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Showing papers in "British Journal of Psychiatry in 1990"


Journal ArticleDOI
TL;DR: A two-day consultation in Geneva in March 2008 was convened to identify knowledge gaps in the public health approach to delivering ART and care in low and middle-income countries, the obstacles that exist to addressing those gaps, and ways to overcome those obstacles.
Abstract: 1. BAckgrounD The World Health Organization (WHO) convened a two-day consultation in Geneva in March 2008 to identify knowledge gaps in the public health approach to delivering ART and care in lowand middle-income countries, the obstacles that exist to addressing those gaps, and ways to overcome those obstacles. The meeting was co-sponsored by the International AIDS Society (IAS), the World Bank and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Participants included leading clinicians, community advocates, programme managers, researchers, donors and normative agency representatives.

1,261 citations


Journal ArticleDOI
TL;DR: It is proposed that insight is not an ‘all-or-none’ phenomenon but is composed of three distinct, overlapping dimensions, namely, the recognition that one has a mental illness, compliance with treatment, and the ability to relabel unusual mental events as pathological.
Abstract: The concept of insight into psychosis has received scant attention in the psychiatric literature. Drawing on sources such as phenomenology, clinical research and experimental psychology, it is proposed that insight is not an 'all-or-none' phenomenon but is composed of three distinct, overlapping dimensions, namely, the recognition that one has a mental illness, compliance with treatment, and the ability to relabel unusual mental events (delusions and hallucinations) as pathological. A scheme is proposed to standardise the assessment of insights to assist further research.

1,099 citations


Journal ArticleDOI
TL;DR: Results from three samples show that the Social Functioning Scale is reliable, valid, sensitive and responsive to change.
Abstract: Social functioning as an outcome variable in family interventions with schizophrenic patients has been a relatively neglected area. The requirements of a scale of social functioning to measure the efficacy of family interventions include: the measurement of skill/behaviour relevant to the impairments and the demography of this group; the ability to yield considerable information with an economy of clinical time; and the establishment of 'comparative' need through comparison between subscales and with appropriate reference groups. Results from three samples show that the Social Functioning Scale is reliable, valid, sensitive and responsive to change.

1,016 citations


Journal ArticleDOI
TL;DR: The Edinburgh Post-natal Depression Scale was validated on a community sample of 702 women at six weeks post-partum using Research Diagnostic Criteria for depression to offer improved guidelines for the use of the EPDS by the primary care team.
Abstract: The Edinburgh Post-natal Depression Scale (EPDS) was validated on a community sample of 702 women at six weeks post-partum using Research Diagnostic Criteria for depression. The estimates of sensitivity, specificity and positive predictive value, being based on a large random sample, offer improved guidelines for the use of the EPDS by the primary care team.

903 citations


Journal ArticleDOI
TL;DR: HADS appears in this study to be a simple, sensitive and specific tool for screening for psychiatric disorders in an oncology in-patient population.
Abstract: The Hospital Anxiety and Depression Scale (HADS), a four-point, 14-item questionnaire, was tested as a screening method for adjustment disorders and major depressive disorders in a sample of 210 cancer in-patients. A receiver operating characteristic (ROC) analysis was performed, giving the relationship between the true positive rate (sensitivity) and the false positive rate (1-specificity). This makes it possible to choose an optimal cut-off point that takes into account the costs and benefits of treatment of psychological distress. For screening for major depressive disorders only, a cut-off score of 19 gave 70% sensitivity and 75% specificity. For screening for adjustment disorders and major depressive disorders taken together, a cut-off score of 13 gave 75% sensitivity and 75% specificity. HADS appears in this study to be a simple, sensitive and specific tool for screening for psychiatric disorders in an oncology in-patient population.

