bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relapse prevention in bipolar I disorder: 18-month comparison of olanzapine plus mood stabiliser v. mood stabiliser alone
Authors: Tohen Mauricio , Chengappa K. N. Roy , Suppes Trisha , Baker Robert W. , Zarate Carlos A. , Bowden Charles L. , Sachs Gary S. , Kupfer David J. , Ghaemi S. Nassir , Feldman Peter D. , Risser Richard C. , Evans Angela R. , Calabrese Joseph R. 
Published: March 2004

BackgroundFew controlled studies have examined the use of atypical antipsychotic drugs for prevention of relapse in patients with bipolar I disorder.AimsTo evaluate whether olanzapine plus either lithium or valproate reduces the rate of relapse, compared with lithium or valproate alone.MethodPatients achieving syndromic remission after 6 weeks'treatment with olanzapine plus either lithium (0.6–1.2 mmol/l) or valproate (50–125 μg/ml) received lithium or valproate plus either olanzapine 5–20 mg/day (combination therapy) or placebo (monotherapy), and were followed in a double-masked trial for 18 months.ResultsThe treatment difference in time to relapse into either mania or depression was not significant for syndromic relapse (median time to relapse: combination therapy 94 days, monotherapy40.5 days; P=0.742), but was significant for symptomatic relapse (combination therapy 163 days, monotherapy42 days; P=0.023).ConclusionsPatients taking olanzapine added to lithium or valproate experienced sustained symptomatic remission, but not syndromic remission, for longer than those receiving lithium or valproate monotherapy.
Relapse in schizophrenia: costs, clinical outcomes and quality of life
Authors: Almond Stephen , Knapp Martin , Francois Clement , Toumi Mondher , Brugha Traolach 
Published: March 2004

BackgroundRelapse is one of the most costly aspects of schizophrenia.AimsTo compare costs, clinical outcomes and quality of life for patients who experienced relapse in schizophrenia with a control group who did not relapse.MethodPatients were randomly selected from current psychiatric case-loads drawn from urban and suburban areas of Leicester. Differences in costs and outcomes by relapse status in the previous 6 months were examined using parametric and non-parametric tests, and multivariate analysis was used to examine factors associated with relapse and costs.ResultsCosts for the patients who relapsed were over four times higher than those for the non-relapse group. There were few statistically significant differences in clinical and quality of life measures by relapse status. Multivariate analyses suggested some significant correlates of relapse and costs.ConclusionsThe higher costs associated with relapse will be of interest to policy-makers who face difficult choices concerning new but more expensive treatments for patients with schizophrenia.
Unusually persistent complainants
Authors: Lester Grant , Wilson Franzcp Beth , Griffin Lynn , Mullen Paul E. 
Published: March 2004

BackgroundQuerulous paranoia may have disappeared from the psychiatric literature, but is it flourishing in modern complaints organisations and the courts? Aims To investigate the unusually persistent complainants who lay waste to their own lives and place inordinate demands and stress on complaints organisations.MethodComplaints officers completed questionnaires on both unusually persistent complainants and matched controls.ResultsPersistent complainants (distinguished by their pursuit of vindication and retribution) consumed time and resources and resorted to both direct and veiled threats. Attempts to distinguish these people from a control group on the basis of the manner in which their claims were initially managed failed.ConclusionsPersistent complainants' pursuit of vindication and retribution fits badly with complaints systems established to deliver reparation and compensation. These complainants damaged the financial and social fabric of their own lives and frightened those dealing with their claims. The study suggests methods of early detection and alternative management strategies.
Spontaneous improvement in severe, chronic schizophrenia and its neuropsychological correlates
Authors: Murray G. K. , Leeson V. , McKenna P. J. 
Published: March 2004

SummaryCognitive impairment is well established in schizophrenia but its relationship to the course of the illness remains incompletely understood. Here we document two patients with schizophrenia who underwent neuropsychological testing while chronically unwell, and this was repeated after improvement took place. Both patients showed significant recovery of general intellectual function, accompanied by improvements in some but not all areas of neuropsychological function: executive function remained particularly impaired.
Psychiatric complications in patients with severe acute respiratory syndrome (SARS) during the acute treatment phase: a series of 10 cases
Authors: Cheng Sammy Kin-Wing , Tsang Jenny Suk-Kwan , Ku Kwok-Hung , Wong Chee-Wing , Ng Yin-Kwok 
Published: March 2004

