bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of phase‐specific treatment of first episode of psychosis on Wisconsin Quality of Life Index (client version)
Authors: Malla Ashok K. , Norman Ross M. G. , McLean Terry S. , McIntosh Elizabeth 
Published: March 2003

Objective: The objective of this study was to assess the impact of a phase‐specific community‐focused treatment program on different dimensions of self‐reported quality of life in a representative sample of first episode psychosis patients. Method: Data were collected on patients presenting with a first episode of psychosis on the Wisconsin Quality of Life Index (client version), positive and negative symptoms, and demographic and clinical variables at baseline following clinical stabilization and at 1 year. Results: Complete data on a representative sample of 41 patients showed a significant improvement in most dimensions of the WQOL at 1 year; these changes were generally independent of changes in symptoms and there were no significant differences in the magnitude of improvement in QOL between those with DUP < or >6 months. Conclusion: Patients with a first episode of predominantly schizophrenia spectrum psychosis show a highly significant improvement in subjectively assessed quality of life following a year of phase‐specific comprehensive treatment.
Cognitive behaviour therapy with coping training for persistent auditory hallucinations in schizophrenia: a naturalistic follow‐up study of the durability of effects
Authors: Wiersma D. , Jenner J. A. , Van De Willige G. , Spakman M. , Nienhuis F. J. 
Published: March 2003

Objective: To investigate the durability of positive effects of cognitive behaviour therapy (CBT) with coping training on psychotic symptoms and social functioning. Method: Forty patients with schizophrenia or related psychotic disorders and refractory auditory hallucinations were given CBT and coping training in an integrated single family treatment programme. In a naturalistic study patients were followed after 2 and 4 years since the start of treatment. Results: The treatment improved overall burden of ‘hearing voices’, with a generalization into daily functioning. Improvement with regard to fear, loss of control, disturbance of thought and interference with thinking was sustained by 60% of the patients while one‐third improved further. Complete disappearance of hallucinations occurred in 18% of the patients. Conclusion: CBT with coping training can improve both overall symptomatology and quality of life, even over longer periods of time, but a status of persistent disablement indicates a continuing need for mental health care.
Predictive factors of post‐discharge follow‐up care among adolescent suicide attempters
Authors: Granboulan V. , Roudot‐Thoraval F. , Lemerle S. , Alvin P. 
Published: March 2003

Objective:  To study short‐term compliance with follow‐up care in a sample of adolescent suicide attempters. Method:  One hundred and sixty‐seven adolescents, aged from 13–18 years and hospitalized after a suicide attempt, completed a questionnaire that included the CES‐Depression Scale and Zung Anxiety Scale. Physicians assessed the hospital care immediately after the attempt, and post‐discharge care plans. Three months later, adolescents were contacted by telephone and asked about follow‐up care. Results:  After 3 months, 91.6% of the adolescents could be contacted: 25.5% never attended any follow‐up; 11.1% went only once; 31.4% missed some appointments; and 32.0% went to all their scheduled appointments. Adolescents who complied with follow‐up care differed significantly from those who did not: they showed more depression, anxiety and illicit drug use at the time of the attempt; they had more often planned the attempt; they were hospitalized longer; and they met with a psychiatrist more often while hospitalized. Compliance was also better when the follow‐up appointment was scheduled before discharge. Conclusion:  Compliance with post‐discharge follow‐up care depends upon the adolescent's psychopathology but may also be improved by the type of hospital care and post‐discharge plans.
CYP2D6 and CYP2C19 genotype‐based dose recommendations for antidepressants: a first step towards subpopulation‐specific dosages
Authors: Kirchheiner J. , Brøsen K. , Dahl M. L. , Gram L. F. , Kasper S. , Roots I. , Sjöqvist F. , Spina E. , Brockmöller J. 
Published: March 2003

Objective: This review aimed to provide distinct dose recommendations for antidepressants based on the genotypes of cytochrome P450 enzymes CYP2D6 and CYP2C19. This approach may be a useful complementation to clinical monitoring and therapeutic drug monitoring.Method: Our literature search covered 32 antidepressants marketed in Europe, Canada, and the United States. We evaluated studies which had compared pharmacokinetic parameters of antidepressants among poor, intermediate, extensive and ultrarapid metabolizers.Results: For 14 antidepressants, distinct dose recommendations for extensive, intermediate and poor metabolizers of either CYP2D6 or CYP2C19 were given. For the tricyclic antidepressants, dose reductions around 50% were generally recommended for poor metabolizers of substrates of CYP2D6 or CYP2C19, whereas differences were smaller for the selective serotonin reuptake inhibitors.Conclusion: We have provided preliminary average dose suggestions based on the phenotype or genotype. This is a first attempt to apply the new pharmacogenetics to suggest dose‐regimens that take the differences in drug metabolic capacity into account.
Structural brain abnormalities in unselected in‐patients with major depression
Authors: Videbech Poul , Ravnkilde Barbara , Fiirgaard Bente , Clemmensen Karin , Egander Annette , Rasmussen Niels Anton , Christensen Thorkil , Sangill Ryan , Rosenberg Raben 
Published: March 2003