512 citations


Journal ArticleDOI
TL;DR: Capgras' syndrome is suggested to involve impairment of processes that can support 'covert' recognition of familiar faces in prosopagnosia, and forms a potential 'mirror image' of the impairments underlying prosopagna, and earlier attempts to link the two conditions directly are questioned.
Abstract: Accounts of the major DMSs are given using theoretical models of the functional components underlying recognition of familiar people. Thus, Capgras' syndrome is suggested to involve impairment of processes that can support 'covert' recognition of familiar faces in prosopagnosia. It therefore forms a potential 'mirror image' of the impairments underlying prosopagnosia, and earlier attempts to link the two conditions directly are questioned. Frégoli syndrome and intermetamorphosis are explained as defects at different stages of an information-processing chain. Not only are these accounts consistent with the association of different DMSs with different brain injuries, but they also offer both suggestions for new inquiries and predictions about possible preserved and impaired abilities.

450 citations


Journal ArticleDOI
TL;DR: Negative schizophrenics were most impaired on every subscale of each measure, followed in order by the non-negative schizophrenics, affective disorder patients, and non-patient controls.
Abstract: Twenty-one schizophrenics with prominent negative symptoms were compared with 37 schizophrenics without them, 33 patients with major affective disorder and 20 non-patient controls on a battery of measures including a role-play test of social skills, the Social Adjustment Scale, and the Quality of Life Scale. The negative schizophrenics were most impaired on every subscale of each measure, followed in order by the non-negative schizophrenics, affective disorder patients, and non-patient controls. The social skill measures were not correlated with positive symptom levels, but were highly correlated with measures of community functioning. The results are consistent with the hypothesis that social dysfunction results from focal deficits in social skills.

399 citations


Journal ArticleDOI
TL;DR: Cognitive function at entry to the study and cognitive deterioration over the succeeding 12 months was not influenced by the presence of disorders of thought content and subjects with other types of delusion had relatively well preserved lateral ventricular size and basal ganglia calcification.
Abstract: In a sample of 178 subjects with Alzheimer's disease, diagnosed by clinical criteria (NINCDS/ADRDA), delusions had occurred in 16% of the sample since the onset of the illness and been present within the last 12 months in 11%. Simple delusions of theft and suspicion were the most common types and a greater proportion of men suffered delusions of theft. Subjects with other types of delusion had relatively well preserved lateral ventricular size and basal ganglia calcification. Twenty per cent of the group had experienced persecutory ideation short of delusions since the onset of the illness. Cognitive function at entry to the study and cognitive deterioration over the succeeding 12 months was not influenced by the presence of disorders of thought content.

376 citations


Journal ArticleDOI
TL;DR: None of the changes observed during the double-blind withdrawal period were identified as withdrawal symptoms or rebound phenomena and citalopram provoked few and comparatively mild side-effects.
Abstract: In this multicenter study, the clinical efficacy of citalopram was investigated in 98 patients with moderate AD/SDAT or VD using a combined double-blind and open technique with placebo and citalopram. Analyses were made for each diagnosis after four weeks of double-blind treatment. Patients with AD/SDAT treated with citalopram showed a significant improvement in emotional bluntness, confusion, irritability, anxiety, fear/panic, depressed mood and restlessness. Those improvements were not found after treatment with placebo. There were no significant improvements in patients with VD. No improvements were recorded in motor or cognitive impairment. Citalopram provoked few and comparatively mild side-effects. None of the changes observed during the double-blind withdrawal period were identified as withdrawal symptoms or rebound phenomena.

374 citations


Journal ArticleDOI
TL;DR: Out of a sample of 178 patients with AD, aggression was present in 20%, wandering in 19%, binge-eating in 10%, hyperorality in 6%, urinary incontinence in 48%, and sexual disinhibition in 7%.
Abstract: Out of a sample of 178 patients with AD, aggression was present in 20%, wandering in 19%, binge-eating in 10%, hyperorality in 6%, urinary incontinence in 48%, and sexual disinhibition in 7%. Behavioural abnormalities were greater in those with more severe dementia. Temporallobe atrophy correlated with aggression, and widening of the third ventricle with hyperorality. Features of the Kluver-Bucy syndrome were commonly seen, but the full syndrome occurred in only one subject. Patients with at least one feature of the Kluver-Bucy syndrome had greater temporal-lobe atropy than those without any of the features.