SummaryIn February 2003, Hong Kong was hit by a community-wide outbreak of severe acute respiratory syndrome (SARS). During the period of the outbreak, 10 patients with SARS with psychiatric complications were referred to our Consultation and Liaison Psychiatry Team for assessment and management. We found that both the direct and indirect effects of SARS such as symptom severity total isolation during treatment and administration of steroid were probable causes of psychiatric complications. In this paper, we report on the nature of their psychiatric problems, challenges to management and psychiatric treatment strategies used during the acute phase.
Diet, diabetes and schizophrenia: Review and hypothesis
Authors: Peet Malcolm 
Published: March 2004

BackgroundDiabetes is more common in people with schizophrenia than in the general population.AimsTo explore the possible reasons for the association between diabetes and schizophrenia.MethodDiet and other lifestyle factors in patients with schizophrenia were reviewed as risk factors for diabetes.ResultsPeople with schizophrenia show features of the metabolic syndrome at the onset of illness, before treatment. They also eat a poor diet, take little exercise and have high rates of smoking. Food intake may be increased further by antipsychotic medication. Nutritional factors appear to have a key role in the development of diabetes in patients with schizophrenia and may also affect the outcome and severity of schizophrenia. A common pathway through which diet might contribute to the development of both diabetes and schizophrenia is proposed.ConclusionsLifestyle factors may influence outcomes in both diabetes and schizophrenia. Lifestyle interventions are the key to improving the long-term health of people with schizophrenia.
Prevalence of diabetes and impaired glucose tolerance in patients with schizophrenia
Authors: Bushe Chris , Holt Richard 
Published: March 2004

BackgroundA number of studies have examined the prevalence of diabetes mellitus and impaired glucose tolerance in general populations and in those with schizophrenia and other forms of serious mental illness.AimsTo establish whether it is possible to describe accurately comparative rates of diabetes mellitus and impaired glucose tolerance in populations of people with schizophrenia and those without mental illness.MethodReview of current literature.ResultsResearch published in the pre-neuroleptic era suggested that people with severe mental illness were at increased risk of developing glycaemic abnormalities. Recent studies appear to confirm that the prevalence of diabetes and impaired glucose tolerance may be higher in people with schizophrenia than in the general population, and suggest that patients with schizophrenia have impaired glucose tolerance even before they begin treatment.ConclusionsSchizophrenia may be a significant and independent risk factor for both diabetes and impaired glucose tolerance. Current data preclude precise estimates of the prevalence of these conditions among people with schizophrenia.
Stress and the genesis of diabetes mellitus in schizophrenia
Authors: Dinan Timothy G. 
Published: March 2004

BackgroundThe incidence of diabetes mellitus is higher in patients with schizophrenia than in the general population. Antipsychotic drugs have been implicated in the development of diabetes, but as non-medicated patients with schizophrenia have high rates of diabetes it is likely that factors other than medication are involved.AimTo examine the role of stress in the emergence of diabetes mellitus in patients with schizophrenia.MethodSelective literature review.ResultsA model is developed suggesting that patients with schizophrenia show overactivation of both the hypothalamic–pituitary–adrenal and sympathoadrenal medullary axes, manifested by increased production of cortisol and adrenaline. Both of these hormones are known to be diabetogenic and are proposed as playing a part in the onset of diabetes mellitus in schizophrenia.ConclusionsStress has an important role in the onset of schizophrenia and may also play a part in relapse. Further research is needed to clarify the extent to which stress accounts for the genesis of diabetes in such patients.
Metabolic disturbance in first-episode schizophrenia
Authors: Thakore Jogin H. 
Published: March 2004