Objective: Several studies have indicated an increased frequency of cerebral atrophy and white matter lesions in patients with major depression, especially in older age groups. Method: Forty‐four representative in‐patients with major depression in which neurological disorders were clinically excluded, and 49 age‐ and gender‐matched controls were MR scanned. Results: Unexpectedly, two of the patients had severe brain pathology which could account for their psychiatric symptoms. Analysis of the remaining patients (mean age 42 years) did not reveal an increased frequency of cerebral atrophy. The number of white matter lesions increased with age to an odds ratio greater than 3 for patients aged 50, but this was not statistically significant. Conclusion: Brain atrophy and white matter lesions did not occur with significantly increased frequency in these relatively young unselected depressives, but the finding of severe brain pathology stresses the importance of brain imaging in late‐onset psychiatric disorders.
Maastricht Assessment of Coping Strategies (MACS‐I): a brief instrument to assess coping with psychotic symptoms
Authors: Bak Maarten , Van Der Spil Farida , Gunther Nicole , Radstake Steven , Delespaul Philippe , Van Os Jim 
Published: March 2003

Objective: To examine the reliability of a brief instrument to assess coping with symptoms by patients with psychotic illness. Method: A semi‐structured interview (MACS) was developed to assess the amounts of distress, control and coping in relation to psychotic symptoms. Two raters interviewed 23 symptomatic but stable patients with a diagnosis of chronic schizophrenia on two separate occasions. Case managers were also interviewed. Results: Both the number of coping strategies used for different groups of symptoms, and the amount of coping used in different domains of coping strategies could be assessed reliably between interviewers (intraclass correlation coefficients range: 0.90–0.97) and between interview sessions (ICCs range: 0.75–0.80). Reliability with case managers, however, was low. Conclusion: The MACS may be a reliable and useful instrument to assess coping in relation to subjective experience of distress by and control over psychotic symptoms.
Care utilization and outcome of DSM‐III‐R major depression in the general population. Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS)
Authors: Spijker J. , Bijl R. V. , De Graaf R. , Nolen W. A. 
Published: March 2003

Objective: To assess care utilization, individual characteristics and clinical and functional outcomes for various modalities of professional care in people with DSM‐III‐R major depression. Method: Psychiatric diagnoses were determined at baseline and 12‐month follow‐up in a representative sample (N=7076) of the Dutch population, using the Composite International Diagnostic Interview (CIDI). Results: A total of 45.3% of the 223 individuals with major depression received professional care in the 12 months between baseline and follow‐up, and 42.6% of these were treated with antidepressant medication. Higher level of care was associated with clinical factors and functional limitations. Clinical outcomes were poorly correlated with functional outcomes. Mild to moderate effects in functional outcome were found for all care modalities. Conclusion: Outcome of antidepressant treatment can be improved and such treatment should focus on the more severe forms of depression. Functional outcome assessment is recommended in addition to clinical assessment.
Is any female preponderance in depression secondary to a primary female preponderance in anxiety disorders?
Authors: Parker G. , Hadzi‐Pavlovic D. 
Published: March 2003

Objective: National community studies consistently identify higher rates of both depressive and anxiety disorders in women. The female preponderance in depression could be primary or, alternatively, a sex difference in anxiety could determine the differential depression rates. We therefore pursue whether the female preponderance in depression is secondary to a female preponderance in anxiety disorders in a community sample. Method: We analyse relevant data from the National Comorbidity Study (NCS) database, examining in particular whether sex differences in anxiety (here those meeting criteria for panic disorder, agoraphobia without panic disorder, generalized anxiety and social phobia) influenced sex differences in the prevalence of both major depression and dysthymia. Results: Survival analyses indicated that, for both major depression and dysthymia, and within subsamples of those with early onset and late onset depression, both female sex and a preceding anxiety disorder made significant contributions, with preceding anxiety making the consistently stronger contribution of the two. Conclusion: A proportion of the female preponderance in major depression and dysthymia in the general community appears determined by a primary sex difference in anxiety.
Dose–response relationship of selective serotonin reuptake inhibitors treatment‐emergent hypomania in depressive disorders
Authors: Ramasubbu R. 
Published: March 2003

