bluuebunny/crossref_metadata_2025_split huggingface dataset:
Towards a standardised brief outcome measure: Psychometric properties and utility of the CORE–OM
Authors: Evans Chris , Connell Janice , Barkham Michael , Margison Frank , McGrath Graeme , Mellor-Clark John , Audin Kerry 
Published: August 2002

BackgroundAn acceptable, standardised outcome measure to assess efficacy and effectiveness is needed across multiple disciplines offering psychological therapies.AimsTo present psychometric data on reliability, validity and sensitivity to change for the CORE–OM (Clinical Outcomes in Routine Evaluation – Outcome Measure).MethodA 34-item self-report instrument was developed, with domains of subjective well-being, symptoms, function and risk. Analysis includes internal reliability, test–retest reliability, socio-demographic differences, exploratory principal-component analysis, correlations with other instruments, differences between clinical and non-clinical samples and assessment of change within a clinical group.ResultsInternal and test–retest reliability were good (0.75–0.95), as was convergent validity with seven other instruments, with large differences between clinical and non-clinical samples and good sensitivity to change.ConclusionsThe CORE–OM is a reliable and valid instrument with good sensitivity to change. It is acceptable in a wide range of practice settings.
Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS–LD)
Authors: Roy Ashok , Matthews Helen , Clifford Paul , Fowler Vanessa , Martin David M. 
Published: August 2002

BackgroundThe Health of the Nation Outcomes Scales (HoNOS) have been developed to measure outcomes in people with mental health problems.AimsFrequent impaired social functioning, problems with communication and associated physical conditions meant that a bespoke instrument was needed for people with learning disabilities. We describe the development of the Health of the Nation Outcomes Scales for People with Learning Disabilities (HoNOS–LD).MethodHoNOS-LD was piloted at 26 sites. Two raters, at two points in time, rated 372 subjects. Analysis determined acceptability, ease of use, interrater reliability, sensitivity to change and reliability with the Aberrant Behavior Checklist (ABC).ResultsThe resulting 18-item instrument demonstrated good reliability and validity characteristics and is generally acceptable to clinicians.ConclusionsHoNOS-LD is an appropriate instrument for measuring outcome in people with learning disabilities with additional mental health needs.
Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS–LD)
Authors: Roy Ashok , Matthews Helen , Clifford Paul , Fowler Vanessa , Martin David M. 
Published: August 2002

Summaryrating instructions: (a) Complete the front sheet including ICD–10 diagnoses and subjective rating. (b) Rate each in order from item 1 to 18. (c) Do not include information rated in an earlier item. (d) Rate the person over the previous 4 weeks. (e) Rate the most severe problem that has occurred during the period rated. (f) All items follow the five-point rating format similar to other HoNOS instruments: 0=no problem during the period rated; 1=mild problem; 2=moderate problem; 3=severe problem; 4=very severe problem.
Subjective experience of a confusional state
Authors: Crammer J. L. 
Published: August 2002

BackgroundConfusional states associated with medical and surgical conditions require more study and biochemical explanation.AimsTo understand impairment of consciousness, cognition and memory.MethodA psychiatrist reports experience of his changing mental state over 5 days from notes made immediately on recovery.ResultsA prodromal phase of declining consciousness, understanding and memory registration over perhaps 48 h was difficult to detect. During unconsciousness there were four brief partial reversals with arousal, and some mental functioning (memory, formation of beliefs) occurred.ConclusionsSelf-report can be a useful addition in clinical study and patients with renal failure require psychological and psychiatric study. Comparison with the mental effects of benzodiazepine or of an anaesthetic such as nitrous oxide might throw light on the pathology.
Impact of a mother–infant intervention in an indigent peri-urban South African context
Authors: Cooper Peter J. , Landman Mireille , Tomlinson Mark , Molteno Christopher , Swartz Leslie , Murray Lynne 
Published: August 2002

BackgroundA high rate of maternal depression and associated disturbance in the mother–infant relationship has been found in an indigent peri-urban South African community Khayelitsha. The question arises whether a community-based intervention could be beneficial.AimsTo train community workers to deliver an intervention to mothers and infants in Khayelitsha, and to compare mothers and infants receiving this intervention with a sample receiving no such intervention.MethodFour Khayelitsha women were trained in a mother-infant intervention, which they delivered to 32 women recruited in late pregnancy. At 6 months post-partum, maternal mood, the mother–infant relationship and infant growth were assessed. The findings were compared with a matched group of 32 mothers and infants.ResultsThere was no reliable impact of the intervention on maternal mood. However, compared with the comparison sample, the quality of mother – infant engagement was significantly more positive for those who had received the intervention.ConclusionsThe pilot study produced preliminary evidence of a benefit of a community-based mother – infant intervention delivered by trained, but otherwise unqualified, community workers, sufficient to warrant a formal controlled evaluation of this treatment.
The case against ‘the evidence’: A different perspective on evidence-based medicine
Authors: Williams D. D. R. , Garner Jane 
Published: August 2002

