Showing papers in "British Journal of Psychiatry in 2002"

The Work and Social Adjustment Scale: a simple measure of impairment in functioning.

Abstract: Background Patients' perspectives concerning impaired functioning provide important information. Aims To evaluate the reliability and validity of the Work and Social Adjustment Scale (WSAS). Method Data from two studies were analysed. Reliability analyses included internal scale consistency, test—retest and parallel forms. Convergent and criterion validities were examined with respect to disorder severity. Results Cronbach's α measure of internal scale consistency ranged from 0.70 to 0.94. Test—retest correlation was 0.73. Interactive voice response administrations of the WSAS gave correlations of 0.81 and 0.86 with clinician interviews. Correlations of WSAS with severity of depression and obsessive—compulsive disorder symptoms were 0.76 and 0.61, respectively. The scores were sensitive to patient differences in disorder severity and treatment-related change. Conclusions The WSAS is a simple, reliable and valid measure of impaired functioning. It is a sensitive and useful outcome measure offering the potential for readily interpretable comparisons across studies and disorders.

Maternal antenatal anxiety and children's behavioural/emotional problems at 4 years. Report from the Avon Longitudinal Study of Parents and Children.

Abstract: Background Animal experiments suggest that maternal stress and anxiety during pregnancy have long-term effects on the behaviour of the offspring. Aims To test the hypothesis that antenatal maternal anxiety predicts behavioural problems at age 4 years. Method Data were collected on multiple antenatal and postnatal assessments of maternal anxiety and depression, antenatal and obstetric risks, psychosocial risks and children's behavioural/emotional problems ( n =7448). Results Antenatal maternal anxiety predicted behavioural/emotional problems in boys (OR=2.14, 95% CI 1.48-3.10) and girls (OR=1.88, 95% CI 1.3-2.69) after accounting for covariates. When covarying maternal anxiety up to 33 months postnatally, antenatal anxiety continued to predict total problems in boys (OR=1.56, 95% CI 1.02-2.41) and girls (OR=1.51, 95% CI 1.22-2.81). Conclusions There could be a direct effect of maternal mood on foetal brain development, which affects the behavioural development of the child.

Fatal and non-fatal repetition of self-harm. Systematic review.

Abstract: Background Non-fatal self-harm frequently leads to non-fatal repetition and sometimes to suicide. We need to quantify these two outcomes of self-harm to help us to develop and test effective interventions. Aims To estimate rates of fatal and non-fatal repetition of self-harm. Method A systematic review of published follow-up data, from observational and experimental studies. Four electronic databases were searched and 90 studies met the inclusion criteria. Results Eighty per cent of studies found were undertaken in Europe, over one-third in the UK. Median proportions for repetition 1 year later were: 16% non-fatal and 2% fatal; after more than 9 years, around 7% of patients had died by suicide. The UK studies found particularly low rates of subsequent suicide. Conclusions After 1 year, non-fatal repetition rates are around 15%. The strong connection between self-harm and later suicide lies somewhere between 0.5% and 2% after 1 year and above 5% after 9 years. Suicide risk among self-harm patients is hundreds of times higher than in the general population.

Towards a standardised brief outcome measure: psychometric properties and utility of the CORE-OM.

Abstract: Background An acceptable, standardised outcome measure to assess efficacy and effectiveness is needed across multiple disciplines offering psychological therapies. Aims To present psychometric data on reliability, validity and sensitivity to change for the CORE—OM (Clinical Outcomes in Routine Evaluation — Outcome Measure). Method A 34-item self-report instrument was-developed, with domains of subjective well-being, symptoms, function and risk. Analysis includes internal reliability, test—retest reliability, socio-demographic differences, exploratory principal-component analysis, correlations with other instruments, differences between clinical and non-clinical samples and assessment of change within a clinical group. Results Internal and test—retest reliability were good (0.75-0.95), as was convergent validity with seven other instruments, with large differences between clinical and non-clinical samples and good sensitivity to change. Conclusions The CORE—OM is a reliable and valid instrument with good sensitivity to change. It is acceptable in a wide range of practice settings.

