bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stress and psychiatric disorder in urban Rawalpindi
Authors: Mumford David B. , Minhas Fareed A. , Akhtar Imtiaz , Akhter Saeed , Mubbashar Malik H. 
Published: August 2002

BackgroundRecent studies in rural areas of Pakistan have yielded high prevalence rates of common mental disorders, especially among women.AimsTo investigate emotional distress and common mental disorders in a poor urban district using the same survey method.MethodFirst-stage screening of a slum district of Rawalpindi used the Bradford Somatic Inventory. Psychiatric interviews were conducted with stratified samples using the ICD–10 research diagnostic criteria.ResultsOn a conservative estimate, 25% of women and 10% of men suffered from anxiety and depressive disorders. Levels of emotional distress increased with age in both men and women. Women living in joint households reported more distress than those living in unitary families. Higher levels of education were associated with lower risk of common mental disorders, especially in younger women. Emotional distress was negatively correlated with socio-economic variables among women.ConclusionsThis study found levels of emotional distress and psychiatric morbidity in a poor district of Rawalpindi to be less than half those in a nearby rural village in the Punjab, although rates in women were still double those in men. Possible explanations are that more healthy people migrate to the cities or that urban living is more conducive to good mental health in Pakistan.
Influence of socio-economic deprivation on the prevalence and outcome of depression in primary care
Authors: Ostler K. , Thompson C. , Kinmonth A.-L. K. , Peveler R. C. , Stevens L. , Stevens A. 
Published: August 2002

BackgroundHealth inequalities exist for many disorders, but the contribution of deprivation to the prevalence and outcome of depressive symptoms in primary care populations has been infrequently studied.AimsTo examine the influence of Jarman under-privileged area (UPA) scores on the prevalence and outcome of depressive symptoms in general practice patients.Method18 414 patients attending 55 representative practices completed the Hospital Anxiety and Depression Scale and a questionnaire for employment status. Outcome of those screening positive was assessed at 6 weeks and 6 months.ResultsThe UPA score accounted for 48.3% of the variance between practices in prevalence of depressive symptoms. Attending a high UPA score practice predicted persistence of depressive symptoms to 6 months.ConclusionsThe socio-economic deprivation of a practice locality is a powerful predictor of the prevalence and persistence of depressive symptoms.
Accuracy of general practitioner's prognosis of the 1-year course of depression and generalised anxiety
Authors: Van Den Brink Rob H. S. , Ormel Johan , Van Der Meer Klaas , Tiemens Bea G. , Van Os Titus W. D. P. , Smit Annet , Jenner Jack A. 
Published: August 2002

BackgroundA prognosis serves important functions for the management of common mental disorders in primary care.AimsTo establish the accuracy of the general practitioner's (GP) prognosis.MethodThe agreement between GP prognosis and observed course was determined for 138 cases of ICD–10 depression and 65 of generalised anxiety disorder, identified among consecutive attenders of 18 GPs.ResultsModest agreement between GP prognosis and course was found, both for depression (κ=0.21) and generalised anxiety (κ=0.111). Better agreement (κ=0.45 for depression, and κ=0.33 for generalised anxiety) was observed between the course and predictions from a statistical model based on information potentially available to the GP at the time the prognosis was made. This model assesses attainable performance for GPs.ConclusionsGeneral practitioners do a fair job in predicting the 1-year course of depression and generalised anxiety. Even so, their performance falls significantly short of attainable performance.
Stroke, vascular risk factors and depression
Authors: Stewart R. , Prince M. , Richards M. , Brayne C. , Mann A. 
Published: August 2002