BackgroundAn evidenced-based approach to psychiatry is playing an increasingly prominent role in treatment decision-making for individual patients and for populations. Many doctors are now critical of the emphasis being placed on ‘the evidence’ and concerned that clinical practice will become more constrained.AimsTo demonstrate that evidence-based medicine is not new, sources of evidence are limited and psychosocial aspects of medicine are neglected in this process.MethodSome of the literature is reviewed. Ideas and arguments are synthesised into a critical commentary.ResultsThese are considered under four headings: evidence-based medicine is not new; what evidence is acceptable; the doctor as therapist; and the emergence of a new utilitarian orthodoxy.ConclusionsIt is agreed that a degree of professional consensus is necessary. However, too great an emphasis on evidence-based medicine oversimplifies the complex and interpersonal nature of clinical care.
Patient adherence in the treatment of depression
Authors: Pampallona S. , Bollini P. , Tibaldi G. , Kupelnick B. , Munizza C. 
Published: August 2002

BackgroundNon-adherence with antidepressant treatment is very common. Increasing adherence to pharmacological treatment may affect response rate.AimsTo review and summarise quantitative evidence on factors associated with adherence and of adherence-enhancing interventions.MethodA systematic review of computerised databases was carried out to identify quantitative studies of adherence in depression. Papers retained addressed unipolar depression and considered adherence as the primary end-point.ResultsOf studies published between 1973 and 1999, 32 met the review criteria: epidemiological descriptive studies (n=14): non-random comparisons of control and intervention groups (n=3); randomised interventions (n=14); and meta-analysis (n=1). Patient education and medication clinics were the interventions most commonly tested, combined with a variety of other interventions.ConclusionsThe studies did not give consistent indications of which interventions may be effective. Carefully designed clinical trials are needed to clarify the effect of single and combined interventions.
The distinction between personality disorder and mental illness
Authors: Kendell R. E. 
Published: August 2002

BackgroundProposals by the UK Government for preventive detention of people with ‘dangerous severe personality disorders' highlight the unresolved issue of whether personality disorders should be regarded as mental illnesses.AimsTo clarify the issue by examining the concepts of psychopathy and personality disorder, the attitudes of contemporary British psychiatrists to personality disorders, and the meaning of the terms ‘mental illness'and ‘mental disorder’.MethodThe literature on personality disorder is assessed in the context of four contrasting concepts of illness or disease.ResultsWhichever of the four concepts or definitions is chosen, it is impossible to conclude with confidence that personality disorders are, or are not, mental illnesses; there are ambiguities in the definitions and basic information about personality disorders is lacking.ConclusionsThe historical reasons for regarding personality disorders as fundamentally different from mental illnesses are being undermined by both clinical and genetic evidence. Effective treatments for personality disorders would probably have a decisive influence on psychiatrists' attitudes.
Old age psychiatry and the law
Authors: Jacoby Robin 
Published: August 2002

BackgroundOld age psychiatry is no less subject to increasing legal and quasi-legal restraint than other branches of the profession, but the emphases are different. Two themes predominate: first, that of capacity or competence; and second, to what extent formal legal measures should be implemented in cases where incapacitated patients do not dissent from, as opposed to giving active consent to, admission to hospital or receiving treatment.AimsTo discuss the issues of capacity or competence, especially in relation to recent legislation and judgements and to proposed legislation in England and Wales.MethodSelective review and discussion of recent case law and current and proposed statute law.Results and conclusionsThe Bournewood case threatened but ultimately failed to upset the status quo. However, the European Convention on Human Rights and the British Human Rights Act 1998 may yet do so.
Costs and cognitive disability: modelling the underlying associations
Authors: Kavanagh Shane , Knapp Martin 
Published: August 2002

BackgroundThe high support needs of elderly people with cognitive disability raise questions about the cost-effectiveness of different treatments. Associations between costs and cognitive disability could be influenced by other factors, particularly comorbidities.AimsTo examine the links between costs and cognitive disability in the context of covariates.MethodSecondary analyses of data from the UK Office of Population Censuses and Surveys disability surveys for over 4500 elderly people living in households were used to examine associations between cost and cognitive disability.ResultsCosts varied considerably, and were associated with severity of disability along a number of dimensions. The cost-raising effects of cognitive disability were smaller when the analyses controlled for levels of disability in other domains.ConclusionsCognitive disability is significantly associated with higher costs, but these analyses highlight the need to examine a range of disabilities.
Frail old people at the margins of care: some recent research findings
Authors: Challis David , Hughes Jane 
Published: August 2002

