bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence, comorbidity, disability and service utilisation
Authors: Andrews Gavin , Henderson Scott , Hall Wayne 
Published: August 2002

BackgroundHealth planning should be based on data about prevalence, disability and services used.AimsTo determine the prevalence of ICD–10 disorders and associated comorbidity, disability and service utilisation.MethodWe surveyed a national probability sample of Australian households using the Composite International Diagnostic Interview and other measures.ResultsThe sample size was 10 641 adults, response rate 78%. Close to 23% reported at least one disorder in the past 12 months and 14% a current disorder. Comorbidity was associated with disability and service use. Only 35% of people with a mental disorder in the 12 months prior to the survey had consulted for a mental problem during that year, and most had seen a general practitioner. Only half of those who were disabled or had multiple comorbidity had consulted and of those who had not, more than half said they did not need treatment.ConclusionsThe high rate of not consulting among those with disability and comorbidity is an important public health problem. As Australia has a universal health insurance scheme, the barriers to effective care must be patient knowledge and physician competence.
Natural course of schizophrenia: 2-year follow-up study in a rural Chinese community
Authors: Ran Maosheng , Xiang Mengze , Huang Mingsheng , Shan Youhe 
Published: August 2002

BackgroundA number of studies have questioned whether the natural course of schizophrenia is more favourable in ‘developing’ than ‘developed’ societies and whether culture is a factor in producing a favourable course.AimsThis prospective study tests the hypothesis that the natural outcome of schizophrenia would be favourable in a Chinese rural area.MethodWe investigated all patients with schizophrenia, including patients who had not received any treatment, among 149 231 rural community population in Xinjin County, Sichuan in 1994. Those patients who had never received treatment were followed up for two years.ResultsThree-quarters of patients with schizophrenia who had not been treated remained symptomatic. As the duration of illness increased, the illness became more serious. The clinical outcome of the drug-treatment group was significantly better than for patients who had not received any treatment.ConclusionsThe natural clinical outcome of schizophrenia in the Chinese rural community was poor, and occupational functioning of patients with schizophrenia was comparatively better. Schizophrenia itself has a specific natural course – antipsychotic drug treatment and psychosocial treatment will produce an improvement in prognosis.
Comparison of the Outcome and Treatment of Psychosis in People of Caribbean Origin Living in the Uk and British Whites
Authors: McKenzie K. , Samele C. , Van Horn E. , Tattan T. , Van Os J. , Murray Robin 
Published: August 2002

BackgroundThe comparative outcome of psychosis in British Whites and UK African-Caribbeans is unclear. Some report that African-Caribbeans have worse outcome, whereas others claim better symptomatic outcome and a more benign course.AimsTo compare the course, outcome and treatment of psychosis in African-Caribbeans and British Whites in a large multi-centre sample.MethodA secondary analysis of 708 patients with research diagnostic criteria-defined psychosis from a 2-year, randomised controlled trial of case management. Outcome measures (hospitalisation, illness course, self-harm, social disability and treatment received) were adjusted for socio-economic and clinical differences between groups at baseline using regression analysis.ResultsAfrican–Caribbeans were less likely to have a continuous illness and to receive treatment with antidepressants or psychotherapy.ConclusionsThe outcome of psychosis is complex but differs between UK African–Caribbeans and British Whites. This may reflect risk factors that increase the rate of psychosis in UK African–Caribbeans. Treatment differences require further investigation.
Intellectual functioning and outcome of patients with severe psychotic illness randomised to intensive case management
Authors: Hassiotis A. , Ukoumunne O. C. , Byford S. , Tyrer P. , Harvey K. , Piachaud J. , Gilvarry K. , Fraser J. 
Published: August 2002