BackgroundStroke, hypertension and diabetes are common in older Caribbean-born populations in the UK who may be at risk of depression secondary to vascular disease.AimsWe examined the association between stroke, vascular risk factors and depression in a community-based Caribbean-born population aged 55–75 years.MethodVascular risk factors were identified by interview, examination and blood tests. Depression was categorised using the Geriatric Depression Scale. Disablement was assessed as a potential mediating factor.ResultsPhysical illness and disablement were strongly associated with depression, independent of disablement. Previous stroke was associated with depression, independent of disablement. No vascular risk factors were associated with depression.ConclusionsThe risk of depression associated with stroke was not explained by disablement. However, the hypothesis that vascular risk factors are important in the genesis of depression was not supported.
Community study of depression in old age in Taiwan
Authors: Chong Mian-Yoon , Chen Chwen-Cheng , Tsang Hin-Yeung , Yeh Tzung-Lieh , Chen Cheng-Sheng , Lee Yi-Hui , Tang Tze-Chun , Lo Hsin-Yi 
Published: August 2002

BackgroundPublished studies of prevalence of depression in old age in Taiwan have yielded equivocal results.AimsTo study the prevalence of depressive disorders among community-dwelling elderly; further, to assess socio-demographic correlates and life events in relation to depression.MethodA randomised sample of 1500 subjects aged 65 and over was selected from three communities. Research psychiatrists conducted all assessments using the Geriatric Mental State Schedule. The diagnosis of depression was made with the GMS–AGECAT (Automated Geriatric Examination for Computerised Assisted Taxonomy); data on life events were collected with the Taiwanese version of the Life Events and Difficulties Schedule.ResultsOne-month prevalence of psychiatric disorders was 37.7%, with 15.3% depressive neurosis and 5.9% major depression. A high risk of depressive disorders was found among widows with a low educational level living in the urban community, and among those with physical illnesses.ConclusionsContrary to most previous reports, we found that the prevalence of depressive disorders among the elderly in the community in Taiwan is high and comparable to rates reported in some studies of UK samples.
Evaluating the use of benzodiazepines following recent bereavement
Authors: Warner James , Metcalfe Chris , King Michael 
Published: August 2002

BackgroundThere is no evidence to support current advice not to use benzodiazepines after bereavement.AimsTo determine the role of benzodiazepines in the management of bereavement.MethodWe conducted a randomised, double-blind, placebo-controlled evaluation of the use of diazepam after recent bereavement. Participants were randomised to either 2 mg diazepam or identically packaged placebo up to three times daily. The primary outcome measure was the Bereavement Phenomenology Questionnaire.ResultsThirty subjects were randomised. No evidence was found of an effect of benzodiazepines on the course of the first 6 months of bereavement (estimated mean difference of combined follow-up assessments=0.3 in favour of placebo; 95% CI –6.2 to +6.7).ConclusionWe found no evidence of a positive or negative effect of benzodiazepines on the course of bereavement.
Suicide or accident – self-killing in medieval England
Authors: Seabourne Alice , Seabourne Gwen 
Published: August 2002

BackgroundLittle is known about suicide in England in the medieval period. Legal records provide the best source of post-mortem data about suicides.MethodSelected Eyre records from the reigns of Henry III (1216–1272), Edward I (1272–1307), Edward II (1307–1327) and Edward III (1327–1377) were translated and examined for details of self-killing.ResultsOne hundred and ninety-eight cases of self-killing were found, eight of which were found to be accidental, non-felonious deaths. Self-killing was more common in men. Hanging was the most common and drowning the second most common method of self-killing in both males and females. Self-killing with sharp objects was predominantly a male method. Other methods of self-killing were rare. There were no reports of deliberate self-poisoning. There is some evidence of underreporting of, and attempts to conceal, self-killing from royal officers.ConclusionsEyre records suggest that although some of the facts surrounding self-killing have changed, others have remained constant, particularly the higher proportion of men who kill themselves and the greater use by men than women of sharp instruments to kill themselves. We discuss the description and understanding of psychiatric states by medieval English Eyres, particularly in terms of the perception of the mental states that accompanied suicidal actions.
Psychiatric and personality disorders in deliberate self-harm patients
Authors: Haw Camilla , Hawton Keith , Houston Kelly , Townsend Ellen 
Published: August 2002