Impact of Event Scale: psychometric properties.

Abstract: Background For more than 20 years, the Impact of Event Scale (IES) has been widely used as a measure of stress reactions after traumatic events. Aims To review studies that evaluated the IES's psychometric properties. Method Literature review. Results The results indicated that the IES's two-factor structure is stable over different types of events, that it can discriminate between stress reactions at different times after the event, and that it has convergent validity with observer-diagnosed post-traumatic stress disorder. The use of IES in many psychopharmacological trials and outcome studies is supportive of the measure's clinical relevance. Conclusions The IES is a useful measure of stress reactions after a range of traumatic events, and it is valuable for detecting individuals who require treatment.

Eating behaviours and attitudes following prolonged exposure to television among ethnic Fijian adolescent girls.

Abstract: Background There are no published studies evaluating the impact of introduction of television on disordered eating in media-naive populations. Aims To assess the impact of novel, prolonged exposure to television on disordered eating attitudes and behaviours among ethnic Fijian adolescent girls. Method A prospective, multi-wave cross-sectional design was used to compare two samples of Fijian schoolgirls before and after prolonged regional television exposure with a modified 26-item eating attitudes test, supplemented with a semi-structured interview to confirm self-reported symptoms. Narrative data from a subset of respondents from the exposed sample were analysed for content relating television exposure to body image concerns. Results Key indicators of disordered eating were significantly more prevalent following exposure. Narrative data revealed subjects' interest in weight loss as a means of modelling themselves after television characters. Conclusions This naturalistic experiment suggests a negative impact of television upon disordered eating attitudes and behaviours in a media-naive population.

Sustained attention deficit in bipolar disorder

Abstract: Background Recovery in bipolar disorder is central to its definition but is rarely complete. Previous work has suggested that neuropsychological impairment persists during the euthymic state but has been confounded partly by mild affective symptoms in remitted patients. Aims To characterise neuropsychological functioning in the euthymic phase of bipolar disorder with an emphasis on tasks of executive functioning. Method Thirty euthymic patients with bipolar disorder were compared with thirty healthy controls on neuropsychological tasks differentially sensitive to damage within prefrontal cortex. Results Bipolar I patients were impaired on tasks of attentional set shifting, verbal memory and sustained attention. Only sustained attention deficit survived controlling for mild affective symptoms. This deficit was related to progression of illness, but was none the less present in a subgroup of patients near illness onset. Conclusions Sustained attention deficit may represent a neuropsychological vulnerability marker for bipolar disorder, providing a focus for further understanding of the phenotype and analysis of the neuronal networks involved.

Violence and schizophrenia: examining the evidence

Abstract: Background It is now accepted that people with schizophrenia are significantly more likely to be violent than other members of the general population. A less acknowledged fact is that the proportion of societal violence attributable to schizophrenia is small. Aims To critically examine the epidemiological evidence for the association between violence and schizophrenia and estimate the impact of this association on society. Method A selective review of the key literature on the epidemiology of violence and schizophrenia. Population-attributable risks for violence in schizophrenia are calculated from population-based studies. Results Most studies confirm the association between violence and schizophrenia. Recent good evidence supports a small but independent association. Comorbid substance abuse considerably increases this risk. The proportion of violent crime in society attributable to schizophrenia consistently falls below 10%. Conclusions Less focus on the relative risk and more on the absolute risk of violence posed to society by people with schizophrenia would serve to reduce the associated stigma. Strategies aimed at reducing this small risk require further attention, in particular treatment for substance misuse.

Duration of major depressive episodes in the general population: Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS)

Abstract: Background Data on the duration of major depressive episodes (MDE) in the general population are sparse. Aims To assess the duration of MDE and its clinical and socio-demographic determinants in a study group drawn from the general population with newly originated episodes of major depression. Method The Netherlands Mental Health Survey and Incidence Study is a prospective epidemiological survey in the adult population ( n =7076), using the Composite International Diagnostic Interview. Duration of MDE over 2 years was assessed with a Life Chart Interview. Results The median duration of MDE was 3.0 months; 50% of participants recovered within 3 months, 63% within 6 months, 76% within 12 months and nearly 20% had not recovered at 24 months. Determinants of persistence were severity of depression and comorbid dysthymia. A recurrent episode predicted shorter duration. Conclusions Although half of those affected with MDE recovered rapidly, the risk of chronicity (duration 24 months or more) was considerable. This underlines the necessity of diagnosing and treating those at risk.