BackgroundLittle research has been carried out on the benefits of intensive case management (ICM) for people with borderline IQ and severe mental illness.AimsTo compare outcome and costs of care of patients with severe psychotic illness with borderline IQ to patients of normal IQ and to assess whether ICM is more beneficial for the former than for the latter.MethodThe study utilises data from the UK700 multi-centre randomised controlled trial of case management. The main outcome measure was the number of days spent in hospital for psychiatric reasons. Secondary outcomes were costs of care and clinical outcome.ResultsICM was significantly more beneficial for borderline-IQ patients than those of normal IQ in terms of reductions in days spent in hospital, hospital admissions, total costs and needs and increased satisfaction.ConclusionsICM appears to be a cost-effective strategy for a subgroup of patients with severe psychosis with cognitive deficits.
Cerebral white matter lesions in bipolar affective disorder: relationship to outcome
Authors: Moore P. Brian , Shepherd Debra J. , Eccleston Donald , Macmillan Iain C. , Goswami Uptal , McAllister Victor L. , Ferrier I. Nicol 
Published: August 2002

BackgroundTwenty per cent of patients with bipolar affective disorder suffer an illness that responds inadequately to treatment and has a poor outcome. Many patients, but not all, with bipolar disorder show white matter abnormalities on T2-weighted magnetic resonance imaging (MRI).AimsTo explore the hypothesis that white matter abnormalities on MRI are seen more frequently in subjects whose illness has a poor outcome compared with those with a good outcome or controls.MethodTwo groups of age- and gender-matched patients with bipolar disorder (14 with a good outcome and 15 with a poor outcome) and 15 controls, aged 20–65 years, were studied. Axial T2-weighted MRI scans were examined for the presence and severity of white matter abnormalities.ResultsSignificantly more poor outcome group members had deep subcortical punctate, but not periventricular, white matter hyperintensities than the good outcome group (P=0.035) or controls (P=0.003) and these abnormalities were of greater severity (P=0.030 and P < 0.014, respectively).ConclusionsSubcortical white matter lesions are associated with poor outcome bipolar disorder.
Highlights of this issue
Authors: Cannon Mary 
Published: August 2002

STIGMA, SOCIETY AND EVOLUTIONSusan Sontag has observed that every society seems to need one illness that attaches stigma and blame to its ‘victims’ – mental illness, particularly schizophrenia, appears to have taken this mantle over from AIDS. A review paper by Haghighat (pp. 207–215) proposes that stigmatisation is a fundamental human tendency – a vestige of our animal evolutionary heritage – and, consequently, anti-stigma campaigns must work on many different levels in order to be successful. The power of the mass media has greatly increased the impact of stigma. If every time we hear the word ‘schizophrenic’ on television there is news of another murder, a form of classical conditioning occurs. Cognitive, affective and cultural strategies are therefore needed to ‘desensitise’ the public's fear and anxiety. Crisp (pp. 197–199), in an accompanying editorial, favours legislative and political interventions and feels that people with mental illnesses, like those with physical disabilities, should be empowered to ‘fight their corner’ and test out the relevance of human rights and disability discrimination legislation for their own ends.
Cognitive deficits in depression: Possible implications for functional neuropathology
Authors: Austin Marie-Paule , Mitchell Philip , Goodwin Guy M. 
Published: August 2002

BackgroundWhile depression is known to involve a disturbance of mood, movement and cognition, its associated cognitive deficits are frequently viewed as simple epiphenomena of the disorder.AimsTo review the status of cognitive deficits in depression and their putative neurobiological underpinnings.MethodSelective computerised review of the literature examining cognitive deficits in depression and their brain correlates.ResultsRecent studies report both mnemonic deficits and the presence of executive impairment – possibly selective for set-shifting tasks – in depression. Many studies suggest that these occur independent of age, depression severity and subtype, task ‘difficulty’, motivation and response bias: some persist upon clinical ‘recovery’.ConclusionsM nemonic and executive deficits do not appear to be epiphenomena of depressive disorder. A focus on the interactions between motivation, affect and cognitive function may allow greater understanding of the interplay between key aspects of the dorsal and ventral aspects of the prefrontal cortex in depression.
A unitary theory of stigmatisation: Pursuit of self-interest and routes to destigmatisation
Authors: Haghighat Rahman 
Published: August 2002

