Evans Chris , McGrath Graeme , Clark John Mellor , Audin Kerry , Connell Janice 
Published: August 2002

BackgroundMeasurement is the foundation of evidence-based practice. Advances in measurement procedures should extend to psychotherapy practice.AimsTo review the developments in measurement relevant to psychotherapy.MethodDomains reviewed are: (a) interventions; (b) case formulation; (c) treatment integrity; (d) performance (including adherence, competence and skilfulness); (e) treatment definitions; (f) therapeutic alliance; and (g) routine outcome measurement.ResultsModern methods of measurement can support ‘evidence-based practice’ for psychological treatments. They also support ‘practice-based evidence’, a complementary paradigm to improve clinical effectiveness in routine practice via the infrastructure of Practice Research Networks (PRNs).ConclusionsAdvances in measurement derived from psychotherapy research support a model of professional self-management (practice-based evidence) which is widely applicable in psychiatry and medicine.
Psychotherapy for patients with complex disorders and chronic symptoms
Authors: Guthrie E. 
Published: August 2002

BackgroundA clear distinction has been made between efficacy and effectiveness in relation to the methods of evaluation of new psychological treatments in psychiatry. Efficacy trials target patients with relatively pure conditions, who may not be representative of the patients who are usually referred for psychological treatment in a clinical setting. Few studies have explored the benefits of psychotherapy in patients with complex disorders and enduring symptoms.AimsTo explore the rationale for the distinction between efficacy and effectiveness, particularly in relation to outcome studies of patients with complex and enduring disorders.MethodA narrative review with examples drawn from the literature, and an illustration of a recent naturalistic outcome study which combines features of both efficacy and effectiveness.ResultsStudies of patients with complex and mixed disorders can be designed so that they retain internal validity, but also have external validity and are relevant to clinical practice.ConclusionStudies which evaluate psychological interventions should be carried out in populations of patients clinically representative of those who are likely to receive the intervention, should it be shown to be of benefit.
Effectiveness of psychotherapeutic treatment of personality disorder
Authors: Bateman Anthony W. , Fonagy Peter 
Published: August 2002

BackgroundPsychiatrists have been criticised for failing to develop adequate treatment for personality disorder. Psychotherapeutic treatments are promising, but their effectiveness is uncertain.AimsTo investigate the evidence for effectiveness of psychotherapeutic treatment for personality disorder.MethodSystematic literature review.ResultsThere is evidence for the effectiveness of psychotherapy for personality disorder. Problems of case identification, comorbidity, randomisation, specificity of treatment and outcome measurement are inadequately addressed. Authors mainly relied on cohort studies. Evidence neither suggests superiority of one type of therapy over another nor indicates which subgroups of patients should be offered psychotherapy as in-patient, day patient, or out-patient.ConclusionsNew research strategies are needed to show that personality change is both measurable and clinically meaningful. Effectiveness studies using randomised controlled designs are required. The literature suggests that effective treatment should be long-term, integrated, theoretically coherent and focused on compliance.
Psychological therapies for post-traumatic stress disorder
Authors: Adshead Gwen 
Published: August 2002

BackgroundAfter exposure to traumatic stressors, a subgroup of survivors (20–30%) will develop post-traumatic stress disorder (PTSD).AimsSince the incidence and prevalence rates for PTSD in the community are significant, it is important that general practitioners and psychiatrists be familiar with possible therapeutic options. In this review we shall look at the published evidence about the effectiveness of psychological treatments for PTSD.MethodThe psychopathological mechanisms involved in PTSD are discussed. Studies of the effectiveness of different psychological therapies are reviewed.ResultsThe review suggests that persistent fear or shame reactions are key aspects of PTSD. Evidence from systematic reviews suggests that psychotherapeutic treatments are effective in the therapy of reactions based on fear, and may increase the effectiveness of pharmacological therapy. There is less systematic evidence for the efficacy of interventions for symptoms based on shame.ConclusionsAlthough a proportion of patients with complex or chronic PTSD may require specialist interventions, most patients can be treated effectively by a general psychiatric service which can offer both pharmacological and psychological interventions.
Definition and prevalence of severe and persistent mental illness
Authors: Ruggeri Mirella , Leese Morven , Thornicroft Graham , Bisoffi Giulia , Tansella Michele 
Published: August 2002