Sexual orientation and mental health: results from a community survey of young and middle-aged adults

Abstract: Background Community surveys have reported a higher rate of mental health problems in combined groups of homosexual and bisexual participants, but have not separated these two groups. Aims To assess separately the mental health of homosexual and bisexual groups compared with heterosexuals. Method A community survey of 4824 adults was carried out in Canberra, Australia. Measures covered anxiety, depression, suicidality, alcohol misuse, positive and negative affect and a range of risk factors for poorer mental health. Results The bisexual group was highest on measures of anxiety, depression and negative affect, with the homosexual group falling between the other two groups. Both the bisexual and homosexual groups were high on suicidality. Bisexuals also had more current adverse life events, greater childhood adversity, less positive support from family, more negative support from friends and a higher frequency of financial problems. Homosexuals reported greater childhood adversity and less positive support from family. Conclusions The bisexual group had the worst mental health, although homosexual participants also tended to report more distress.

Dissociation and post-traumatic stress disorder: two prospective studies of road traffic accident survivors.

Abstract: Background Dissociative symptoms during trauma predict post-traumatic stress disorder (PTSD), but they are often transient It is controversial whether they predict chronic PTSD over and above what can be predicted from other post-trauma symptoms Aims To investigate prospectively the relationship between dissociative symptoms before, during and after a trauma and other psychological predictors, and chronic PTSD Method Two samples of 27 and 176 road traffic accident survivors were recruited Patients were assessed shortly after the accident and followed at intervals over the next 6 months Assessments included measures of dissociation, memory fragmentation, data-driven processing, rumination and PTSD symptoms Results All measures of dissociation, particularly persistent dissociation 4 weeks after the accident, predicted chronic PTSD severity at 6 months Dissociative symptoms predicted subsequent PTSD over and above the other PTSD symptom clusters Memory fragmentation and data-driven processing also predicted PTSD Rumination about the accident was among the strongest predictors of subsequent PTSD symptoms Conclusions Persistent dissociation and rumination 4 weeks after trauma are more useful in identifying those patients who are likely to develop chronic PTSD than initial reactions

Brief screening instrument for post-traumatic stress disorder

Abstract: Background Brief screening instruments appear to be a viable way of detecting post-traumatic stress disorder (PTSD) but none has yet been adequately validated. Aims To test and cross-validate a brief instrument that is simple to administer and score. Method Forty-one survivors of a rail crash were administered a questionnaire, followed by a structured clinical interview 1 week later. Results Excellent prediction of a PTSD diagnosis was provided by respondents endorsing at least six re-experiencing or arousal symptoms, in any combination. The findings were replicated on data from a previous study of 157 crime victims. Conclusions Performance of the new measure was equivalent to agreement achieved between two full clinical interviews.

Influence of supplementary vitamins, minerals and essential fatty acids on the antisocial behaviour of young adult prisoners. Randomised, placebo-controlled trial.

Abstract: Background There is evidence that offenders consume diets lacking in essential nutrients and this could adversely affect their behaviour. Aims To test empirically if physiologically adequate intakes of vitamins, minerals and essential fatty acids cause a reduction in antisocial behaviour. Method Experimental, double-blind, placebo-controlled, randomised trial of nutritional supplements on 231 young adult prisoners, comparing disciplinary offences before and during supplementation. Results Compared with placebos, those receiving the active capsules committed an average of 26.3% (95% CI 8.3-44.33%) fewer offences (P=0.03, two-tailed). Compared to baseline, the effect on those taking active supplements for a minimum of 2 weeks (n=172) was an average 35.1% (95% CI 16.3-53.9%) reduction of offences (P < 0.001, two-tailed), whereas placebos remained within standard error. Conclusions Antisocial behaviour in prisons, including violence, are reduced by vitamins, minerals and essential fatty acids with similar implications for those eating poor diets in the community Declaration of interest The research was supported by a grant from the research charity Natural justice (see Acknowledgements) and managed from the University of Surrey Scotia Pharmaceuticals Ltd and Unigreg Ltd supplied nutritional supplements.