BackgroundStigmatisation is of increasing importance in relation to racism, ageism and sexism but also as an impediment to treating patients.AimsTo develop a theoretical foundation to help comprehend the core meaning of stigmatisation and to guide practical anti-stigmatisation measures.MethodPersonal reflection; re-interpretation of stigmatisation and reformulation of the relevant concepts.ResultsEmergence of a unitary theory of stigmatisation.ConclusionsBased on the structure of stigmatisation one could explore six levels of intervention in anti-stigmatisation campaigns: the cognitive level – educational intervention; the affective level – psychological intervention; the discrimination level – legislative intervention; the denial level – linguistic intervention; the economic origin – political intervention; the evolutionary origin – intellectual and cultural intervention. As destigmatisation has to challenge fundamental human tendencies, anti-stigmatisation campaigns have to be continuous, non-stop, open-ended projects aiming at keeping alive thought processes that moderate and humanise the pursuit of self-interest and the urge to survive in a competitive world.
Psychological therapies for adults with anorexia nervosa
Authors: Dare Chris , Eisler Ivan , Russell Gerald , Treasure Janet , Dodge Liz 
Published: August 2002

BackgroundCurrently, without systematic evidence, psychotherapy for anorexia nervosa in adults draws on psychodynamic, cognitive and systemic theories.AimsTo assess effectiveness of specific psychotherapies in out-patient management of adult patients with anorexia nervosa.MethodEighty-four patients were randomised to four treatments: three specific psychotherapies – (a) a year of focal psychoanalytic psychotherapy; (b) 7 months of cognitive-analytic therapy (CAT); (c) family therapy for 1 year – and (d) low contact, ‘routine’ treatment for 1 year (control).ResultsAt 1 year, there was symptomatic improvement in the whole group of patients. This improvement was modest, several patients being significantly undernourished at follow-up. Psychoanalytic psychotherapy and family therapy were significantly superior to the control treatment; CAT tended to show benefits.ConclusionsPsychoanalytic and family therapy are of specific value in the out-patient treatment of adult patients with anorexia.
Income inequality and the prevalence of common mental disorders in Britain
Authors: Weich Scott , Lewis Glyn , Jenkins Stephen P. 
Published: August 2002

BackgroundIt has been hypothesised that the association between greater income inequality and increased mortality is mediated by poor psychosocial health.AimsTo test the hypothesis that individuals in regions of Britain with the highest income inequality have a higher prevalence of the common mental disorders, after adjusting for individual income.MethodCross-sectional survey of 8191 adults aged 16–75 in private households in England, Wales and Scotland. The prevalence of common mental disorders was assessed using the General Health Questionnaire.ResultsThe association between income inequality and prevalence of the common mental disorders varied with individual income level. Among persons with the highest incomes, common mental disorders were more frequent in regions with greater income inequality (as indicated by high Gini coefficient) (adjusted OR 1.31, 95% CI 1.05–1.65; P=0.02). The opposite was true for those with the lowest incomes.ConclusionsIncome inequality was associated with worse mental health among the most affluent individuals.
Common mental disorders in Santiago, Chile
Authors: Araya Ricardo , Rojas Graciela , Fritsch Rosemarie , Acuña Julia , Lewis Glyn 
Published: August 2002

BackgroundThere have been relatively few surveys in Latin America that have attempted to estimate the prevalence of psychiatric morbidity in private households.AimsTo determine the prevalence of common mental disorders and socio-demographic correlates among adults from Santiago, Chile.MethodCross-sectional survey of private households with a probabilistic sampling design was used. Common mental disorders were measured using the Clinical Interview Schedule–Revised (CIS–R).ResultsThree thousand eight hundred and seventy adults were interviewed. Twenty-five per cent were CIS–R cases and 13% met criteria for an ICD–10 diagnosis. Low education, female gender, unemployment, separation, low social status and lone parenthood were associated with a higher prevalence.ConclusionsPrevalence rates were higher than those found in urban areas of Great Britain, both for ICD–10 diagnoses and ‘non-specific neurotic disorders’. Similar socio-demographic factors were associated with an increased prevalence of common mental disorders in Chile as in the UK. There is a need to unify methodologies to be able to compare results internationally.
Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors
Authors: Thase Michael E. , Entsuah A. Richard , Rudolph Richard L. 
Published: August 2002