BackgroundPrevious UK studies have reported much lower rates of psychiatric and personality disorder in those who attempt suicide than in those who die by suicide.AimsTo determine the nature and prevalence of psychiatric and personality disorders in deliberate self-harm (DSH) patients.MethodA representative sample of 150 DSH patients who presented to a general hospital were assessed using a structured clinical interview and a standardised instrument. Follow-up interviews were completed for 118 patients approximately 12–16 months later.ResultsICD–10 psychiatric disorders were diagnosed in 138 patients (92.0%), with comorbidity of psychiatric disorders in 46.7%. The most common diagnosis was affective disorder (72.0%). Personality disorder was identified in 45.9% of patients interviewed at follow-up. Comorbidity of psychiatric and personality disorder was present in 44.1%.ConclusionsPsychiatric and personality disorders, and their comorbidity, are common in DSH patients. This has important implications for assessment and management.
Medium secure forensic psychiatry services
Authors: Coid Jeremy , Kahtan Nadji , Gault Simon , Cook Adrian , Jarman Brian 
Published: August 2002

BackgroundRegional medium secure developments have proceeded unevenly, with wide variations in resources to deliver services.AimsTo compare patients admitted to seven (pre-reorganisation) regional services and styles of service delivery.MethodA record survey of a complete sample of 2608 patients admitted on 3403 occasions between 1 January 1988 and 31 December 1994.ResultsServices differed according to location of patients before admission, their legal basis for detention, criminal and antisocial behaviour, diagnosis, security needs and length of stay. Regions with more resources and lower demand provided a wider range of services. Thames services were relatively under-provided during the study period, with North East Thames substantially reliant on admissions to private hospitals.ConclusionsUncoordinated development led to under-provision despite high demand. Certain regions prioritised offender patients and did not support local psychiatric services. New standards are required for service specification and resource allocation to redress inequality. Traditional performance measures were of limited usefulness in comparing services.
Survey of patients from an inner-London health authority in medium secure psychiatric care
Authors: Lelliott Paul , Audini Bernard , Duffett Richard 
Published: August 2002

BackgroundUnderprovision by the National Health Service (NHS) has led to an increase in medium secure psychiatric beds managed by the independent sector. Black people are overrepresented in medium secure care.AimsTo describe those people from an inner-London health authority occupying all forms of medium secure provision. To compare those in NHS provision with those in the independent sector, and Black patients with White patients.MethodA census of those in medium secure care in August 1997.ResultsThe 90 patients in independent-sector units were similar to the 93 patients in NHS units except that they were more likely to have been referred from general psychiatric services (48% v. 19%) and less likely to have been referred from the criminal justice system or a high-security hospital (37% v. 63%). There were few differences between Black and White patients.ConclusionsThe NHS meets only part of the need for medium secure care of the population of this London health authority. This comparison of the characteristics of Black and White patients does not help to explain why Black people are overrepresented in medium secure settings.
Legal pitfalls of psychiatric research
Authors: Dawson John , King Michael , Papageorgiou Alexia , Davidson Oliver 
Published: August 2002

BackgroundThe increasing complexity of psychiatric research, including recent attempts to evaluate mental health legislation, suggests legal advice may be valuable in a wide range of research contexts.AimsWe aim to illustrate both the legal pitfalls of research in psychiatry and the potential for solutions if the methods are carefully chosen.MethodTwo examples of research are subject to legal analysis, one involving advance directives, the other the random discharge of compulsory out-patients.ResultsThis analysis illustrates that participation in research may expose clinicians to additional forms of liability, but the legal risks can be minimised through changes in the methods or additional safeguards.ConclusionsCollaboration between academic law and psychiatry can enrich research agendas and avoid serious legal pitfalls. We argue that sound legal advice should be sought at the planning stage of research in psychiatry, but the fear of liability should not lead to overly defensive research practices. The aim should be to strike the right balance between avoiding unacceptable exposure to liability and stifling innovative research.
Genetic risk of Alzheimer's disease: advising relatives
Authors: Liddell M. B. , Lovestone S. , Owen M. J. 
Published: August 2002