Prevalence and correlates of personality disorders in a community sample

Abstract: Background Knowledge of the prevalence and correlates of personality disorders in the community is important for identifying treatment needs and for provision of psychiatric services. Aims To estimate the prevalence of personality disorders in a community sample and to identify demographic subgroups with especially high prevalence. Method Clinical psychologists used the International Personality Disorder Examination to assess DSM-IV and ICD-10 personality disorders in a sample of 742 subjects, ages 34-94 years, residing in Baltimore, Maryland. Logistic regression was used to evaluate the association between demographic characteristics and DSM-IV personality disorder clusters. Results The estimated overall prevalence of DSM-IV personality disorders was 9%. Cluster A disorders were most prevalent in men who had never married. Cluster B disorders were most prevalent in young men without a high school degree, and cluster C disorders in high school graduates who had never married. Conclusions Approximately 9% of this community sample has a DSM-IV personality disorder. Personality disorders are over-represented in certain demographic subgroups of the community.

Randomised controlled trial of cognitive-behavioural therapy in early schizophrenia: acute-phase outcomes.

Abstract: Background Cognitive—behavioural therapy (CBT) improves persistent psychotic symptoms. Aims To test the effectiveness of added CBT in accelerating remission from acute psychotic symptoms in early schizophrenia. Method A 5-week CBT programme plus routine care was compared with supportive counselling plus routine care and routine care alone in a multi-centre trial randomising 315 people with DSM—IV schizophrenia and related disorders in their first (83%) or second acute admission. Outcome assessments were blinded. Results Linear regression over 70 days showed predicted trends towards faster improvement in the CBT group. Uncorrected univariate comparisons showed significant benefits at 4 but not 6 weeks for CBT v . routine care alone on Positive and Negative Syndrome Scale total and positive sub-scale scores and delusion score and benefits v . supportive counselling for auditory hallucinations score. Conclusions CBT shows transient advantages over routine care alone or supportive counselling in speeding remission from acute symptoms in early schizophrenia.

Post-partum depression in a cohort of women from a rural area of Tamil Nadu, India. Incidence and risk factors

Abstract: Background Community-based epidemiological data on post-partum depression from developing countries are scarce. Aims To determine the incidence of and risk factors for developing post-partum depression in a cohort of women living in rural south India. Method We assessed 359 women in the last trimester of pregnancy and 6-12 weeks after delivery for depression and for putative risk factors. Results The incidence of post-partum depression was 11% (95% CI 7.1-14.9). Low income, birth of a daughter when a son was desired, relationship difficulties with mother-in-law and parents, adverse life events during pregnancy and lack of physical help were risk factors for the onset of post-partum depression. Conclusions Depression occurred as frequently during late pregnancy and after delivery as in developed countries, but there were cultural differences in risk factors. These findings have implications for policies regarding maternal and childcare programmes.

Neuroimaging findings in post-traumatic stress disorder. Systematic review

Abstract: Background Findings from neuroimaging studies complement our understanding of the wide-ranging neurobiological changes in trauma survivors who develop post-traumatic stress disorder (PTSD). Aims To determine whether neuroimaging studies had identified structural and functional changes specific to PTSD. Method A review of all functional and structural neuroimaging studies of subjects with PTSD was carried out. Studies were identified using general medical and specific traumatic stress databases and paper searches of current contents and other secondary sources. Results The most replicated structural finding is hippocampal volume reduction, which may limit the proper evaluation and categorisation of experience. Replicated localised functional changes include increased activation of the amygdala after symptom provocation (which may reflect its role in emotional memory) and decreased activity of Broca's area at the same time (which may explain the difficulty patients have in labelling their experiences). Conclusions Evidence from neuroimaging studies has suggested areas of the brain that may be damaged by psychological trauma. The clinical implications of these neuroimaging findings need to be investigated further because they challenge traditional therapeutic approaches.