BackgroundSchizophrenia shortens life, e.g. through suicide and obesity-related diseases such as type 2 diabetes mellitus. It is assumed that medications play a major role, but most of the evidence for this comes from studies poorly controlled for variables such as lifestyle and medication status.AimsTo determine whether schizophrenia is associated (independently of medication) with the development of certain metabolic disturbances and whether these might be explained by stress axis dysfunction.MethodLiterature review.ResultsMost studies did not control for confounding factors such as previous usage of medication, lifestyle, age and ethnicity. A few conducted in drug-naive patients with first-episode schizophrenia appear to indicate that these patients have higher than expected rates of visceral obesity and impaired fasting glucose concentrations, which may be related to a subtle disturbance of the hypothalamic–pituitary–adrenal axis.ConclusionsSchizophrenia is independently associated with physical illnesses that have a metabolic signature. Therefore, patients need to have a thorough physical assessment at diagnosis and at regular intervals thereafter. Metabolic disturbances have been found in drug-naïve patients with first-episode illness and may be an inherent part of the illness.
Antipsychotics and diabetes: Review of non-prospective data
Authors: Haddad Peter M. 
Published: March 2004

BackgroundMuch of the existing data regarding the relationship between antipsychotic medications and diabetes mellitus are non-prospective.AimsTo review critically non-prospective studies examining antipsychotic medications as risk factors for diabetes mellitus.MethodDatabase and manual searches.ResultsAnecdotal reports indicate that conventional and atypical antipsychotics can cause diabetes mellitus. However, retrospective studies cannot reliably quantify this association, as they do not adequately control for confounding risk factors for diabetes, or for variation in detection and diagnosis of this illness. Most studies report a higher rate of diabetes in patients who use antipsychotic medication than in non-users, and in patients taking atypical v. conventional antipsychotics. Studies assessing the relative risks of diabetes between individual atypical antipsychotics are contradictory.ConclusionsRetrospective data are of limited value. Well-designed prospective studies, which account for potential confounders, are needed to investigate the true association between antipsychotic medications and diabetes.
Association between atypical antipsychotic agents and type 2 diabetes: Review of prospective clinical data
Authors: Bushe Chris , Leonard Brian 
Published: March 2004

BackgroundMost evidence suggesting an association between schizophrenia, antipsychotic medications and diabetes has been based on retrospective studies not controlled for important confounders.AimsTo compare diabetogenic risk between antipsychotic medications; and to describe the limitations of current prospective data-sets.MethodSystematic review of prospective clinical data.ResultsNo difference in the incidence of glycaemic abnormalities between placebo cohorts and antipsychotic medication cohorts was identified. No significant difference between any of the antipsychotic medications studied in terms of their association with glycaemic abnormalities was identified. Treatment-related weight gain did not appear to increase the risk of developing diabetes.ConclusionsDiabetogenic potential ascribed to atypical antipsychotic drugs, resulting from retrospective studies, may be incorrect. Cohort sizes and incomplete sampling must preclude any definitive conclusions. Long-term, large, comparative prospective trials are needed, along with agreement upon glucose measurement of choice.
Retrospective analysis of risk factors in patients with treatment-emergent diabetes during clinical trials of antipsychotic medications
Authors: Cavazzoni Patrizia , Mukhopadhyay Nitai , Carlson Christopher , Breier Alan , Buse John 
Published: March 2004

AimsIn this retrospective analysis, we assessed the short-term risk of treatment-emergent diabetes (TED) among patients with schizophrenia during clinical trials of antipsychotic medications.MethodFrom a non-diabetic cohort of patients with schizophrenia (n=5013), the relationship between baseline non-fasting glucose measurement, presence at baseline of risk factors for diabetes, weight gain and therapy assignment on the risk of treatment-emergent diabetes were assessed.ResultsAt the baseline assessment, about a third of patients identified with TED during treatment had non-fasting glucose levels over 7.8 mmol/l and two-thirds had multiple diabetes risk factors. Both baseline non-fasting glucose level and the presence of multiple pre-existing diabetes risk factors appeared to have a major impact on the risk of developing diabetes.ConclusionsOverall, risk factors for diabetes in patients with schizophrenia overlap those in the general population. The results also suggest that many patients identified with TED might have had pre-existing glycaemic abnormalities or a high baseline burden of diabetes risk factors.
Cognitive therapy training for psychiatrists: impact on individual clinical practice
Authors: Swift G. , Durkin I. , Beuster C. 
Published: March 2004