372 citations


Journal ArticleDOI
TL;DR: Subjects with depressive symptoms had less cognitive impairment and less ventricular enlargement on CT compared with those without symptoms, and Widening of the interhemispheric fissure was associated with symptoms of mania but was inversely related to presence of depressive symptoms.
Abstract: Of 178 patients with AD, at least one depressive symptom was reported by 63%, 24% were rated as being depressed by a trained observer, and 43% were considered depressed by their relatives. Ten per cent had a previous history of depression. Elevated mood was rare, occurring in only six patients (3.5%). Subjects with depressive symptoms had less cognitive impairment and less ventricular enlargement on CT compared with those without symptoms. Widening of the interhemispheric fissure was associated with symptoms of mania but was inversely related to presence of depressive symptoms.

Journal ArticleDOI
TL;DR: Patients with schizophrenia showed both absolutely and relatively reduced metabolic rates in the frontal cortex and in the temporoparietal regions compared with normal controls.
Abstract: Local cerebral uptake of glucose labelled with fluorine-18 was measured by positron emission tomography in 13 patients with schizophrenia and 37 right-handed volunteers. Patients received no medication for a minimum of 31 days and a mean of 30 weeks. The subjects were administered the labelled deoxyglucose just after the beginning of a 32-minute sequence of blurred numbers as visual stimuli for the Continuous Performance Test. In normal controls, task performance was associated with increases in glucose metabolic rate in the right frontal and right temporoparietal regions; occipital rates were unchanged. Patients with schizophrenia showed both absolutely and relatively reduced metabolic rates in the frontal cortex and in the temporoparietal regions compared with normal controls.

Journal ArticleDOI
TL;DR: The group practising problem solving improved significantly more than controls on ratings of depression, hopelessness, suicidal ideation and target problems at the end of treatment and at follow-up of up to one year, and there was evidence of an effect on the rates of repetition over the six months after treatment.
Abstract: In a controlled trial, 20 patients at high risk of repeated suicide attempts were randomly allocated to either cognitive-behavioural problem solving or a 'treatment-as-usual' control condition. The group practising problem solving improved significantly more than controls on ratings of depression, hopelessness, suicidal ideation and target problems at the end of treatment and at follow-up of up to one year, and there was evidence of an effect on the rates of repetition over the six months after treatment.

Journal ArticleDOI
TL;DR: Over the last ten years a new approach to psychiatric knowledge has developed under the influence of social anthropology, its origins, assumptions, methods, achievements, and limitations are reviewed.
Abstract: Over the last ten years a new approach to psychiatric knowledge has developed under the influence of social anthropology. Its origins, assumptions, methods, achievements, and limitations are reviewed.

Journal ArticleDOI
TL;DR: To compare the crime rate of schizophrenia with that of the general population, data from the Central Swedish Police Register on 790 schizophrenic patients discharged from hospitals in Stockholm in 1971 was analysed for the period 1972–86.
Abstract: To compare the crime rate of schizophrenics with that of the general population, data from the Central Swedish Police Register on 790 schizophrenic patients discharged from hospitals in Stockholm in 1971 was analysed for the period of 1972-86. Relative risk of criminal offence was assessed by comparing the observed number of offences committed with the expected number (estimated from official statistics). The crime rate among male schizophrenics was almost the same as that in the general male population, whereas among females it was twice that of the general female population. The rate of violent offences was, however, four times higher among the schizophrenics. The violence recorded was almost exclusively of minor severity.

Journal ArticleDOI
TL;DR: It is reported of an earlier finding that the symptoms of patients with chronic schizophrenia segregate into three syndromes: psychomotor poverty, disorganisation, and reality distortion.
Abstract: Confirmation is reported of an earlier finding that the symptoms of patients with chronic schizophrenia segregate into three syndromes: psychomotor poverty (poverty of speech, flatness of affect, decreased spontaneous movement); disorganisation (disorders of the form of thought, inappropriate affect); and reality distortion (delusions and hallucinations).