Effects of exercise on depressive symptoms in older adults with poorly responsive depressive disorder: Randomised controlled trial

Abstract: Background Depression is common in later life. Aims To determine whether exercise is effective as an adjunct to antidepressant therapy in reducing depressive symptoms in older people. Method Patients were randomised to attend either exercise classes or health education talks for 10 weeks. Assessments were made ‘blind’ at baseline, and at 10 and 34 weeks. The primary outcome was seen with the 17-item Hamilton Rating Scale for Depression (HRSD). Secondary outcomes were seen with the Geriatric Depression Scale, Clinical Global Impression and Patient Global Impression. Results At 10 weeks a significantly higher proportion of the exercise group (55% v. 33%) experienced a greater than 30% decline in depression according to HRSD (OR=2.51, P =0.05, 95% CI 1.00-6.38). Conclusions Because exercise was associated with a modest improvement in depressive symptoms at 10 weeks, older people with poorly responsive depressive disorder should be encouraged to attend group exercise activities.

Efficacy and tolerability of venlafaxine compared with selective serotonin reuptake inhibitors and other antidepressants: a meta-analysis

Abstract: Background In individual studies and limited meta-analyses venlafaxine has been reported to be more effective than comparator antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs). Aims To perform a systematic review of all such studies. Method We conducted a systematic review of double-blind, randomised trials comparing venlafaxine with alternative antidepressants in the treatment of depression. The primary outcome was the difference in final depression rating scale value, expressed as a standardised effect size. Secondary outcomes were response rate, remission rate and tolerability. Results A total of 32 randomised trials were included. Venlafaxine was more effective than other antidepressants (standardised effect size was -0.14, 95% Cl -0.07 to -0.22). A similar significant advantage was found against SSRIs (20 studies) but not tricyclic antidepressants (7 studies). Conclusions Venlafaxine has greater efficacy than SSRIs although there is uncertainty in comparison with other antidepressants. Further studies are required to determine the clinical importance of this finding.

Stigma by association: Psychological factors in relatives of people with mental illness

Abstract: Background Stigma affects not only people with mental illnesses, but their families as well. Understanding how stigma affects family members in terms of both their psychological response to the ill person and their contacts with psychiatric services will improve interactions with the family. Aims To investigate factors of psychological significance related to stigma of the relatives. Method In a Swedish multi-centre study, 162 relatives of patients in acute psychiatric wards following both voluntary and compulsory admissions were interviewed concerning psychological factors related to stigma. Results A majority of relatives experienced psychological factors of stigma by association. Eighteen per cent of the relatives had at times thought that the patient would be better off dead, and 10% had experienced suicidal thoughts. Stigma by association was greater in relatives experiencing mental health problems of their own, and was unaffected by patient background characteristics. Conclusions Interventions are needed to reduce the negative effects of psychological factors related to stigma by association in relatives of people with mental illness.

Mental health and the built environment: cross-sectional survey of individual and contextual risk factors for depression.

Abstract: Background Little is known about the effects of the physical environment on individual health. Aims The present study tested the hypothesis that the prevalence of depression is associated with independently rated measures of the built environment, after adjusting for individuals'socio-economic status and the internal characteristics of their dwellings. Method Cross-sectional survey of 1887 individuals aged 16 years and over in two electoral wards in north London. Depression was ascertained using the Center for Epidemiologic Studies Depression scale (CES—D). The built environment was rated independently, using a validated measure. Results After adjusting for socio-economic status, floor of residence and structural housing problems, statistically significant associations were found between the prevalence of depression and living in housing areas characterised by properties with predominantly deck access (odds ratio=1.28, 95% CI 1.03-1.58; P =0.02) and of recent (post-1969) construction (odds ratio=1.43, 95% CI 1.06-1.91; P =0.02). Conclusions The prevalence of depression was associated with independently rated features of the built environment, independent of individuals' socio-economic status and internal characteristics of dwellings.