Objective: The notion that antidepressant treatment‐associated hypomania or mania being pharmacologically induced has been challenged. To determine whether selective serotonin reuptake inhibitors (SSRI) induced hypomania is secondary to medication effects, we examined the dose–response relationship of SSRI‐induced hypomania in two patients with depressive disorder. Method: Case study. Result: Hypomanic symptoms emerged during treatment with sertraline at the dose of 300 mg per day in a 45‐year‐old male with major depression. Paroxetine treatment at the dose of 80 mg per day induced hypomania in a 37‐year‐old female with dysthymia and trichitillomania. These patients have no family or personal history of bipolar disorder. Hypomania resolved when sertraline was decreased to 200 mg per day and paroxetine to 40 mg per day. No hypomanic switch was observed during 18–24 months follow‐up. Conclusion: In the absence of risk factors for manic switch, SSRI‐induced hypomania may be dose‐dependent medication effects.
Lower suicide risk with long‐term lithium treatment in major affective illness: a meta‐analysis
Authors: Tondo Leonardo , Hennen John , Baldessarini Ross J. 
Published: March 2003

Objective: To compare suicide rates with vs. without long‐term lithium treatment in major affective disorders. Method: Broad searching yielded 22 studies providing suicide rates during lithium maintenance; 13 also provide rates without such treatment. Study quality was scored, between‐study variance tested, and suicide rates on vs. off lithium examined by meta‐analyses using random‐effects regression methods to model risk ratios. Results: Among 5647 patients (33 473 patient‐years of risk) in 22 studies, suicide was 82% less frequent during lithium‐treatment (0.159 vs. 0.875 deaths/100 patient‐years). The computed risk‐ratio in studies with rates on/off lithium was 8.85 (95% CI, 4.12–19.1; P<0.0001). Higher rates off‐lithium were not accounted for by treatment‐discontinuation. Conclusion: Suicide risk was consistently lower during long‐term treatment of major affective illnesses with lithium in all studies in the meta‐analysis, including the few involving treatment‐randomization.
Quality of life in schizophrenia in India: comparison of three approaches
Authors: Lobana Aprajita , Mattoo Surendra K. , Basu Debasish , Gupta Nitin 
Published: March 2003

Objective: To compare ratings of quality of life in patients with established schizophrenia in Chandigarh, India, in both subjective and objective view points and between patients' and relatives' ratings. Method: Subjective and objective quality of life was assessed in 38 patients with schizophrenia using the Quality of Life Interview – Brief Version and WHO Quality of Life – Bref scale. Key family members were also interviewed using the same scales. Results: Subjective and objective quality of life are moderately well correlated (r=0.43) and similar agreement was found between patients and relatives (r=0.46). Conclusion: Although quality of life is characteristically measured with subjects, the use of objective measures of quality of life and key informants of patients provide useful proxy measures.
Mental health in Europe: problems, advances and challenges
Authors: Rutz W. 
Published: March 2003

Objective: To describe mental health care needs and challenges across the WHO European region of 51 nations. Method: Based on morbidity and mortality data from HFA Statistical Database and Health21, the policy framework of WHO Europe, major trends in mental health care needs, psychiatric reform and mental health promotion are discussed. Results: There is a mortality crisis related to mental ill health in Eastern European populations of transition. Destigmatization is required to improve early intervention and humanization of services, and national mental health audits are needed to create the basis for national mental health planning, implementation and monitoring. There are both problems and advances in service restructuring, and comprehensive mental health promotion programmes, preventive and monitoring strategies are required. Conclusion: Partnerships between national and international organizations, especially WHO and the European Union, have to be strengthened to make progress on the way to integrated community mental health services.
Mental health reforms in Eastern Europe
Authors: Tomov T. 
Published: March 2003

Objective: To describe the background in general culture, public and professional discourse against which mental health care reform initiatives in Eastern Europe need to be seen. Method: An account of some key aspects of sociopolitical and cultural transition in Eastern European countries is given, and core results of a research project on attitudes and needs assessment in psychiatry in six Eastern European countries are reported. Results: In post‐totalitarian cultures mental health reforms impinge on imagination in ways which are not easy to predict. Some of the reasons for this are traced to the psychiatric practices under the system of total control, e.g. dispensary care, political abuse, reification of classificatory terms. Data on a study of attitudes suggest that institutions had replaced community life in those parts of Europe. Conclusion: It is predicted that with time trust in the capacity of community to contain mental illness will be regained.
Psychiatric reform in Germany
Authors: Bauer M. , Kunze H. , Von Cranach M. , Fritze J. , Becker T. 
Published: March 2003

