bluuebunny/crossref_metadata_2025_split huggingface dataset:
Suicide in psychiatric hospital in-patients
Authors: Powell John , Geddes John , Deeks Jonathan , Goldacre Michael , Hawton Keith 
Published: August 2002

BackgroundPsychiatric hospital inpatients are known to be at high risk of suicide, yet there is little reliable knowledge of risk factors or their predictive power.AimsTo identify risk factors for suicide in psychiatric hospital in-patients and to evaluate their predictive power in detecting people at risk of suicide.MethodUsing a case–control design, 112 people who committed suicide while in-patients in psychiatric hospitals were compared with 112 randomly selected controls. Univariate analysis and multivariate analyses were used to estimate odds ratios and adjusted likelihood ratios.ResultsThe rate of suicide in psychiatric in-patients was 13.7 (95% CI 11.7–16.1) per 10 000 admissions. There were five predictive factors with likelihood ratios >2, following adjustment: planned suicide attempt, 4.1; actual suicide attempt, 4.9; recent bereavement, 4.0; presence of delusions, 2.3; chronic mental illness, 2.2; and family history of suicide, 4.6. On this basis, only two of the patients who committed suicide had a predicted risk of suicide above 5%.ConclusionsAlthough several factors were identified that were strongly associated with suicide, their clinical utility is limited by low sensitivity and specificity, combined with the rarity of suicide, even in this high-risk group.
Childhood predictors of adult medically unexplained hospitalisations
Authors: Hotopf Matthew , Wilson-Jones Charlotte , Mayou Richard , Wadsworth Michael , Wessely Simon 
Published: August 2002

BackgroundIt has been suggested that adults with medically unexplained physical symptoms experienced greater ill-health then others (either in themselves or their families) during childhood.AimsTo test these hypotheses.MethodWe used data from the Medical Research Council (MRC) National Survey of Health and Development, a population-based cohort study established in 1946 (n=5362). Subjects were followed from birth in 1946 until 1989 (age 43 years). As outcome, we used operationally defined medically unexplained hospital admissions at age 15–43 years. Exposure variables included childhood illness, and illness in parents during the childhood of the subjects.ResultsThe risk set (n=4603) comprised individuals still in the Survey at age 15. Ninety-five unexplained hospital admissions were identified. Subjects whose mothers reported below-average health in the father were at increased risk of subsequent unexplained admissions. Below average reported health in the mother was not associated with this increased risk. Defined physical diseases in childhood were not associated, but persistent abdominal pain at age 7–15 years was.ConclusionsUnexplained hospital admissions are associated with certain childhood experiences of illness, but defined physical illness in childhood is not a risk factor.
Obsessive-compulsive disorder and delusions revisited
Authors: O'Dwyer Anne-Marie , Marks Isaac 
Published: August 2002

BackgroundThe concept of fixed, unshakeable (delusional) beliefs within the context of obsessive–compulsive disorder (OCD) is one that has received varying amounts of attention in the literature, and has not yet received universal acknowledgement. There are good grounds for including these cases within the diagnostic concepts of OCD, with significant implications for clinical management.AimsTo present cases with unusual OCD, in order to re-evaluate the issue of delusions and OCD.MethodThe cases of five subjects with delusions in the course of obsessive–compulsive disorder are presented to illustrate ‘delusional’ OCD. The management and outcome of these cases are discussed.ResultsFixity and bizarreness of beliefs in OCD occur on a continuum from ‘none’ to ‘delusional intensity’ and may fluctuate within subjects.ConclusionsThe idea that these cases may represent a form of OCD has implications for management, as, if this is correct, they should be able to respond to appropriate behavioural and/or pharmacological strategies used in OCD.
Psychiatric symptoms among clients seeking treatment for drug dependence
Authors: Marsden John , Gossop Michael , Stewart Duncan , Rolfe Alexandra , Farrell Michael 
Published: August 2002