Effectiveness of a brief cognitive—behavioural therapy intervention in the treatment of schizophrenia

Abstract: Background Little evidence exists to indicate whether community psychiatric nurses can achieve the results reported by expert cognitive—behavioural therapists in patients with schizophrenia. Aims To assess the effectiveness and safety of a brief cognitive—behavioural therapy (CBT) intervention in a representative community sample of patients with schizophrenia in secondary care settings. Method A pragmatic randomised trial was performed involving 422 patients and carers to compare a brief CBT intervention against treatment as usual. Results Patients who received CBT ( n =257) improved in overall symptomatology ( P =0.015; number needed to treat [NNT]=13), insight ( P <0.001; NNT=10) and depression ( P =0.003; NNT=9) compared with the controlgroup ( n =165). Insight was clinically significantly improved (risk ratio=1.15, 95% CI 1.01-1.31). There was no increase in suicidal ideation. Conclusions Community psychiatric nurses can safely and effectively deliver a brief CBT intervention to patients with schizophrenia and their carers.

Borderline Personality Disorder: A Clinical Guide

Abstract: This is a masterly contemporary clinical, empirical and theoretical overview of borderline personality disorder (BPD). The author was considerably involved in the differentiation and professional recognition of the condition more than 20 years ago.[⇓][1] ![][2] Whatever your

Depressive symptoms and cognitive decline in elderly people. Longitudinal study.

Abstract: Background Depressive symptoms are associated with cognitive decline in elderly people, but the nature of their temporal relationship remains equivocal Aims To test whether depressive symptoms predict cognitive decline in elderly people with normal cognition Method The Center for Epidemiologic Study depression scale (CES—D) and the Mini-Mental State Examination (MMSE) were used to evaluate depressive symptomatology and cognitive functioning, respectively A sample of 1003 persons aged 59-71 years and with a MMSE score of 26 or over was selected Cognitive decline was defined as a drop of at least 3 points on the MMSE at 4-year follow-up Results Baseline high levels of depressive symptoms predicted a higher risk of cognitive decline at 4-year follow-up The MMSE score of participants with depression was more likely to fall below 26 at 2-year follow-up and to remain below at 4-year follow-up than the MMSE score of those without depressive symptoms Persistent but not episodic depressive episodes were associated with cognitive decline Conclusions High levels of depressive symptoms, when persistent, are associated with cognitive decline in a sample of elderly people

Psychosocial factors at work, personality traits and depressive symptoms. Longitudinal results from the GAZEL Study.

Abstract: Background An association between stressful job conditions and depressive symptoms has been reported. This association could be explained by personality traits. Aims To examine the relationship between psychosocial factors at work and changes in depressive symptoms, taking into account personality traits. Method The role of occupational characteristics, psychosocial stress and personality traits in predicting an increase of depressive symptoms was evaluated in 7729 men and 2790 women working at the French National Electricity and Gas Company, with a 3-year follow-up. Results In men, high decision latitude was predictive of a decrease in the Centre for Epidemiologic Studies — Depression scale (CES—D) scores. In both genders, high job demands and low social support at work were predictive of increased scores, irrespective of personality traits and covariates. Conclusions Adverse psychosocial work conditions are predictors of depressive symptom worsening, independent of personality traits.

Patient adherence in the treatment of depression.

Abstract: Background Non-adherence with antidepressant treatment is very common. Increasing adherence to pharmacological treatment may affect response rate. Aims To review and summarise quantitative evidence on factors associated with adherence and of adherence-enhancing interventions. Method A systematic review of computerised databases was carried out to identify quantitative studies of adherence in depression. Papers retained addressed unipolar depression and considered adherence as the primary end-point. Results Of studies published between 1973 and 1999, 32 met the review criteria: epidemiological descriptive studies ( n =14): non-random comparisons of control and intervention groups ( n =3); randomised interventions ( n =14); and meta-analysis ( n =1). Patient education and medication clinics were the interventions most commonly tested, combined with a variety of other interventions. Conclusions The studies did not give consistent indications of which interventions may be effective. Carefully designed clinical trials are needed to clarify the effect of single and combined interventions.