Aims and MethodWe aimed to survey how psychiatrists with in-depth training in cognitive therapy use these skills. A postal questionnaire based on a previous survey was sent to all psychiatrists who are accredited members of the British Association for Behavioural and Cognitive Psychotherapies.ResultsThere was a 94% response rate. Psychiatrists in non-psychotherapy posts used formal cognitive therapy, with an average of 20% of new patients compared with 65% for those in psychotherapy posts, and were less satisfied with the extent to which they were able to use their skills (20%v. 80%). A total of 85% of respondents described themselves as being involved in teaching, training and supervision of cognitive therapy.Clinical ImplicationsUnless psychiatrists are planning on working in specialised psychotherapy posts, they are unlikely to use cognitive therapy training in formal therapy sessions. Further research is needed to determine whether cognitive therapy training for psychiatrists translates into improved outcomes for patients.
Domiciliary phlebotomy for elderly people with mental illness
Authors: Darley Malcolm , Siller Catherine , Anderson David 
Published: March 2004

Aims and MethodThis paper reports the evaluation of a pilot domiciliary phlebotomy service provided by an old age psychiatry service to enhance the management of patients in their own homes. Clinical and demographic data were collected and the costs of phlebotomy home visits compared with those of ambulance transport.ResultsOf 511 phlebotomy visits made to 307 patients, only 8% were unsuccessful. A subgroup analysis indicated that 70% of patients would have been unable to leave home unaccompanied to attend for venepuncture. The cost of the phlebotomist's travel was comparable with the estimated cost of providing ambulance transport for patients who would have required it.Clinical ImplicationsDomiciliary phlebotomy can be a viable method of performing blood investigations in an old age psychiatry service to support home assessment.
Trainee psychiatrists' assessment outcomes
Authors: Tunbridge Michael , Dickinson David , Swan Pauline 
Published: March 2004

Aims and MethodThe Record of In-Training Assessment grades of all registrars in the psychiatric specialties in the UK were analysed for each of three successive years, specialty by specialty, and compared with the average outcome for registrars in all disciplines over the same period.ResultsOver 98% of psychiatry registrars were assessed as satisfactory, 1.2% needed targeted training and 0.7% were graded as unsatisfactory, requiring repeat training. Targeted training and repeat training led to a satisfactory outcome in the majority of cases.Clinical ImplicationsThe process of assessment needs to become more objective, and should do so as the Royal Colleges develop better measures of clinical competence.
The Disability Discrimination Act 1995 and psychiatry: lessons from the first seven years
Authors: Glozier Nick 
Published: March 2004

Aims and MethodTo extract relevant information for clinicians from reported and/or accessible cases involving psychiatric illness brought under the Disability Discrimination Act 1995 (DDA). Institutional databases were searched for DDA cases and relevant guidance from case law extracted.ResultsOver half the cases reaching higher courts involve psychiatric illness. A number of decisions provide guidance for clinicians wishing to aid their own patients, and those involved as expert witnesses. These cover which conditions are included as impairments (almost everything in ICD–10), what associated effects are to be considered, and the relevance of comorbidity and treatment. Cases often involve recovery of clinical documents that reveal interesting variation in professional standards.Clinical ImplicationsVirtually all patients of psychiatrists in secondary care would be covered by the DDA. Knowledge of this Act could be used to enhance a patient's access to employment and services, and potentially overcome some of the effects of stigmatisation.
Retirement intentions of older consultant psychiatrists
Authors: Mears Alex , Kendall Tim , Katona Cornelius , Pashley Carole , Pajak Sarah 
Published: March 2004