Journal ArticleDOI
TL;DR: A self-report questionnaire completed by 177 out-patients showed that hypochondriasis and amplification had a zero-order correlation and amplification was more powerful in women than in men and was also a significant correlate of somatisation, explaining 12% of the variance.
Abstract: A self-report questionnaire completed by 177 out-patients showed that hypochondriasis and amplification had a zero-order correlation of 0.56, and in stepwise multiple regression amplification accounted for 31% of the variance in hypochondriasis, after sociodemographic variables had been accounted for. Fears of ageing and death, and a childhood history of illness in the family, increased the R2 to 0.50. Amplification was more powerful in women than in men and was also a significant (although weaker) correlate of somatisation, explaining 12% of the variance. Somatisation also correlated with being female, the propensity to seek medical care, and a diminished sense of efficacy over one's health. Our findings are consistent with the possibility that somatosensory amplification occurs in hypochondriasis.

Journal ArticleDOI
TL;DR: The schizophrenic and manic subjects both demonstrated poor performance on the WCST, suggesting that cognitive inflexibility and/or pre-frontal dysfunction, is not specific to schizophrenia (although laterality differences could exist).
Abstract: The ability to shift cognitive set, which is probably subserved, at least in part, by the pre-frontal cortex, was determined for schizophrenic, bipolar (manic) and control subjects, using the Wisconsin Card Sorting Test (WCST). The schizophrenic and manic subjects both demonstrated poor performance on the WCST, suggesting that cognitive inflexibility and/or pre-frontal dysfunction, is not specific to schizophrenia (although laterality differences could exist). Moderate levels of poor performance in the non-psychiatric control group suggest the need for a review of the cut-off figures in the WCST currently used for predicting 'brain damage' and 'focal frontal involvement', especially given the trend for the increasing use of cognitive assessment and rehabilitation in the major psychoses.

Journal ArticleDOI
TL;DR: The pattern of psychiatric symptoms in the CFS patients was significantly different to that of 48 patients with non-endogenous depression, but was comparable with that observed in other medical disorders.
Abstract: The prevalence of psychiatric disorder in 48 patients with chronic fatigue syndrome (CFS) was determined. Twenty-two had had a major depressive (non-endogenous) episode during the course of their illness, while seven had a current major (non-endogenous) depression. The pre-morbid prevalence of major depression (12.5%) and of total psychiatric disorder (24.5%) was no higher than general community estimates. The pattern of psychiatric symptoms in the CFS patients was significantly different to that of 48 patients with non-endogenous depression, but was comparable with that observed in other medical disorders. Patients with CFS were not excessively hypochondriacal. We conclude that psychological disturbance is likely to be a consequence of, rather than an antecedent risk factor to the syndrome.

Journal ArticleDOI
TL;DR: Subjects with hallucinations had a greater deterioration in cognitive function at 12-month follow-up, which could not be accounted for by neuroleptic medication.
Abstract: In a sample of 178 patients with AD, visual hallucinations had been experienced by 13% and auditory hallucinations by 10%. Thirty per cent had misidentification syndromes; these were associated with a younger age and younger age at onset of illness, and proportionally more men than women were affected. There was a reduced 30-month mortality rate in this group. Subjects with hallucinations had a greater deterioration in cognitive function at 12-month follow-up, which could not be accounted for by neuroleptic medication.

Journal ArticleDOI
TL;DR: It is argued that the concept of a general neurotic syndrome depends in part on the presence of such predisposing personality factors, and that reduction in this predisposition to neurosis should be the focus of treatment.
Abstract: Neurotic syndromes are defined by characteristic patterns of symptoms, but the validity of the distinction between one syndrome and another depends on associations between the syndromes and clinical history, or treatment response factors that are independent of the defining phenomena. In both a group of twin volunteers and a group of patients with panic disorder/agoraphobia, the lifetime experience of more than one diagnosis of a neurotic syndrome was common but there was no evidence of patterns of co-occurrence of diagnoses being associated with particular syndromes. Receiving a diagnosis was associated with abnormal scores on measures of neuroticism and locus of control, the extent of the abnormality increasing with the number of different diagnoses satisfied. It is argued that the concept of a general neurotic syndrome depends in part on the presence of such predisposing personality factors, and that reduction in this predisposition to neurosis should be the focus of treatment.