BackgroundMany people with substance use disorders are vulnerable to other psychiatric disorders and present to addiction treatment services with comorbid psychiatric symptoms.AimsTo describe the prevalence of recent psychiatric treatment and current psychiatric symptoms and explore links between substance misuse, personal/social functioning and symptom severity.MethodSubjects were 1075 adults recruited to the National Treatment Outcome Research Study (NTORS), of whom 90% were opiate-dependent. Psychiatric symptoms at intake were recorded using sub-scales from the Brief Symptom Inventory.ResultsRecent psychiatric treatment was reported by one in five subjects. Psychiatric symptom levels were high and females had elevated scores on all scales. Symptoms were elevated among opiate users who were also frequent users of benzodiazepines, alcohol and, in particular, stimulants. Gender, physical health, drug dependence and personal relationship problems were more powerful predictors of psychiatric symptoms than substance use.ConclusionsAddictions service providers should be vigilant to psychiatric problems among their clients at intake to treatment. Psychiatric symptoms are more closely linked to polydrug use than to opiate use in this population.
Developing a clinically useful actuarial tool for assessing violence risk
Authors: Monahan John , Steadman Henry J. , Robbins Pamela C. , Silver Eric , Appelbaum Paul S. , Grisso Thomas , Mulvey Edward P. , Roth Loren H. 
Published: August 2002

BackgroundA new actuarial method for violence risk assessment – the Iterative Classification Tree (ICT) – has become available. It has a high degree of accuracy but can be time and resource intensive to administer.AimsTo increase the clinical utility of the ICT method by restricting the risk factors used to generate the actuarial tool to those commonly available in hospital records or capable of being routinely assessed in clinical practice.MethodA total of 939 male and female civil psychiatric patients between 18 and 40 years old were assessed on 106 risk factors in the hospital and monitored for violence to others during the first 20 weeks after discharge.ResultsThe ICT classified 72.6% of the sample as either low risk (less than half of the sample's base rate of violence) or high risk (more than twice the sample's base rate of violence).ConclusionsA clinically useful actuarial method exists to assist in violence risk assessment.
Evidence-based rehabilitation in forensic psychiatry
Authors: Lindqvist Per , Skipworth Jeremy 
Published: August 2002

BackgroundThe extent to which forensic psychiatric rehabilitation alters an individual's level of risk is unclear.AimsTo highlight some essential features of a forensic psychiatric rehabilitation system, and to discuss risk assessment in this context to create a conceptual framework for risk research and practice.MethodThe applicability of risk assessment instruments to forensic psychiatric rehabilitation was examined. Core processes and elements considered essential in this type of rehabilitative work were reviewed.ResultsCurrent risk research has limited application to rehabilitation. Future research aimed at analysing forensic psychiatric rehabilitation will be hampered by the complexity of the treatment systems and the number of methodological issues relevant to this type of research.ConclusionsNovel research approaches are suggested to analyse further the risk factors and processes important in forensic psychiatric rehabilitation.
Involuntary out-patient commitment and reduction of violent behaviour in persons with severe mental illness
Authors: Swanson Jeffrey W. , Swartz Marvin S. , Wagner H. Ryan , Burns Barbara J. , Borum Randy , Hiday Virginia A. 
Published: August 2002

BackgroundViolent behaviour among persons with severe mental illness (SMI) causes public concern and is associated with illness relapse, hospital recidivism and poor outcomes in community-based treatment.AimsTo test whether involuntary out-patient commitment (OPC) may help to reduce the incidence of violence among persons with SMI.MethodOne-year randomised trial of the effectiveness of OPC in 262 subjects with psychotic or major mood disorders and a history of hospital recidivism. Involuntarily hospitalised subjects awaiting OPC were randomly assigned to release or court-ordered treatment after discharge. Those with a recent history of serious assault remained under OPC until expiry of the court order (up to 90 days); then OPC orders were renewed at clinical/court discretion. Control subjects had no OPC. Four-monthly follow-up interviews with subject, case manager and collateral informant took place and service records were collected.ResultsA significantly lower incidence of violent behaviour occurred in subjects with ⩾6 months' OPC. Lowest risk of violence was associated with extended OPC combined with regular out-patient services, adherence to prescribed medications and no substance misuse.ConclusionsOPC may significantly reduce risk of violent behaviour in persons with SMI, in part by improving adherence to medications while diminishing substance misuse.
Future directions for treatment in forensic psychiatry
Authors: Gunn John 
Published: August 2002