From passive subjects to equal partners: qualitative review of user involvement in research.

Abstract: Background The Department of Health and UK funding bodies have suggested that clinical academics work closely with mental health service users in research projects. Although there are helpful guidelines on the issues that have to be dealt with, there have been few examples of how this partnership research might be undertaken. Aims To illustrate the challenges in joint research projects. Method We subjected the process of user involvement to ten questions which arose in the development of a joint research project. The answers are an amalgamation of the user and clinical researcher considerations and are affected by hindsight. Results The involvement of the user-researcher changed the focus of the study and its design and content. More attention was paid to the intervention itself and the way in which it was delivered. This process increased the amount of time taken to carry out and write up the project as well as incurring financial costs for user consultation payments and dissemination. Conclusions This experience has clarified the contribution that users can make, for example by raising new research questions, by ensuring interventions are kept ‘user friendly’, and the selection of outcome measures.

Case-control study of neurocognitive function in euthymic patients with bipolar disorder: an association with mania.

Abstract: Background Neurocognitive impairments in euthymic patients with bipolar disorder may represent trait rather than state variables. Aims To test the hypothesis that euthymic patients with bipolar disorder would exhibit impairment in verbal learning and memory and executive function compared with healthy controls matched for age, gender and premorbid IQ. Method Twenty euthymic patients with bipolar disorder were matched, on a case-by-case basis, to twenty healthy community controls. Cases and controls were tested with a battery of neuropsychological tests. Results Impairments were found in cases compared with controls in tests of verbal learning and memory. Verbal learning and memory correlated negatively with the number of manic episodes. Conclusions Impaired verbal learning and memory may be a trait variable in bipolar disease. There are implications for adherence to medication and relapse and for the role of early treatment interventions. Prospective designs and targeting first-episode groups may help to differentiate trait v . disease process effects.

Occurrence of hallucinatory experiences in a community sample and ethnic variations.

Abstract: Background Hallucinations typically are associated with severe psychiatric illness but also are reported by individuals with no psychiatric history.Aims To examine the prevalence of hallucinations in White and ethnic minority samples using data from the Fourth National Survey of Ethnic Minorities.Method Interviews of 5196 ethnic minority and 2867 White respondents were carried out. The respondents were screened for mental health problems and the Psychosis Screening Questionnaire asked about hallucinations. Those who screened positive underwent a validation interview using the Present State Examination.Results Four percent of the White sample endorsed a hallucination question Hallucinations were 2.5-fold higher in the Caribbean sample and half as common in the South Asian sample. Of those who reported hallucinatory experiences, only 25% met the criteria for psychosis.Conclusions The results provide an estimate of the annual prevalence of hallucinations in the general population. The variation across ethnic groups suggests cultural differences in these experiences, Hallucinations are not invariably associated with psychosis.Declaration of interest None.

Effects on the brain of a psychological treatment: cognitive remediation therapy: functional magnetic resonance imaging in schizophrenia.

Abstract: Background The results of one randomised control trial testing a psychological rehabilitation programme aimed at information processing strategies showed improvements in cognition posttreatment. Aims To determine whether there are concomitant brain activation changes as a result of engaging in cognitive remediation therapy (CRT). Method Three groups (patients receiving control therapy or CRTand a healthy control group) were investigated in a repeated measures design using the two-back test. Functional magnetic resonance imaging (fMRI) data and a broad assessment of executive functioning were completed at baseline and posttreatment. Brain activation changes were identified after accounting for possible task-correlated motion artefact. Results fMRI analyses indicate that the control group showed decreased activation but the two patient groups showed an increase in activation over time. The patient group that received successful CRT had significantly increased brain activation in regions associated with working memory, particularly the frontocortical areas. Conclusions This is the first time that brain activation changes in a seriously disabled group of patients with schizophrenia can be associated clearly with psychological rather than pharmacological therapy Declaration of interest This work was supported by the WellcomeTrust.