BackgroundClinicians are increasingly asked by relatives of patients with Alzheimer's disease to advise on their genetic risk of developing Alzheimer's disease in later life. Many clinicians find this a difficult question to answer.AimsTo provide information for old age psychiatrists wishing to advise relatives of their risk of developing Alzheimer's disease.MethodA selective review of the key literature on the genetic epidemiology of Alzheimer's disease.ResultsCurrently a DNA diagnosis is attainable in some 70% of families with autosomal dominant Alzheimer's disease. In first-degree relatives of most cases, risk is increased some three- or four-fold relative to controls, but only one-third of this is realised in the average life span. Apolipoprotein E genotyping cannot be used as a predictive test and confers only minimal diagnostic benefit.ConclusionsPedigrees with familial Alzheimer's disease should be referred to a Regional Centre for Medical Genetics. Accurate risk prediction is not possible in the vast majority of pedigrees with Alzheimer's disease, although it is possible for the psychiatrist to give a rough estimate of the risk, which can reasonably the couched in reassuring terms.
Mortality and long-term course in schizophrenia with a poor 2-year course
Authors: Mojtabai Ramin , Susser Ezra , Varma Vijoy K. , Malhotra Savita , Mattoo Surendra K. , Misra Arun K. , Wig Narendra N. 
Published: August 2002

BackgroundThe short-term course of schizophrenia is reported to be better in some developing country settings. The long-term course in such settings, however, has rarely been studied.AimsTo examine the long-term course and mortality of schizophrenia in patients with a poor 2-year course.MethodThe report is based on two incidence cohorts of first-contact patients in urban and rural Chandigarh, India, originally recruited for the World Health Organization Determinants of Outcome of Severe Mental Disorders study. Patients were assessed using standardised instruments at 2- and 15-year follow-ups.ResultsNinety-two per cent of the patients with a poor 2-year course had a poor long-term course and 47% died – a nine times higher mortality rate than among patients with other 2-year course types.ConclusionsIn this developing country setting, a poor 2-year course was strongly predictive of poor prognosis and high mortality, raising questions about the adequacy of care for such patients.
Ambulance personnel and critical incidents
Authors: Alexander David A. , Klein Susan 
Published: August 2002

BackgroundThe association between mental health and occupational factors among ambulance personnel has not been thoroughly investigated in the UK.AimsTo identify the prevalence of psychopathology among ambulance personnel and its relationship to personality and exposure to critical incidents.MethodData were gathered from ambulance personnel by means of an anonymous questionnaire and standardised measures.ResultsApproximately a third of the sample reported high levels of general psychopathology, burnout and posttraumatic symptoms. Burnout was associated with less job satisfaction, longer time in service, less recovery time between incidents, and more frequent exposure to incidents. Burnout and GHQ–28 caseness were more likely in those who had experienced a particularly disturbing incident in the previous 6 months. Concerns about confidentiality and career prospects deter staff from seeking personal help.ConclusionsThe mental health and emotional well-being of ambulance personnel appear to be compromised by accident and emergency work.
Pharmacology and effects of cannabis: A brief review
Authors: Ashton C. Heather 
Published: August 2002

BackgroundIncreasing prevalence of recreational cannabis use among the young population has stimulated debate on the possible effects of acute and long-term use.AimsTo highlight recent knowledge of mechanisms of action, effects on psychomotor and cognitive performance, and health risks associated with cannabis consumption.MethodA brief review of recent literature on the prevalence of recreational cannabis use, the potency of modern cannabis preparations and the pharmacological actions of cannabis.ResultsCannabinoids derived from herbal cannabis interact with endogenous cannabinoid systems in the body. Actions on specific brain receptors cause dose-related impairments of psychomotor performance with implications for car and train driving, aeroplane piloting and academic performance. Other constituents of cannabis smoke carry respiratory and cardiovascular health risks similar to those of tobacco smoke.ConclusionsCannabis is not, as widely perceived, a harmless drug but poses risks to the individual and to society.
Therapeutic aspects of cannabis and cannabinoids
Authors: Robson Philip 
Published: August 2002