BackgroundAs the availability of mental hospital beds has fallen, so the number of people in prison has risen.AimsTo review current policy trends in British forensic psychiatry and put them in an international context.MethodLiterature on the prevalence rates of psychiatric disorder in prisons and jails has been examined for the USA, England & Wales and New Zealand.ResultsAll studies show a high prevalence of mental disorder in prisons and jails. Authors in the USA suggest that prisons are replacing mental hospitals. In England & Wales rates of psychosis are reported as 4–10% for remanded prisoners and 2–7% for sentenced prisoners. Substance misuse among prisoners is a major problem. Prison is the preferred place of disposal for large numbers of mentally disordered people. Does this matter? Why should this be the case? Is this the cheapest option? Politicians are considering new powers to direct more people into institutions (presumably prisons) on the grounds of public protection.ConclusionsWe need more information about attitudes and their formation. We need more interprofessional dialogue about the best arrangements for people with mental disorders, and inter-disciplinary education.
Violence in the workplace: new perspectives in forensic mental health services in the USA
Authors: Fletcher Tony A. , Brakel Samuel Jan , Cavanaugh James L. 
Published: August 2002

BackgroundThis paper reviews current research on workplace violence in the USA and offers suggestions concerning the roles that mental health professionals with forensic expertise can play in this expanding field.AimsTo clarify the role of the mental health professional in evaluating issues related to workplace violence.MethodManual and computer literature searches were performed.ResultsThe incidence of reported workplace violence is on the rise and can be devastating beyond the immediate injury. Forensically oriented mental health professionals can assist companies by providing pre-employment screenings, fitness-for-duty evaluations and threat assessment by using the results of current research on potentially violent individuals.ConclusionsWith the growing interest in workplace violence come many opportunities for mental health professionals to assist companies in assessment, intervention and prevention.
Substance misuse, psychiatric disorder and violent and disturbed behaviour
Authors: Soyka Michael 
Published: August 2002

BackgroundEpidemiological studies suggest schizophrenia and substance misuse to be associated with a higher rate of violence and crime.AimsThe literature was evaluated to assess whether people with schizophrenia who use substances have an increased risk for violence and disturbed behaviour.MethodA detailed Medline analysis was performed and relevant studies were reviewed.ResultsA large number of studies have linked substance misuse in schizophrenia with male gender, high incidence of homelessness, more pronounced psychotic symptoms, non-adherence with medication, poor prognosis, violence and aggression. The latter has been proved by clinical, epidemiological and longitudinal prospective studies of unselected birth cohorts. The increased risk for aggression and violent acts cannot be interpreted only as a result of poor social integration. Male gender, more severe psychopathology, a primary antisocial personality, repeated intoxications and non-adherence with treatment are important confounding variables.ConclusionSubstance misuse has been shown consistently to be a significant risk factor for violence and disturbed behaviour. Future research should try to evaluate possible pharmacological and psychosocial treatment approaches.
Psychiatric morbidity of a rural Indian community
Authors: Nandi D. N. , Banerjee Gauranga , Mukherjee S. P. , Ghosh Asit , Nandi P. S. , Nandi S. 
Published: August 2002

BackgroundCross-sectional studies give no indication of the changes that may occur in the mental health status of a community in course of times. Studies should be designed to assess these changes.AimsTo assess the changes, if any, in the prevalence of mental disorders in a rural community after an interval of 20 years in the context of its changing socioeconomic conditions.MethodA door-to-door survey of the prevalence of psychiatric morbidity in two villages was conducted by a team of psychiatrists. The survey was repeated after 20 years by the same team and by the same method. Changes in the mental health status of the community were compared.ResultsTotal morbidity per 1000 fell from 116.8 to 105.2. Morbidity in men fell from 86.9 to 73.5 per 1000 and in women from 146.8 to 138.3 per 1000. Rates of anxiety, hysteria and phobia had fallen dramatically and those of depression and mania had risen significantly.ConclusionThe level of psychiatric morbidity showed no statistically significant change. The morbidity pattern (relative proportion of type of morbidity), however, showed some interesting changes. Similar studies should be done on a larger sample.
Catatonia in autistic spectrum disorders
Authors: Wing Lorna , Shah Amitta 
Published: August 2002