Journal ArticleDOI
TL;DR: The psychoses may represent aberrations of a late evolutionary development underlying the recent and rapid increase in brain weight in the transition from Australopithecus through Homo habilis and Homo erectus to Homo sapiens.
Abstract: Attempts to draw a line of genetic demarcation between schizophrenic and affective illnesses have failed. It must be assumed that these diseases are genetically related. A postmortem study has demonstrated that enlargement of the temporal horn of the lateral ventricle in schizophrenia but not in Alzheimer-type dementia is selective to the left side of the brain. This suggest that the gene for psychosis is the 'cerebral dominance gene', the factor that determines the asymmetrical development of the human brain. That the psychosis gene is located in the pseudoautosomal region of the sex chromosomes is consistent with observations that sibling pairs with schizophrenia are more often than would be expected of the same sex and share alleles of a polymorphic marker at the short-arm telomeres of the X and Y chromosomes above chance expectation. That the cerebral dominance gene also is pseudoautosomal is suggested by the pattern of verbal and performance deficits associated with sex-chromosome aneuploidies. The psychoses may thus represent aberrations of a late evolutionary development underlying the recent and rapid increase in brain weight in the transition from Australopithecus through Homo habilis and Homo erectus to Homo sapiens.

Journal ArticleDOI
TL;DR: An examination of the characteristics of all patients admitted to the ward revealed that the violent patients were significantly younger, more likely to have been admitted compulsorily and less likely to be depressed than non-violent ones.
Abstract: The increase in violent incidents on an acute psychiatric ward over a 15-month period was found to be strongly associated with the increase in use of temporary nursing staff (r = 0.63; P = 0.0005). The change in staffing patterns accounted for 39% of the variance in violence. An examination of the characteristics of all patients admitted to the ward revealed that the violent patients were significantly younger, more likely to have been admitted compulsorily and less likely to be depressed than non-violent ones.

Journal ArticleDOI
TL;DR: Good occupational outcome in patients with a relatively short pre-treatment duration of illness was associated with the prescription of placebo medication during the follow-up period and with more ‘neurological soft signs'.
Abstract: The outcome at two years of patients who were eligible for a study of first schizophrenic episodes was assessed in terms of occupation (n = 237) and in terms of number of days spent as an in-patient from the time of first admission (n = 252), and was related to social, behavioural, mental state and neurological measures during the initial admission. Poor outcome was in general associated with more social withdrawal, inactivity and abnormal social presentation and with more 'neurological soft signs'. Good occupational outcome in patients with a relatively short pre-treatment duration of illness was associated with the prescription of placebo medication during the follow-up period.

Journal ArticleDOI
TL;DR: A hypothesis is developed which may help to account for the wide variability encountered in individual susceptibility to alcoholic brain damage and its varied manifestations.
Abstract: Some of the major effects of alcohol, and alcoholism, on the brain are reviewed, with reappraisal of evidence drawn from brain imaging, neuropathology, clinical psychology, and laboratory experimental work. A hypothesis is developed which may help to account for the wide variability encountered in individual susceptibility to alcoholic brain damage and its varied manifestations. Therapeutic implications are considered.

Journal ArticleDOI
TL;DR: A standardised clinical examination which focused on neurologicalsoft signs (NSS) was used by a neurologist blind to diagnosis to assess the presence of neurological soft signs and schizophrenics had significantly higher NSS total scores than normal controls but did not differ significantly from their first-degree relatives' group.
Abstract: A standardised clinical examination which focused on neurological soft signs (NSS) was used by a neurologist blind to diagnosis to assess the presence of neurological soft signs. A comparison of NSS score was made among three groups of subjects consisting of 58 DSM-III schizophrenics, 31 of their healthy first-degree relatives and 38 normal controls. The schizophrenic group had significantly higher NSS total scores than normal controls but did not differ significantly from their first-degree relatives' group. The relatives' group showed higher NSS total scores than did normal controls although to a lesser extent than schizophrenics.