BackgroundThere is little consistency in how severe mental illness (SMI) is defined in practice, and no operational definitions.AimsTo test two operationalised definitions, based on the National Institute of Mental Health (1987) definition: the first uses three criteria (diagnosis of psychosis; duration of service contact ≥ 2 years; GAF score ≤ 50), the second only the last two.MethodAnnual prevalence rates of SMI in two European catchment areas for each criterion and the criteria combined were calculated.ResultsThe first definition produced rates of 2.55 and 1.34/1000 in London and Verona, respectively; the second permitted an additional 0.98/1000 non-psychotic disorders to be included in Verona.ConclusionsThe three-dimensional definition selects a small group of patients with SMI who have psychotic disorders. The two-dimensional approach allows estimates of SMI prevalence rates which include all forms of mental disorder.
Long-term survival, place of death, and death certification in clinically diagnosed pre-senile dementia in northern England
Authors: Kay David W. K. , Forster Donald P. , Newens Andrew J. 
Published: August 2002

BackgroundInformation on survival and cause of death in pre-senile dementia is scarce and the organisation of services controversial.AimsTo study survival, place of death and death certification in pre-senile dementia.MethodPatients aged 45–64 were identified from hospital and community sources in the Northern health region (1985–89) and classified as having pre-senile dementia of Alzheimer type (PDAT) or pre-senile vascular dementia (PVD) by applying an algorithm to case notes. Deaths were ascertained from the National Health Service Central Registry (NHSCR) to 31 December 1998. Survival analysis was performed using the SPSS/PC program, and expected survival calculated from life tables.ResultsMedian survival time from diagnosis was 6.08 years and did not differ significantly in PDAT and PVD, or by age or gender; 19.3% of deaths occurred at home, 24.5% in nursing or residential homes and 56.3% in hospital; 72.4% of the death certificates mentioned dementia or Alzheimer's disease; 15.4% were still alive.ConclusionsPre-senile dementia has a variable but usually chronic course, requiring appropriate planning and services.
Selective serotonin reuptake inhibitor treatment in the UK: Risk of relapse or recurrence of depression
Authors: Claxton Ami J. , Li Zhiming , McKendrick Jan 
Published: August 2002

BackgroundPatients with depression are often not prescribed antidepressants for an adequate period of time.AimsThe impact of antidepressant prescribing patterns on the risk of relapse or recurrence of depression is examined.MethodThe Medi Plus UK Primary Care Database was used to identify patients treated for depression with a selective serotonin reuptake inhibitor (SSRI). Records were used to construct hierarchical prescription patterns (less than 120 days, switching/augmentation, upward titration, or stable use) as indicators for the occurrence of relapse or recurrence of depression.ResultsPatients with stable use experienced the lowest risk of relapse or recurrence. Factors significantly associated with increased risk include prior use of anxiolytic medications, more comorbid conditions and younger age.ConclusionsThe SSRI prescription pattern most consistent with recommended depression treatment guidelines was associated with the lowest risk of relapse or recurrence.
Interhemispheric asymmetry of motor cortical excitability in major depression as measured by transcranial magnetic stimulation
Authors: Maeda Fumiko , Keenan Julian P. , Pascual-Leone Alvaro 
Published: August 2002

BackgroundNeuroimaging studies of major depressive disorder (MDD) indicate interhemispheric differences in prefrontal cortical activity (right greater than left).AimsTo investigate whether there are any interhemispheric differences of motor cortical excitability in MDD.MethodEight patients with treatment-refractory MDD off medication were assessed for the severity of their depression, and transcranial magnetic stimulation studies (bilateral motor threshold and paired-pulse studies) were conducted. Eight normal controls were also studied.ResultsMDD patients showed significant interhemispheric differences in motor threshold and paired-pulse curves, both of which showed lower excitability on the left hemisphere. Such differences were absent in controls.ConclusionsOur findings may aid the further understanding of the neurophysiology underlying MDD.
Effects of chewing betel nut (Areca catechu) on the symptoms of people with schizophrenia in Palau, Micronesia
Authors: Sullivan Roger J. , Allen John S. , Otto Caleb , Tiobech Josepha , Nero Karen 
Published: August 2002