BackgroundReview commissioned in 1996 by the Department of Health (DOH).AimsAssess therapeutic profile of cannabis and cannabinoids.MethodMedline search, references supplied by DOH and others, and personal communications.Results and ConclusionsCannabis and some cannabinoids are effective antiemetics and analgesics and reduce intraocular pressure. There is evidence of symptom relief and improved well-being in selected neurological conditions, AIDS and certain cancers. Cannabinoids may reduce anxiety and improve sleep. Anticonvulsant activity requires clarification. Other properties identified by basic research await evaluation. Standard treatments for many relevant disorders are unsatisfactory. Cannabis is safe in overdose but often produces unwanted effects, typically sedation, intoxication, clumsiness, dizziness, dry mouth, lowered blood pressure or increased heart rate. The discovery of specific receptors and natural ligands may lead to drug developments. Research is needed to optimise dose and route of administration, quantify therapeutic and adverse effects, and examine interactions.
Psychiatric effects of cannabis
Authors: Johns Andrew 
Published: August 2002

BackgroundCannabis is commonly regarded as an innocuous drug and the prevalence of lifetime and regular use has increased in most developed countries. However, accumulative evidence highlights the risks of dependence and other adverse effects, particularly among people with pre-existing psychiatric disorders.AimsTo re-evaluate the adverse effects of cannabis in the general population and among vulnerable individuals, including those with serious psychiatric disorders.MethodA wide-ranging review of the topics related to these issues.Results and conclusionsAn appreciable proportion of cannabis users report short-lived adverse effects, including psychotic states following heavy consumption, and regular users are at risk of dependence. People with major mental illnesses such as schizophrenia are especially vulnerable in that cannabis generally provokes relapse and aggravates existing symptoms. Health workers need to recognise, and respond to, the adverse effects of cannabis on mental health.
Evaluating alternative cannabis regimes
Authors: MacCoun Robert , Reuter Peter 
Published: August 2002

BackgroundCannabis policy continues to be controversial in North America, Europe and Australia.AimsTo inform this debate, we examine alternative legal regimes for controlling cannabis availability and use.MethodWe review evidence on the effects of cannabis depenalisation in the USA, Australia and The Netherlands. We update and extend our previous (MacCoun & Reuter, 1997) empirical comparison of cannabis prevalence statistics in the USA, The Netherlands and other European nations.ResultsThe available evidence indicates that depenalisation of the possession of small quantities of cannabis does not increase cannabis prevalence. The Dutch experience suggests that commercial promotion and sales may significantly increase cannabis prevalence.ConclusionsAlternatives to an aggressively enforced cannabis prohibition are feasible and merit serious consideration. A model of depenalised possession and personal cultivation has many of the advantages of outright legalisation with few of its risks.
Amitriptylinev.the rest: still the leading antidepressant after 40 years of randomised controlled trials
Authors: Barbui Corrado , Hotopf Matthew 
Published: August 2002

BackgroundTricyclic antidepressants have similar efficacy and slightly lower tolerability than selective serotonin reuptake inhibitors (SSRIs). However, there are no systematic reviews assessing amitriptyline, the reference tricyclic drug,v.other tricyclics and SSRIs directly.AimsTo review the tolerability and efficacy of amitriptyline in the management of depression.MethodA systematic review of randomised controlled trials (RCTs) comparing amitriptyline with other tricyclics/heterocyclics or with an SSRI.ResultsWe reviewed 186 RCTs. The overall estimate of the efficacy of amitriptyline revealed a standardised mean difference of 0.147 (95% CI 0.05–0.243), significantly favouring amitriptyline. The overall OR for dropping out was 0.99 (95% CI 0.91–1.08) and that for side-effects was 0.62 (95% CI 0.54–0.70), favouring the control drugs. With drop-outs included as treatment failures, the estimate of the effectiveness of amitriptylinev.tricyclics/heterocyclics and SSRIs showed a 2.5% difference in the proportion of responders in favour of amitriptyline (number needed to treat 40, CI 21–694; OR 1.12 (95%CI 1.01–1.24)).ConclusionsAmitriptyline is less well tolerated than tricyclics/heterocyclics and SSRIs, but slightly more patients treated on it recover than on alternative antidepressants.