BackgroundThe clinical pictures of autistic spectrum disorders include features described in catatonia.AimsTo examine the severe exacerbation of the catatonic features of autistic disorders in adolescence or early adult life, which occurs in some individuals.MethodA semi-structured interview schedule was used to collect information from parents or other care-givers concerning 506 referrals to a specialist clinic for autistic spectrum disorders. Individuals with severe exacerbation of catatonic features were compared with a same-age group of referrals without this type of deterioration in skills and behaviour.ResultsSeventeen per cent of referrals aged 15 or over had severe exacerbation of catatonic features. They were significantly more likely than the comparison group to have had, before the onset of the change in behaviour, impaired language and passivity in social interaction.ConclusionsCatatonia is a later complication of autistic spectrum disorders, which adds considerably to the burden of caring. More research is needed to identify causes, neuropathology, and early signs of vulnerability.
Interruption of selective serotonin reuptake inhibitor treatment
Authors: Michelson David , Fava Maurizio , Amsterdam Jay , Apter Jeffrey , Londborg Peter , Tamura Roy , Tepner Rosalinda G. 
Published: August 2002

BackgroundAbrupt interruption of therapy with selective serotonin reuptake inhibitors (SSRIs) has been associated with somatic and psychological symptoms.AimsSystematically to assess symptoms and effects on daily functioning related to interruption of SSRI therapy.MethodPatients treated with fluoxetine, setraline or paroxetine underwent identical five-day periods of treatment interruption and continued active treatment under double-blind, order-randomised conditions, with regular assessment of new symptoms.ResultsPlacebo substitution for paroxetine was associated with increases in the number and severity of adverse events following the second missed dose, and increases in functional impairment at five days. Placebo substitution for sertraline resulted in less pronounced changes, while interruption of fluoxetine was not associated with any significant increase in symptomatology.ConclusionsAbrupt interruption of SSRI treatment can result in a syndrome characterised by specific physical and psychological symptoms. Incidence, timing and severity of symptoms vary among SSRIs in a fashion that appears to be related to plasma elimination characteristics.
Labour and delivery complications at birth and later mania
Authors: Browne Roy , Byrne Majella , Morris Mary , O'Callaghan Eadbhard , Mulryan Niamh , Scully Ann , Kinsella Anthony , McNeil Thomas F. , Walsh Dermot 
Published: August 2002

BackgroundSeveral reports postulate that manic depression and schizophrenia share environmental risk factors. Although obstetric adversity has been suggested as a risk factor for schizophrenia, few studies have examined its relationship to bipolar affective disorder.AimsTo assess the rate of obstetric complications incurred by patients with mania compared with controls.MethodFrom the Dublin Psychiatric Case Register we identified individuals with a discharge diagnosis of mania and traced their birth records. Each case was matched with a control of the same gender, born in the same hospital, in the same year, matched for maternal age, parity and social class. Two obstetric complication scales were used to make blind evaluations of labour and delivery data.ResultsPatients with mania did not experience a greater frequency or severity of labour and delivery complications than their matched controls. Rates of obstetric adversity were unrelated to the presence or absence of family history of psychiatric disorder. Obstetric adversity was unrelated to the age at first diagnosis.ConclusionsThese findings suggest that obstetric adversity is not a risk factor for later mania.
Self-efficacy as a mediator between stressful life events and depressive symptoms
Authors: Maciejewski Paul K. , Prigerson Holly G. , Mazure Carolyn M. 
Published: August 2002