BackgroundCommunity-based care at the margin is a substitute for institutional care. Three factors are considered critical: definitions of eligibility, assessment procedures and balance of care.AimsTo examine determinants of the margin between institutional and home-based care, review current practice, identify the implications and contribute to planning of integrated long-term care services.MethodA selective review was made of findings from research conducted after the community care reforms.ResultsMarked variability and inconsistency in eligibility and assessment processes may contribute to misplacement of frail older people. There remains capacity to shift the balance of care from institutional to home-based care within reasonable cost parameters, particularly with more integrated services.ConclusionsGreater standardisation of approaches to the determination of eligibility for social care and to assessment of need is required. Providing care at home for some of those currently entering care homes is feasible, but will require different service structures and staff roles, including specialist clinicians.
Genotype and phenotype in Alzheimer's disease
Authors: Holmes Clive 
Published: August 2002

BackgroundPatients with Alzheimer's disease show a wide variation in clinical phenotype. Genetic research has been largely concerned with the role of mutations or common variants as risk factors for the disease. Do genetic factors also influence clinical phenotype?AimsTo examine the evidence that genetic factors influence the clinical expression of the disease in addition to influencing risk.MethodA selective review was made of the key literature.ResultsMutations in three genes, coding for amyloid precursor protein, presenilin-1 and presenilin-2, and a common variation (ε4) in another gene, APOE, have been shown to lead to an earlier development of the disease. More recently, genetic association and twin studies have suggested a role for genetic factors in the development of other aspects of clinical phenotype, notably the appearance of non-cognitive symptoms.ConclusionsIn Alzheimer's disease genetic variation influences a number of aspects of clinical phenotype.
New drugs for Alzheimer's disease and other dementias
Authors: Bullock Roger 
Published: August 2002

BackgroundAlzheimer's disease management involves symptomatic drug treatments passed by the National Institute for Clinical Excellence. Disease modification is now the goal.AimsTo review current and developmental drugs for Alzheimer's disease, their usage, and the clinical context of known facts and proposed specific models.MethodA brief evidence-based review was made, using literature where available, or evidence from consensus groups where it was absent.ResultsThere is good evidence to support the use of cholinesterase inhibitors, and perhaps vitamin E. Oestrogen and anti-inflammatory agents show possibility, but there is not enough evidence to support routine use.ConclusionsSymptomatic treatments exist for Alzheimer's disease. Observational studies and increasing knowledge of brain biology are leading towards further treatment options. Old age psychiatrists have valuable treatments they now have to learn to use.
Frontotemporal dementia
Authors: Snowden Julie S. , Neary David , Mann David M. A. 
Published: August 2002

BackgroundFrontotemporal dementia accounts for up to 20% of cases of dementia in the presenium, yet remains poorly recognised. Diagnostic criteria have been devised to aid clinical diagnosis.AimsTo provide an overview of clinical and pathological characteristics of frontotemporal dementia and its nosological status.MethodsThe review summarises consensus diagnostic criteria for frontotemporal dementia and draws on the authors'clinical experience of 300 frontotemporal dementia cases, and pathological experience of 50 autopsied cases.ResultsFrontotemporal dementia is characterised by pronounced changes in affect and personal and social conduct. Some patients also develop motor neuron disease. Mutations in the tau gene account for some but not all familial cases of frontotemporal dementia.ConclusionsFrontotemporal dementia is a focal form of dementia, which is clinically and pathologically distinct from other dementias. It represents an important model for understanding the functions of the frontotemporal lobes.
Dementia with Lewy bodies
Authors: McKeith Ian G. 
Published: August 2002

BackgroundDementia with Lewy bodies (DLB) is a common dementia subtype that has only been recognised in the past decade and that remains widely underdiagnosed.AimsTo review the pathological and clinical features of DLB, to consider methods of investigation and diagnosis, and to recommend safe and effective management strategies.MethodA selective review was made of the key literature.ResultsUsing operationalised criteria, DLB can be clinically diagnosed with an accuracy similar to that achieved for Alzheimer's disease or Parkinson's disease. Underdetection is largely due to poor definition of the criterion of cognitive fluctuation. Ancillary investigations, particularly neuroimaging, can aid in differential diagnosis. Extreme caution in the use of neuroleptic medication is advised. Cholinesterase inhibitors may be particularly effective in DLB.ConclusionsClinicians should be aware of DLB as part of a spectrum of Lewy body disorders. Neuroleptic sensitivity reactions and good response to cholinergic therapies are important aspects of management.
Subcortical dementia
Authors: Turner Mark A. , Moran Nicholas F. , Kopelman Michael D. 
Published: August 2002