BackgroundIt had been suggested that the antidepressant venlafaxine, which inhibits reuptake of both serotonin and (at higher doses) noradrenaline, may result in better outcomes than treatment with selective serotonin reuptake inhibitors (SSRIs).AimsTo compare remission rates during treatment with SSRIs or venlafaxine.MethodData from eight comparable randomised, double-blind studies of major depressive disorder were pooled to compare remission rates (Hamilton Rating Scale for Depression score ≤ 7) during treatment with venlafaxine (n=851), SSRIs (fluoxetine, paroxetine, fluvoxamine;n=748) or placebo (four studies;n=446).ResultsRemission rates were: venlafaxine, 45% (382/851); SSRIs, 35% (260/748); placebo, 25% (110/446) (P< 0.001; odds ratio for remission is 1.50 (1.3–1.9), favouring venlafaxinev.SSRIs). The difference between venlafaxine and the SSRIs was significant at week 2, whereas the difference between SSRIs and placebo reached significance at week 4. Results were not dependent on any one study or the definition of remission.ConclusionsRemission rates were significantly higher with venlafaxine than with an SSRI.
Psychiatric battle casualties: An intra- and interwar comparison
Authors: Jones Edgar , Wessely Simon 
Published: August 2002

BackgroundPsychiatric casualties are recognised as an important and inevitable feature of modern warfare. At the beginning of the 20th century they were scarcely acknowledged and still less treated. Today, as a result of lessons learned in the First and Second World Wars, numbers can be predicted on the basis of battle intensity and effective clinical interventions applied.AimsTo discover more about the factors that cause psychiatric casualties and their relationship to total battle casualties.MethodA survey of historical War Office reports and the papers of Royal Army Medical Corps psychiatrists has provided both statistics and treatment strategies.ResultsReported psychiatric casualties were low in the Boer War, influenced, in part, by the misdiagnosis of psychosomatic disorders. Their incidence rose appreciably in the First World War with the identification of shell-shock and neurasthenia. The Second World War saw the collection of accurate data, and combat stress was treated efficiently, although few soldiers returned to fighting units.ConclusionsA constant relationship exists between the incidence of the total killed and wounded and the number of psychiatric casualties, mediated by the nature of the fighting and quality of the troops involved.
Relatives of patients with severe psychotic disorders: Factors that influence contact frequency
Authors: Harvey Kate , Burns Tom , Sedgwick Philip , Higgitt Anna , Creed Francis , Fahy Tom 
Published: August 2002

BackgroundThe isolation experienced by many patients with severe psychotic disorders is generally assumed to be due to their social withdrawal. An alternative possibility is that relatives avoid frequent contact with patients because they find the situation distressing.AimsTo examine the predictors of frequent patient-relative contact, in particular the role of relatives' experience.MethodUK700 trial data were used to determine baseline predictors of frequent contact and establish whether relatives' experience at baseline predicted continued frequent contact 2 years later.ResultsNeither characteristics associated in the literature with relatives' ‘burden’ nor relatives' experience predicted patient-relative contact frequency. Instead, the predictors were mainly demographic.ConclusionsMany relatives experience considerable distress, but the evidence does not suggest that they avoid frequent contact with the patient as a consequence.
Suicidal behaviour in psychosis: Prevalence and predictors from a randomised controlled trial of case management
Authors: Walsh Elizabeth , Harvey Kate , White Ian , Higgitt Anna , Fraser Janelle , Murray Robin 
Published: August 2002