BackgroundSelf-efficacy, a characteristic that is protective against depressive symptoms, may be undermined by stressful life events.AimsTo estimate the effects of stressful life events on self-efficacy, and to examine self-efficacy as a mediator of the effect of stressful life events on symptoms of depression.MethodUsing a sample of 2858 respondents from the longitudinal Americans' Changing Lives study, path analyses were used to evaluate interrelationships between self-efficacy, life events and symptoms of depression controlling for a variety of potentially confounding variables. Separate models were estimated for those with and without prior depression.ResultsFor those with prior depression, dependent life events had a significant, negative impact on self-efficacy. For those without prior depression, life events had no effect on self-efficacy.ConclusionsFor those with prior depression, self-efficacy mediates approximately 40% of the effect of dependent stressful life events on symptoms of depression.
Psychometric properties of the Social Phobia Inventory (SPIN)
Authors: Connor Kathryn M. , Davidson Jonathan R. T. , Churchill L. Erik , Sherwood Andrew , Weisler Richard H. , Foa Edna 
Published: August 2002

BackgroundOf available self-rated social phobia scales, none assesses the spectrum of fear, avoidance, and physiological symptoms, all of which are clinically important. Because of this limitation, we developed the Social Phobia Inventory (SPIN).AimsTo establish psychometric validation of the SPIN.MethodSubjects from three clinical trials and two control groups were given the 17-item, self-rated SPIN. Validity was assessed against several established measures of social anxiety, global assessments of severity and improvement, and scales assessing physical health and disability.ResultsGood test – retest reliability, internal consistency, convergent and divergent validity were obtained. A SPIN score of 19 distinguished between social phobia subjects and controls. The SPIN was responsive to change in symptoms over time and reflected different responses to active drugsv.placebo. Factorial analysis identified five factors.ConclusionsThe SPIN demonstrates solid psychometric properties and shows promise as a measurement for the screening of, and treatment response to, social phobia.
Subjective imagery in obsessive–compulsive disorder before and after exposure therapy
Authors: Marks Isaac M. , O'Dwyer Anne-Marie , Meehan Oscar , McGuire Philip , Greist John , Baer Lee 
Published: August 2002

BackgroundDistressing mental imagery is hard to study experimentally in obsessive–compulsive disorder (OCD).AimsTo develop a way to assess mental imagery in OCD during functional magnetic resonance imaging (fMRI).MethodA small randomised study, controlled for type and order of mental imagery and for treatment condition (exposure therapy guided by a computer or by a therapist, or relaxation guided by audio-tape). Before and after treatment, during fMRI scanning, patients imagined previously-rehearsed scenarios that evoked an urge to ritualise or non-OCD anxiety or a neutral state, and rated their discomfort during imagery.ResultsThe method evoked greater discomfort during OCD imagery and anxiety (non-OCD) imagery than during neutral imagery. Discomfort was reduced by cancelling imagery. Discomfort during OCD imagery (but not during anxiety non-OCD imagery) fell after exposure therapy but not after relaxation.ConclusionsResults showed differences between OCD and non-OCD images and their change after successful treatment, and confirmed clinical suggestions that cancelling images reduced OCD discomfort. The method's success paves the way for further studies of mental imagery in OCD: for instance, during fMRI.
Treatment interventions and findings from research: bridging the chasm in child psychiatry
Authors: Graham Philip 
Published: August 2002

BackgroundAlong with all other branches of medicine, child and adolescent psychiatry is faced with the need to consider its evidence base and justify its activities accordingly.AimsTo consider critically the use of the term ‘evidence’, to suggest limits to the value of conventionally defined evidence and to point to possible ways forward to bridge the gap between research findings and clinical practice.MethodA review of the literature relating to the use of evidence-based methods.ResultsThe term ‘evidence’ needs to be used more widely than is conventionally the case. Substantial evidence exists from controlled trials, but there are barriers to its use.ConclusionsA move away from non-validated methods of intervention is both desirable and feasible. The use of qualitative methods of enquiry, both in situations where controlled trials are unlikely to be feasible and as adjuncts to quantitative methods, should be considered more seriously.