BackgroundDrawing a distinction between cortical and subcortical dementias seems both useful and justified. Recent research has, however, cast doubt on the clinical, neuropsychological, neuroimaging and neuroanatomical basis of the distinction.AimsTo arrive at a reasoned conclusion about the relationship between the two types of dementia and the validity of distinguishing between them.MethodThe historical and recent clinical and scientific literature on subcortical dementia was reviewed.ResultsThe traditional claim that subcortical dementia has distinct clinical manifestations, neuroimaging findings and a neuropathological profile is not altogether borne out by the literature. Some studies show that frontal executive dysfunction and the profile of memory deficits are not significantly different from those seen in Alzheimer's disease. Neuropathological findings also overlap.ConclusionsThe category of subcortical dementia may be clinically useful in highlighting the likelihood that an individual with dementia is more likely to suffer from bradyphrenia and motor difficulties. As neuroscience advances a preoccupation with the distinction may hinder the assessment and treatment of individual cases.
Vascular dementia: A diagnosis running out of time
Authors: Stewart Robert 
Published: August 2002

BackgroundThe concept of vascular dementia has a long history but its usefulness as a diagnostic category has been called into question.AimsTo evaluate vascular disease as a risk factor for dementia and the interface between cerebrovascular pathology and Alzheimer's disease.MethodThe literature on this topic was selectively reviewed and synthesised.ResultsRisk factors for cerebrovascular disease are also risk factors for dementia. However, the course of dementia, once it has developed, appears to be frequently determined by Alzheimer's disease.ConclusionsAs a public health measure, modification of vascular risk represents a potentially powerful means to prevent dementia through delaying its onset. However, an effect on progression of dementia, once it has developed, has yet to be established. The traditional view of vascular dementia and Alzheimer's disease as distinguishable conditions is becoming steadily less tenable.
Vascular basis of late-onset depressive disorder
Authors: Baldwin Robert C. , O'Brien John 
Published: August 2002

BackgroundGrowing evidence suggests that there may be a subtype of depression arising in later life that is characterised by a distinct clinical presentation and an association with cerebrovascular disease. This has been termed ‘vascular depression’.AimsTo review the evidence for associations between cardiovascular disease and depression and between cerebrovascular disease and depression, and to examine implications for clinical practice and research.MethodThe authors reviewed the medical literature covering the past 5 years.ResultsThere is strong evidence for an association between cardiovascular disease and depression, but this is not confined to older people. The causal pathway may be bi-directional. There is also a convergence of evidence suggesting a causal link between cerebrovascular disease and depression, especially that occurring later in life. The major focus has been on neuroradiological findings thought to be due to vascular disease, although the pathology may be heterogeneous.ConclusionsAlthough there are gaps in the evidence there is strong support for the concept of vascular depression, characterised by reduced depression ideation, subcortical neurological dysfunction, apathy and psychomotor change. This has implications for both treatment and prevention.
Rating scales in old age psychiatry
Authors: Burns Alistair , Lawlor Brian , Craig Sarah 
Published: August 2002

BackgroundThere is a vast array of scales available to assess all aspects of mental and physical health in older people which may be of relevance to the work of old age psychiatrists.AimsTo summarise some of the scales that may be commonly used in clinical and research practice and to give the reader guidelines as to where further information can be obtained.MethodThe scales were selected on the basis of the authors' own clinical and research knowledge and information was gathered from a comprehensive text on assessment scales in old age psychiatry.ResultsThe selected scales are described in brief and a table outlines the purposes for which they are most suitable.ConclusionsAlthough many scales are available, the choice of the individual scale relies specifically on the question that is to be asked. The ideal scale does not exist.
Bio-social origins of depression in the community
Authors: Strickland Paul L. , Deakin J. F. William , Percival Carol , Dixon Joanne , Gater Richard A. , Goldberg David P. 
Published: August 2002

BackgroundSocial adversity may be a risk factor for depression, by increasing Cortisol secretion, which impairs serotonin (5-HT) neurotransmission.AimsTo examine this causal pathway in a community setting.MethodWomen who were currently ICD–10 depressed (n=94), vulnerable to depression but not depressed (n=166) and non-vulnerable controls (n=177) were recruited. We assessed social adversity and vulnerability (Life Eventsand Difficulties Schedule; Self Evaluation and Social Support Scales) and psychiatric state (Schedules for Clinical Assessment in Neuropsychiatry). Salivary cortisol concentrations were measured at 09.00 and 23.00 h. Serotonin function was assessed using prolactin responses to dexfenfluramine.ResultsCortisol concentrations were not increased in the depressed or vulnerable. Morning salivary and serum cortisol were reduced in depression. Evening cortisol was increased after recent life events. Life events and depression were associated with increased prolactin responses.ConclusionsThe hypothalamic–pituitary–adrenal axis is sensitive to social stress but does not mediate vulnerability to depression. Exaggerated 5-HT2 receptor responsiveness to stress may play a role in the evolution of depression.