Objective: To describe the ongoing process of German psychiatric reform and the structure and functioning of mental health services. Method: Information sources used include official reports describing mental health services, relevant publications related to organization and functioning of services. Results: There has been far‐reaching change in mental health care since the late 1960s: psychiatric hospitals have lost about 50% of their beds and one psychiatric hospital has been closed. One hundred and sixty‐five general hospital psychiatric units have been built up. Out‐patient, community and residential services have been developed. There is a lack of diversified residential and rehabilitation services, particularly for the most severely ill. Co‐ordination of care is not always ensured, transfer of patients to remote nursing homes has occurred in some places. Carers and service users articulate their views to an increasing degree. Conclusion: Political and professional enthusiasm have been important in implementation of the German reform. Evolving it further will require major efforts.
Mental health care in Germany: carers’ perspectives
Authors: Brand U. 
Published: March 2003

Objective: To assess the mental health care system in Germany from the point of view of the federal association of family carers of people with mental illness. Method: Family carer involvement and perspective are discussed on the basis of available literature, questionnaire surveys and documents of carer organizations. Results: At the beginning of the reform movement the views of informal carers were not discussed. Since 1985 family carers have joined forces to express their views on needs of the severely mentally ill and their carers. Their aim is to point out deficits of the care system and to work towards improved care for their relatives with mental illness and changes in the mental health care system. Conclusion: In the reform process informal carers should receive support and be respected as experts and partners.
Mental health service provision in England
Authors: Johnson S. , Zinkler M. , Priebe S. 
Published: March 2003

Objective: To describe mental health service provision for adults of working age in England. Method: Services in an inner London area are described so as to illustrate current patterns of service organization in England. National trends are then discussed. Results: Despite relatively low public expenditure, substantial progress has been made in deinstitutionalization and development of comprehensive community‐based services. Persisting difficulties include high staff turnover, a minority of patients who do not engage with community services, user and carer dissatisfaction with emergency services, and social exclusion because of stigma. Recent government policy advocates resolving some of these problems using new service models such as assertive outreach and crisis teams. Conclusion: Closure of the large asylums has largely been accomplished. England is now entering a new phase in community service development, with a range of innovative developments aimed at resolving problems still encountered after the initial phases of integrated community service development.
Trends and developments in public psychiatry in France since 1975
Authors: Provost Dominique , Bauer Andrée 
Published: March 2003

Objective: The authors present an account of the current state of sectorization in France and its development over the last decade. Method: The paper is based on statistics collected by the French Health Ministry and on relevant laws and regulations. Comments by patients, families and professionals are presented. Results: The supply of mental health care is usually satisfactory, and there is a tendency for in‐patient units to be converted into day hospitals. There is a large disparity between regions, especially in child and adolescent psychiatry. The 1838 law governing compulsory admissions was revised in 1990, and this revision was the object of a commission of inquiry in 1995. Psychiatric units work on the borders between health and social services and are forging new links between the two. Conclusion: Psychiatric care requires an integrated health and social perspective. In the field of mental health legislation European recommendations are called for.
Mental health care reform in Sweden, 1995
Authors: Stefansson C.‐G. , Hansson L. 
Published: March 2003

Objective: To describe the content of the Community Mental Health Care reform in Sweden, in effect from 1995 and directed to severely mentally ill people (SMI). Method: Evaluating changes, at local and national level, in living conditions among SMI and resources of services directed to them, by using registers, questionnaires, interviews and case studies. Results: A survey, covering 93% of the population, identified 43 000 SMI (prevalence of 0.63%); 4000 long‐stay patients and 400 rehabilitation programmes were transferred from psychiatric services to social services (15% of the budget of psychiatric services). Employment and rehabilitation projects, family support and user programmes and educational projects for social services staff, were launched (funded by state subsidies). Conclusion: SMI still have difficulties in obtaining adequate support on the basis of disability laws and there continue to be barriers between social services and psychiatric services.
Spanish psychiatric reform: what can be learned from two decades of experience?
Authors: Vázquez‐Barquero José Luis , García José , Torres‐González Francisco 
Published: March 2003

Objective: The objective of the paper is to describe the impact of Spanish psychiatric reform on the organization and functioning of mental health services.Method: This paper is based on official administrative reports and on relevant related publications.Results: The most significant achievements of Spanish psychiatric reform have been: (i) the development of a new organization of mental health care, decentralized in character and territorially based; (ii) the integration of psychiatric patients in general health care; (iii) the creation of an extensive community network of health centres; and (iv) the development of more positive attitudes towards mental illness. However, our analysis also reveals the existence of significant deficiencies.Conclusion: Analysis of the Spanish experience shows that the process of psychiatric reform depends basically on long‐term commitments, which in a system such as Spain’s must come from central administration and also from the autonomous communities.