BackgroundAlthough millions of people with schizophrenia live in betel chewing regions, the effects of betel chewing on their symptoms are unknown. Betel nut alkaloids include potent muscarinic cholinomimetics: recent research suggests that these agents may be therapeutic in schizophrenia.AimsTo compare the primary and extrapyramidal symptom profiles and substance-using habits of betel chewing v. non-chewing people with schizophrenia.MethodA cross-sectional study of 70 people with schizophrenia. Symptom ratings measured by the Positive and Negative Syndrome Scale (PANSS) and Extrapyramidal Symptom Rating Scale (ESRS), and demographic and substance-use data, were compared for 40 chewers and 30 non-chewers of betel nut.ResultsBetel chewers with schizophrenia scored significantly lower on the positive (P=0.001) and negative (P=0.002) sub-scales of the PANSS than did non-chewers. There were no significant differences in extrapyramidal symptoms or tardive dyskinesia.ConclusionsBetel chewing is associated with milder symptomatology and avoidance of more harmful recreational drugs. These initial results indicate that longitudinal research is merited.
The London Depression Intervention Trial
Authors: Leff J. , Vearnals S. , Brewin C. R. , Wolff G. , Alexander B. , Asen E. , Dayson D. , Jones E. , Chisholm D. , Everitt B. 
Published: August 2002

BackgroundRelapse of depression is associated with a criticising attitude of the patient's partner.AimsTo compare the relative efficacy and cost of couple therapy and antidepressant drugs for the treatment and maintenance of people with depression living with a critical partner.MethodA randomised controlled trial of antidepressant drugs v. couple therapy. The subjects were 77 people meeting criteria for depression living with a critical partner.ResultsDrop-outs were 56.8 % from drug treatment and 15% from couple therapy. Subjects' depression improved in both groups, but couple therapy showed a significant advantage, according to the Beck Depression Inventory, both at the end of treatment and after a second year off treatment. Adding the costs of the interventions to the costs of services used showed there was no appreciable difference between the two treatments.ConclusionsFor this group couple therapy is much more acceptable than antidepressant drugs and is at least as efficacious, if not more so, both in the treatment and maintenance phases. It is no more expensive overall.
Developmental psychiatry – insights from learning disability∗
Authors: Hollins Sheila 
Published: August 2002

BackgroundThe Blake Marsh lecture, an annual lecture on learning disability, was endowed in 1963 in memory of Dr Blake Marsh, the former medical superintendent of Bromham House Colony in Bedford. The first lecture was given in 1967.AimsTo review the speciality of the psychiatry of learning disability and how it is currently practised in the UK.MethodClinical, service, research and educational issues in learning disability psychiatry are reviewed and illustrated.ResultsKey issues which emerge in all four areas include the importance of communication skills, consultation with users and carers, professional education and partnership.ConclusionsThe psychiatry of learning disability is a complex, varied and stimulating branch of psychiatry with a strong developmental focus.
West London first-episode study of schizophrenia
Authors: Barnes Thomas R. E. , Hutton S. B. , Chapman M. J. , Mutsatsa S. , Puri B. K. , Joyce Eileen M. 
Published: August 2002

BackgroundStudies in schizophrenia suggest that a longer initial period of untreated illness is associated with a poorer clinical outcome.AimsTo determine whether, in first-episode schizophrenia, a longer duration of untreated psychosis (DUP) or of untreated illness (DUI) (DUP plus any prodrome) is associated with clinical variables that could mediate a poor prognosis.MethodClinical, social, neuropsychological and oculomotor function data on 53 patients with first-episode schizophrenia were related to the DUP and DUI.ResultsComparing short and long DUP groups split around the median showed no statistically significant differences (except age); patients in the latter group tended to perform worse on an executive attentional set-shifting task, and were more likely to be unemployed, and living alone or homeless.ConclusionsThere was little evidence of any association between either DUP or DUI and progressive deterioration in the schizophrenic illness or the development of resistance to initial drug treatment. Social variables that augur a poor prognosis may be associated with delayed presentation of schizophrenia to psychiatric services.
Causes of the excess mortality of schizophrenia
Authors: Brown Steve , Inskip Hazel , Barraclough Brian 
Published: August 2002

BackgroundThe excess mortality of schizophrenia is well recognised, but its precise causes are not well understood.AimsTo measure the standardised mortality ratio (SMR) and examine the reasons for any excess mortality in a community cohort with schizophrenia.MethodWe carried out a 13-year follow-up of 370 patients with schizophrenia, identifying those who died and their circumstances.ResultsNinety-six per cent of the cohort was traced. There were 79 deaths. The SMRs for all causes (298), for natural (232) and for unnatural causes (1273), were significantly higher than those to be expected in the general population, as were the SMRs for disease of the circulatory, digestive, endocrine, nervous and respiratory systems, suicide and undetermined death. Smoking-related fatal disease was more prominent than in the general population.ConclusionsSome of the excess mortality of schizophrenia could be lessened by reducing patients' smoking and exposure to other environmental risk factors and by improving the management of medical disease, mood disturbance and psychosis.