Journal ArticleDOI
TL;DR: A review of the evidence shows that there is no convincing support for a separate clinical diagnosis of ‘cannabis psychosis' but cannabis can, however, produce brief acute organic reactions and, in moderate to heavy doses, psychotic episodes in clear consciousness.
Abstract: A review of the evidence shows that there is no convincing support for a separate clinical diagnosis of 'cannabis psychosis'. Cannabis can, however, produce brief acute organic reactions and, in moderate to heavy doses, psychotic episodes in clear consciousness. Ingestion in naive users or increasingly heavy use in habitual users can precipitate a schizophreniform episode. Heavy users may have an increased risk of developing schizophrenia in the subsequent 15 years. Well controlled, longitudinal studies are required to explore these associations further and their possible aetiological significance.

Journal ArticleDOI
TL;DR: The case notes of 295 suicides in prisons in England and Wales between 1972 and 1987 were studied and found there was an association between suicide and both guilt for the offence and being charged or convicted of a homicide offence.
Abstract: The case notes of 295 suicides (98.3% of the total) in prisons in England and Wales between 1972 and 1987 were studied. This period has witnessed an increase in the suicide rate far in excess of the rate of rise in the prison population. The most common method of suicide was by hanging, usually at night. There was a frequent past history of psychiatric treatment and self-injury. People charged or convicted of violent or sexual offences were over-represented, as were those serving life sentences. There was an association between suicide and both guilt for the offence and being charged or convicted of a homicide offence. Some suicides occurred many years after reception into prison. Routine enquiry about previous suicide attempts must be implemented, along with better, ongoing, active communication between staff and inmates.

Journal ArticleDOI
TL;DR: Five heterogeneity models and a number of quantitative approaches are described to apply rigorous methods of study to the comparison of unitary models and competing heterogeneity models of schizophrenia.
Abstract: Schizophrenia is clinically heterogeneous but it is not known whether this is due to the existence of discrete subtypes. For the purpose of explication, 'indicators' of schizophrenia are divided into three levels: phenomenology, pathophysiology, and aetiology. Five heterogeneity models and a number of quantitative approaches are described. It is imperative to apply rigorous methods of study to the comparison of unitary models and competing heterogeneity models of schizophrenia.

Journal ArticleDOI
TL;DR: Experimental design rather than any particular cognitive or psychomotor test appears to have determined the sensitivity of detection of neuroleptic drug effects, and three main hypotheses to replace early arousal theories are proposed: normalisation of attention, facilitated indirectly by suppression of 'released' limbic dopamine hyperactivity; normalisation
Abstract: There has been great variability and inconsistency in the reported effects of neuroleptic drugs on cognitive and psychomotor function in both patients and normal controls. Experimental design rather than any particular cognitive or psychomotor test appears to have determined the sensitivity of detection of neuroleptic drug effects. In general, sedative phenothiazines have been found to depress psychomotor function and sustained attention, but higher cognitive functions are relatively unaffected. In the majority of studies of schizophrenic patients, both cognitive function and attention improve with neuroleptic treatment, in parallel with clinical recovery. Negative symptoms are not increased and usually show slight improvement with neuroleptic treatment. Controls are more sensitive than schizophrenic patients to neuroleptic drug-induced impairments. Tolerance has been seen in patients but has not been demonstrated in normal volunteers. The way in which neuroleptics produce their beneficial effects in patients remains unknown. Three main hypotheses to replace early arousal theories are proposed: normalisation of attention, facilitated indirectly by suppression of 'released' limbic dopamine hyperactivity; normalisation of asymmetrical temporohippocampal function; or direct improvement of attentional processing. Studies of the effects of new antipsychotic drugs with selective actions and the development of more reliable and selective tests of psychomotor and cognitive functions are required.