Aims and MethodThis survey gathered data on the retirement intentions of consultant psychiatrists over the age of 50 years, in order to address retention issues. A questionnaire was sent to all 1438 consultants over this age in the UK.ResultsA total of 848 questionnaires were returned, an adjusted response rate of 59%. The mean age at which consultants intended to retire in this sample was 60 years (s.d. 4.16), suggesting a potential loss of 5725 consultant years. Reasons for early retirement are complex: factors encouraging retirement include too much bureaucracy, lack of free time and heavy case-loads; those discouraging retirement include enjoyment of work, having a good team and money. Mental Health Officer status is an important determinant in the decision to retire early.Clinical ImplicationsWith numerous vacancies in consultant psychiatrist posts throughout the UK, premature retirement is a cause for concern, possibly contributing to an overall reduction in consultant numbers of 5%. Addressing factors that influence consultants' decisions to leave the health service early should form an important part of an overall strategy to increase consultant numbers.
Neonatal Estrogen Exposure Disrupts Uterine Development in the Postnatal Sheep
Authors: Hayashi Kanako , Carpenter Karen D. , Spencer Thomas E. 
Published: April 2004

AbstractPostnatal development of the ovine uterus between birth and postnatal day (PND) 56 involves budding differentiation of the endometrial glandular epithelium from the luminal epithelium (LE) followed by extensive coiling and branching morphogenesis of the tubular glands. To determine the short- and long-term effects of estrogen on neonatal ovine uterine development after PND 14, neonatal sheep were randomly assigned at birth (PND 0) to be treated daily with estradiol-17β benzoate (EB; 0, 0.01, 0.1, 1, or 10 μg/kg body weight·d) during one of two developmental periods (PND 14–27 or 42–55). All ewes were hemiovariohysterectomized at the end of EB treatment on either PND 28 or 56, and the remaining uterine horn and ovary removed on PND 112. Immediate responses to EB treatment included dose- and age-dependent increases in uterine wet weight, thickness of the endometrium, myometrium, and LE, but decreases in endometrial glands on PND 28 and 56. Transient exposure to EB decreased gland number and thickness of the endometrium and LE on PND 112 but did not affect extrauterine reproductive tract structures. The mechanism of estrogen inhibition of uterine development did not involve effects on cell proliferation. Real-time PCR analyses found that EB exposure disrupted normal patterns of growth factor (IGF-I, IGF-II, fibroblast growth factor-7, fibroblast growth factor-10, and hepatocyte growth factor) and receptor mRNA expression in the uterus. Transient exposure of the neonatal ewe to estrogens during critical periods specifically alters growth factor networks that perturb normal development of the uterus, leading to permanent alterations in uterine structure and function.
Prices, contracts and motivations: institutional arrangements in domiciliary care
Authors: Forder Julien , Knapp Martin , Kendall Jeremy , Matosevic Tihana , Hardy Brian , Ware Patricia 
Published: April 2004

English
The social care reforms of the early 1990s have had profound effects on the domiciliary care system. The adoption of markets and the ‘enabling’ role for local authorities are central features. In contrast to much of the original rhetoric that lay behind these reforms, economic theory emphasises the importance of the institutional arrangements in affecting performance. Given the discretion that local authorities have over the specific form of transactions with providers, questions about contract choices are especially pertinent. This article describes the range of arrangements being used and the different implications of contract choices. In the context of relatively competitive markets and organisations exhibiting a range of business motivations, the evidence supports the hypothesis that for otherwise equivalent providers, prices are significantly affected by contract type. In short, institutional arrangements matter.
Towards the “Pressure and Materials Gap”: Hydrogenation of Acrolein Using Silver Catalysts
Authors: Bron M. , Kondratenko E. , Trunschke A. , Claus P. 
Published: April 2004

Abstract
The hydrogenation of acrolein has been studied over various Ag/SiO2 catalysts in a pressure range from 50mbar to 20bar. Increasing partial pressures of acrolein and/or hydrogen lead to increasing selectivities of allyl alcohol. The selectivity towards allyl alcohol also depends on the structural features of the Ag/SiO2 catalyst. Larger particles seem to favour the production of propanal. This observation is discussed in view of the different plane-to-edge-ratio of the different catalysts. The interaction of hydrogen with silver samples has been studied with TAP at very low pressures as well as with calorimetry at ambient pressures. Both methods indicate, that also the hydrogen adsorption is structure-sensitive. No interaction of hydrogen with electrolytic silver or the support material alone was observed. IR spectroscopy has been used to elucidate the interaction of acrolein with Ag/SiO2 catalysts. A strong interaction with the support material was found, hindering the observation of probable silver-acrolein interaction.