BackgroundIt is unclear whether intensive case management influences the prevalence of suicidal behaviour in patients with psychosis.AimsTo compare the effect of intensive case management and standard care on prevalence of suicidal behaviour in patients with chronic psychosis.MethodPatients with established psychosis (n=708) were randomised either to intensive case management or to standard care. The prevalence of suicidal behaviour was estimated at 2-year follow-up and compared between treatment groups. Suicide attempters and non-attempters were compared on multiple socio-demographic and clinical variables to identify predictors of suicidal behaviour.ResultsThere was no significant difference in prevalence of suicidal behaviour between treatment groups. Recent attempts at suicide and multiple recent hospital admissions best predicted future attempts.ConclusionsIntensive case management does not appear to influence the prevalence of suicidal behaviour in chronic psychosis. Predictors identified in this study confirm some previous findings.
Changes in the quality of life of patients receiving antidepressant medication in primary care: Validation of the WHOQOL–100
Authors: Skevington Suzanne M. , Wright Anne 
Published: August 2002

BackgroundThe study arises from the need for good quality of life (QOL) assessment and a new comprehensive generic QOL profile for cross-cultural use.AimsTo examine changes in the QOL of patients receiving antidepressants from a general practitioner, and to assess the validity and sensitivity of a new QOL measure, the World Health Organization Quality of Life Assessment (100-item version) (WHOQOL–100).MethodPatients with moderate depression (n=106) completed the WHOQOL–100 and Beck Depression Inventory at the start of treatment and again after 6 weeks.ResultsDepression decreased significantly over 2 months and 74% reported feeling better. WHOQOL–100 scores increased in 24 of the 25 facets, demonstrating that QOL improves significantly in the 8 weeks following the start of antidepressant treatment. It also shows the instrument's validity and sensitivity to changes in clinical condition.ConclusionsThe UK WHOQOL–100 is confirmed as excellent to good. Antidepressants significantly and comprehensively improve QOL.
Subjective and objective dimensions of quality of life in psychiatric patients: A factor analytical approach
Authors: Ruggeri Mirella , Warner Richard , Bisoffi Giulia , Fontecedro Laura 
Published: August 2002

BackgroundBoth subjective and objective information is necessary to assess quality of life (QOL).AimsTo explore the role of subjective and objective QOL dimensions and their cross-sectional and longitudinal predictors.MethodThe relationship between QOL, as measured by the Lancashire Quality of Life Profile (LQL), and demographic variables, diagnosis, psychopathology, disability, functioning, affect balance, self-esteem, service use and service satisfaction was investigated at two points in time, using factor analysis and multiple regression techniques.ResultsOne subjective and two objective LQL factors with strong face validity were identified. Cross-sectional predictors of the subjective factor were primarily subjective measures; longitudinally, few predictors of this factor were identified. The cross-sectional and longitudinal predictors of the objective factors were primarily demographic and observer-rated measures.ConclusionsSubjective and objective data are distinct types of information. Objective measures may be more suitable in detecting treatment effects. Subjective information is necessary to complete the QOL picture and to enhance the interpretation of objective data.
How antidepressants work: New perspectives on the pathophysiology of depressive disorder
Authors: Reid Ian C. , Stewart Caroline A. 
Published: August 2002

BackgroundNew research in animals is beginning to change radically our understanding of the biology of stress and the effects of antidepressant agents.AimsTo relate recent findings from the basic neurosciences to the pathophysiology of depressive disorder.MethodDrawing together findings from molecular and physiological studies in rats, social studies in primates and neuropsychological studies in humans, we review the neurotrophic and neuroplastic effects of antidepressants and stress.ResultsStress and antidepressants have reciprocal actions on neuronal growth and vulnerability (mediated by the expression of neurotrophins) and synaptic plasticity (mediated by excitatory amino acid neurotransmission) in the hippocampus and other brain structures. Stressors have the capacity to progressively disrupt both the activities of individual cells and the operating characteristics of networks of neurons throughout the life cycle, while antidepressant treatments act to reverse such injurious effects.ConclusionsWe propose a central role for the regulation of synaptic connectivity in the pathophysiology of depressive disorder.